WHITE COAT BLACK HAT

Elliott (Bioethics/Univ. of Minnesota; Better than Well: American Medicine Meets the American Dream, 2003, etc) examines the part played by the pharmaceutical industry in constructing “a medical system in which deception is often not just tolerated but rewarded.”

While some abuses—including the use of subjects to test drugs without informed consent—are not new, these practices continue despite the existence of regulatory institutional-review boards set up by Congress, because these too have now become profit centers. Elliott writes that pharmaceutical companies hire PR specialists who not only supply educational materials to promote products, they also train medical professionals to be “opinion leaders” and even write papers in their name. In 1998, the Journal of the American Medical Association “found evidence of ghost authorship in 11 percent of articles published in six major American medical journals.” In the late-’90s, articles touting the benefits of the weight-loss drug Fen-Phen—later taken off the market because of potentially fatal side effects—were a key piece in a “complex multimillion-dollar public relations strategy” that minimized worries about the safety of the drug. Market-research firms, writes the author, profile doctors as a preliminary to major sales campaigns offering them tickets to sports events and inviting them on junkets in order to persuade them to become advocates for new drugs. Further, medical professionals are offered research grants and paid large honorariums for speaking engagements and other events. Disguised marketing is even more insidious—e.g., treating menopause as a disease that transforms a woman into a “dull-minded but sharp-tongued caricature of her former self” in order to promote estrogen-replacement therapy.

The author provides little information that informed readers don’t already know, but the gripping anecdotal evidence has important societal implications.