White Coat, Black Hat

There is a review of Carl Elliott’s ‘White Coat, Black Hat’ in JAMA. The reviewer comments:

Some of these people, who have worked for the pharmaceutical industry, have been interviewed extensively by Elliott. Their insider accounts make this book especially interesting. One former drug representative told Elliott that “pharmacists are like pigeons. Only instead of bread crumbs, you toss them pizzas and sticky notes.” The trick with physicians, according to Elliott, is to “give doctors gifts without making them feel that they are being bought”—to offer, as one former drug representative told him, “bribes that aren’t considered bribes.” Using these sources, Elliott paints a most disturbing story of how sales tactics have changed since “detail men” visited his father’s South Carolina general practice when he was a child. He describes how these detail men of old have become the drug representatives of today: often, they are “young, well groomed, and strikingly good-looking.” Despite the protestations of physicians, he convincingly shows how their little gifts and occasional meals alter prescribing habits. Elliott also depicts how these methods have evolved over time, moving from gifts and golf outings to systematic “script-tracking” that allows the pharmaceutical house to track prescriptions using large databases and to compensate and provide incentives for representatives based on solid data.

It really is an excellent book. The reviewer in JAMA seems to wish for a little more ‘shades of grey’ in terms of how to work with pharma but I wouldn’t fault the book on this score. I think it is a very measured critique of a lot of modern medicine, and the relation between medicine, the universities and the drug business.

Post by Jonathan Rees

Clinical academic and skin watcher at the University of Edinburgh

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