White Coat, Black Hat Quotes

“What makes our contemporary neurobiological concepts different is the extent to which they have been promoted by pharmaceutical marketers. You are not shy; you have social anxiety disorder. You are not absentminded, dreamy, or fidgety; you have ADHD. You are not moody; you are bipolar. Each diagnosis comes with a prescription. Your need for medication becomes part of your identity.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“Whether doctors and reps are all that different from each other is no longer clear. Doctors know a lot more about medicine, and drug reps dress a lot better, but these days both are Organization Men, small cogs in a vast health-care machine. They are just doing their jobs in a market driven health-care bureaucracy that Americans have deigned and that we define vigorously to critics elsewhere in the world. Like anyone else, doctors and reps are responding to the pressures and incentives of the system in which they work.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“Medical care is neither a right nor a privilege: it is a service provided by doctors and other to people who wish to purchase it.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“This is not something you or I do. This is something the poor do so that the rich get better drugs.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“More important, prescription tracking helped reps figure out which doctors to target. They no longer had to waste time and money on doctors with conservative prescribing habits; they could head straight to the high prescribers, or high writers.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“Over the past twenty years, the evidence that gifts and payments have a profound influence on doctors has become virtually indisputable. Doctors who are paid by a company are more likely to write prescriptions for that company’s drugs, more likely to give talks that are favorable to the company, and more likely to produce research that benefits the company.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“itself is becoming more and more commercialized. Beginning in the 1980s, a series of legislative initiatives pushed science and commerce much closer together, especially the Bayh-Dole Act, which (among other things) gave universities the right to profit financially from their scientific research. The purpose of these initiatives was to bring scientific discoveries to market faster, but it also encouraged scientists to behave like entrepreneurs—or, as Shapin might have it, for gentlemen to behave like merchants.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“Perhaps the most brazen ghostwriting campaign was that of GlaxoSmithKline, which came under fire for its promotion of the antidepressant Paxil as safe and non-habit-forming when evidence had linked the drug to an increased risk of suicidal ideation in children.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“The more papers a physician authors, the higher he or she elevates in the academic hierarchy. And if an academic physician is not actually doing the work behind the papers but is simply signing articles written by agency-employed medical writers, that physician’s taking credit for the paper seems scandalous, like a student who buys a paper on the Internet. “I don’t feel really good about ghostwriting an article that is going to appear under the name of a doctor at Brown University who is going to get twenty-five hundred dollars to do nothing more than review it,” says Susan Gilbert, a writer who worked briefly for a medical communications agency before going into bioethics. “The whole structure of the business was wrong to me.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“The safety of new drugs has always depended on the willingness of someone to test them, and it seems inevitable that the job will fall to people who have no better options. Guinea-pigging requires no training or skill, and in a thoroughly commercial environment, where there can be no pretense of humanitarian motivation, it is hard to think of it as meaningful work. As Dave Onion puts it, “You don’t go home and say to yourself, ‘Now, that was a good day.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“During our early years of medical school, my classmates and I were given a course in physical diagnosis. Usually, we practiced on one another. Each of us would percuss a classmate’s chest or listen to his heart with a stethoscope. But some procedures were considered too personal to practice on a classmate. For some of these, we were assigned a “model patient”—someone from the community who was “compensated” in exchange for undergoing an examination. This was how I performed my first rectal exam. A large group of us were led into a room where our model patient was bent over an examining table with his pants around his ankles. One by one, we approached him nervously from behind, inserted a gloved, lubricated finger into his rectum, and felt around for the prostate. “Thank you,” we all said politely to the model patient as we removed our index fingers from his anus. The model patient stared straight ahead, saying nothing. What made the experience oddly disturbing was not just the forced, pseudo normality of the instruction or the fact that the exam could have been done more privately, but the instrumentality of the encounter: a pretend patient bending over naked for anonymous strangers in exchange for money. The fact that the model patient had been paid did not make his work seem any less degrading. (Tipping him would have made it even worse.)”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“As the figure of the traditional doctor fades away, it is being replaced by a figure to the drug rep, one whose responsibility is to compete as vigorously as possible in the medical marketplace. Patients are being replaced by health-care consumers, who shop for the best medical bargains they can find.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“The whole business of medical journals is corrupt because owners are making money from restricting access to important research, most of it funded by public money.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“In the culture of academic medicine, accepting credit for a ghosted journal article is not seen as a serious ethical failing, simply because the skill of writing is not seen as a valuable intellectual talent.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“But there is a lot of fuzziness in the notion of "intellectual contribution." In some academic units, for example, junior scholars are expected to list their department chairs or lab chiefs as coauthors on all their publications, whether or not these people have actually contributed anything to the paper. In fact, I have heard some senior academics argue that they should be listed as coauthors on anything written by anyone being paid out of their grants. The polite term for this is honorary authorship or gift authorship, a practice that is officially frowned upon by journal editors but that remains relatively common.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“To many critics, the main problem with medical ghostwriting is that academic physicians get credit for articles that they didn't actually write. the status of any academic for articles that they didn't actually write. The status of any academic depends heavily on his or her scholarship, and in academic medicine, the most important measure of scholarship is the sheer quantity of articles produced. The more papers a physician authors, the higher he or she elevates in the academic hierarchy. And if an academic physician is not actually doing the work behind the papers but is simply signing articles written by agency-employed medical writers, that physician's taking credit for the paper seems scandalous, like a student who buys paper on the Internet.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine

“Meanwhile, our patchwork regulatory system insures that no single institution is keeping track of how many deaths and injuries befall healthy subjects in clinical trials. Nobody appears to be tracking how many clinical investigators are incompetent of have lost their licenses, or have questionable disciplinary records.. Nobody is monitoring the effect that so many trials have on the health of professional guinea pigs. In fact, nobody is even certain whether the trials generate reliable data.”
― Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine