Healthcare For All, Continued

The patient, self-conscious as she sits on an examination table wrapped in a paper gown, begins to describe her troubling symptoms.  Which should she emphasize:  the pain in disparate parts of her body is what she feels the most, but does the 3-pound weight loss have a higher priority?  Or the sweating at night?  Should she start with the weird rash on her legs, or perhaps mention that her grandmother died of leukemia?  Does her recent trip to Laos have anything to do with this?  The old doctor, who types away as he stares at a computer screen, doesn’t seem to be paying much attention anyway.  While in the waiting room, the patient skimmed the Nov. 12, 2018 issue of New Yorker magazine, in which Atul Gawande (The upgrade: why doctors hate their computers) wrote:  “Many fear that the advance of technology will replace us all with robots.  Yet in fields like health care the more imminent prospect is that it will make us all behave like robots.”

That old but tech-savvy doctor, having reviewed the patient’s Problem List, recent labs and his previous visit note, is editing the pre-written template for the current encounter.  Computers have helped in many ways, but have also added greatly to time demands.  Despite running late, he tries intermittently to smile in a reassuring way, and to read the patient’s eyes and body language; he realizes that it’s not going well.  Why does she keep pointing at her neck and shoulders, when the pustules on her shins give away the diagnosis?  On the computer screen, the cursor flashes over Laboratory and Radiologic Tests he wants to order, click-click-click-click, then pauses over the Diagnosis section.  Which ones can the doctor justify; which diagnoses will not bounce back from the Auditing Department?

Meanwhile, the clinic Administrator is reviewing a huge pile of committee reports and computer printouts on her desk.  Weekly access data.  Numbers of Urgent Care drop-ins vs scheduled appointments.  Emergency Room visits.  Subspecialty same-day access. Patient satisfaction scores.  Not great, but reasonable.  She turns her attention to coding errors in diagnoses, which cause the most blowback, and even accusations of fraud, from insurers and the Federal Government– and which, even now, cause her to wince with displeasure.  She’ll have another firm talk with the Auditing Department.  Thank God for the computers, which give her some semblance of control over a thousand clinicians; whoever complained about herding cats should try her job!

In this imaginary scenario, the Secretary of Obamacare issues two things:  the first is a deep sigh of frustration.  Why?  Millions of previously uninsured people have gained medical coverage, including the poor and disenfranchised; those with pre-existing health conditions; women in need of contraception or maternal care; those in underserved rural areas.  But all of that is now in danger of vanishing!  The second thing issued by the Secretary is a nationwide announcement that the President of the United States is moving to eliminate Obamacare– against the will of the vast majority of Americans– this time through the courts, since his efforts in Congress have repeatedly failed.

It’s a huge, complicated picture with many moving parts.  A pessimist reduces it to the classic scene of a small fish about to be swallowed by a big fish, which, in turn, is about to be swallowed by a bigger fish with sharp teeth.  And that fish has an even bigger fish, blond hair flapping weirdly and mouth wide open, swimming up right behind it.

An optimist sees a pyramid.  At its base is a federal government composed of enlightened, aisle-crossing politicians with the best interests of the populace at heart, a government which supports an efficient system of universal health coverage.  Above that are the pharmaceutical companies (reined in by government) and the insurers, which are technologically advanced, innovative, not-for-profit and cooperative while still competitive and capable of adaptation.  On the next level are the unified healthcare providers, including attentive, non-distracted physicians who are led to best practices by technology even while working side-by-side, rather than top-down, with their patients.  And those patients, empowered by their providers, insurers and government, sit at the very peak!

Even assuming a change of Presidents and a radical return to normalcy in Congress, achieving the optimist’s view of healthcare will take major reforms in the insurance industry and advances in technology such as artificial intelligence.   With so many separate moving parts generating friction and threatening to fly apart, artificial intelligence can act as both glue and lubrication, especially in adapting quickly as circumstances (political, demographic, climate etc.) change.  But a progressive, widely-held understanding of subtle nuances and the “big picture” will also be needed, and unfortunately, those are not coming anytime soon– not before the next election, anyway.

