With an unassuming, thoughtful manner, Carl Elliott hardly looks like a rabble-rouser.
But the University of Minnesota bioethics professor is an outspoken critic of the pervasive relationships between pharmaceutical companies and doctors, academics and students. It's a deeply entrenched alliance he documents in his new book, "White Coat, Black Hat, Adventures on the Dark Side of Medicine" (Beacon Press).
Each chapter is devoted to a different constituency in what Elliott sees as a broad-based and highly effective con job perpetuated by Big Pharma to influence drug-prescribing patterns. These include professional "guinea pigs" -- wily patients who enroll in clinical studies for cash -- ghostwriters who anonymously pen positive articles about drugs using someone else's name and other ethically challenged players. Big money is involved at every turn.
A native South Carolinian who retains a slight drawl from his home state, Elliott is a non-practicing physician with a doctorate in philosophy. Beyond penning four books, he's contributed articles to national publications including the New Yorker, the Atlantic and Mother Jones.
Elliott is not afraid to criticize his own employer and colleagues. Recently, he and seven others in the U's Bioethics Department sent a letter to the Board of Regents calling for an investigation into the death of Dan Markingson, a schizophrenic who committed suicide while enrolled in a drug study at the university.
The letter questions whether Markingson was fit to consent to research, and whether financial incentives from drugmaker AstraZeneca, which funded the study, presented a conflict of interest for the researchers.
QHow did you get interested in the relationship between business and medicine?
AI have a medical degree, my brother's a doctor, my father's a doctor, I grew up around drug reps and pharmaceutical stuff. I never liked it, but I wasn't terribly concerned. What got me interested was finding out that bioethicists were working as consultants for pharmaceutical companies. How can ethicists justify this? On the one hand they're saying it's a conflict of interest for doctors to take money from the pharmaceutical industry, but it's fine for me.
QWhat should I do if I discover my doctor is paid by a drug company?
AIf it were me, I'd get another doctor. But obviously, there are limitations on insurance plans, it's a pain to change [doctors] and often you're limited in whom you can pick.
QYou're pretty unsparing about some colleagues at the U, what's the response been?
AIt depends on which side of Washington Avenue you're from. On the side where the humanities and social sciences and basic sciences are based, a lot of support. In the medical school? Not so enthusiastic.
QDid anything surprise you while researching the book?
AA lot of things -- extraordinarily ingenious scams that I had no clue about. There's a story about a drug rep, Gene Carbona, who managed to make an enormous amount of money by increasing prescriptions for [gastric drug] Prilosec. He brought in a financial consultant for a large [physicians'] group practice free of charge. They all thought he was such a great guy for doing that and wrote prescriptions for Prilosec like crazy. That was so successful, they took the scheme on the road.
QIs the medical device industry different?
AI don't know enough to say.
QWhat do you think about U's new conflict-of-interest policy overseeing relationships between business and academia?
AIt's an improvement, but still not very good. Look at the Dan Markingson scandal -- the kinds of relationships in place there, all of those would still be allowed -- [payments for doctors] on [drug company] speakers' bureaus, the consulting fees and the financial incentives for enrolling and keeping patients in clinical trials.
QHas anything changed at the U after these revelations?
AWe've had one scandal after another [involving payments to U doctors by drug and device companies]. It's depressing; nothing really has happened. At other institutions, a panel is usually appointed to look into something. Here, the PR response is, "We don't think we've done anything wrong." I have some hope things will change with the new president coming in [at the U]. But, who knows?
Janet Moore • 612-673-7752