The latest doctor drama.

The latest doctor drama.

The latest doctor drama.

Reading between the lines.
March 1 2006 7:01 AM

Doctor Lit

Allegra Goodman's Intuition incisively portrays the cut-throat lives of doctors.

Intuition, by Allegra Goodman

Most modern medical fiction is pure fiction, remote from the real dramas that play out at the patient's bedside or at the researcher's lab bench. With the exception of Thomas Mann's Magic Mountain and Robertson Davies'The Cunning Man, there are remarkably few ambitious novels of social realism set in the medical world. And yet the culture of modern medicine offers a promising array of themes for a novelist to draw on: the tension between the humanitarian impulse and the hunger for quick fame; between the imperative to be harshly self-critical about one's discoveries and the financial benefits of self-promotion; between the painstaking pace of research and the pressure to produce results quickly to obtain grant money; the ethic of sharing data with colleagues and the competitive ethos that pervades academia. The novelist faces a tension in her own work: the impulse to tell a "complete" story and the incompletion of all scientific truth. Witness, for example, the recent debacle of the Korean stem-cell studies conducted by Dr. Hwang Woo-Suk, who falsified key cloning experiments, and the scandal faced by the Nobel laureate David Baltimore in the late 1980s, accused of condoning fraudulent experiments. It took mere months for Hwang to be unmasked, but nearly a decade for Baltimore to be vindicated and his reputation fully restored.

Allegra Goodman, in her timely new novel Intuition, enters this competitive and contentious world of high-profile medical research. Intuition is a sharp detour from Goodman's prior books on family and on faith. Dr. Sandy Glass, a medical oncologist, and his Ph.D. collaborator, Marion Mendelssohn, work at the Philpot Institute in Cambridge, a research facility ranked one peg down from the renowned laboratories of Harvard and MIT. It has been a long dry spell for Glass and Mendelssohn, and it is not clear whether, without exciting new research results, they will be able to secure the money for their program to survive. As the novel opens, the prospects do not look good. Cliff Bannaker, a postdoctoral fellow who arrived in their laboratory with great promise, has failed in his project of using a genetically engineered virus as an anti-cancer treatment. Then, on the brink of being let go, Cliff produces some startling results. It turns out, he declares, that treatment with the virus causes some human cancers implanted in mice to melt away. Sandy Glass launches a PR blitz, while Marion Mendelssohn, reluctant at first to release preliminary results, ultimately publishes a paper announcing them in the prestigious journal Nature. Bannaker has rescued the laboratory; once shunned, he is now widely celebrated. Then—as you might guess—questions arise about his results, which prove difficult for other researchers to reproduce.

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Goodman displays remarkable knowledge of the inner workings of the modern biomedical enterprise, especially how the drive for big money and the thirst for prestige clash with the classical style of muted, deliberate, and often disappointing research far from the glare of the public eye. Each character embodies a distinct player in the corps that makes up this real-world enterprise. Sandy Glass is the brash big-picture clinician, not a real scientist, but pretending to be one. His skill is as the front man, the doctor who conjures the dream and communicates the message. Sandy's wife, Ann, a refined WASP, tries to keep him grounded and in touch with reality; she insists on including a menorah at the family Christmas party. Marion Mendelssohn is the self-critical researcher, a throw-back to an earlier era, struggling not to be seduced by Sandy's hype and her own growing hopes. Her husband, Jacob, was a child prodigy who realized that, despite all his brilliance, he lacked creativity and so has devoted his life to his wife's career. The postdoctoral fellows in the Glass-Mendelssohn laboratory also fit familiar phenotypes: Feng, from Beijing, works with quiet efficiency and is inscrutable, because he says the opposite of what he thinks; Robin, Cliff's co-researcher and girlfriend, is sexy and ambitious, and her envy and resentment of Cliff make her into a whistle-blower used by academic enemies against the Philpot team. Jacob's well-intentioned machinations also backfire, working to undermine Marion.

At each turn in the story, Goodman has her doctors and scientists wrestle with how deeply they want to dig to find the truth. And, in what may come as a surprise to a lay reader, she shows how hard it can be to ultimately discern truth in science. Experiments, when repeated, may not yield the same results, because scores of maddening technical details involved in each attempt can keep the researcher in limbo. All the while, the powerful cultural forces of fame, money, and envy work to press Glass and Mendelssohn for a definitive answer—or not. When the doubts about Cliff's data explode into a national scandal, Glass is forced to testify in front of Congress, and his inquisition in Washington mirrors that of David Baltimore—except that Sandy does not invoke science to counter the politicians but rather employs a clever cultural ruse.

Each of Goodman's characters could be cartoonish, except that such individuals in fact do heavily populate the Boston-Cambridge biomedical axis. She so deftly captures them—their talents, incentives, foibles, and language—that I found myself linking the fictional names to real-life faculty and fellows at local universities and hospitals. This authenticity is the greatest strength of Intuition. Rarely has a novel so deeply probed the thoughts and actions of physicians and scientists as they strive to succeed. It lifts the veil off this world and exposes its promise and peril. Whether Cliff made an honest technical error out of excess enthusiasm, or cheated like Hwang, or really had genuine but hard-to-replicate data—like that from Baltimore's lab—is kept in suspension for nearly the entire book. Goodman is doing more than creating a mystery; she is raising a question of epistemology.

Goodman adopts the traditional conceit of the omniscient narrator, knowing the mind and heart of each protagonist, but by refraining from exposing Cliff Bannaker as a charlatan or lauding him as a hero until the very end, she prompts us to reflect on the broader issue of truth in today's culture. Medical science becomes a window into the world of politics, business, and personal relationships, and we begin to question whether the truth always sets us free. Goodman concludes that it does, but in unexpected ways.