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White Coat, Black Hat: Adventures on the Dark Side of Medicine Hardcover – September 14, 2010

ISBN-13: 978-0807061428 ISBN-10: 0807061425 Edition: 1st

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Product Details

  • Hardcover: 224 pages
  • Publisher: Beacon Press; 1 edition (September 14, 2010)
  • Language: English
  • ISBN-10: 0807061425
  • ISBN-13: 978-0807061428
  • Product Dimensions: 6.2 x 0.8 x 9.3 inches
  • Shipping Weight: 8 ounces
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (31 customer reviews)
  • Amazon Best Sellers Rank: #541,723 in Books (See Top 100 in Books)

Editorial Reviews

From 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 Booklist

*Starred Review* Any physician knows that the careless mingling of certain medical interventions can lead to unwanted—even fatal—consequences for the patient. That explains why physician-philosopher Elliott decided to pen this cautionary book, exposing example after example of the adverse effects of mixing capitalism with the practice of medicine. It leads, he says, to a situation where there is no true advocate for the patient. Patients have become health-care consumers shopping for “the best medical bargains they can find.” In such an atmosphere, neither the pharmaceutical company nor the medical researcher, not even one’s own doctor, can be relied upon to place a patient’s best interests above profits. Besides the obvious perils inherent when a physician accepts “gifts” from pharmaceutical and medical-equipment salespeople, there are risks when authorities trusted with oversight also have conflicts of interest. Many medical journals depend upon corporate advertising, and clinical-trial oversight committees are populated with people who are on a pharmaceutical company’s payroll. Moreover, because medical research has become so proprietary, he notes, no one is sharing basic discoveries, resulting in needless duplication of efforts that can delay or kill advanced scientific developments. Elliott’s dim view ought to be a real eye-opener for health-care patients-cum-consumers. --Donna Chavez

Customer Reviews

4.4 out of 5 stars
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See all 31 customer reviews
Even the more prestigious medical journals are in good part funded by drugs advertisements.
Gaetan Lion
Encyclopedic in its information, it provides the reader with an excellent overview of the topic.
Mark K. Wedel
In sum, well written, easily understood, amusing and appalling -- and very finely researched.
Tom Nesi

Most Helpful Customer Reviews

50 of 50 people found the following review helpful By Tom Nesi on September 19, 2010
Format: Hardcover
As a person who has written about the pharmaceutical industry for years, been a pharmaceutical executive and both a critic and supporter of the industry, I highly recommend this book for its unique perspective on the practice of medicine, the drug business, and the many people (both good and bad) involved. Dr. Carl Elliott has done an excellent job of using his own background in medicine (his father was a physician), his research in philosophy and his own perspective as an MD and professor of bio-ethics, to give a very balanced overview of the many problems besieging the modern pharmaceutical industry. Please don't let all these credentials make you believe this is yet another pedantic study of medicine. The writing is superb and compelling, the stories both often funny, sad and touching and the narrative clear and straight forward. Best of all, while the book maintains a high level of scholarship, it never loses its human touch. As an example of why anyone who has taken a drug should read this book, is Dr. Elliott's examination of the types of facilities and the kinds of people on whom drugs are frequently tested. (It is shocking, but true that drugs released to millions of people are often tested on a limited number of people who are not at all representative of the population as a whole.) Dr. Elliott also does a superb job of helping the reader navigate through what has become a vast, medical-industrial complex: including government regulators, universities, physician groups, medical journals and "continuing medical education" that is sponsored by drug companies. The reader will ask after reading this book just what the difference between marketing and science really is?Read more ›
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23 of 23 people found the following review helpful By JEANNETTE on October 31, 2010
Format: Hardcover
I'm an oncologist who likes to think that oncology studies are better controlled and more fastidious than other studies. But as I read this book, I wondered whether I was deluding myself about that. More and more of our studies are pushed by pharm. companies and fewer by nationally run cooperative groups. Also, I was disconcerted and somewhat nauseated to think I may be writing prescriptions that don't do what they're advertised to do. I've always had a healthy skeptism for drug reps - or at least I thought I did - and put up with them so that my staff could get lunch. No more. I will not give them any more of my time.

This is a book that all doctors should read, which won't happen of course. It's an eye opener, quite dismaying. I'm grateful to the author for writing it. We (I) need books like this to maintain a critical eye.
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20 of 22 people found the following review helpful By Irene M. Piekarski on September 17, 2010
Format: Hardcover Verified Purchase
I was in medical school in the 60s and saw pharmaceutical research expand and devolve from an NIH--academic project to a business run by large drug companies for profit. This whole idea that a public service should be treated like a commodity is new and not without ethical problems, especially for physicians and those who look to physicians for advice.
Dr. Elliott is a well-known psychiatrist/bioethicist who writes in a conversational tone of the difficult, shocking dilemmas we all face when buying or evaluating medications. He has 7 chapters covering drug reps, clinical drug research, me-too drug development, FDA evaluations, and the ethical challenges even bioethicists face when asked to consult for industry. Nothing new here, but wonderfully and accurately portrayed without hysteria.
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28 of 37 people found the following review helpful By Loyd E. Eskildson HALL OF FAME on September 17, 2010
Format: Hardcover
Author Elliott reports that the culture of deception within the medical community has become pervasive - driven by profit-maximizing drug companies. He buttresses that conclusion with innumerable vignettes of how they have withheld negative outcomes information about their products, while creating slanted supportive reports in ghost-written medical journal articles, CME presentations, and various forums for both physicians and the public. Supportive physicians are likely to find themselves basking in the sun on a drug-company vacation. Meanwhile, the ranks of drug reps have ballooned to one for every 2.5 physicians - handing out lots of free lunches and small gifts, promoting high-volume 'off-label' uses in sly ways that don't create FDA punishment (the temptation to avoid replicating development costs is enormous), and analyzing 'script-tracking' data from pharmacies to identify the most profitable physician 'high-writers.' Little of this is news, and most all of it is better told in Marcia Angell's "The Truth About Drug Companies," and John Abramson's "Overdosed America."

The one 'surprise' in "White Coat, Black Hat" was learning how much is charged for scientific journals as a result of their having a stranglehold on university libraries. Annual subscriptions can run $20-30,000; these high rates restrict access to important research, most of which was funded by public money, contributed free by authors, and also peer-reviewed without charge as well.

The author also bemoans the loss of much clinical trial 'business' from academic medical centers to for-profit entities.
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More About the Author

Carl Elliott prefers to write about himself in the third person in order to give the impression that he is too important to submit his own biography. A native South Carolinian, Elliott teaches bioethics and philosophy at the University of Minnesota and writes occasionally for magazines such as The New Yorker, The Atlantic Monthly and Slate.com. His estranged younger brother ridicules him periodically at the unfortunate website, www.whitecoatblackhat.com. His attorneys are addressing the situation.