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

by Carl Elliott

Over the last twenty-five years, medicine and consumerism have been on an unchecked collision course, but, until now, the fallout from their impact has yet to be fully uncovered. A writer for The New Yorker and The Atlantic Monthly , Carl Elliott ventures into the uncharted dark side of medicine, shining a light on the series of social and legislative changes that have sacrificed old-style doctoring to the values of consumer capitalism. Along the way, he introduces us to the often shifty characters who work the production line in Big from the professional guinea pigs who test-pilot new drugs and the ghostwriters who pen “scientific” articles for drug manufacturers to the PR specialists who manufacture “news” bulletins. We meet the drug reps who will do practically anything to make quota in an ever-expanding arms race of pharmaceutical gift-giving; 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 that commercialized medicine has to offer from their pharma-funded perches.
 
Taking the pulse of the medical community today, Elliott discovers the culture of deception that has become so institutionalized many people do not even see it as a problem. Head-turning stories and a rogue’s gallery of colorful characters become his 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? Elliott asks all these questions and more as he examines the underbelly of medicine.

Genres: Nonfiction, Science, Medicine, Medical, Health, History, Health Care

224 pages, Hardcover

First published January 1, 2010

About the author

Carl Elliott is a professor of philosophy at the University of Minnesota. Trained in medicine as well as philosophy, Elliott is the recipient of a Guggenheim Fellowship, a National Endowment for the Humanities Public Scholar Award, the Cary and Ann Maguire Chair in Ethics and American History at the Library of Congress, a resident fellowship at the Rockefeller Center in Bellagio, and the Weatherhead Fellowship at the School for Advanced Research in Santa Fe. His writing has appeared in The New Yorker, The Atlantic, The New York Review of Books, The New York Times, Mother Jones and The American Scholar. He has been a visiting faculty member at the Institute for Advanced Study in Princeton, the University of Sydney, and the University of Otago in New Zealand, where he is an affiliate of the Bioethics Centre.

Reviews

[RKanimalkingdom · Rating 4 out of 5]

Given the capitalistic society we live in, it shouldn't come as a surprise to anyone that you can no longer trust a person. For most of civilization, every person has had their own agenda; nothing really came out of goodness. While we were aware of that as humans, we always held science to another level. The level of truth akin to a kind of god. It was unattainable, only expandable.

Well, that fantasy has been shattered.

Review Continued Here

[Judd Street · Rating 5 out of 5]

A strong contender for "best read of the year," White Coat, Black Hat is an excellent introduction to the dark and dismal ways of medicine and the pharmaceutical industry.

It is, perhaps, a dangerous and slightly unnerving book to read at the height of the COVID pandemic, as we hope desperately for a vaccine rollout to cover for our inability to manage the disease through wise policy or caring personal actions. But, nevertheless, it's a critical book: one you must read now.

Divided up into six sections, Elliott's "White Coat, Black Hat" introduces us to a series of different forms of evil lurking in medicine. The first chapter, "The Guinea Pigs," deals with the way that big pharma's drug testing has largely created a class of people so desperate for money that they'll sell their bodies (and lie about their conditions) to get a chance to have drugs tested on them (with all the obvious implications for quality of research that you can imagine). The second chapter, "The Ghosts," explores the practice of 'ghostwriting' pro-drug articles that will then be signed by respected scientists, giving these big pharma perspectives an air of credibility. Perhaps most striking in this chapter is Elliott's evidence around how endemic this practice is, to the point of ghostwriting articles /years/ before a drug is even tested, simply to lay the groundwork for its eventual acceptance.

The third chapter turns to "The Detail Men," or those folks (often attractive women) who serve as pharmaceutical reps, hawking drugs to doctors. More strikingly, in conjunction with chapter four, "The Thought Leaders," it lays out a terrifying case for the ways that doctors themselves are implicated into this, suggesting drugs to their colleagues and shoring up support. These chapters are terrifying for both just how cheaply doctors can be bought off, and how much effort and money overall goes into influencing these systems. The drugs you are taking aren't because they're the best for you; it's because they've been sold to your doctors. The fifth chapter, "The Flacks," also explores the marketing angle of this, drawing out the ways that not just drugs are sold, but also the diseases themselves are created and marketed (such as erectile disfunction or overactive bladders). The discussion of "Video News Releases" (p. 113) is particularly nefarious and concerning.