As I begged in my previous post, please don’t forget to vote in 2020!

 

 

 

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Healthcare For All

With so many progressive Democratic candidates lining up for the 2020 presidential election, national attention has once again focused squarely on healthcare, despite stiff competition from a plethora of federal investigations, scandals and grift, a fake national emergency and other signs of our chaotic times.  Deceptively tidy expressions such as “Medicare For All” and “single-payer alternative” have emerged on the left, countered by cries of “socialized medicine” on the right.  In reality, when it comes to the complex spectrum of healthcare, no soundbite can adequately describe any candidate’s platform.

At one end of the spectrum lies the impersonal, bureaucratic federal government.  You don’t want them taking out your gall bladder.  At the other end are the healthcare providers (for this discussion, I include the insurers, hospitals, physicians/nurses, but also pharmaceutical companies and academic researchers) with their murky mix of traditional practices, profit motives, professional egos and noble ideals.  How heavy should the government’s hand be, in steering our nation’s providers?  Can it keep rampant drug costs down by fiat?  What about unnecessary procedures performed for profit?  Does “Medicare For All” mean universal free healthcare (no), or is it universal insurance with limited coverage?  To what extent is it fee-for-service, and how will total cost be controlled?  Will it reduce innovation and quality by removing competition?  Can government overcome the resistance (circle those wagons!) that prevents successful, forward-thinking healthcare models from entering certain areas of the country– areas where private practice/ fee-for-service/ traditional providers of healthcare are still firmly entrenched?

Not being a policy wonk or even well-versed in economics, I have no clear answers.  But the harder I imagine the ideal healthcare system, the closer I come to something that looks remarkably like the Affordable Care Act, otherwise known as Obamacare.  The ACA is– and was meant to be– a work in progress:  imperfect, but at least addressing some of the worst imbalances that made the previous “system” unsustainable.  Remember the cost and extreme inefficiency of so many uninsured patients showing up in emergency rooms for medical care (crisis management in the absence of preventive measures)?  And the selective enrollment of only young, healthy members by HMOs that ultimately proved ill-equipped to provide timely diagnosis and treatment (hence their insistence on low-risk patients without pre-existing conditions)?  Such skimming of healthy patients resulted in older and sicker patients, and their attendant higher costs, overloading health plans that did accept them.

On the societal level, all I know is that everyone needs to be insured, and that the risk needs to be pooled uniformly over all providers, in order to maximize efficiency and fairness.  Everyone having health insurance can be required by law and funded by taxes (not necessarily higher, just re-distributed).  Yes, many, especially in the GOP, objected to the mandatory participation in Obamacare, but enforcement through fines does have a Draconian feel to it.  We pay taxes for defense, infrastructure, water quality:  why not for healthcare, as in almost every other country in the world?

Plus:  the federal government is the only entity that can ensure universal coverage for pre-existing conditions, provide cost-sharing subsidies, and organize exchanges in which competing, innovative health plans can participate.  That sounds a lot like Obamacare, doesn’t it, before the GOP did all they could to sabotage it?  Government has the clout to pressure drug companies, encourage new models of medical education geared towards primary care, and guarantee employment for graduates of such programs.  In the dazzling new world of biologic agents, genetic engineering, stem cell technology and artificial intelligence, focusing government funding for medical research can keep it moving in the most relevant direction.

