Use of the powerful gene-editing tool gone awry is also the focus of author and physician Robin Cook‘s new novel “Pandemic,” in which the mysterious death of a woman on a New York subway opens a window into a lab that’s pushing the boundaries of medical ethics.
The book’s antagonist is a wealthy Chinese scientist who’s settled in the U.S. and is funding a hospital and a gene-research empire. Cook tells Here & Now‘s Robin Young he wasn’t surprised to find out a Chinese scientist was also at the center of a real-life CRISPR controversy.
“The fact that my bad guy, so to speak, is a Chinese individual was not by accident,” Cook says. “The Chinese are very interested in biotechnology, as they are in all technologies. It’s also true that the Chinese philosophy is somewhat different from our philosophy. They don’t have the same sense of the importance of the individual versus the society.”
While Cook says he believes CRISPR is a milestone in biotechnology — “maybe even more important than the discovery of antibiotics” — its misuse could also mean significant dangers for humanity, like reducing cells’ resistance to viruses like influenza.
“There’s a lot of things that would keep you awake at night if you knew what was going on,” Cook says of what he found while researching the novel. “Unfortunately … CRISPR is so powerful and so easy to use.”
On why He Jiankui’s use of CRISPR has been so controversial
“[It was in secret], and it didn’t have any peer review, etc. It also is known that as accurate as this CRISPR Cas9 is … it’s not completely, totally accurate. There can be other changes, other places in the genome, which if these kids survive and they go on to reproduce, that will be part of the human genome. That’s really the worry. … You can use CRISPR — which is how most of us see it being used — in terms of treating an individual, but not putting it into the germ line, so that when they have children, whatever happened to them is not going to happen to the children.
“The other thing is, even though it sounds like it might have been, ‘Protect these infants from HIV,’ which the father had, it’s already known that since the fathers were on anti-HIV medication, that they wouldn’t pass it on. So, why did you do this? And without knowing what else is going to happen. But the real problem I think that most researchers feel is that this episode is going to encourage legislators to suddenly want to put restrictions on this CRISPR technology. The promise of this technology is unbelievable.”
On researching the book by talking with medical examiners and health officials
“I actually took a course in forensic pathology myself in order to be able to write these books, and I have indeed talked to lots of medical examiners. And indeed I’m also one of those people who is terrified of a repeat of the 1918 flu pandemic. A lot of people feel, ‘Well, nowadays with antivirals and antibiotics, that couldn’t happen today’ — it very well possibly could happen today. And so those of us in the know are always a little bit afraid of that, especially when you start seeing certain strains of flu popping up here and there. You read about it in the newspaper, a new flu strain kills 20 people in China, and you think, ‘Wow, thank goodness it’s in China.’ But the way the world is interconnected now, this could really, really happen.
“They have been training in New York City for a repeat of the 1918 flu pandemic. They have mobile units … they can erect and actually make different morgues out in the parking lot in tents. If you have three, four, five hundred deaths a day in New York City, can you imagine what this would be like?”
On whether the light bulb went off after he was invited to a conference on CRISPR
“Not right away, but I knew of this and I had been reading about this and I wanted to write a book about it. Because that’s really what I do, I write fiction to entertain people yet also to get them to understand some of the amazing things that are happening in biotechnology and medicine. … I wanted to scare people who are even in this field, so I have to be very realistic about it.”
On his frustration that some continue to believe vaccines can cause autism
“That is one of the issues that I’m particularly interested in, because vaccines are a tremendous help — probably more help in terms of saving lives than even antibiotics — and the fact that conspiracy-minded people think there’s something wrong and tell their neighbors, etc., even though it’s been totally disproved, these vaccinations do not cause autism, there are still people out there who believe it does.”
Book Excerpt: ‘Pandemic’
by Robin Cook
Later that morning …
Monday, November 5, 10:30 a.m.
