Book Note: 'The Dark Side of Medicine'

Just out from Beacon Press: A book that shreds any lingering tatters of public naivete about the influence of money on medicine.

In "White Coat Black Hat: Adventures on the Dark Side of Medicine," ethicist and New Yorker writer Carl Elliott portrays an American medical scene permeated by commerce in every corner. As I read it this weekend, I felt various Pollyanna-ish notions of mine explode. At one point, reading about the financial forces behind the kinds of medical studies I've written about hundreds of times, I found myself thinking, "I'm such a dewy-eyed fool."

Elliott, a bioethics professor at The University of Minnesota, even shows how bioethics itself is subject to the swaying power of money. He divides the book into six chapters, ruthlessly summarized below. Lest the whole thing get too depressing, I'm going to write Elliott and ask him for simple suggestions on how to cure these ills:

1. The Guinea Pigs: Takes a close look at how money influences the people who sign up for clinical trials and the researchers who run them, leading to potentially distorted results.

2. The Ghosts: Describes the "medical communications" industry and the ghost writers who write up studies at the behest of drug companies — avoiding unfavorable findings — and sign on academics as "authors."

3. The Detail Men: Vividly explores the world of the "drug reps" and how they ingratiate themselves with doctors in order to persuade them to prescribe more of the drugs they're selling.

4. The Thought Leaders:  Goes a bit inside the heads of the "Key Opinion Leaders" who willingly — and lucratively — tout the virtues of drugs and devices to their colleagues. "It strokes your narcissism," says one psychiatrist.

5. The Flacks: Dissects how drug companies use subtle public relations campaigns to lay the groundwork for upcoming drugs, often beginning years before the drugs come out.

6. The Ethicists: Reveals that even bioethics itself faces financial conflicts of interest, from centers funded by drug company money to commercial review boards that compete for business.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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