Monday, August 23, 2010

Hooked: Ethics, Medicine and Pharma

Ethics Problems at the University of Minnesota


New book of interest from Carl Elliot:

I have been privileged to receive an advance copy of Carl Elliott's White Coat, Black Hat: Adventures on the Dark Side of Medicine (Boston: Beacon Press, 2010, ISBN 978-0-8070-6142-8; $24.95 hardcover, 211 pp.). I have only just dipped into it, and may post more after I have read it all, but wanted to waste no time in getting the word out.

Carl, who has been mentioned in these parts previously, is an MD who then went on and got a PhD in philosophy and has taught bioethics at a number of world universities, currently at University of Minnesota. He's published his essays in such places as The New Yorker and The Atlantic Monthly, and I feared at first that this book would be merely a collection of those essays, but I see he's reworked the material for this book specifically.

Carl is concerned about the cast of characters that populates the "dark side of medicine" where business and market values seem to have taken over from any sort of professional commitment to the care and well-being of patients, with a special focus on Pharma.

His chapters deal, respectively, with

professional guinea pigs who volunteer for one research study after another;

the "ghosts" who actually write ghost-written articles;

drug reps; medical "key opinion leaders"; marketers;

and finally, a group that Carl has practically made a career of irritating, bioethicists like Carl and me who (unlike Carl and me) get seduced into signing on with corporate boards and taking corporate cash, assuming that the corporations actually want us to tell them what's ethical, and might listen if we tell them (while meanwhile we get to fly to their meetings first class and stay in five-star hotels).

The book is nicely illustrated with anecdotes and interviews, such as this nice quote from former drug rep Jordan Katz, about how the code of ethics introduced by PhRMA in 2002 actually made things worse: "The companies that tried to follow the guidelines lost a ton of market share, and the ones who didn't gained it. The bottom line is that if you don't pay off the doctors, you will not succeed in pharmaceuticals. Period."

I think it's a safe bet that readers who find this blog interesting will like this book.

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