By 10:30 in the morning all eight autopsy tables at New York City’s Office of the Chief Medical Examiner, known colloquially as the OCME, were in use, as the team tried to catch up with demand. Over the weekend there had been a backup of ten bodies that had not been considered forensic emergencies and had been left for Monday morning. Besides those ten, six new cases had come in between late Sunday afternoon and early that morning. Table #1, the table farthest from the stainless-steel sinks, had seen the most action. This was the table favored by Dr. Jack Stapleton. Since he was almost always the first doctor in the “pit” in the morning, he got to choose his station, and he always told Vinnie Ammendola, the mortuary tech with whom he usually teamed, to nab it. Situated at the periphery, it was a little bit separate from the main commotion in the autopsy room when all the tables were in use. At that time Jack was already starting his third case. Most of the other tables were still on their first.
“So!” Jack said, straightening up. He had just carefully shaved away the blood-soaked, matted hair from the right side of the victim’s head. He had been very careful not to distort the wound he wished to expose. What was now obvious was a completely circular dark-red-to-black lesion an inch or two above the woman’s right ear, surrounded by a narrow circular abrasion. The patient was on her back, with her head rotated to the left and propped up on a wooden block. She was naked and so pale she could have been mistaken for a wax-museum model.
“Is the entrance wound round or oval?” Jack liked a didactic style and frequently used it even when other people weren’t listening, as often happened when he was working with Vinnie. Vinnie had a habit of zoning out on occasion. But this morning Jack had an attentive audience. Lieutenant Detective Lou Soldano, an old friend of Jack and Jack’s wife, Laurie, had shown up. Over the years Lou had come to truly appreciate the enormous benefits forensic pathology could provide to law enforcement, particularly when it came to homicide investigation, which was his specialty. Whenever there was a case that Lou thought could be helped by forensics, he made it a point to observe the autopsy. Although there hadn’t been any such cases for a number of months, that morning there had been three.
“I’d say circular,” Lou said. Lou was standing across from Jack on the patient’s left side. Also on that side was Vinnie. Next to Jack was a second mortuary tech, Carlos Sanchez, who had been newly hired by the OCME and was now at the very beginning of his orientation and training. As one of the more experienced techs, Vinnie generally broke in newbies by having them work closely with him. Jack was accustomed to the routine and usually didn’t mind, provided it didn’t slow him down too much. Jack was one of those people who didn’t like to waste time and had little patience for incompetence. So far, he wasn’t all that impressed with Carlos. It wasn’t anything specific, more an attitude thing, as if the man wasn’t all that interested.
“I agree,” Jack said. “Vinnie?”
“Circular,” Vinnie said, rolling his eyes. Vinnie and Jack had worked with each other so many times over so many years that they could anticipate each other. Vinnie knew that the tone of voice Jack had used strongly suggested he was about to start a “teaching” session, which invariably meant the autopsy would end up taking considerably longer than otherwise, keeping Vinnie away from the coffee break he always took after the third case was over. Vinnie was a coffee addict and his last cup had been just after seven that morning.
“Mr. Sanchez?” Jack asked, ignoring Vinnie’s mild acting out.
“Huh?” Carlos blurted.
Jack turned to look into the eyes of the new hire, just visible through the man’s plastic face shield. “Are we keeping you from some other, more interesting engagement, Mr. Sanchez?” he asked sarcastically, but then let it go. He turned back to Lou. “It is definitely circular, meaning the bullet entered perpendicular to the plane of the skull. More apropos, it is certainly not what is described as stellate or jagged. Now, do you see any stippling around the periphery of the wound?” The little red dots in the skin that sometimes surrounded gunshot wounds resulted from gunpowder residue emerging from a gun barrel along with the bullet.
“I don’t see that much except on the ear,” Lou said, trying to be optimistic.
“There is a bit on the ear and also some on the neck,” Jack said, pointing. “Obviously the full head of hair absorbed most of it.”
“I don’t think I’m going to like where you’re going with all this,” Lou said. The victim was the wife of one of Lou’s detective colleagues who also worked out of the NYPD’s Homicide Division.
Jack nodded. There was no doubt that Lou had become quite forensically knowledgeable over the years of their friendship. “There’s more. Let’s use a wooden dowel to align this entrance wound above the right ear with the exit wound below the left mandible.”
