The Bookworm Sez

Book Review: White Coat, Black Hat

By Terri Schlichenmeyer
Real AspenOctober 19, 2010

You’re sick.

You hurt more than you’ve ever hurt before and you generally feel terrible, but you know there’s relief – you saw it on TV last week, a shining promise of better feeling, available through your physician. As soon as you can muster the energy to rise from bed, you’re going to call and plead your case.

You need a prescription, stat.

White Coat, Black Hat: Adventures on the Dark Side of Medicine” by Carl Elliott c.2010, Beacon Press $21.95 / $28.95 Canada 224 pages

But wait a minute. Who said those pills were right for what ails you now? In the new book “White Coat, Black Hat” by Carl Elliott, you might be surprised….

As both son and brother of doctors and as a bioethicist himself, Carl Elliott says that the world of pharmaceuticals was always just a part of life. He and his brother played with branded toys and wrote with logo pens on trademarked paper that their father brought home from work, courtesy of drug reps. Pharma was familiar.

For some of his adult life, Elliott studied and worked abroad. He returned to the U.S. around the time the FDA began allowing prescription drug ads on TV, and the new influence that the drug industry had on the medical world dismayed him. When he left America, medicine was a practice. When he returned, it was a business.

Pharmaceutical drug trials, once performed at medical schools and teaching hospitals, have moved to the private sector. Human “guinea pigs” are paid big bucks; for some of them, participation in drug trials is their only job. For-profit institutional review boards are set up to protect test subjects but if there’s a problem, drug companies simply find another IRB: the people doing the testing must ensure that they get the results they need to move the drugs forward.

Once a drug is released, medical “ghost writers” and marketers are paid to put “spin” on individual drugs, even if risks outweigh benefits. Paid medical-based “thought leaders” lend further credibility to the PR. Drug reps freely bring gifts to doctors and their staffs to encourage product usage which, studies show, influences prescribing rates. And advertising directly to customers, a multi-billion dollar industry itself, cements the need for the drug in patient’s eyes – even if the malady was Madison Avenue-created.

But is this ethical? You’d have to ask ethicists, some of whom are – surprised? – on drug company payrolls.

Holding a copy of “White Coat, Black Hat” is a little like throwing dynamite in a barrel of gasoline. It’s highly explosive, very incendiary, and the aftermath won’t be pretty.

Though the information in this book is something most readers know about – at least peripherally – it’s absolutely chilling to see it in print. Author and bioethics teacher Carl Elliott makes this subject accessible, easily understood, and shocking. The questions he subtly poses will make you more aware when noticing drug ads and, more importantly, before requesting a specific prescription.

American drug prices are the highest in the world, says Elliott, and this book may explain why. If you’ve got an interest in health care, in fact, what you read here may make you a little sick.


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