The final chapter has, to me, the most novel and striking content of the book. Whereas the preceding chapters provided evidence of rot I already knew about, the sixth chapter turns to the corruption of bioethics as a profession; a discipline that has largely been bought out by industry money, taken over by 'yes men' doctors eager to push the boundaries, and dominated by for-profit review of the ethics of research designs by companies with strong incentives to please the industries they're "reviewing." There's also some good discussion in here about the role of placebos versus best known treatments, which harkens back to Epstein's account of AIDS activists (p. 163).

I think this book is worth its weight in gold for the examples and evidence it contains of the phenomenon described above. If you haven't had a chance to delve into these issues before, you'll be horrified at what is revealed. But, in many ways, the contribution of the book goes further than that. Its deeper argument is about the structural ways that both medical research and the provisioning of medical care are, through capitalism, utterly eroded and turned into a shell of their true selves. Sure, this complex might well be able to deliver you some performance enhancing drugs, but it's long left behind any intentions of trying to 'care' for patients in a substantive way. Rather, like with so many other sectors - universities included - the relationship now is between seller and buyer; it's traditional marketing (and all its more modern, targeted versions). It's an industry that seeks to suck your cash and the government's money, while providing only enough 'outcomes' to spin in its favour.

When I was living in the United States, I was in a doctor's office at one point seeking help with some symptoms. The physician eagerly offered up some free samples of a medicine to 'see if they'd work' (we'd sort out the cost of ongoing doses afterwards, he reassured me). I asked him whether he had received any money from the pharmaceutical company selling it, which flummoxed him. He said he'd never had anyone ask that before, but no, he hadn't. Well, other than a trip he had taken that they paid for. But no, he hadn't.

I declined the samples and left the office with a frustration at the rot within the system. So, when I picked up this book, not a lot within it surprised me or came as a shock. But, the degree of detail with which Elliott describes it - and the masterful way in which the book is structured, organized, and written - races this book towards the best of the year for me thus far. It's a book everyone should read, now.

[11811 (Eleven) · Rating 3 out of 5]

I skimmed this one because I've read some of the same anecdotes in other sources. Good stuff but I'm not interested in reading the same stories penned by a different author. A lot of it was exactly the same as Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients.

[Ilgar Adeli · Rating 4 out of 5]

خوک های گینه ای یه گونه از خوکچه های کوچک نازی هستن که احتمالا دوس داریم. ولی قضیه پشت این خوک ها قطعا دوست داشتنی نیست.(خوک توی ادبیات ما یکم بار معنای توهین امیز داره پس با اون زاویه بهش نگاه نکنید.؟)

کتاب white coat, black hat رو حدود یکماه پیش شروع کردم و واقعیتش جز فصل اول حس کردم خوندن بقیش برای فضای درمانی ما زیاد اهمیتی نداره.هر چند سه فصل و بصورت گذرا بقیشو نگاه کردم. همین فصل اول هم بیشتر متوجه شرکت های بزرگ دارو سازیه ولی خوندنش خالی از لطف نیست.


خوک های گینه ای اصطلاحیه که به افرادی اطلاق میشه که دارو ها در فاز های انسانی روشون تست میشه. تا اینجا قضیه تا حدی تاریکه ولی تا پشت پرده ای ازمایشات رو بررسی نکنیم به ابعاد غیر انسانی اون نمیشه پی برد.

خوک های گینه ای

افرادی که ازمایشات روشون اجرا میشه به ازای هر ازمایش پول دریافت میکنن. و میزان این پول رابطه مستقیمی داره با میزان تهاجمی بودن ازمایش یعنی ازمایشاتی که امکان اسیب توشون بیشتر باشه مبالغ بیشتری میدن.

حال چرا این افراد این کار رو میکنند؟ نیاز مالی . بیشتر ازمایش شوندگان از بی خانمانان و زندانیان و حتی افراد کشور های فقیر هستند.

در پرونده های عجیب و ناراحت کننده ای حتی دیده شده که روی کودکان کشور های فقیر هم ازمایش صورت گرفته.