Then there is the provider end of the spectrum (and there I do have some first-hand knowledge, having worked as a rheumatologist at Kaiser Permanente for several decades).  KP, a not-for-profit HMO which aims for pre-paid, quality healthcare with an emphasis on preventive care, is tripartite:  there is the health insurance plan; they also have brick-and-mortar hospitals, replete with cardiac cath labs, MRI machines and pharmacies; and, of course, physicians, who work for a set salary.  Having all three under one roof creates greater efficiency as well as economies of scale.  There is even a highly productive Division of Research.  One reason I chose to work for KP:  all the incentives seemed to be aligned with rational, high-quality care.  New members are often surprised to learn that KP physicians have complete freedom to prescribe treatments and order tests regardless of cost, as long as our decisions are evidence-based.  Prior authorization from the insurer is not required, and there is not a single “death panel” in sight.

Several people in my life (two, by coincidence, in New York state) have recently experienced serious health problems.  This blog is meant to support my science fiction trilogy Fourth World, not act as an ad for Kaiser Permanente, but I am struck by the contrast between the overall care my friends have been receiving in New York and the high expectations that we providers hold at KP.  To be sure, our expectations are not always met, but at least the system is set up with optimal care– as opposed to maximizing stockholders’ dividends– as a goal.  My friends have experienced long delays in getting urgent appointments; found no-one covering when a specialist went on vacation; witnessed poor communications between primary care docs and specialists, as well as between different consultants; been told of the unavailability of previous blood test and imaging results at various doctor’s visits; experienced complications in setting up long term care; the list of frustrations goes on.  Again, KP is far from perfect, but an urgent referral gets a specialty appointment the same day; multiple specialists cover for one another, so that treatment can move ahead when someone goes on vacation; consultants and pharmacies are located within a block or two, often in the same building or down the hall; labs, x-rays, scans etc. are all available in one statewide electronic health record system; followups, social services and long term care are all arranged before discharge, and so on.  The advantage of a unified system is so obvious that I had been taking it for granted, until I began to follow my friends’ travails.

I will summarize by saying that the government has an important role to play, although the exact nature of the ideal interface between government and healthcare providers is unclear– something like Obamacare, in my opinion.  On the other side of that interface:  competing, forward-thinking, not-for-profit, technologically advanced companies which encompass the insurance aspect of healthcare, as well as hospitals, doctors, research and medical education.  Such a system would be our best chance at maximizing quality while minimizing cost to society.

Only one more thing:  none of this is happening if our slash-and-burn Chaos President manages to win re-election– so it’s not too early to say, please, please don’t forget to vote!

 

My Super Bowl Prediction

Which football team will win the Super Bowl tomorrow, the Rams or the Patriots?

The answer is obvious.  But first, allow me to present the initial sentence in Chapter 3 of Fourth World, written about ten years ago:

“The ME120 Glidebus, Mars-Elegna’s oldest model, emerged from South Tunnel and adjusted its course five degrees to the west.”

If you start at the second letter in “oldest”– L– and read backwards, you get “Los Angeles Rams.”  This may seem trivial, but note that when the sentence was written, the Rams still played football in St. Louis!

When it comes to sports, I am no Nostradamus, but the Fourth World trilogy has successfully predicted several events over the past decade, including the discovery of subsurface water on Mars; the increasing alarm generated by the USA (especially led by our Chaos President) among the nations of the world; and the ethical crises facing the fields of human genetic engineering (although my creatures are chimeras, combining the DNA of multiple species), stem cell therapy and big Pharma, not to mention unsanctioned drug trials and marketing of high-risk medications in developing nations.

Probably the strongest impulse of science fiction writers is to push the envelop outward, to extrapolate from what is currently known, to connect seemingly unrelated dots, and thus to predict the future.  Often that future is dystopian, harsh and ugly– for example, what if the Patriots were to win?  What could be more unmanageable than “New England Patriots” spelled backwards?

Brexiting Is Hard To Do

Hoof beats clatter on ancient cobblestone streets.  The rider, someone named Paul who has a heavy Eurozone accent, shouts into the night:  “The British are leaving!  The British are leaving!”  To coin a palindrome, we’ve been de-Revered.  And hard-core Brexiteers are showing the same understanding of Brexit’s consequences to Ireland, Scotland and Europe as King George III showed toward the American Colonies.

