White Coat, Black Hat: Adventures on the Dark Side of Medicine

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From a New Yorker and Atlantic Monthly writer, a darkly humorous account of the serious business of medicine
Over the past twenty-five years, the practice of medicine has been subverted by the business of medicine, sacrificing old-style doctoring to fit the values of consumer capitalism. In this lively narrative, physician and moral philosopher Carl Elliott traces for the first time the evolutionary path of this new direction in health care, revealing the dangerous underbelly of the beast that has emerged. We’re introduced to the often shifty characters who work the production line in Big Pharma: the professional guinea pigs who test-pilot new drugs; the ghostwriters who pen “scientific” articles for drug manufacturers; the PR specialists who manufacture “news” bulletins; the drug reps who will do practically anything to get their numbers up; the “thought leaders” who travel the world to enlighten the medical community about the wonders of the latest release; even, finally, the ethicists who oversee all this from their pharma-funded perches.
Head-turning stories and colorful characters provide Elliott the springboard for exploring larger ethical issues surrounding money. Are there certain things that should not be bought and sold? In what ways do the ethics of business clash with the ethics of medical care? And what is wrong with medical consumerism anyway? Fake science, fake news, fake research subjects, fake researchers—sometimes it seems that deception is emblematic of what American medicine has become.

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Editorial Reviews

Publishers Weekly
While most people are vaguely aware of the uncomfortable symbiosis between doctors and the pharmaceutical industry, few would believe the flagrant bribery and brow-beating that occurs, according to Elliott's (Better Than Well) latest. Pharmaceutical companies have overwhelming influence over research studies, grant funding, and the decisions or suggestions that doctors make regarding the care of their patients. As the financial stakes continue to increase, the pharmaceutical industry has an even greater incentive to obfuscate potentially harmful findings about their products. Elliot, a professor of bioethics at the University of Minnesota, methodically exposes every aspect of the connection between Big Pharma and medicine, interviewing experiment subjects, doctors, pharmaceutical sales reps, and others on the frontlines of the issue to give readers a thorough understanding of what lies behind a simple prescription. Employing often shocking stories to reveal larger ethical problems in the industry, Elliott offers no easy answers in an effort that informs and inflames in equal measure.
(c) Copyright PWxyz, LLC. All rights reserved.
From the Publisher
"Elliott grips the reader's attention all the way."
Scientific American

"Dr. Elliott's entertaining and extremely readable essays will have you convinced that in comparison to the shenanigans that go into the creation of a single prescription pill, fingerprint erasure might actually be a little dull."
—Abigail Zuger, MD, New York Times

“If you think your doctors prescribe medications for you on the basis of their unbiased judgment and objective medical research, this book will disabuse you of that old-fashioned fantasy. In his superb exposé, Carl Elliott shows how the big drug companies have bribed and corrupted the medical establishment so that we no longer know which drugs are effective or why our doctors prescribe them.”
—Marcia Angell, author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It

“Beneath the white coats and sterile labs of the great American heath care system, Carl Elliott finds a drug-addled, gang-run, con game—sometimes bizarre, often hilarious. The noble arc that runs from Hippocrates to Sherwin Nuland washes out in a ‘business model’ apparently inspired by Timothy Leary, John Gotti, and that infomercial pitch guy for ShamWow.”
—Jack Hitt, contributing editor for This American Life and author of Off the Road

"Enjoyable to read and laced with sardonic wit, this is an eye-opening work that all consumers of health care should read."
Library Journal

“Carl Elliott has written a deep, daring, and sometimes very funny book about aspects of medicine you’ve never seen, and probably never will unless you take the time to crack this cover. You’ll discover what it means when healers forget—or maybe never grasped—their main mission and pollute not only medicine but all those within its circle. Elliott’s book describes the conundrum of modern medical practice wittily, incisively, and beautifully. This book should be required reading for anyone who has ever been a patient—in other words, for everyone.”
—Lauren Slater, author of Opening Skinner's Box and Prozac Diary