در سال 1996 شرکت فایزر قصد داشت انتی بیوتیک trovan رو ازمایش کنه تا ببینه چه تاثیری بر روی کودکان میزاره. کشوری که انتخاب شد نیجریه بود. این دارو در دور اول ازمایش بر روی 200 کودک نیجریه ای ازمایش شد. نصف این کودکان درمان ثابت شده رو دریافت میکردند که بیماری رو درمان میکرد و نصف دیگه این داروی جدید رو.

یازده کودک در این ازمایش مردند پنج نفر از گروه داروی جدید و شش نفر از درمان عادی. تا اینجا تنها نکته غیر اخلاقی این بود که خانواده ها حتی خبر نداشتند این یک ازمایشه و فکر میکردند که بچشون داره درمان میشه ولی قضیه با دو مورد خیلی دارک میشه. اول اینکه اون گروهی که داروی جدید رو گرفته بودن علاوه بر این 5 مرگ بسیاری از کودکان کر، کور، معلول و دچار اسیب مغزی شدند. و از اون طرف در سال 2006 طبق اسنادی که لو رفت معلوم شد شرکت فایزر دوز درمان ثابت شده رو کمتر از مقدار توصیه شده داده تا امار این داروی جدید در مقایسه بهتر بشه.

از این چنین پرونده های توی کتاب خیلی هست. از بی خانمانین که به حرف خانه و غذا بردنشون و روشون ازمایش انجام دادن بگیر تا تست دارو های اعصاب و روانی که موجب خودکشی تعدادی شدند.

حال سوال اینجاست که چرا این افراد شکایت نمیکنند؟ در بخش بعدی میگم

پزشکی در دست تجارت

توی سریال بیگ بنگ تئوری پنی یکی از شخصیت ها مسئول معرفی دارو های یه شرکت بزرگ دارویی به پزشکان میشه. و یکی دیگه از شخصیت ها داروساز همون شرکته. خیلی طنز های جالبی راجب این تجاری سازی پزشکی و دارو سازی انجام میشه. بگذریم. حرف کتاب اینه پزشکی داره توسط شرکت های تجاری اداره میشه و این ترسناکه.

پزشکی نه به معنای عام اون بلکه کل سیستم درمانی. منطورم پول دوست بودن پزشکان نیست (که جمله ای است کلی و اطلاق اون به همه اشتباه. حتی در صورت اطلاق هم لزوما غلط بودنش رو نشون نمیده)

حال این تجاری سازی چه عواقبی داره؟ مورد هایی که کتاب اشاره میکنه به اینه که این تجاری سازی موجب تقلب در نتایج ازمایشات دارویی، نقض اصول اخلاقی در ازمایشات و تغییر قوانین این ازمایشات در امریکا توسط وکلا و چول فراوانی که دارن.

کتاب توضیح کاملی ارائه میده از نحوه قبول شدن نتایج یک ازمایش دارویی در امریکا. به طور خلاصه بخوام بگم تقریبا شرکتی که پول داشته باشه میتونه دارو هاش رو ثبت کنه به این صورت که حتی اگه یک بازرس دارو رو رد کنه میتونن به یک بازرس دیگه مراجعه کنن و اگه قبول بشه رد قبلی فاقد اهمیته.

اینجاست که آزانس های حقوقی به وجود میان که با دریافت مبالغ زیادی میتونن دارو ها رو ثبت کنن. و این فارغ از میزان نقض قوانین اخلاقی در ازمایشات و احتمالا تقلب در نتایج اونه.

حال برسیم به سوال اینکه چرا این افراد شکایت نمیکنند؟ در واقع این تجاری سازی در این بخش هم اثر گذاره. این قوانین که جلوی این کار رو نمیگیره باعث به وجود اومدن آژانس های کاملا قانونی شده که برای این افراد کار و ازمایش جدید پیدا میکنه. و این افراد در صورت داشتن سابقه شکایت استخدام نمیشن.

از اون طرف در صورتی که فرد زودتر از موعد از ازمایش خارج بشه بهش پول خیلی کمتری از مبلغ قرارداد داده میشه و همین باعث میشه در صورت وجود ساید افکت ها باز هم این افراد در ازمایش بمونن و آسیب ببینند.

