“We operate in a regulatory gray area. A lot of your readers won’t like it, I’m warning you.”

I nodded.

“About five years ago, the FDA created an exception in the informed consent laws. They wanted to leave room for emergency research.”

I recalled Dr. Massengale using these words in Arcade.

“What does ‘emergency research’ mean?”

“It means if the subject isn’t in a condition to provide consent, and if available treatments are unsatisfactory, then experimental treatment becomes an acceptable course.”

“So you look for someone who meets these exemptions,” I said, “and they become subjects in the trial?”

“Like I said, a lot of people will think we’re out of bounds. They’ll say we’re using human beings as guinea pigs. I know you haven’t written on science before, but if you do some digging, you’ll find that guinea pigs have it a lot better than humans in most medical trials. Let me explain a typical setup. The corporation hires out the work to a CRO—that’s a contract research organization—which rounds up ex-cons and alcoholics for the trial. The CRO pays a physician a small fortune to lend their imprimatur, even though the doctor usually doesn’t have any research training whatsoever. And the physician, in turn, delegates the trial’s day-to-day operations to a monitor, usually some low-wage nurse, who treats it as an audition for a better job at the corporation that hired the CRO in the first place. This is how corporations acquire the results they need to get past the FDA. It sounds like it should be the biggest scandal in the country, but in fact it’s happening all the time.”

“So you’re saying your trial is more ethical?”

“There is no perfect trial,” said Dr. Kriss. “But in our case, the subjects are dying, one second to the next. There are no services for them, period. We’re not replacing some other, more conventional treatment they’d otherwise receive. While they’re here, they receive the very best care, I supervise absolutely everything, and of course we throw in a small amount of money when we discharge them as well.”

My initial reaction was that it seemed exploitative, targeting these health care deserts to bypass informed consent.

“Couldn’t you just bring them a regular bag of blood?”

Dr. Kriss must’ve shadowboxed this argument a million times in her head. “In the permanent drought,” she said, “subjects like ours are not prioritized, to put it kindly. If Americans want to donate more blood, and get more of these people medical insurance, I’d be overjoyed about it. But that’s not my cause. My cause is the trial. We’re presented with a unique opportunity to advance medical science. We’d be killing untold millions if we didn’t seize our chance.”

I jotted down her remarks, and said, “How long will Quinn be here?”