Chapter 101

There was no question about the paper's truth, and for rigour's sake Auren James repeated the experiments in it, and having resolved a few queries began genuinely to consider what it would mean.

"When you put that plan to me two years ago I thought it nonsense. I hadn't expected diabetes to actually be overcome."

"It's only the theory at this stage. Whether it's workable depends on the clinical results." Knowing perfectly well what the hydroxy insulin would do, Li Lan was modest about it.

Auren James was not a man with half a grasp of anything; his experience let him see at once which research is fantasy and which has value, and to his mind this had a great deal of value and was highly feasible. "You are all far too modest. Even if the hydroxy insulin fails in trials, it gives other researchers something to work from, and within five years an insulin that cures diabetes could be developed."

Which reminded him of something. "Rather late in the day — would you like me to introduce you to some sponsors? I imagine the pharmaceutical companies would be glad to support your next stage, having read this."

Kindly meant. She'd completed the crucial theoretical work, and what it does clinically depends on the trials, which is genuinely difficult for one person.

Late in the day, because a project can usually look for sponsorship once the plan is settled — research funding, as it's called. He was consultant to an international pharmaceutical company, and with his name, finding her a sponsor was a matter of a sentence — though he didn't find sponsors for anybody whose work he didn't rate, or he'd have raised it two years ago rather than now.

She was grateful, and destined to disappoint him. "Thank you, Professor. I found a sponsor a year ago, though — this year's work has been done with their support."

He was surprised; the student had found a backer without saying anything. "Had you? Which company?"

She didn't conceal it. "Cerulean Pharmaceuticals."

He thought, and had no memory of the name, and seeing his puzzlement she added, "A Chinese company."

He didn't press further. Offering to find her a sponsor was his responsibility as her supervisor; he wasn't an employee of any pharmaceutical company and had no reason to labour the point, and if she had a sponsor, where it came from didn't matter. Nor was he interested in taking a share of her work; his existing patents had brought him a comfortable amount.

So he moved on. "Then I shan't. The content looks sound, so adjust the formatting and submit it. As for the journal — I'd suggest The Lancet. With a paper of this weight you needn't worry about acceptance, and it should generate a certain amount of discussion in medicine."

He paused. "Incidentally, there's something you might consider."

"What is it?"

"The NCI in America wrote to me last month asking me to recommend someone as a researcher. Would you be interested?"

Li Lan was surprised. The NCI is the American National Cancer Institute and the leading institution in cancer research worldwide, involved in a great deal of drug development; a good many of the specific treatments in the field have the NCI somewhere in them. She was extremely interested in a period there and wasn't going to miss it, and rallied and agreed at once. "Very much. Thank you, Professor."

He was pleased, and smiled. "There's no hurry — it would be after Christmas. So before that, do you want to apply to graduate?"

Which stopped her.

She'd spent the last couple of days working out how to raise graduating, and here he was raising it himself.

Taking her silence for absence of the intention, he explained. "You know the British term system — three terms a year, and you can apply in any of them. Your project is complete, so applying this term is no difficulty at all. As for publication, The Lancet's process is fast; it won't hold you up.

"So — what are your thoughts?" he repeated at the end.

Put like that she could hardly refuse, and she'd intended it anyway. "Yes please. Thank you. I was wondering how to raise it with you."

He nodded, and added, half joking, "And there is a difference between arriving at the NCI as a doctor and arriving as a doctoral student."

---

Monday the fifth of October 2015. London, the Elsevier offices.

The Lancet being one of the world's leading medical journals, the mail it receives daily is not as heavy as one might imagine — a consequence of its standing and its rejection rate. By the figures, some eight and a half thousand papers were submitted last year, of which twelve per cent reached peer review, and of that twelve per cent only four per cent were ultimately published.

Rolf, one of the senior editors, spent his days reading papers from everywhere in the world, some of them making up the numbers and a good many genuinely valuable. The editorial office being the first gate, his main task was eliminating nearly eighty-eight per cent of submissions and keeping the research that mattered.

Opening the system as usual and finding only four papers today, he was relieved: four plus the two he hadn't got to yesterday meant finishing early and going down for a coffee. Only four today — though that hardly made it a leisurely job.

Eight and a half thousand submissions a year averages twenty or thirty a day, and the office has five editors, so four to six each. Which sounds like little, and every paper has to be read properly and takes real time — particularly with Tuesdays and Thursdays kept clear, those being the selection meetings, where each editor puts forward suitable papers for discussion of whether they merit peer review.

Experienced as he was, the title and abstract told him whether a paper was competent, and he still had to read each one through and give an appropriate recommendation — which, in most cases, was rejection.

Six papers, and it was two in the afternoon when he reached the last. Five rejection recommendations written, he came to the day's final paper in good spirits. The title — reasonable enough.

Beneath it the authors. Two only. The first meant nothing to him; at the second his eyes widened. As a Lancet editor he knew the name Auren James, and had he suspected coincidence, the institutional affiliation made it certain: the Nobel laureate.

So this Li Lan was his student, he guessed, and rallied somewhat, with some interest in the content. Perhaps today wouldn't be a waste. In that frame of mind he read on to the abstract and the body.

…

The following day.

"Hello, Rolf. How was last week?"

Another editor greeted him on the way to the meeting.

"One surprise. You?"

"As usual. What surprise?" He shrugged.

Having read it, Rolf kept it back. "I'll say at the meeting. I think everybody will be interested."

Which made his colleague more curious. Between them they read hundreds of papers a year, and hearing that from Rolf was rare. "Is that so? I'll wait for it, then. Don't disappoint me."

They reached the office, where a long table stood and the editors sat round it talking, with Richard Horton, the editor-in-chief, in the middle.

Nearly forty papers were down for discussion, which is a considerable amount of work, and covering a great range: foetal abnormality, HIV, even whether installing exercise equipment in workplaces is beneficial.

Through vigorous discussion, Rolf's turn came. Several days' accumulation wouldn't produce one or two papers; he had brought four, of which only one reached peer review. The first three discussed, he cleared his throat.

"I'd like you all to listen closely to this one. It may not change our own lives greatly. For people with diabetes it may change everything."

Which told the room the paper was about diabetes — and from the way he'd said it, had another new insulin been developed? While they were speculating about its properties, what he said next astonished them.

"Because it may hold the hope of curing diabetes."

"What?"

He looked round, satisfied with the reaction; his own shock yesterday had been no smaller. He'd spoken somewhat early, in fact, not being a researcher and having no way of knowing whether it was true. As an editor he could find no error in it; the deeper work was for peer review. On his reviewing experience, though, he put its truth at ninety per cent.

Once they'd settled he summarised it — time not permitting the whole thing, only the important parts. Afterwards they looked at one another, and the editor who'd greeted him that morning chose his words and spoke first. "The originality and the ambition of this are beyond question, the subject is diabetes, which is under intense attention, and it offers a solution. I consider it a paper that meets our standards."

The others nodded, with none of the fierce argument other papers got, and after a few minutes' silence Richard Horton made the decision. "If nobody objects, then: to peer review, and feedback as soon as possible."

Rolf nodded, and prepared to send it once the meeting closed.

Of forty papers, five were selected for peer review.

The Lancet's reviewers being specialists in different fields around the world, feedback comes within ten days. Rolf watched for it — partly from curiosity, and partly for a more private reason: his mother had been diabetic for years, so any submission on diabetes always got a little more of his attention.

Five days after sending it, three reviews came back — and encouragingly, all three gave extremely high marks on the hypothesis, the methods, the results and the conclusions. After a further round of editorial discussion, it was decided to publish in the last week of October.