جمع بندی

امن بودن داروهایی که ما داریم استفاده میکنیم در بک گراندش چنین اتفاقاتی در حال رخ دادنه. من واقعا نمیدونم چیکار میشه کرد. ولی بنطر فشار های قانونی و نظارت میتونه شدت این فجایع رو کمتر کنه.

کتاب مثال های خیلی بیشتر و ترسناکتری میزنه و این فصل حدود 40 صفحس اگه علاقه داشتین برید بخونید.

در صورتی که نتونستید فایل کتاب رو پیدا کنید بگید براتون بفرستم.

[Jen · Rating 5 out of 5]

A fascinating - if also troubling - look at the intersection of medicine and commerce. The author, a medical ethics teacher and doctor in Minneapolis, looks at the issues around and about how various medical companies seek to drive business in ways that not only don't necessarily improve health, but can even harm it.

Well-written, with lot of specific examples, evidence, and stories, it makes for a compelling read. If you like Atul Gawande's work, this should definitely also go on your to-be-read list.

[Anannya Das · Rating 4 out of 5]

I thought this book was an interesting discourse about the ways that the pharmaceutical industry had influenced the ways doctors treat their patients. It was surprising and eye opening to see the psychological techniques they used to get more money and how they aren’t looking out for anyone’s best interest (of course as they’re businesses). An interesting book, though it did get a little too in depth about types of pharmaceutical businesses for my taste but overall very interesting and has great take always to be aware of as a doctor.

[Jacob Hay · Rating 3 out of 5]

An informative expose on the pharmaceutical industry which left many more questions than answers. An extensive amount of research and information about the misdeeds of medicine are presented however, the overarching thread is loose and the pacing is shaky.

[Jai · Rating 5 out of 5]

For anyone who is employed in healthcare, this will likely be the most important book you come across. Carl Elliott does an astounding job of traversing a sticky spider web of connections between medicine and industry that no one wants to admit exist, and yet are incredibly important in gaining an understanding of the culture of consumer healthcare within which we currently reside. In a clear, understandable manner, Elliott does not simply comment on the ethical concerns these ties give rise to, but provides example after example of what these connections mean.

What does it mean that the industry conducts trials with research subjects that are cognizant of the hoops they must jump through to be approved as a subject? What is the real life impact of the pharmaceutical industry’s motivation to keep patented drugs on the market? 38,000 dead due to a company’s refusal to admit a serious side effect exists. What are the implications of an industry structure in which the holders of morality, our bioethicists, are being paid by the industry they are supposed to evaluate?

Elliott’s dissection of this web of connections in his clear, concise, yet revealing manner allows the reader time to reflect on the implications. If much (and really any) of the knowledge medical providers uphold in the name of evidence based medicine is disseminated by the pharmaceutical industry, how can providers trust their own judgment? Even when conflicts of interests are announced, as they often are now, who will choose not to read a concisely written review article about a condition you need to know more about simply because the authors have multiple industry ties? This book pushes the reader to think twice. These articles are often written with a purpose, those advertisements have a goal, the leaders with industry ties have ulterior motives.

If nothing else, Elliott’s book pushes us to think critically about the world around us, about the reaches of capitalism, and how even the sanctity of the doctor-patient relationship is continually encroached upon by a desire for profiteering.

[Tova · Rating 5 out of 5]

This book focuses more on the marketing of drugs than on the bad medicine/studies of Bad Pharma, but was as infuriating and believable. The drug rep I saw at my pediatrician's office stood behind the reception desk, as if he worked there, and took up the doctor's time to show him stuff on his iPad despite the full waiting room.
It's scary to think that not only are we being prescribed medicine based on relationships with drug reps, we're also getting medicine based on faulty science. I highly recommend both Bad Pharma and White Coat, Black Hat.

[Lisa · Rating 4 out of 5]

This was excerpted in the New Yorker.... frightening, particularly regarding ghostwritten medical studies. Should be required reading for anyone who consumes or offers healthcare in the US.

[Abby Higgins · Rating 5 out of 5]

Great book! Very informational! It was extremely infuriating!

