DOI: https://doi.org/10.20529/IJME.2013.017
The world of clinical trials is ethically fragile. Huge amounts of money are at stake and a handful of people are privy to a lot of confidential information about the trials. This imbalance in money and knowledge sometimes results in an unholy nexus. Known as insider trading, progress reports of a trial are sometimes passed on to investors so that they can augment or deplete their share in the investment before the trial results are officially made public. The person(s) passing on the information would also have vested interests in the profits. This unmitigatedly unethical practice is explored by the book, using the genre of a murder thriller.
Johan PE Karlberg (using the pseudonym Markus Swan) sets his fiction in the picturesque locale of Svanstrand, a hamlet in Sweden, in winter. The story revolves around a desperate killer nicknamed “The Fox”, a handsome police inspector, Kacka, his efficient assistant, Madelene Trolle, Markus Swan and his wife. The narrative is woven in with the required elements of a thriller: death threats, murders, sword fights, decapitated bodies (of humans and animals), spy cameras and several miles of “Fox chase”. There’s also a story of unrequited love.
The story begins when Swan visits his summer house in Svanstrand in the autumn; he happens to get a brief view of two people fighting, but dismisses it as a local skirmish. However, when he returns with his wife to prepare for a family Christmas, things start to snowball. First, a headless body is fished out of the waters. It is believed to belong to a man killed about two months earlier, presumably in the tussle that Swan witnessed during his last visit. In a sub-plot, two women from Lund are admitted to the city hospital with acute liver damage. Swan learns of a herbal drug trial for weight loss that is on at nearby Lund. He speculates that there is a connection between the trial and the critically ill women. Many killings, Fox-hunts and death threats follow before the story reaches its climax and the killer and their motives are exposed.
The novel reveals the dark underbelly of some clinical trials and the extents to which drug companies can go to make huge profits and in that sense it is extremely timely. In 2012, India was in the news after it emerged that more than 200 trial participants had died within a span of six months. However, this news is unlikely to ensure that informed consent will be taken from participants in the future, let alone that compensation is given for injuries or deaths in trial.
As a literary piece, however, the novel loses pace at various points, such as when Swan talks at length of other infamous and unethical clinical trials. While such information is important, this is not explicitly a history of medicine narrative, and the format does not allow for such ruminations that dilute the tension that has been built up. There are other historical details on the city of Darwolo, the AGA cooker, Lakerol candies and even a few recipes, which might have been reduced in number and length. There is an occasional problem with the narrative voice – while the novel is largely in the first person, in some instances the narrator assumes the voice of the third person without explaining the shift. Also, each chapter has been penned in the format of a personal journal, with a date and time at the start. But at times, the temporal descriptions do not do justice to this format. Perhaps this can be addressed in future editions of the book.