By Elizabeth Svoboda, author of “What Makes a Hero?: The Surprising Science of Self-Sacrifice.” Originally published in Undark.
Carl Elliott is, by his own estimation, an absurdist wonder. When the University of Minnesota bioethicist was a medical student, he was ordered to perform a bone marrow biopsy. Afraid to ask for help, he faked a procedure he had never tried, leaving his patient moaning in pain. And when he saw the resident dose of a benzo-groggy patient with IV naloxone, a futile and potentially dangerous bid to wake him up, Elliott shut his mouth. “Did I know this was wrong? Yes,” Elliott wrote. “Did I object? No I did not.”
It’s a controversial way to present a book-length study of spoilers, a group Elliott himself belongs to. But the self-deprecating tone also feels appropriate. The central theme of “Human Devotion Through the Times: Medical Experiments and the Price of No” — equal parts investigative report, history, and memoir — is that those who expose medical malpractice are hardly heroes, at least not in the liberating Hollywood sense. Unlike Bennet Omalu or Erin Brockovich, who became famous for highlighting corruption and bringing about change and whose stories eventually reached the big screen, most science journalists stay under the radar, their efforts rarely bring justice to the victims. By speaking out, they may give up their career opportunities, bringing with them the sad question: Was it all really worth it?
Like journalist Tom Mueller’s “The Problem of Conscience: Whistleblowing in an Age of Fraud,” which includes case studies on whistleblowing in general, Elliott’s book unfolds as a series of character profiles. He is interviewing an ace lineup of opponents, from Peter Buxtun, who exposed the US government’s Tuskegee syphilis study where Black men with the disease were not treated, to John Pesando, who raised warnings about a bone marrow transplant protocol that killed cancer patients. Elliott analyzes the behavior of his subjects through change and nutrition, describing the internal breakdown that occurs when whistleblowers, frustrated by the disagreements of those in charge, grow cynical and abusive. Speaking of Buxtun, Elliott comments, “He has the air of a man who fears a world full of bullies and bullies.
Sadly, that defensive attitude may turn away even more people, especially those who question the crusader’s underlying motives. “When you’re on the outside,” Elliott writes, “it’s hard to know whether a would-be whistleblower is a conscientious objector or a misguided conspirator.”
Elliott’s membership in the club of disaffected publishers lends itself to such statements. More than 15 years ago, he read an article in the newspaper St. Paul Pioneer Press about the illegal tactics Minnesota member Stephen Olson used to recruit and retain subjects in a study of the antipsychotic drug Seroquel. One of the participants – 26-year-old Dan Markingson, who had signed a consent form when he was mentally ill – died by suicide after a few months on Seroquel. Although Markingson’s mental state had deteriorated since starting the drug, his mother Mary Weiss’ pleas to release him from the study were not ignored.
Surprised by Markingson’s fate and concerned about other studies, Elliott took action. He wrote a humorous article about the Seroquel study in Mother Jones magazine. He filed complaints with the university and tried to find ways to have the research reviewed externally.
But like his interlocutors, Elliott was often overlooked and discredited. He saw firsthand what happens when moral motivation conflicts with what is best for society: protecting institutional power. When Elliott cited the compromised Seroquel study in a university speech, “the question-and-answer period felt like what sociologists call a ‘degradation ceremony,'” he writes, as the Minnesota faculty was outraged that it was the one who brought the case. “I remember fighting the urge to go back to my office, crawl under my desk, and open a bottle of Jack Daniels. It was 9am”
It was a tragic end for Mary Weiss, who filed a lawsuit alleging negligence at the University of Minnesota in the Seroquel study after her son’s death. Weiss’ case was established when a judge declared the university “not guilty,” and the university, adding insult to injury, slapped Weiss with a bill for more than $56,000 to cover its legal fees. Weiss then suffered a stroke and years later died after her live-in caregiver took money from her bank accounts, Elliott wrote. No funeral was held.
What drives medical whistleblowers to risk stigmatization when so many others remain silent? Elliott’s answers are complex and contradictory, perhaps on purpose. On the other hand, he notes a pragmatic case for intervention. He writes: “The act of whistle-blowing is based on the belief that exposing moral outrage will be enough to prompt others to respond.”
His interviewees’ stories and his own, however, show that the callers’ primary motivations are very good. They do not act because they expect certain results, but because of an internal compulsion; that is, the feeling that if they did not speak, they would no longer be able to bear their presence. “How can you stand by and let these things happen?” a study coordinator with the pseudonym Sasha told Elliott after reporting to the investigator who compiled the study data. “He’s going to bed at night. You look at yourself in the mirror. I don’t understand.”
Still, Elliott is reluctant to put whistleblowers on the moral trail. Like social psychologist Philip Zimbardo, who argues that heroes are ordinary people in many ways, Elliott insists that whistleblowers are human and fallible just like everyone else — and that some, like him, have historically sided with bad managers. “Like Stanley Milgram’s listening test subjects, I did as I was told,” he writes, reflecting on his time as a young doctor. “The opportunity to object never occurred to me.”
Yet Elliott leaves an interesting question that has not been explored much: how does a person who cannot think of opposition become someone who does not consider opposition not only possible, but necessary.
Recent studies suggest that cumulative effects of regret play a role, as they may have for Elliott. In a 2022 study, would-be whistleblowers were encouraged to anticipate the regret they would feel if they did not say something. Some research has found that reassurances of social support — workplace managers setting a moral tone, for example — encourage those who see wrongdoing to blow the whistle.
Although Elliott did not delve too deeply into possible ways to make whistleblowing less difficult, his experience may have steered him away from such an idealized framework. Even though an external review of the University of Minnesota’s research oversight program reported serious flaws, no one at the university has yet admitted wrongdoing in the Seroquel research studies. “It can be difficult for perpetrators to justify actions that cost them so much and accomplish so little,” Elliott wrote. “They need a story where their sacrifice makes sense.”
Although Elliott hates Hollywood stories, part of what elevates his book is his efforts to create such a meaningful story. In bringing the actions of unknown criminals to the fore, he bends their narratives, however subtly, to direct justice. Years after speaking out, Peter Buxtun, John Pesando, and Mary Weiss – and even Carl Elliott – are still going strong.
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