In 2009 I attended the annual meeting of the American Society for Bioethics and Humanities. The keynote speaker was Carl Elliott. I knew he was a Professor at the Center for Bioethics at the University of Minnesota and I knew he wrote for The New Yorker. I had assigned his piece on the lives of human research participants, Guinea-Pigging, to both my science writing and genomics-in-society classes. But none of that prepared me for his speech, which was eloquent, thoughtful, accusatory, profane, and above all, funny as hell. In 25 years of academic conferences, I can’t recall hearing another talk that made me laugh until I cried.
There were hilarious vignettes from Elliott’s South Carolina childhood and jabs at “bioethicists for hire” (including many in the audience–at times it was almost as though the National Cattlemen’s Beef Association had invited a strident and acerbic member of PETA to deliver its keynote). But in between was a question: why weren’t more of us doing what he was doing? Why weren’t we investigating egregious, troubling or even benign-but-fascinating practices in medicine? Why weren’t we trying to reach bigger audiences to call attention to acute issues in bioethics? Why weren’t we, you know, talking to people?
I suspect that the answer is because most of us are neither professionally nor intestinally equipped to do it with the pointed grace and art of Carl Elliott, as evidenced by his recent book, White Coat, Black Hat: Adventures on the Dark Side of Medicine. Part I of our email conversation after the jump.
Bioethicists have written op-eds for a long time. But you went further and began to write long-form narrative nonfiction about corrupt and/or disturbing practices in the pharmaceutical industry (and the “medico-industrial complex”). What led you there? Was it an epiphany or a gradual thing?
Carl Elliott: Well, it wasn’t an epiphany. It was probably closer to a slow, simmering anger, at least where the medical-industrial complex is concerned. (That, combined with a sense of shame at being a part of it.) The move to narrative nonfiction was sort of an accident. I just started trying to write more like the writers I admired, and at some point, people started telling me I was doing journalism. Which suits me fine. The occupational hazard of professional philosophy is the suspicion that you are wasting your life.
Who were/are the writers you admired?
CE: That would be a long list, even if you limit it to narrative nonfiction. David Foster Wallace, Jack Hitt and Michael Lewis would all probably be close to the top. Also, Hunter S. Thompson in small doses. The guy had a genius for insults and invective. Right now I am reading a collection of the best nonfiction I have read in a very long time — Pulphead, by John Jeremiah Sullivan.
Has writing in a more literary and accessible style changed your approach to scholarship? Does a publication in The New Yorker “count” as much as one in AJOB in the eyes of your peers? More? Does it matter?
CE: Well, writing for magazines with serious fact-checking departments has definitely changed my approach. I don’t think most academics understand how rigorous and obsessive this fact-checking is. It can be painful and humbling. It’s way easier to get inaccuracies and mistakes into a peer-reviewed journal than it is into The Atlantic or The New Yorker.
As for what counts: I’ve never given much thought to it, actually.
Longtime New Yorker writer Janet Malcolm famously wrote, “Every journalist who is not too stupid or too full of himself to notice what is going on knows that what he does is morally indefensible…[A journalist] is a kind of confidence man, preying on people’s vanity, ignorance or loneliness, gaining their trust and betraying them without remorse.” Can an investigative journalist defy this fate and if so, how? And is it more difficult for someone whose business card says “ethicist?”
CE: You’re calling me an ethicist? Man, that hurts.
There’s a lot of truth in what Malcolm says. Personally, I have often found the investigative stories the least troubling of those I have written, because often there is a clear villain. When a powerful doctor has lied, cheated, bullied and exploited vulnerable patients and gotten away with it — bringing those stories to light seems like the right thing to do. The troubling areas are in the grey zones, where honesty seems to require you to reveal unflattering things about people whom you genuinely like.
You call out bioethicists for explicit/implicit conflicts of interest, out and out corruption, shoddy scholarship, hypocrisy, and what I guess I would call institutional arrogance and narcissism. Are bioethicists doomed to fall prey to the sins you cite?
CE: I’m not sure I’d say bioethicists are doomed. A lot of them seem to be doing just fine, as long as they keep their blinkers on. Most bioethicists are professionally, personally and financially dependent on the medical-industrial complex — which is, let’s face it, unjust and corrupt. So bioethicists have to close their eyes to a lot of wrongdoing if they expect to survive. Either that or pretend that they are working behind the scenes to make things better from the inside. That requires a lot of self-deception.
Wittgenstein used to discourage his students from going into philosophy; he said it was it was hard to be both a professional philosopher and a decent human being. It’s not that different in bioethics.
Obviously you are not making ad hominem attacks against bioethicists, but neither are you shying away from criticizing their behavior or their stances. What’s it like for you at ASBH meetings? Have any of your targets ever said, “Gee, Carl, you’re right. I shouldn’t have taken that money from Pfizer” or “I’ve come to realize that commercial IRBs are problematic?” Do they get defensive? Do you think you’re seen as a pariah by the bioethics community (if such a thing exists)? Or a useful antiseptic–like a shot of conscience?
Naming names makes me uncomfortable, to be honest. But I’m also ashamed to be associated with a field that has elevated working for powerful, corrupt corporations into a mark of professional status. So speaking out is a way of distancing myself.
Still, I’m often surprised by how many people in bioethics agree with me and tell me so, in private. I just wish that some of them would speak out publicly. But how can you really blame them, when that would mean alienating some of the most powerful people in the field? Maybe they see me as a kind of useful stooge who is dumb enough to say the rude and unpleasant things that nobody else wants to say.