Kirkus Reviews
Elliott (Bioethics/Univ. of Minnesota; Better than Well: American Medicine Meets the American Dream, 2003, etc) examines the part played by the pharmaceutical industry in constructing "a medical system in which deception is often not just tolerated but rewarded."While some abuses-including the use of subjects to test drugs without informed consent-are not new, these practices continue despite the existence of regulatory institutional-review boards set up by Congress, because these too have now become profit centers. Elliott writes that pharmaceutical companies hire PR specialists who not only supply educational materials to promote products, they also train medical professionals to be "opinion leaders" and even write papers in their name. In 1998, the Journal of the American Medical Association "found evidence of ghost authorship in 11 percent of articles published in six major American medical journals." In the late-'90s, articles touting the benefits of the weight-loss drug Fen-Phen-later taken off the market because of potentially fatal side effects-were a key piece in a "complex multimillion-dollar public relations strategy" that minimized worries about the safety of the drug. Market-research firms, writes the author, profile doctors as a preliminary to major sales campaigns offering them tickets to sports events and inviting them on junkets in order to persuade them to become advocates for new drugs. Further, medical professionals are offered research grants and paid large honorariums for speaking engagements and other events. Disguised marketing is even more insidious-e.g., treating menopause as a disease that transforms a woman into a "dull-minded but sharp-tongued caricature of her former self" in order to promote estrogen-replacement therapy. The author provides little information that informed readers don't already know, but the gripping anecdotal evidence has important societal implications. Agent: Andrew Blauner/Blauner Books Literary Agency
Abigail Zuger
"Adventures on the dark side of medicine”—now that sounds like a lot of fun. A few juicy stories about black-market organs, fingerprint erasure, murder and mayhem in the I.C.U. would make a welcome change from the usual humdrum stuff of hospital and clinic, where the big events are a drug that doesn't work properly, or a visit from a pharmaceutical salesman that screws up the entire afternoon schedule. But no: In Dr. Carl Elliott's survey of all that is shifty in modern medicine, those humdrum events are exactly what make up medicine's dark side. And, indeed, Dr. Elliott's entertaining and extremely readable essays will have you convinced that in comparison to the shenanigans that go into the creation of a single prescription pill, fingerprint erasure might actually be a little dull. After all, what is more sinister than the dubious mechanics of the ordinary, the sausage factory behind the breakfast special?
—The New York Times
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Product Details

  • ISBN-13: 9780807061428
  • Publisher: Beacon
  • Publication date: 9/14/2010
  • Pages: 224
  • Sales rank: 1,279,146
  • Product dimensions: 9.52 (w) x 11.28 (h) x 0.85 (d)

Meet the Author

Carl Elliott is a professor at the Center for Bioethics at the University of Minnesota. His work has appeared in the New Yorker, Atlantic Monthly, the Believer, and on Slate. He is the author or editor of six previous books, including Better Than Well, Prozac As a Way of Life, Rules of Insanity, and A Philosophical Disease. Elliott lives in Minneapolis, Minnesota.

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Table of Contents


Chapter One The Guinea Pigs 1

Chapter Two The Ghosts 25

Chapter Three The Detail Men 51

Chapter Four The Thought Leaders 75

Chapter Five The Flacks 109

Chapter Six The Ethicists 139

Coda 173

Acknowledgments 176

Notes 178

Index 195

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Customer Reviews

Average Rating 4.5
( 6 )
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Sort by: Showing all of 6 Customer Reviews
  • Anonymous

    Posted August 8, 2012


    As a physician assistant, I knew or suspected for years what was going on, but I didn't know for how long it had been going on, and to what extent. It's interesting to explore why the situation exploded as technology changed and as the medical playing field changed. Very disillusioning and disheartening, but no worse, in my opinion, than all the other scandals that become public every day, only a little closer to home. The whole medical field today is just a business; we might as well swap our white lab coats for suit jackets. This is just one more reason I don't practice clinically anymore. Very sad. A must-read for anyone in the medical field, and I daresay that many of my friends and colleagues will see their reflections here.

    1 out of 1 people found this review helpful.

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  • Posted May 7, 2011

    highly recommended-must read if you're interested in current pharma and physician ethics

    Carl Elliott does an outstanding job of laying out the ethical issues that medicine has been facing for the last twenty years. With the empathy of a physician and the research of a scientist, he presents the issues and the challenges in a thought provoking manner. I understood the challenges of the pharmaceutical companies, their motivations, and the concerns and challenges of the physicians and scientists. He also provided insight into drug testing and research results that was both interesting and valuable in our family making future medical decisions for those around us. A must read if you want to understand what's happening in medicine, pharmaceuticals and research.

    1 out of 1 people found this review helpful.

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    Posted February 8, 2011

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    Posted January 24, 2014

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    Posted January 21, 2011

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  • Anonymous

    Posted November 13, 2010

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