Professor Susan Hurley, author of the brilliant new thriller Eight Lives, has worked in the commercially-focused pharmaceutical world for decades, so it’s natural that her debut novel revolves around this competitive industry. One of the key challenges Susan faced was in making complex immunology accessible for the average reader. While she may have made it look easy, it took a lot of work in the writer’s room. Here, Susan shares the scientific approach she applied to the plot.
In 2006 I read about a London drug trial that ended tragically, when a new drug was tested for the first time on humans. The drug was a monoclonal antibody, for diseases of the immune system. The six healthy men who each received the drug all suffered a severe reaction, and almost died. It was a horrific outcome. I felt awful for the men and their families and was shaken by the catastrophic consequences. But it also struck me that such a trial would be a suitably dramatic starting point for a novel. Animal experiments, no matter how comprehensive, can’t completely predict a drug’s effects in humans, so testing a drug on humans for the first time is always a step into the unknown.
Overseeing this step into the unknown are scientists and executives with reputations at stake, while on the other side, those volunteering for the trial are people with much less power. Historically, trial participants have often been the powerless: prisoners, military personnel, people who are institutionalised. Even this century, in the United States, drug trials have been conducted on the homeless and undocumented immigrants.
So, you have an inherently perilous experiment and a moral dilemma. We want safe and effective medicines. Someone has to take risks for us to get them. Who should that be?
There’s also a lot of money at stake. A successful trial of a monoclonal antibody like the one tested in the London trial can turn a quick profit of around $20 million. It sounded like there was the bones of a story. A thriller.
But to write such a story I needed to understand immunology, and I’m not an immunologist. My training and experience is in pharmacology (the study of how drugs work), epidemiology (the study of disease in populations) and health economics.
To research Eight Lives I used similar techniques to those I’ve applied to that work, with a twist. I read the scientific literature and I talked with experts in the field, as I’ve always done. But for my novel I looked for the points of conflict. I would ask the immunologists I interviewed: What do you most fear? What’s the worst thing that can happen in your area of interest? A first-in-human trial failing is every medical researcher’s worst nightmare, but I learned about what can go wrong before that step.
My research gave me some key plot points. Now I needed to express them in a way that non-scientists would find interesting. I was writing a novel, not a non-fiction piece. I wanted readers to learn something through engagement with the characters. I had experience writing what the science world calls ‘plain language’ summaries: precis of research that non-scientists can understand. Plain language statements have their place but are way too dry for a novel.
Instead, I used two techniques. The first was to describe the scientific concepts by analogy. In this way I explained the concept of monoclonal antibodies by comparing them to CIA assassins. Assassins target people perceived as ‘bad guys’. Monoclonal antibodies target molecules that are behaving badly and causing disease.
The second technique I used was to have non-scientist characters taking a shot at explaining the science. So, for example, Sally Southcott, the mother of one of the narrators in the novel, who describes herself as ‘more an arty person than a science person’, tells us that cancer patients don’t lose their hair when they’re treated with monoclonal antibodies.
It was fun to get creative and dramatise science in these ways, but I was wary of over-simplifying to the point of getting things wrong. The experts I talked with very kindly checked excerpts of Eight Lives to make sure the science was authentic, and one particularly generous immunologist fact-checked the whole novel for me. Pleasingly, I passed.