This started out well, but got kind of boring. What interested me most was hearing about all the human "guinea pigs" that serve as test subjects for medicines. How any drug can be truly deemed safe during these trials is beyond me. ( )

We have gotten so accustomed to the notion of prescription drugs as a commodity, an item to be priced, sold, and advertised, that it is hard to imagine that things could be another way. It all seems perfectly ordinary. Yet somehow, marketing the drugs at a luxury resort at the margins of the developing world feels slightly unsettling, like passing a homeless person on the way into an expensive restaurant. Prescription drugs may be a market commodity, but were they really meant to be a consumer good? Prescription drugs fill genuine human needs, or at least they are supposed to. It is only when you are faced with genuinely needy people that the prescription-drug marketplace begins to seem perverse.

Although I often enjoy non-fiction for its content, it is rare that I can also say I’ve enjoyed a non-fiction book for the read. Carl Elliott’s White Coat, Black Hat is definitely in this minority. All of Elliott’s writing is tinged with a fantastic dark humor and sarcasm that makes the read itself as valuable as the information gleaned from it. I can honestly say I enjoyed this book from cover to cover.

White Coat, Black Hat is, I guess, intended as a sort of exposé about the medical industry and the various players involved in it. I would assume that much of the general thrust of this book involves practices that most people are probably already aware of, such as pharma gifts to physicians and ethicists who receive honoraria from the very companies they lambaste in their treatises. There is a great deal here, though, that I imagine is not such general knowledge. Elliott takes the reader on a tour through the various “professions” associated with the medical industry, and some of the darker corners of each of those professions’ hallways. The two chapters I found most interesting and disturbing, perhaps because of my own unfamiliarity with some of the activities he discusses, were his chapter on the ghost-writing of medical journal articles (a practice which I admit I never dreamed was so widespread), and that on pharma’s use of “key opinion leaders” – well-respected consultants who can be paid to travel the country, lending their credence to pharmaceutical products.

Obviously Elliott has an agenda in this book. He expresses clear discomfort with the level of influence industry has come to exert over the medical profession(s). And so I am certain that someone could put together a book just as long filled with the saints of the profession(s) and adequately show that not all industry is bad, that pharma isn’t the bad guy. Counter-examples, however, are not enough to undermine the disturbing extent to which self-serving motives have infiltrated what was once considered the most honorable profession. And besides, a book like that wouldn’t be nearly so controversial and fun to read! (I’m only half-joking). Anyway, this was a thoroughly enjoyable read. I go farther than to recommend it: I’ve actually bought two friends copies as gifts, so sure was I that it’s appeal would be wider than those actually interested in medical ethics. ( )

A really engaging, if depressing, read. Elliott starts with a chapter on human guinea pigs, who lie and are lied to and whose experiences determine what drugs will be available to the general population. He covers medical ghostwriters (and the prominent physicians who allow their names to be put on papers ghostwritten for drug companies), drug sales reps, “thought leaders” who promote drugs for pharmaceutical companies, marketers reaching out to doctors and consumers, and even ethicists, who are now often on the payroll of some corporation or another. Medicine has been commercialized in so many ways that thinking of it as a profession is more distracting than useful. Elliott has no proposals to fix the problems that arise from pervasive self-interest pretending to be objective advice, making the book as worrisome as it is engaging. ( )

White Coat, Black Hat: Adventures on the Dark Side of Medicine increased my belief that modern medicine has little to do with promoting health and is instead one more example of capitalism gone wild. Test subjects are the worst, least altruistically motivated or compliant people on whom to test medicine or medical procedures; fashion models working as drug reps have no interest in promoting health; doctors, no matter how much they think they are immune to drug money, are easily influenced to speak well of potentially dangerous or just uselessly redundant drugs; likewise bioethicists; and drug companies continue to invent diseases in order to sell drugs as we've all noticed with the growth of what he terms "cosmetic psychopharmacology" - drugs that make a healthy, normal person feel extra perky and energetic (kind of like the ideal drug rep). Carl Elliot even throws out the idea that the idea of labeling oneself transexual didn't really take off until surgeries were developed to redesign genitals. All in all the best medicine I can think of is take 2 aspirin and don't call anyone in the morning. ( )

One thing : Vioxx actually worked ( )