Vinnie handed Jack the wooden rod he had leaned against the autopsy table. Grasping it at both ends, Jack held it so that it rested on the crown of the patient’s head but lined up with the two wounds.
Lou reluctantly agreed. “I’m getting the picture: The pathway of the bullet is definitely downward.”
“I’m sorry to be the bearer of bad news,” Jack offered, hearing the disappointment in his friend’s voice. “Unfortunately, what we see here is not a contact wound. My guess at this point would be that the gun barrel had to have been about two feet away and maybe as much as thirty inches. And the trajectory was definitely oriented caudally. Are you aware of the statistics about this?”
“Not exactly,” Lou said. “But I know it’s not what I was hoping. Jesus, I’ve known this guy for more than twenty years. I’ve even had dinner in their home out in Queens a dozen times, especially after I got divorced. They had their problems, like all couples. But hell! They have two grown kids.”
“Ninety percent or more of small-arms suicides are contact wounds, meaning the barrel of the gun is up against the skull when discharged. In only about five percent of suicides is the bullet path downward, and an even smaller percentage where it’s directed from the back to the front, both of which we see here.”
“So you don’t think this was a suicide?” Lou asked, almost plaintively.
Jack shook his head.
“Can we get on with this freakin’ autopsy,” Vinnie complained.
Jack flashed a dirty look at his favorite mortuary tech. Vinnie ignored it. “I’m having caffeine withdrawal.”
“Was there a suicide note?” Jack asked, returning his attention to Lou.
“Clutched in her left hand,” Lou said with a nod. “One of Walter’s service automatics was in her right hand. She was lying on their bed on her back. It was a mess.”
“And he had called you?” Jack said.
“Yeah,” Lou said. “We’d been together most of the evening after being called out on that first autopsy we did. Walter found her dead when he got home, or so he said. I was the one who put in the nine-one-one call as I was leaving my apartment on my way over to see him. I got there before anyone else, and the man was beside himself. It was godawful. Not that I haven’t seen worse.”
“Well, we’ll have to see how it plays out,” Jack said. “Maybe there was a third party involved. But I certainly will not be signing this out as a suicide. I’m definitely thinking homicide. But let’s do the autopsy and go from there.”
“Hallelujah,” Vinnie said, making a rapid sign of the cross in the air in appreciation.
“Let’s not be blasphemous,” Jack chided sardonically.
“You should talk,” Vinnie scoffed. More than anyone at the OCME, Vinnie knew just how irreverent Jack Stapleton could be. Jack was not a religious man after his first wife and two young daughters had been killed in a commuter plane crash. He couldn’t imagine a Christian God would let such a terrible thing happen.
The postmortem went quickly. Other than a number of uterine fibroids, the woman’s general health had been excellent and there was no pathology. The part of the autopsy that took the longest came after Vinnie had shown Carlos how to remove the skull cap. With appropriate exposure, Jack had carefully followed the bullet’s transit through the brain, where it had wreaked complete havoc. While Jack was busy, Vinnie exposed the underside of the skull cap to photograph the beveled edges of the inner aspect of the entrance wound.
When Jack’s third autopsy was complete, he left Vinnie and Carlos to clean up and return the cadaver to the walk-in cooler. Although Lou usually departed as soon as the main part of the autopsy was over, on this occasion he stayed until the bitter end. Jack sensed he was reluctant to head back to his lonely apartment in SoHo. The implication was that he needed to talk more about the disturbing autopsy results, even though he was plainly exhausted from having been up all night.
After changing out of their autopsy gear, Jack took Lou up to the so-called lunchroom on the second floor, which wasn’t much with its blue-painted concrete-block walls, cheap molded-plastic furniture, and handful of vending machines. For a modern medical examiner’s office with a staff of highly trained, world-class forensic pathologists, it was pathetic. But there was a light at the end of the tunnel. A brand-new high-rise NYC medical examiner’s building had been constructed on 26th Street, four blocks south of the sad, existing six-story structure that had been built almost a century ago at 30th Street and First Avenue. Most of the Manhattan office’s hundreds of employees had already moved to the palatial new location. Those who had yet to go were the toxicologists and the entire bevy of MEs. The problem was that the new building did not have an autopsy room. A new state-of-the-art autopsy facility was still in the planning stages, to be built as a separate structure next to the new high-rise. Until it was operational, Jack and his colleagues had to remain in the old, outdated structure.