[Alex Elman · Rating 4 out of 5]

Carl Elliott, an MD-turned-bioethicist, reveals the transformation of the pharmaceutical industry from a responsible, tightly regulated academic industry into one that is deeply consumer-driven and profit hungry. Elliott introduces us into a world of crooked regulation, political cronyism, the personal vanity of doctors and corporate disregard for patient safety. The invention of the blockbuster drug category forever changed the mission of the industry from the patient to the bottom line.

This muckraking book isn't supposed to be an exposure or slam piece where it blows the lid off of the maleficence of Big Pharma. Nothing in this book is presented as some new revelation that hasn't already been exhaustively criticized by others. This book scans as a report card on the ethical side of medicine. It waxes critically on the development of practices that reflect the changing values of the institution as a whole.

The tail wags the dog in a sense. This book makes clear that Big Pharma has an undeniable influence over a large part of the medical agenda in the United States. They sit on medical boards, chair university departments, and float into hospital administration positions. They win over the support of physicians and nurses by slowly implanting bias into their unconscious with fancy lunches, paid speaking engagements, and the promise of thought leader glory. This doesn't escape the ire of the vox populi. Elliott closes his book with a figure from Harris Polls that reveals plummeting public approval rating of the pharmaceutical industry. From 1997 to 2005, public approval dropped from 80% to 9%. This stunning blow is indicative of an industry that has shifted medical treatment from a public necessity guided by an ethical social contract to one of a poorly regulated consumer product.

Elliott writes from the perspective of a critical bioethicist and skeptic. He rakes over Institutional Review Boards (IRB) tasked with ethically regulating medical trials. He also exposes the poor practices of medical trials themselves. Most shocking is the willingness to prescribe placebos to patients with severe psychiatric diseases where effective treatment was otherwise available. Also troubling, the book details a story about a man named Dan who was sent to the hospital for psychiatric treatment by his Mother after exhibiting signs of delusions and trouble grappling with reality. After demonstrating that Dan was a threat to himself and to society by an independent clinical psychiatrist, it was recommended that Dan be involuntarily committed into an institution. An alternative was presented. If Dan were to enter a drug study, a court would grant a stay of commitment. In the year-long trial Dan was randomly assigned an anti-psychotic drug by a computer even though he demonstrated that he was highly unstable and prone to violence. During the trial, Dan committed suicide. When the blind on the study was broken, it was revealed that Dan was given an experimental and thus unproven drug.

Not absent from Elliott's analysis of Big Pharma is the rise of the SSRI and the generous broadening of its clinical and off-label uses. Ethical questions were posed regarding the practice of cosmetic psychopharmacology or using SSRIs to blunt the rough edges of life; to become "better-than-well". Prescriptions of Prozac hit such levels as to officially herald the Age of the Blockbuster Drug. Pharmaceuticals as a public commodity mirroring that of cars or home furnishings are deeply troubling.

While I enjoyed the analysis and criticisms in White Coat, Black Hat, I felt like the book as a whole was a little disjoint and poorly organized. The flow wasn't intuitive and the anecdotes sometimes seemed too strained such as using the Michael Oldani narrative to demonstrate the transition of detail men into drug reps during the 1960s and 1970s. These are minor criticisms within an otherwise outstanding body of journalism. Recommended read for those interested in the commercialization of medicine and ethics of developing and prescribing medicine.

[Michael Burnam-Fink · Rating 5 out of 5]

This book is a tour de force investigation into the deeply complicated and corrupt nexus of science, medicine, and money. From barely paid professional human guinea pigs, to feted key opinion leaders, Carl Eliot exposes a medical system that is far from transparent and scientific. Medicine has become a business, driven from the top by pharmaceutical marketing agents on the search for the next blockbuster lifestyle drug. Science, supposed the ultimate arbiter of truth, has been coopted with ghostwritten articles, and company approved presentations. Ironically, precisely because doctors believe they are too intelligent and impartial to be swayed by mere marketing, they are vulnerable to the simplest ploys of free pens and a little gilded prestige.

The key observation of the book is not that this medical system is inherently bad; markets are very good at providing many goods. Rather, people approach medicine half as patients and half as consumers. The traditional role of the doctor is being supplanted by medical technicians and salesmen. To me, it appears that efforts to remove money from medicine are already doomed to failure. Rather than trying to restore a halcyon past, we should instead ask how the strengths of corporate medicine can be used to improve access, care, and outcomes.

