By Fr Joseph Tham, LC , PhD, MD

Recently, I wrote this book review on an interesting work, White Coat, Black Hat: Adventures of the Dark Side of Medicine, by Carl Elliot.

In this work, the author delves into the well known problems that medicine faces as it divides its attention between patient care and profit making.  As medical expenses tops the GNP of developed nations, healthcare has become a profitable venture for the entrepreneurial minded.  However, is the lofty ideal of caring for the sick being compromised in this process of commercialization of the medical enterprise?

Elliott is a known critique of this shady collaboration that has become endemic in medicine and the pharmaceutical industry.  In this highly readable work, he delves into known cases of abuse, collusions, and manipulations for the sake of the profit margin which is often at the expense of scientific objectivity and the patient’s good.

The chapter on “guinea pigs” describes the haunting experiences of professional research subjects who offer themselves to be tested in exchange for income.  The ethical problems with this are foreseeable—the safety of these subjects who do it for money and not for love of science, and the objectivity of the results because the overdosed guinea pigs (sometimes they are on different trials at once, and they enroll continuously in different trials) might not accurately reflect a normal population.  Yet, the cut-throat nature of the drug producing process makes the existence of this subculture of test-subjects indispensible.

“Ghostwriters” refer to hired guns of pharmaceutical companies who would write scientific papers that will be published under the names of other famous researchers or doctors.  Thus, the companies get a credible promotion of their products, and the academics get paid as well as new publications to boost their curriculum vitae, a veritable win-win situation.   In a similar way, the pharmaceutical industry often grooms certain “thought leaders”—academics or physicians with reputation—to become covert spokesperson of their products.  This is done because physicians tend to trust and listen to other physicians, especially those with a certain expertise and fame.  Elliot described cases of thought leaders who receive payback for their services that runs into 6 or 7 digits!  The problem of this is evident, since it is a form of advertisement paid by the industry that corrupts scientific objectivity and provides biased information to the medical readers.

Drug companies are also known to entice doctors and medical students with gifts, free lunches, favors, sample medications to influence their prescribing patterns.  The chapter of “detail man” or drug reps is just a manifestation of the fact that most drug companies spend four times more money in their budget on marketing than on research and development.

Finally, medical ethicists and bioethicists are also being singled out on their collusion with the industry, at times unknowingly.  The author describes how they are sometimes hired or manipulated into testifying on behalf of the pharmaceutical companies, which in effect gave a rubber stamp of ethical approval before the skeptical public, or are used for damage control when scandals break.  Many bioethicists sit on the advisory boards of pharmaceutical companies, and the author is concerned that they are not critical enough because it is hard to bite the hands that feed you.  As a result, this conflict of interest gives bioethics a bad name.

Even though the book is highly readable and even entertaining, the evidence the author demonstrated is mostly anecdotal and must be taken with a grain of salt.  Nonetheless, it is a noteworthy effort to increase awareness in a popular way about the intricate relationships within the healthcare provision chain, which is becoming more and more commercialized as diseases become potentials for profit-making and as patients are viewed upon as customers.