Bioethicist Carl Elliott seems to relish stirring up fellow bioethicists and the medical profession. In his latest book, The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No, he examines the role of whistleblowers in uncovering medical scandals. 

He knows from experience. He fought for years to get his own institution, the University of Minnesota, to acknowledge its role in the suicide of a man in an industry-funded clinical trial of antipsychotic drugs. 

The New York Times recently published a brief excerpt from his book in which he asks why doctors end up participating in atrocities like the Tuskegee syphilis trials or the Willowbrook hepatitis study. Elliott is scathing. He says that students and doctors can be socialised into accepting morally indefensible situations. Courageous whistleblowers are essential to shatter the bubble of self-assured expertise. 

Medical traditions are notoriously difficult to uproot, and academic medicine does not easily tolerate ethical dissent. I doubt the medical profession can be trusted to reform itself … 

To embark on a career in medicine is like moving to a foreign country where you do not understand the customs, rituals, manners or language. Your main concern on arrival is how to fit in and avoid causing offense. This is true even if the local customs seem backward or cruel. What’s more, this particular country has an authoritarian government and a rigid status hierarchy where dissent is not just discouraged but also punished. Living happily in this country requires convincing yourself that whatever discomfort you feel comes from your own ignorance and lack of experience. Over time, you learn how to assimilate. You may even come to laugh at how naïve you were when you first arrived … 

One of the great mysteries of human behavior is how institutions create social worlds where unthinkable practices come to seem normal. This is as true of academic medical centers as it is of prisons and military units. When we are told about a horrific medical research scandal, we assume that we would see it just as the whistle-blower Peter Buxtun saw the Tuskegee syphilis study: an abuse so shocking that only a sociopath could fail to perceive it.

Yet it rarely happens this way. It took Mr. Buxtun seven years to convince others to see the abuses for what they were. It has taken other whistle-blowers even longer. Even when the outside world condemns a practice, medical institutions typically insist that the outsiders don’t really understand.