[Lage von Dissen · Rating 4 out of 5]

This book exposes many of the secrets within modern medicine and health care, most notably its intricate relationship (and conflict of interest) with the pharmaceutical industry (Big Pharma). I will not go into too much detail as I don't want to spoil it for the would-be reader, but I will say that this book just gave me further confirmation of findings I've collected over the years through some labored independent research. We have a for-profit health care industry and this means that good quality health care is sacrificed at the expense of capitalistic, free-market models that minimize that care to maximize profits. Capitalism has its advantages, but those advantages can be negated by an industry that shouldn't look to cut corners nor depend on the premise of rational consumers who know what care they need -- when they obviously don't. Public health care policies and legislation are largely affected by this conflict of interest with pharmaceutical company lobbyists entering Washington with a bottomless checkbook and a for-profit agenda. Read this book and you will not be disappointed in it (I can't say the same for how you may feel about your doctors, your politicians, or corporations in general). Have a look and give it a chance.

[Jenna Copeland Kristensen · Rating 1 out of 5]

The emperor has no clothes. This book purports to criticize the misdeeds of pharmaceutical science without demonstrating any scientific rigor itself. In short, despite pages of references, it is little more than a rant that parades individual opinions as facts and extrapolates those opinions into supposed truths. There is no consideration of all perspectives as would be expected in any fair and balanced scientific analysis. Carl Elliot discredits himself and his position with such trite analysis. Yes, there are problems in the pharma industry, but this book offers no viable recommendations to solve them and instead chooses to demonize thousands of scientists for their money-grubbing ways. How much money is he making with this book? Is any of it being donated to patient advocacy programs?

[Analog · Rating 4 out of 5]

This has been an interesting read for me, a person who works in the veterinary field - the drug reps still buy lunch, they still hand out pens and notepads, and still sponsor continuing education talks. Though I don't think there's any way to get away from the issues raised in this book (on the human or veterinary side of medicine), it is important to be aware of what has come before, and what is still happening.

I did feel as though I needed to do extra wiki research on some of the major topics (e.g. the Vioxx VIGOR scandal) that are discussed as though the reader is very familiar with them - and maybe the target reader would be.

Overall, though, the writing is in relatively plain language that doesn't require an MD to understand, and the quotes from industry insiders bring significant value to the text. Very recommended.

[JDK1962 · Rating 4 out of 5]

Very readable book on the interactions between the medical and pharmaceutical industries, and how the former is manipulated by the latter. I admit that the author's views are similar to my own: I think that pharmaceutical companies are in the business, first and foremost, of making money, and if they can identify a drug that addresses a primary symptom--however effectively or ineffectively--they will not try all that hard to truly understand the system dynamics of what it does and the secondary conditions or side effects that it may cause. As an example, in the news right now, we're seeing studies on the longer term effects of proton pump inhibitors, which do a great job of treating GERD (i.e., heartburn)...but there seems comparable little interest in looking too closely at the follow-on effects of messing with acidity in the gut. Especially if it means selling less omeprazole.

[Deborah · Rating 4 out of 5]

A very interesting and probably horrifying book to most readers who are not already familiar with how the pharmaceutical industry has infiltrated their doctor's office, the surgery suite, and even academia.

As an academic, the part I was most appalled by was the documentation regarding peer-reviewed articles not even being written by the medical faculty identified as authors, but rather written by agents in the pharmaceutical industry and signed-off by medical faculty. This is such an egregious breach of integrity, particularly where reputations are made and opportunities created based on one's publication record.

Should be read by everyone!!

[Darcy Knight · Rating 5 out of 5]

As a look at the influence of the pharmaceutical industry on medicine as a whole, this book is fantastic. From your neighborhood doctor to college professors, from medical ethicists to the review boards that are supposed to control research, Big Pharma is everywhere...and for the most part, people don't even know it. Written by a knowledgeable insider, this is a book I recommend for anyone who needs to know the why and how of corporate influence on all our everyday medications. Well written, fascinating read.

