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Book and Media Reviews
December 28, 2011

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

Author Affiliations

Author Affiliation: Division of Medical Ethics, New York Weill Cornell Medical Center, New York, New York (jjfins@med.cornell.edu).

JAMA. 2011;306(24):2733-2734. doi:10.1001/jama.2011.1878

Carl Elliott, a physician, philosopher, and professor at the Center for Bioethics at the University of Minnesota, has written a compelling critique of the medical-industrial complex, first described by Arnold Relman. Elliott carries on this tradition in White Coat, Black Hat: Adventures on the Dark Side of Medicine with a writing style that is one part academic and one part journalistic, with arguments that are both cogent and colorful.

Elliott's tone is reminiscent of that of Christopher Hitchens, another fine writer with whom one might not always agree but whose prose is always memorable and leaves a deep impression, often challenging received wisdom. In this book, Elliott presents a withering analysis of how market forces have deprofessionalized medicine and turned the enterprise into a business. From the recruitment of paid research participants to ghost-written papers, co-optation of academic opinion leaders, and direct-to-consumer advertising of drugs, Elliott tells an alarming tale that shows how many of the impartial “norms of science” have been corrupted. He is willing to take on everyone—including the University of Minnesota in connection with the suicide of a participant in a psychiatric drug trial as well as persons working in his primary field of bioethics—often bringing psychological insight into how good people end up participating in activities that they might later regret and publicly repudiate.

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