Dear reader, I have become sort of obsessed with Carl Elliott’s new book. In it, he writes of his own experiences as a medical whistleblower about perceived research misconduct at the University of Minnesota. That part of the book is deeply personal and describes in heart wrenching detail the price he paid for trying to help Mary Weiss, a mother whose son committed suicide while in a research study. Elliott recounts in detail how his whistleblowing led to ostracization. “There were ominous threats, bitter arguments, formal complaints about my behavior.” He developed “paranoia and self-pity, volatile moods, dismissive attitudes toward colleagues.” Searching for metaphors, he describes whistleblowers as “radioactive” or as stigmatized and shunned like people with Ebola. Friends and colleagues abandoned him. He went to “a dark place” from which he wasn’t sure that he would ever emerge.
He became fascinated with the ethical ambiguities of whistleblowing and set out to meet and analyze others who had chosen a similar path. In 2016, he was awarded a Guggenheim to “look at research scandals exposed by whistleblowers in four different countries in order to explore the institutional forces that discourage conscientious dissenters from speaking out.” In 2019, he continued this work at the Kluge Center of the Library of Congress. His book recounts discussions with a number of medical whistleblowers around the world and detailed discussions of six specific scandals. He shows how his experience was similar to that of other whistle blowers who suffered from depression, ostracization, and job loss. “Many whistleblowers lose everything. Their careers end in ruins. They are forced into bankruptcy. Their spouses abandon them. They descend into a swirling eddy of rancor and self-loathing.” At the same time, the miscreants upon whom they blow the whistle often thrive. They win awards. They have monuments erected in their honor. They make money.
This is not a book that someone should read for encouragement if they are thinking about whistleblowing. That said, Elliott says that he wrote it in order to “help others undergoing similar struggles.” So, it may be useful as a sort of informed consent for whistleblowers, describing in detail the risks and benefits of the endeavor they are undertaking.
The benefits of whistleblowing are unclear. There is seldom a clear victory or a clear defeat. Bad people are seldom punished. Good people are seldom rewarded. Occasionally, there is an apology, as with President Clinton’s apology to the victims of the Tuskegee Syphilis Studies. Sometimes, victims win lawsuits. One particularly fraudulent researcher was sent to prison.
Elliott’s own whistleblowing led to some good things. He was able to get his story out in the media, he found allies both within his university and around the world, he convinced the Minnesota legislature to investigate, and some of the most ethically questionable characters stepped down from their leadership roles. But he did not get an apology or any compensation for the alleged victims on whose behalf he was blowing the whistle. In the end, he, like many whistleblowers, was left disillusioned, exhausted, and unsure if his efforts have led to any real change.
How depressed should we be by the events that Elliott describes? One caveat about the book is that Elliott is writing as an investigative journalist. He is a good journalist. He has taught a course on “Investigative Journalism and Bioethics” and views journalists as the heroes of many whistleblowing stories. But he doesn’t trust journalists, and quotes Janet Malcolm who noted that journalists are con-men, “preying on people's vanity, ignorance or loneliness, gaining their trust and betraying them without remorse.” She thinks the work of all journalists is “morally indefensible.” Elliott is so aware of these criticisms that he begins the book by making the case for why we should trust him. He did not, he claims, want to be a whistle-blower. Like many of the other whistleblowers whose stories he tells, he could not have done other than he did. It did not feel like a choice. Instead, it felt like an obligation. But he also clearly admires whistleblowers and believes that "the act of whistleblowing rests on the faith that exposing a moral outrage will be sufficient to move others to respond." But his experiences teach him that "exposure is rarely enough."
Because Elliott’s book is so far reaching, so searching in its inquiries, so even-handed, and so ambiguous in its conclusions, I haven't been able to summarize the central message or distill my responses down to a single blog post. So I’ll be doing a few posts over the next few weeks, looking at various issues raised by the book, including questions about whether research necessarily involves "the occasional human sacrifice" and about Elliott's claims that our system of protections for research subjects has largely failed.