In a NYT Opinion piece, The Malign Incompetence of the British Ruling Class, Pankaj Mishra says that with Brexit, the Brits are getting a taste of their own medicine.  After all, the current crisis– the separation of the UK from the European Union scheduled to take place in just two months– is not the first, or even the second or third, example of a precipitous Brexit.

The British Ruling Class, composed largely of self-involved, elite former schoolmates, seem to have a very hard time withdrawing from situations where they have no reason to be, in the first place.  At the height of the Empire, they subjugated and enslaved native populations from Asia to Africa; exploited local resources; and applied military and political force to crush efforts at democracy– and then, when the Empire was no longer tenable, withdrew in sometimes haphazard fashion.  Most notably, the re-drawing of national boundaries was often done without knowledge or sensitivity to ethnic/religious/historical dynamics, resulting in many decades of needless regional suffering.

Palestine comes first to my mind, but Mishra points to the partition of India, Pakistan and the disputed territory of Kashmir when the British exited in 1947:

“Dividing agricultural hinterlands from port cities, and abruptly reducing Hindus, Muslims and Sikhs on either side of the new border to a religious minority, Radcliffe delivered a plan for partition that effectively sentenced millions to death or desolation while bringing him the highest-ranked knighthood.  Up to one million people died, countless women were abducted and raped, and the world’s largest refugee population was created during the population transfers across Radcliffe’s border…”

The terrible price of Empire and colonialism is a central theme in the Fourth World trilogy– second only to the ethics of genetic engineering at the turn of the 23rd century.  Here’s an excerpt from Child of the Fourth World, in which the PWE assassin Najib Singh struggles with his family’s past:

Najib’s grasp of history was more localized and had nothing to do with datadisc textbooks.  It arose from Singh family lore stretching back more than four centuries, carried forward from one generation to the next by the original social medium:  word of mouth.

…..

Seemingly since the beginning of time, wars had played a primary role in his family history.  First, there were endless inter-tribal skirmishes and invasions for territory and grazing rights.  Then had come large-scale wars, brought by British imperial forces in the early days of exploitation, slavery and genocide; generations of Singhs had participated in uprisings against their colonial masters; India had been complicit in the Opium Wars with China (two of his great-great-grand-uncles had grown poppy to produce sticky black opium, to be bartered like currency for Chinese tea); and, at long last, as the sun was setting on the British Empire, the separation of Pakistan from India had set off a Hindu-Muslim war.  Remarkable: that vast empire, launched from a small island tucked away in a cold and foggy corner of Europe, was responsible for over two centuries of Singh family misery. Even after the transition of empire into the “family of nations” known as the British Commonwealth, Singhs who had naively migrated to the United Kingdom as Commonwealth Citizens had, decades later, been subject to deportation. That was during the reign of Queen Lizzie III; one of the great ironies of the previous century, thought Najib: deeply-rooted racism and xenophobia lying at the head— and, more importantly, at the heart— of a multiracial, fifty-nation “family.”

Had he forgotten anything?  Oh yes: it wasn’t all the fault of the British!  A branch of the family living at the Suez Canal had first been decimated by French colonials, then completely wiped out by the Israelis; the family coffers had been depleted by cyber-warfare between India and China in the late 21st century; countless family members had been killed by North Korean nuclear attacks in the Asia/Pacific War, and that was before the War of Unification finished off the rest.  The Singh dynasty of Hyderabad, once wealthy and powerful in government and the fashion and textile industries, had been destroyed by colonialism and war, then as a result of the great Indian diaspora (2104-2110), the few remaining survivors had been scattered like ashes to the four winds. Najib sighed deeply and whispered to himself: now that was real history.

