Robin Cook, M.D., is a man with a mission: to communicate the sorry state of American medicine. And his method has made his name as synonymous with medical potboilers as Louis L'Amour's is with westerns.
Because "practically nobody, including most doctors, pays attention to the problem or reads the editorials in the New England Journal of Medicine," he says, "I decided early on that I would couch my stories as thrillers. It was an opportunity to get the public interested in things about medicine they didn't seem to know about."
And that's how Robin Cook became the king of the doc-schlock novel.
His latest, "Mindbend," is holding its own on major best-seller lists, and his earlier "Fever" will shortly go into film production in Canada.
All of his medical novels have two things in common: a one-word title ("Coma," "Godplayer," "Brain") and a medical message of some sort. Cook's technique is to take a particular issue and weave it into a suspenseful, mildly sexual, occasionally gory story that requires little more than a two-hour investment and takes his medical "problem" to a logical if fanciful conclusion.
In "Coma" it was the "harvesting" of human organs from comatose patients who were maintained until needed on heart-lung machines in a hospital-warehouse. "Godplayer" dealt with medicine's failure to police itself, "Fever" with misapplied cancer research, "Brain" with the use of human gray matter to create a part-human computer. In "Mindbend," pharmaceutical companies seduce and then drug and brainwash physicians into prescribing their products, even when patently dangerous, as, of course, they are in the book. Cook's villains may be greedy, gullible and misguided doctors, but his heroes are all doctors, too -- larger than life, vigorous and not above a little fisticuffs here and there.
Sam Spade, M.D.
Cook wrote his first medical book, "Year of the Intern," while he was in the Navy, out at sea on a nuclear submarine. "I don't believe too many people read it," he says, "and I believe it was kind of boring." His only nonmedical novel, "Sphinx," a bow to his first love, archeology, was a best seller. He chose medicine over archeology as a career, he says, "because I thought all the really good buried cities had already been discovered."
In any case, researching "Sphinx" -- which was made into a movie, "but not with my story and not with my characters" -- sent Cook to Egypt, "where I posed as a museum buyer and I bought and sold antiquities for a couple of months. It was a crazy time, and a lot of things that happened to my main character actually happened to me."
The message in "Sphinx" was to call attention to the damage to archeological investigation that "the artificial market in antiquities has created." The message in the movie got lost somewhere in a sub-pyramid chase scene, which is why Cook will be coproducing "Fever."
Born in New York City 45 years ago, Cook grew up mostly "just across the George Washington Bridge in Leonia, New Jersey," also the home, he says proudly, "at one time or another, of Robert Ludlum, Alan Alda, Pat Boone and Buddy Hackett." He went to Wesleyan University in Connecticut and studied chemistry, physics and math, avoiding literature "because no matter how much time you put in on it, you never knew what kind of grade you would get. Now, with thermodynamics, say, either you knew it or you didn't."
He went on to Columbia College of Physicians and Surgeons and was headed for general surgery when, as he tells it, "I was fairly far along and one day -- I can remember it clearly -- I was elbow deep, literally, in a gall bladder operation. I got the gall bladder out and looked at it and thought to myself that I really didn't feel any euphoria whatsoever . . .
"I realized I liked people and liked dealing with them, but in surgery, when you're giving the patient the most attention, the person is essentially a vegetable."
During his summer vacations Cook was an assistant to Jacques Cousteau, and he elected to serve in the Navy when he was drafted in the late 1960s. Then he became fascinated with nuclear subs, which was how his first novel, about his disenchantment with medical school, got written, as he likes to say, "under water."
He met his actress wife Barbara Moughlin Cook at a sneak preview of the film version of "Coma." They live with their dog, a bichon frise, in one or another of their houses in Florida, New York, Massachusetts and New Hampshire, depending on the season. When he isn't writing -- he made the leap from longhand to word processor on "Mindbend" -- Cook may be scuba diving or surfing or skiing or playing basketball. He practices medicine, too -- eye surgery -- but not lately.
Cook is deeply concerned about the state of American medicine, and the morals of his fables are stated as plainly as those of Aesop. Within a few years, he fears, doctors will be working for huge hospitals or health maintenance organization chains with no freedom to practice the kind of medicine they were trained for -- a situation they brought on themselves.
"Only a few" physicians were among the greedy, he believes, "but the rest never bothered to look at the broad picture." Now, he says, people are saying, " 'Well, medical economics is in such a weird state of disrepair, why not allow the marketplace to come in and organize things . . . We believe in private enterprise.'
"The trouble is, there are no real 'consumers' in medicine who are going to choose between one TV set and another and make the bad ones go out of business. Patients are not consumers in any traditional sense. They are, essentially, told what goods and services they need to buy."
With medical corporations, Cook says, "where the people who are going to benefit are faceless investors, they'll want to sell everything to maximum. They own a piece of X-ray equipment and they'll want it to be used 24 hours a day. It doesn't matter if it is overutilized. It doesn't matter if it hurts people to a certain extent. So in terms of commercialization and overutilization, we're now into a situation where that's going to be encouraged even more.
"In a certain sense, the medical profession has participated in its own sort of demise as an autonomous organization because back in the '50s, boy, they were in the driver's seat. And what did they do? Unfortunately, they were very self-serving and developed a medical system that was overspecialized, overpriced and not meeting the needs of the public."
Drug companies, he suggests, may not be turning doctors literally into pill-popping dealers, hooking their patients as they do in "Mindbend." But on the other hand, says Cook, his scene in which a smooth-talking pharmaceutical detail man snows a busy doctor "is just the way it happens. Don't think it isn't because the scene is faintly humorous. Some of the doctors are that stupid about drugs.
"Don't forget, once a doctor leaves his training program he never again is told that he is doing wrong unless it is a monumental screw-up. In fact, their patients tell them they're doing a wonderful job, and their nurses tell them they're doing a wonderful job, even if they're doing a lousy job . . . And one thing they're not really well informed about is drugs, so they rely on those detail men to come in and tell them."
Cook is now spending his time trying to "tell them" himself, about drugs, about medical corporations, "via movies and TV, to promote the ideals of medicine." Technically he's "on leave" from the Massachusetts medical clinic where he practiced, but it's beginning to look as though his patients may have a long wait.