“Knowing the choices, what can I get you?” Jack asked. He regarded his friend of almost twenty years. As his name clearly suggested, Lou was distinctly southern Italian, with thick, reasonably long, mostly dark hair and equally dark eyes and decidedly olive skin. A handsome, heavy-featured man of medium height and musculature, with a girth that suggested too much pasta and not enough exercise. As usual, he was wearing a dark blue suit that didn’t appear to have been pressed in the previous year. His rumpled white dress shirt was open at the collar and his gravy-stained silk tie was loosened and appeared never to have been untied, but rather slipped over the head at the end of each and every day.
The comparison with Jack was stark, especially when the two were standing right next to each other as they were now. Jack’s hair was a light brown, cut moderately short, with a blush of gray over his temples. His eyes were the color of maple syrup and his complexion suggested he had a slight tan even when he hadn’t been in the sun for months. At six feet two inches tall, with an athletic build from bike riding and street basketball, he seemed to tower over Lou, whose habit was to hunch over as if his head were far too heavy.
“I don’t know,” Lou admitted. He was having trouble making up his mind.
“How about a water,” Jack suggested. He knew the last thing Lou needed was more coffee. What he really needed was sleep.
“Yeah, water’s fine,” Lou said.
Jack got two waters and sat down across from Lou.
“You’ll let me know what toxicology shows on the second case,” Lou said.
“Absolutely,” Jack said. “As soon as I know.” All three cases that Lou had come in to watch that morning involved the NYC Police Department. The one Lou was currently referring to was a “death in custody” case. During the autopsy Jack had been able to show Lou that the prisoner’s hyoid bone had been fractured, which was a clear demonstration that a lethal choke hold had been used. It had happened during an arrest. The question now was whether the force was justified or whether it was excessive. The neighborhood where it had happened was up in arms and wanted answers.
Lou was also awaiting final word on the first case he had watched Jack handle that morning. It, too, was an arrest that had gone bad, resulting in a shootout with the victim holed up in his car, where he was hit four times. Several bystanders claimed that the victim had yelled “enough” and had stopped firing, yet still the police shot him. Once again it was a potential PR nightmare for the police department, and a tragedy if it proved to be true. To get answers, Jack had painstakingly tracked all four bullets in the man’s body and now wanted to re-create the scene in the special laboratory in the new high-rise building to figure out exactly what had happened and when.
“It’s been an interesting morning,” Jack said. “I’m especially sorry that I couldn’t be more help for your buddy. Probably the case is going to turn on the suicide note and whether it’s authentic. Divorce isn’t fun, but it is a lot better than homicide, if that’s what the case turns out to be.”
“Enough about me and my problems,” Lou said with a wave of dismissal. “What’s up at the Stapleton-Montgomery household these days? I haven’t talked to you or Laur for ages.” Lou had met Laurie Montgomery, Jack’s wife, before Jack had been hired by the NYC OCME. Lou and Laurie had even briefly dated until they both sensed it wasn’t to be and became fast friends instead. When Jack came on the scene, Lou had been his advocate. Laur had been the name one of Lou’s daughters had used when she’d first met Laurie, and, thinking it cute, Lou had adopted it as well.
“Please,” Jack said. “Let’s not go there.”
“Uh-oh.” Lou leaned forward over the table. “Knowing you as I do, I don’t like the sound of this. What’s up?”
“I don’t know if I want to get into it,” Jack told him.
“If you don’t talk to me, who are you going to talk to?” Lou arched a brow. “I love both you guys.”
Excerpted from the book PANDEMIC by Robin Cook. Copyright © 2018 by Robin Cook. Republished with permission of G.P. Putnam’s Sons.