The Trilogy is Complete (Shameless Commercial III)

Another reader made the following comments:

 

Fourth World Nation is available on Amazon; here’s a link to the Amazon site:

https://www.amazon.com/Fourth-World-Nation/dp/1973142503/ref=sr_1_1?ie=UTF8&qid=1509379909&sr=8-1&keywords=Fourth+world+nation

For those who have yet to read the first book in the trilogy, it really is best to start at the beginning.  Fourth World is also available on Amazon, as a paperback or eBook.  Here’s a link to that site:

https://www.amazon.com/dp/B01LWVNG6A/ref=cm_cr_ryp_prd_ttl_sol_0

 

Finally, I want to extend my sincerest thanks to all of you.  Child of the Fourth World is dedicated to all readers of the Fourth World Trilogy, who have been so generous and indulgent in sharing, at least for a time, the world of imagination with me.

With all my best wishes,

Chee Chow

If You Like Beer…

“I like beer,” Judge Brett Kavanaugh announced defiantly to members of the Senate Judiciary Committee.  “I liked beer in high school.  I still like beer.”

I wonder how Kavanaugh reacted to the news earlier this week that global warming is adversely affecting barley, a drought- and temperature-sensitive crop.  As the world heats up, harvests of barley worldwide will steadily diminish, and one of its most popular products, beer, is projected to skyrocket in price as its availability plummets.

Sharon Lerner wrote in the NY Times this morning that now-lifetime-Supreme-Court-Justice Kavanaugh, when he was an appeals court judge, had a history of striking down environmental regulations– for example, the Environmental Protection Agency’s 2015 rule restricting the emission of hydrofluorocarbons (HFCs) from air conditioners and refrigerators.  HFCs are the fastest-growing type of heat-trapping greenhouse gas on the planet, trapping 1,300 times more heat than CO2 does.

This reminds me of a seemingly innocuous question that my 7th-grade science teacher asked his class in 1967, in the early days of ecologic awareness:  “On a hot day, why not cool off your house by leaving the refrigerator door open?”  We stared at him dumbly.  “Yes, it feels cooler right in front of the fridge, but the cooling process generates more heat than it removes, and that heat comes out the back of the fridge!” was the answer.  We rushed home to our kitchens to check it out, and you know, he was right!  In 7th grade, I learned that leaving the fridge door open would heat up, not cool off, the entire house.

That’s entirely different from the question of HFC emissions, but since 1967, I have pictured all the air conditioners in all of the houses, apartment buildings, shopping malls and corporate skyscrapers, pumping heat out of buildings and into the air outside, as a sort of massive global refrigerator with its door kept wide open.  So the answer to global warming is not to turn up the AC during a heat wave– a classic example of short vs. long term thinking.  The answer is to stop trapping heat with greenhouse gases.

According to Lerner, alternatives exist, but replacing HFCs with ammonia, propane or iso-butane has been blocked, not by science, but by politics.  And politics threaten to encroach ever more on the rulings of the right-leaning Supreme Court.  More government regulations, environmental or otherwise, are likely to fail.  Imagine the irony, when Brett Kavanaugh one day reaches into the mini-fridge in his chambers for a cold beer– only to discover that there is no more beer!

Personally, my adult beverage of choice is wine.  But my concerns, at least in that particular area, parallel those of beer-lovers:  global warming is already affecting grape harvests.  Not long ago, I stood on a terrace in the Rheingau, in northern Germany, looking out at a hillside vineyard with the owner.  His family had been in the wine business for centuries, producing fine riesling at the northernmost latitude still hospitable to grapes of the original European type, vitis vinifera.  Because of steady temperature rises over the past two decades, he told me, riesling will now grow much farther to the north.  “German winegrowers will have to move to the North Pole,” he half-joked.  The land we were looking at will one day be more suitable for grapes grown in southern France!

Here’s an excerpt from Fourth World, the first novel in my science fiction trilogy.  The third book, Child of the Fourth World, is now complete, and I will post on this blog when it becomes available on Amazon.  In this excerpt, I have taken out a paragraph, so as not to spoil the plot for new readers.

