White Coat, Black Hat: Adventures on the Dark Side of Medicine

This book discusses important topics that we all should know about; The nontrivial conflicts-of-interest between pharmaceutical firms and doctors and researchers need to have some more time in the sun so that we all know what they are (and the first step in finding a solution to a problem is to understand that you have a problem and what it is). The large-scale big-money push by pharmaceutical firms to get their drugs into the market, to get them recommended by medical professionals and researchers and into your prescriptions creates all sorts of conflicts-of-interest that consumers, patients and the general public need to know more about. The disclosure of the financial (monetary and other) arrangements between pharmaceuticals and doctors and researchers needs to be vastly improved. The treatment of medical (human) research subjects is, at times, seriously problematic, unethical and dangerous. The true authorship of medical and research papers "written" by the publicly named authors needs to be disclosed. The true conductors of the research needs to be acknowledged. The financial sponsorship of the research needs to be disclosed and finally the raw data needs be disclosed so that different conclusions can be drawn as data can be cherry-picked to fit a conclusion. It is not the basic business of pharmaceuticals that is being challenged in this book, it is how some of this business is conducted. This is an important book because the more people who know about the issues discussed in it then the greater likelihood that appropriate solutions will materialize to the problems discussed. Sunshine (the disclosure of true and complete information) is a powerful disinfectant. Highly recommended!

There was some careful product placement here and misleading advertising. Carl Elliott's articles in the New Yorker describe lurid medical misconduct. The doctors in this book are only evil enough to allow themselves to be swayed in their prescribing by gifts of pens and coffee mugs. It's not a textbook of medical ethics. There's nothing about Kant's categorical imperatives or the Golden Rule or dropping bombs on Nazi German cities. In the opening chapter he describes an interesting and classical quandary. Two drugs are known to be effective for a disease. It would help us to know which is best. The victims of the disease are mentally ill, or are children in Africa. Solving a problem like this demands a lot of careful logic and fancy statistics (calculations of power requirements, number-needed to-treat, optional stopping etc). Elliott gives us none of this but gives a highly colored anecdotal account of the people involved (the American ones anyway). He writes as a journalist rather than as a philosopher and flogs some rather dead horses in order to produce readable anecdotes His accounts of doctors being influenced by free meals and rides in fancy limousines rather bemused me. Most of those I know can afford their own food and cars, and make more money from a day in the office or O.R. than from giving an out-of-town lecture. It's partly about medical ethicists, who apparently live in their own circles and get free meals and rides in fancy limousines and are corrupted by pens and coffee mugs. Is seems the only way for an ethicist to stay incorruptible is to have a private income held in a blind trust. That all sounds rather negative, but this is an intersting and well-written book that I enjoyed reading and learned a lot from.

A highly interesting book covering a wide range of physician malfeasance and moral bankruptcy regarding medicine and medical research. Many of the examples are of particular relevance to those familiar with the University of MN (full disclosure: I'm an alumnus of the medical school, residency, and infectious diseases fellowship programs at the U of MN, and am also on the faculty, albeit at an affiliated hospital), which has not distinguished itself with handling these issues. Readers will gain a great deal of insight into the unsavory details of some clinical trials, the all-too-cozy relationships between academia and industry, and the lengths to which rather reprehensible behavior is excused, and sometimes even rewarded. Highly recommended for anyone in the healthcare field, and also anyone who wants to learn about how deeply industry has insinuated itself in universities and the research world.

This was the first time that I bought on Amazon. As I live in Brazil, I had a little afraid of making a purchase from a site abroad. But ... everything was great! The product arrived on time! No delay! The book is also great. I did not find to sell in Brazil. I recommend both the site and the product! Esta foi a primeira vez que comprei no Amazon. Como eu moro no Brasil, tive um pouco de medo em fazer uma compra num site internacional. Mas... tudo foi ótimo!!! O produto chegou no tempo certo! Nenhum atraso!!! O livro também é ótimo. Eu não encontrava para vender aqui no Brasil. Eu recomendo tanto o site como o produto!

As a physician who's spent half my life in clinical practice and half as a physician executive in biotech, I laud the author's thorough preparation for writing this book. It is clear a lot of energy has gone into the research for the piece and it far similar treatises that deal only with anecdote and superficiality. Encyclopedic in its information, it provides the reader with an excellent overview of the topic. It is so thorough it is almost textbook in scope yet the author writes with a clear and straightforward style that makes is enjoyable for virtually anyone interested in the topic.

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.

This is a story about what goes on in the testing of pharmaceuticals prior to their approval for use and what the process of marketing new drugs is. It is disturbing. One of the factors in the high cost of health care is the cost of medications and one of factors that contributes to the high cost of drugs is marketing, particularly direct-to-consumer marketing. This book describes the shortcuts drug companies take in testing the products to determine safety and the techniques they use to persuade physicians to prescribe their products. The information in the book is scandalous. Every time I ass an ad on TV that includes the phrase "ask your doctor about..." I think about this book and the seedy practices of drug companies and their enormous profits. A little known fact: when Congress passed Part D of Medicare, the prescription drug benefit, they agreed not to negotiate lower drug prices, which was a huge bonus to drug companies. Given the purchasing power of the Medicare program, it was in the position to bargain for lower costs of prescription drugs for Medicare beneficiaries and Congress didn't do it. One of the Congressmen who was the chief architect of the Part D legislation left congress and became a lobbyist for the pharmaceutical industry.

Engaging writing, terrifying stories. You will never look at your prescriptions and vaccinations the same way again. Discover what drug "research and testing" really is. Written by a professor with inside knowledge and experience in medicine and the pharmaceutical industry, this true recounting of the most publicized cases of bad drugs (Vioxx, for example) should have all of us questioning the tactics of Pharma and the FDA. Find out how "published studies in prestigious medical journals" are literally marketing ad copy written by non-physicians and how deaths by drugs are covered up. If you ever find yourself sitting in a doctor's office or hospital, these issues will affect you personally. Read and share this book.

Describe en forma detallada algunos aspectos de la medicina en Estados Unidos que, sin embargo, también ocurren en nuestros países de América Latina aunque en una escala menor, tanto en frecuencia como en poder económico. Es explícito sobre casos que uno intuye, pero desconoce los detalles de toda una industria que va ligada a la Medicina.

Very well written book providing a lot of insight into the relationship between medicine and commercial pharma.

Excellent read about how Big Pharma actually works. Gives an in-depth explanation of the additional influences and pressures a doctor has to contend with. Very informative and written in a language that is easily comprehended.

An important book that analyzes how drug companies are misleading both doctors and the general public in order to sell more pills.

I truthfully did not finish this book. I stopped about halfway and read the coles notes online after. While Carl Elliott makes some great points about the corruption and misguided nature of medicine, he does so in a long form that doesn't seem to be a good return on invested time. Most of his points can be paraphrased in much more reasonable 100 page book, and I feel like I would have preferred that. Good ideas, but in an execution that I didn't have the time to focus on finishing.