Futures | Published:

Treatment naive

Nature volume 517, page 522 (22 January 2015) | Download Citation

A testing time.

The newcomer spotted the cowboy, one arm draped on his horse, bracing himself. He looked as if he would fall over if the horse moved just a few inches.

Image: Illustration by Jacey

The newcomer noted the cowboy's weariness and approached with caution.

Not looking up, the cowboy said: “What brings you to town? Got a name?” Before the newcomer could answer, the cowboy sized up his too-new cowboy clothes and said: “I'm going to call you Airman. Simple as that. You popped out of thin air on me.”

The cowboy straightened up and seemed to be revived by Airman's approach. A good sign.

Airman shuffled his feet and noticed the brown patina that coated his formerly antiseptic white shoes, the only thing he hadn't replaced when he arrived. No time to get fitted for boots. “I'll take that. Airman. It fits.”

Newly named Airman sighed, but knew he had made a connection. The interviews always went much smoother after that. The prize was big and Airman would have to deliver.

“Mind if I asked you some questions?” Airman said as he tapped his tablet. He kept it hidden in his palm, a technique he had learned long ago so as not to spook interviewees.

The cowboy stroked his horse and shrugged. “Day's just about over. Been a hard ride. Wouldn't mind the company. So shoot.”

The cowboy leaned against a fence post and chuckled as he rested his hand on his gun.

Airman jumped to attention, a little twitchy about the cowboy's firearm. He reluctantly trained his eyes on the script. “Are you between 18 and 65 years old, inclusive?”

“Yep. On the older end.”

“You ever been diagnosed with major depressive disorder, also known as clinical depression or major depression, by a medical doctor?” Got to get better writers for these scripts. He'd tell his boss that later.

The cowboy smiled. “That's a mouthful, Airman. And kind of personal.”

Airman would have to go off script. Improvise. “Ever been sad?”

The cowboy scanned the horizon for the sinking sun. “Comes on me almost every day at sunset.”

“Good. So it never goes away, this sadness?”

The cowboy tipped his hat and shook his head. “Get over it when the sun goes down and I hit the sack.”

Airman moved on to the next question on his screen. “How tall are you?”

The cowboy measured himself against his horse's shoulder, holding his hand above his head. “Oh, about five foot and a half,” he said.

“Your weight?”

“Pretty scrawny, if I do say so. Maybe a buck forty, after Sunday dinner.”

The questions would get harder. “Are you taking any antidepressant medication?”

“Shot of whiskey when I need it.”

Airman was surprised at the quick response. “Fine,” he said. “Alcohol's a depressant. How many drinks do you have a week?”

“Don't usually count them.”

Airman sighed. “Three to six? Seven to ten?”

“That's about right.”

“I guess that's a seven to ten.”

The cowboy looked to the horizon. The sun was pinking out. Airman followed up: “Does whiskey make you feel better?”

“When I'm drinking it, but not the next morning.” The cowboy spat a brown gob of tobacco juice, which splashed Airman's shoes.

“Use tobacco?”

The cowboy smiled.

“Doesn't disqualify you,” said Airman, who checked a box.

“Do you suffer or have you ever suffered from one of the following?” Airman scanned the list and thought the script writers could have tailored it better to this population.

“Psychotic symptoms? Stroke? Head trauma? Dementia?”

The cowboy considered the list, scratching three days of beard. “Maybe I fell off my horse a few times on my head.”

“Doesn't mean you suffered head trauma. Did you go to the doc?”

“Why bother? No blood. Got used to it.”

“Okay with me,” Airman said, checking off the box.

The big question. “Have you participated in a clinical trial in the past six months?”

The cowboy looked wistful. “Sure have. Took me in an air machine way up there and back east to a big hospital in Boston. Seen your kind before, Airman.”

Airman slumped.

“You two were real similar,” the cowboy said. “He said it was a hard business, finding patients who were, what did he call it, treatment naive. Guess you don't have many left where you come from with all the medications you got.”

Airman put away his tablet. “Huh, I figured I was the first in this sector.”

The cowboy settled his horse. “I'd do it again for you. You're a nice enough fella. And it was worth getting poked and prodded for the gold pieces and the big ride in the sky.”

“Too late. You're not naive anymore. I have to move on.”

****

The messages from his boss had piled up while he was chasing the cowboy. Airman buzzed him.

“You've got to come through for me,” the boss said. “This is a blockbuster trial. Time is money. Could be the biggest antidepressant ever.”

You told me this was a pristine time,” Airman said. “I'm doing the best I can. CanadaPharm got here first for an anti-anxiety drug trial and got all the eligible volunteers.”

“You are giving me anxiety,” the boss said.

“Then give me a better territory,” he snapped.

“I've got one,” the boss said. “But this is your last chance. Don't blow it.”

“Where?” Airman asked.

“I am sending you to China, to a time before they developed medicine. It's an untapped time. Get at least one volunteer or you're through.”

Notes

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  1. Steve Zisson is a journalist who has written extensively about clinical research.

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DOI

https://doi.org/10.1038/517522a

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