 

Professor Neelin added a generous pinch of salt to the lovely stew of root vegetables simmering on his stove.  The dignified sweetness of parsnips, carrots, and onions: three-part harmony, in parallel with the strains of a Bach Cantata drifting in from his living room.  Add textural overtones: the pillowy comfort of soft-cooked potatoes contrasting with the mild firmness of beets. Ah, nuances! Earthy, seductive perfumes of cumin, coriander and cardamom.  The challenge of cayenne and paprika. A distraction of lemon zest. Magnificent.

You really should watch the salt, he reminded himself- but the cautionary thought passed as quickly as a false alarm ringing in a distant corridor.  Hypertension, vascular disregulation, auto-inflammation, endocrine imbalance: what did those matter, in this context? The stew was a masterpiece, destined for an important dinner with the Senior Fellows of Mellon College- blood pressure was several levels of concern beneath that.  Now, what about the wine? Neelin glanced at the snow flurries outside his kitchen window, the heavily bundled students hurrying along High Street, a Campus Police car pulling over to the icy sidewalk. A red, certainly: full-bodied, warming, with peppery spice to highlight the stew, low in intellectual gravity, perhaps, but high in immediate gratification.  He smiled at the thought. Grenache would be perfect. Yes, a Garnacha from the Spanish District- algo muy especial, verdad? There were only a few old bottles of Garnacha remaining in his cellar three stories down, but why not- they probably should be drunk up, now that their youthful tannins had melted away.

———–

He gave the stew a final stir, carefully turned off the stove, took a wicker wine basket from his pantry, and donned a comfortable pair of leather slippers kept by the front door.  Life as Most Senior Fellow was good, undeniably, and yet he held an image in his mind of a peaceful retirement in the wine country of far Northern California- if only it weren’t in the Quarantine Zone.  The classic vineyard a hundred and fifty years ago would have been on a mountaintop overlooking the Napa Valley, but over the past century that had become too hot and dry, thanks to global climate change; the southernmost latitude suitable for the cultivation of cabernet sauvignon- or any variety of vitis vinifera– lay on the upper slopes of Mt. Shasta.  Still, far-northern California was a beautiful area. Neelin hummed with contentment as he opened his front door.

A campus policeman, obviously in poor condition, was laboring heavily up the last few steps to his landing.  Neelin recognized the man as head of security, often seen stalking around the Old Campus- and hadn’t his picture been on a poster denouncing drug abuse in the YaleConn community?  His name was Haley, or Halsey, something like that. He waited patiently for the cop to pass by, but instead, Halsey stopped at his door.

“Dr. Neelin?” he asked in between gulps of air.  “I’m. Torch Halsey. Security. Have to ask you.  To come with me, sir. Routine questioning. Recent events on campus.”

Ah, thought Neelin, his wicker basket dropping to the floor.  Here at last: inevitable, really. He closed his eyes. Perhaps the dream of retiring to Northern California wasn’t that farfetched, after all.

Nobel Intentions

The yearly Nobel prizes are traditionally awarded for great accomplishments in various fields– either singular achievements or those accumulated over a lifetime– but more and more, the winners seem to be chosen with the intention of shining a light on issues of growing worldwide concern, if not alarm.

On the same day that the United Nations warned that new studies indicate climate change and its disastrous effects are coming much faster than previous calculations had shown, and that we are already seeing irreversible damage to the environment, the Nobel Prize in Economics  (one of two) was awarded to William D. Nordhaus, a professor of economics at Yale.  Nordhaus created a model for analyzing the costs of climate change and has promoted a global system of carbon taxes to combat problems caused by greenhouse gases.  Having read the Freakonomics books, I have a strong feeling that the solution to climate change will come from the field of economics.  For those interested (and all of us should be), among books by Nordhaus on the subject are The Climate Casino and A Question of Balance.

