By New Yorker and Atlantic writer Carl Elliott, a readable and even funny account of the serious business of medicine. A tongue-in-cheek account of the changes that have transformed medicine into big business. Physician and medical ethicist Carl Elliott tracks the new world of commercialized medicine from start to finish, introducing the professional guinea pigs, ghostwriters, thought leaders, drug reps, public relations pros, and even medical ethicists who use medicine for (sometimes huge) financial gain. Along the way, he uncovers the cost to patients lost in a health-care universe centered around consumerism. "Elliott grips the reader's attention all the way." — Scientific American "Dr. Elliott's entertaining and extremely readable essays will have you convinced that in comparison to the shenanigans that go into the creation of a single prescription pill, fingerprint erasure might actually be a little dull." —Abigail Zuger, MD, New York Times “If you think your doctors prescribe medications for you on the basis of their unbiased judgment and objective medical research, this book will disabuse you of that old-fashioned fantasy. In his superb exposé, Carl Elliott shows how the big drug companies have bribed and corrupted the medical establishment so that we no longer know which drugs are effective or why our doctors prescribe them.” —Marcia Angell, author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It “Beneath the white coats and sterile labs of the great American heath care system, Carl Elliott finds a drug-addled, gang-run, con game—sometimes bizarre, often hilarious. The noble arc that runs from Hippocrates to Sherwin Nuland washes out in a ‘business model’ apparently inspired by Timothy Leary, John Gotti, and that infomercial pitch guy for ShamWow.” —Jack Hitt, contributing editor for This American Life and author of Off the Road "Enjoyable to read and laced with sardonic wit, this is an eye-opening work that all consumers of health care should read." — Library Journal “Carl Elliott has written a deep, daring, and sometimes very funny book about aspects of medicine you’ve never seen, and probably never will unless you take the time to crack this cover. You’ll discover what it means when healers forget—or maybe never grasped—their main mission and pollute not only medicine but all those within its circle. Elliott’s book describes the conundrum of modern medical practice wittily, incisively, and beautifully. This book should be required reading for anyone who has ever been a patient—in other words, for everyone.” —Lauren Slater, author of Opening Skinner's Box  and Prozac Diary Carl Elliott is a professor at the Center for Bioethics at the University of Minnesota. His work has appeared in The New Yorker, Atlantic Monthly, the Believer, Slate, the London Review of Books, and the American Prospect. His six previous books include B etter Than Well, Prozac As a Way of Life, Rules of Insanity, and A Philosophical Disease.  Chapter One The Guinea Pigs   On September 11, 2001, James Rockwell was camped out in a clinical-research unit on the eleventh floor of a Philadelphia hospital where he had enrolled as a subject in a high-paying drug study. As a rule, studies that involve invasive medical procedures are more lucrative—the more uncomfortable, the better the pay—and in this study, subjects had a fiber-optic tube inserted in their mouths and down their esophaguses so that researchers could examine their gastrointestinal tracts.   Rockwell had enrolled in many previous studies at corporate sites, places like Wyeth and GlaxoSmithKline. But the atmosphere there felt professional, bureaucratic, and cold. This unit was in a university hospital, not a corporate lab, and the staff had a casual attitude toward regulations and procedures. “The Animal House of research units” is what Rockwell calls it. “I’m standing in the hallway juggling,” he says. “I’m up at five in the morning watching movies.” Although study guidelines called for stringent dietary restrictions, the subjects got so hungry that one of them picked the lock on the food closet. “We got giant boxes of cookies and ran into the lounge and put them in the couch,” Rockwell says. “This one guy was putting them in the ceiling tiles.” Rockwell has little confidence in the data that the study produced. “The most integral part of the study was the diet restriction,” he says, “and we were just gorging ourselves at two a.m. on Cheez Doodles.”   On the morning of September 11, nearly a month into the five-week study, the subjects gathered around a television and watched the news of the terrorist attacks through a drug-induced haze. “We were all high on Versed after getting endoscopies,” Rockwell says. He and the other subjects began to wonder if they should go home. But a mass departure would have ruined the study. “The doctors were like ‘No, no!’ ” Rockwell recalls. “‘No one’s going