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25th novel marks Cook as master of medical mystery

Marker, By Robin Cook, Putnam, 533 pp, $25.95

With enough books on the bestseller list, a writer's name eventually appears at the top of the jacket, as large as, or larger than, the title. So, with the publication of his 25th book, a silver anniversary of medical thrillers, we see that ''ROBIN COOK" has written ''MARKER."

It cries out to be a movie, which it no doubt will be. For Cook, a doctor, has a formula, combining his medical knowledge with his talent as a mystery writer, to produce a sort of adult, physician-centered Nancy Drew series. ''Marker" is a fun page-turner, and a perfect airplane novel.

A marker hereditarily links a human to specific abnormal genes and ''marks" him or her for a medical problem later in life. The identification of markers comes out of a relatively new science called medical genomics, dealing ''with the enormously complex flow of information within a cell." Laurie Montgomery, a forensic pathologist at the office of the chief medical examiner of New York, finds that she has the marker for a specific mutation of the BRCA1 gene, which means she is likely to develop a cancerous tumor.

She and boyfriend Jack Stapleton, a pathologist in the office, have accidentally created a baby in what may be the least poetic description of the sex act ever put on a page: ''The cellular event occurred in a moment of intense bliss and involved the forcible injection of slightly more than two hundred and fifty million sperm into a vaginal vault."

Laurie's ruptured ectopic pregnancy creates a medical emergency that eventually leads to the answer to the tale's mystery: Why are young, healthy individuals who have just come through a variety of surgeries at Manhattan General Hospital suddenly dying of heart attacks on the day following surgery?

Laurie suspects homicide first, and Jack and their friend, homicide detective Lieutenant Lou Soldano, finally agree with her moments before a catastrophe is averted.

In an interesting twist, we see the perpetrator commit the crimes early on, before everyone else. This individual, contacted by a representative of a large insurance agency to ''sanction" certain patients who are going to be costly to the company because they are all markers, jumps at the chance and at the $5,000 per case. Discovering the perpetrator's method -- a lethal injection of potassium chloride into an IV, which stops the heart and kills the cells yet masks itself before anyone can discover it -- presents a complicated challenge for Laurie and Jack.

There's just enough information about hospital politics and medical language in the story to let us know this doctor-author knows the ins and outs of that world. And there's just enough to allow us to infer his meaning without keeping a medical dictionary beside the book. The finale is most inventive, and it's a perfect, explosive ending for what could be a nail-biting ''ER"-type TV series, as well as a great horror film.

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