The Pill That Could

Chapter 12: The Patients Who Waited

On a Tuesday morning in the spring of 2026, in the same hematology clinic at Oregon Health Sciences University where this book began, Brian Druker is seeing patients.

He is sixty-nine years old. He stepped down a few years ago from running the Knight Cancer Institute, the cancer center at OHSU that he led for many years and that grew, in some part on the strength of imatinib's success, into one of the major American cancer research institutions. He still sees patients. He still runs a research program. He still writes letters about CML and about other cancers and about the people taking the drugs and about the people developing the drugs that come next.

The clinic on this particular Tuesday is a follow-up clinic. Most of the patients on his schedule are CML patients who have been coming to see him for ten, fifteen, twenty, twenty-five years. Many of them he has known longer than he has known some of his own colleagues. He has watched them through their disease and through the rest of their lives. He has watched their children grow up. He has gone to a few weddings. He has attended a few funerals — mostly, in recent years, for things other than the disease that brought him into their lives.

The first appointment of the morning is a woman in her early seventies. She was diagnosed with CML in 1995, three years before the phase 1 trial of imatinib opened. She was on hydroxyurea and then interferon for three years before she enrolled in the phase 2 trial in 1999. She has been on imatinib continuously since. Her blood counts are normal. Her latest PCR result, on the chart in front of Druker, shows BCR-ABL transcripts undetectable on the standard assay — deeper than MR4.5. She has been at this level for more than a decade. The conversation lasts about twenty minutes. They talk about her grandchildren. They talk about a recurrent shoulder problem that she is going to get a steroid injection for. They talk briefly about whether she might be a candidate for a treatment-free remission attempt; she says she has thought about it and would rather just keep taking the pill, because the pill works and she sees no reason to fix what isn't broken. Druker says that's reasonable. He writes the prescription renewal. They schedule her next appointment for six months out.

She gathers her things and leaves. The next patient is already in the waiting room.

* * *

What this clinic looks like, in 2026, is what the prologue's clinic in 1993 was reaching for, across the gap that this entire book has been about.

In 1993, Druker had patients with a fatal disease and inadequate tools. In 2026, he has patients with a managed disease and tools that work. The clinic visits in 1993 had to be conversations about how to live with a worsening cancer. The clinic visits in 2026 are conversations about pill adherence, blood draws, side effects, and the ordinary medical concerns of people who happen to have once had something serious that has, in the language clinicians now use without embarrassment, become a chronic condition.

Some of the patients in this clinic in 2026 — perhaps a quarter of them, perhaps a third — have been coming to see Druker since the 1990s. Many of them are patients he saw in his early years at OHSU, when there was nothing to give them but the inadequate options of the era. Many of them survived long enough to enroll in the phase 1 trial, or the phase 2 trials that came after, or to receive the drug commercially after May 2001. They are, for the most part, alive. They are, for the most part, well.

There are also patients in his clinic this morning who are newer — diagnosed last year, the year before, five years ago. They were not part of the original cohort that lived through the long argument from 1993 to 1998 to 2001. They came in after the drug was already there. They started imatinib, or one of the second-generation drugs, within weeks of their diagnosis. Their experience of CML has been, from the start, a daily pill and a routine blood draw and a normal life expectancy. They are aware, generally, that this was not always how the disease worked. Few of them know the history in detail. Most of them, gracefully, do not have to.

* * *

The patient after the first one is a man Druker has known since 1998.

He was sixty-three when he was diagnosed and is ninety-one now. He was one of the patients in the early phase 1 cohort — not the very first patient, but in the first wave, dosed somewhere in the middle of the 1998 escalation. He had advanced disease at enrollment; he had, in the conversation he and Druker had before the trial, been told that the drug was experimental, that it might not work, that he was very ill, and that the alternatives — by which they meant the lack of alternatives — were what they were. He took the first dose with his wife in the room, the way several of the early patients did. The wife is no longer with him; she died of unrelated causes about six years ago. The man is here this morning by himself. He came in by Lyft. He is, by his report, doing well.

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