[Priyanka · Rating 5 out of 5]

If I didn't have to read this for my Bioethics course, I may have never picked it up - but I'm really glad I did. I feel that anyone who is entering medical research or practice should read this book or something like it. It's quite an eye-opening experience to understand the incentives that major players in the field have; and even if Elliott is biased and jaded by his interactions with the industry, it is important to know how bad it can get. Highly recommend if you are interested in any aspect of the pharmaceutical industry.

[Kirk · Rating 4 out of 5]

Series of solid essays describing how different elements of medical practice are becoming increasingly corporatized and its ethical implications. Covers clinical research, drug marketing, science writing, PR, clinical ethics, etc. Interesting perspectives mainly sourced through primary discussions from former employees who left their jobs because they felt conflicted about the morality of their careers.

[Jan · Rating 4 out of 5]

Dark side of medicine -- really all about ethics -- how drugs are tested, how they get on the market, shady practices in the above. Fascinating read. Don't ever be a guinea pig for one of the drug companies -- their ethics are less than stellar.

[Shelie · Rating 3 out of 5]

This book was eye opening. I thought I knew about drug companies unethical practices but this made me see there is so much more to the story. It reinforces my belief that drugs should be used cautiously and only when needed. Marketing is a psychological game but even more so with drug marketing.

[Andrea · Rating 4 out of 5]

Eye opening and bubble bursting. A must read for all doctors and patients alike.

[Joy Urban]

Had to read it for Bioethics class, but I liked it as far as nonfiction goes. Very interesting, albeit disappointing as far as reality goes, and I learned a lot.

[Yilin Wong · Rating 5 out of 5]

Really informative. The ethical issues talked about in the book can be expanded to topics outside of medicine and pharmaceutical companies.

[Ivars Neiders · Rating 5 out of 5]

This is must read for anybody who studies medicine.

[Catherine Austen · Rating 4 out of 5]

Makes you never want to buy a pill again.

[Barbara Clarke · Rating 5 out of 5]

I have to wonder why this book didn't get a National Book Award or a Pulitzer when it was published. Written in 2010, Elliott manages to unveil (with abundant references and examples) what in 2024 is finally making the news at least on social media platforms and X.

I've completed a manuscript on the state of U.S. healthcare and had to go back and add in some of what Elliott knew back then. My experience was still jaw dropping even after having read a boatload of books, including Elliott's latest (another 5 star book) The Occasional Human Sacrifice that came out this year on whistleblowers, with Elliott among them.

The NYT on my paperback edition's cover says the book is "entertaining..." I'm not sure that's the word I'd choose given the self-deception, cynicism, fraud, corruption, death and destruction that the unchecked pharmaceutical industry and the oh-so willing doctors, sales reps, ethicists, and others that have contributed.

I kept thinking while I read this great book about Elliott's own bravery as a whistleblower (you don't win friends that way but may save lives) and the question I (and he) asked - how do these people look at themselves in the mirror? Are their mirrors AI managed so that they can see someone else - a facsimile of themselves appearing to be a good person who just happens to be getting wealthy? Is it always ultimately about the money? Or some kind of screwy prestige? Or believing that they are just one cog in a massive wheel and their contribution, however lucrative or ego feeding, doesn't really hurt anyone or matter?

Take a walk on the "wild side" with Carl - he never disappoints (fine writer and thoughtful of his readers) and like me, be amazed that almost 15 years later what he said in 2010 is finally coming into the light. Thank you Carl.

[Belle · Rating 3 out of 5]

White Coat, Black Hat offers a sharp and unsettling look at the inner workings of Big Pharma, particularly how financial incentives can distort medical research, prescribing practices, and patient trust. The book’s greatest strength is its use of concrete examples. The case studies and firsthand accounts make the ethical failures of the pharmaceutical industry tangible rather than abstract, which I appreciated, especially from a medical humanities perspective.

That said, the book becomes repetitive at times. Many chapters reinforce the same core arguments, and while the message is important, the redundancy dulls its impact. I found myself wishing the material had been more tightly edited or expanded into deeper analysis rather than circling the same points.

Overall, it’s a valuable and informative read, especially for anyone interested in medicine, public health, or ethics. While not groundbreaking in structure, it succeeds in exposing systemic issues that deserve attention. The substance is there, even if the execution could have been sharper.