After a year of the #MeToo movement and its effects on society and culture worldwide, the degree to which the movement is limited and as yet unformed becomes painfully clear when someone like Brett Kavanaugh is elevated to the US Supreme Court.  Despite “greater awareness”, some things still don’t seem to matter:  the fact that women who have been sexually assaulted or harassed (leaving aside the particular allegations of Dr. Blasey-Ford) feel that men in power don’t sincerely listen, and don’t prioritize their reality over politics; the fact that many abused women will no longer speak out, fearing the destruction of “stepping in front of a train that will get where it’s going anyway”; and critically, the fact that many men will see no need to challenge themselves to become better people.  In the immediate wake of the Kavanaugh debacle, the Nobel Committee saw fit to recognize Denis Mukwege and Nadia Murad with the Nobel Peace Prize, for their “efforts to end the use of sexual violence as a weapon of war and armed conflict.”  No doubt the winners were selected some time ago, but the message is a timely one.

This year the Committee has also chosen more women for the Nobel Prize:  Donna Strickland in physics and Frances Arnold in chemistry.  Aside from the outstanding merits of their work, these winners may encourage more girls at school age to head into the STEM disciplines.

I have to admit, as Friday and the announcement of the Nobel Peace Prize drew near, my greatest fear was that Donald Trump might win it (as a number of his supporters have chanted at rallies), along with the leaders of North and South Korea, for the negotiations over de-nuclearization of the Korean Peninsula.  The Peace Prize is often awarded, not for a goal already reached, but in order to encourage a peace process to keep on going.  But consider this year’s winners.  How insulting would it be to them, to award the prize to a man who mocked Dr. Blasey-Ford at a political rally; who bragged about committing sexual assault; who denies science and is withdrawing the US from the Paris Agreement, working to undo measures that increase fuel efficiency, and who favors coal and oil over clean, sustainable energy sources like wind and solar?

The Nobel Prize Committee has shown sensitivity and good sense (and yes, that includes Bob Dylan!).  May the Nobel Prize continue not only to reward human accomplishment, but also to shape our view of the human condition.

On the lighter side, here is an excerpt from Fourth World, the first novel in my science fiction trilogy.  The pharmaceutical researcher Walther Beame has one eye on the Chimera Project, and his other eye on the Nobel Prize:

Dr. Walther Beame, recently-appointed Project Director at Eunigen.  Scion of a distinguished medical family, graduate of a prestigious internship and post-doctoral fellowship at MassMed.  Developer of numerous theraproteomic patents, holder of top industry awards. He was even listed, in a recent issue of Inner Circle Magazine, among New York Metropol’s most-eligible bachelors.  Ha! White-haired and balding on top, in his late fifties, still most eligible!

Yet never had he possessed the same gravitas as on this particular evening.  It was the culmination of years of work, and the potential for a major scientific advance could be compared to… well, there was simply no precedent!  Not the first multi-species gene created; not the first stem cell injected into a lab animal; not even the discovery, over two centuries ago, that DNA could be snipped apart and recombined.  But it wasn’t over yet- Beame glanced back at the two security men following him at a discreet distance, slowed his pace and forced himself to take a deep breath as he rounded the corner to enter the main lobby, where his guests were waiting.

Beame stopped abruptly and stared.  What he saw under the five-story-high ceiling looked distinctly like a religious tableau:  two women sat to the right side, heads bowed slightly in quiet conversation. By the entrance on the left, a third woman had the vigilant stance of a sentry.  And alone in the center of the dome-shaped lobby stood Benn Marr, looking so innocent and vulnerable (appearances certainly can be deceiving, thought Beame). Looming high in the air directly above Benn was a huge glowing holographic projection of Eunigen’s symbol, the caduceus entwined with a double-helix of nucleic acid sequences in lieu of snakes.  The caduceus rotated slowly on its axis, creating the effect of a giant drill pointing downward right at Benn Marr. It was one of those unplanned moments rich with symbolic meaning: He is the One. The message would hardly have been clearer if a golden halo borne by cherubs had suddenly been placed on top of Benn’s head.