White Coat, Black Hat Adventures on the Dark Side of Medicine

The Ethicator Interview: Michael Palmieri and Donal Mosher

Posted by B Elliott

Michael Palmieri and Donal Mosher's new film, Off Label, premieres at the Tribeca Film Festival on April 19, then plays at HotDocs in Toronto the last weekend of April. We spoke by email.

E: Congratulations on scoring an interview with the Ethicator. Please state your name, your occupation, and the product you are trying to sell us.

MP/DM: We are documentary filmmakers, we made a film called "Off Label", a new film premiering at the Tribeca Film Festival on April 19th in their competition program. So I guess this is the "product we are selling".

The film examines life on the margins of the medicalized landscape of America. Human guinea pigs, army medics with PTSD, an anarchist labor organizer on Adderall, a drug detail man turned medical anthropologist studying the effects of Paxil on chimps at the Milwaukee zoo, train-hopping newlyweds on a litany of test medications, and a woman who lives in the back of a Bigfoot museum on 20 separate meds for bipolar schizophrenia are some of the subjects covered in the film. So I guess at the very least, Bigfoot is in it.

E: Doctors and drugs and bad guys.  I get it. Now, does my name appear in the credits?

MP/DM: No, it doesn't. Actually, we took a closer look at your website and it seems that you actually know Carl, but I get the feeling you don't like him very much. Did you know we were heavily inspired by his work in the making of this film? Is that a problem?

E: "His" work?  That's what he told you?  Nothing to do with me? Actually, no, it's not a problem.  I've moved on. 

So, just for the sake of argument, what part of "Carl's" work was it that supposedly inspired you?  Was it "his" philosophical ideas?  Or was it his more recently acquired, nearly sociopathic resentment of the pharmaceutical industry and anyone who works for a living?  Or could it have been his knack for stealing other people's ideas and making money off them? Does plagiarism inspire you?

MP/DM:  I hardly consider Carl's work "plagiarism", nor our interest in expanding upon the subject in his article through a documentary film, but given your tone, it seems like anything's game. "Better Than Well" was a huge inspiration on the film, as well as "White Coat, Black Hat", the book you're promoting on your site that you seem to love so much. But Carl's article in the New Yorker, "Guinea-Pigging" was a sort of launching-off point for us and began us down a long and winding path examining medicine on the margins. A character in the film, Robert Helms, is actually in that article.

Say, I notice you designed the whitecoatblackhat.com web page in the Vegur font, one of those go-to fonts everyone seems to be using these days. Did you know it's a blatant ripoff of the Myriad font? And lemme guess, you're probably using the Word-Press template for the site. How… original.

E: Oh, right, that's it! I forgot to invent a new font for the website!  Hey, I bet that's why Carl hates me. It's because I've been sticking with standard-issue fonts. That must be such a drag for him after paying -- how much for his website again? -- oh, yeah. NOTHING.  Whatever.

But enough about me. I notice the two of you collaborated on this Bigfoot movie of yours, and that you've also done a couple of projects together in the past.  Yet interestingly, I'm only hearing from one of you (Michael). My question is: Does either one of you ever feel the urge to hog all the glory, or maybe steal the other person's ideas? For example, have you ever collaborated with one another via email for months on end, only to see the other person run off with a script, make a pile of money and give you no credit? Then, maybe coming back later, saying something like, "hey, buddy, how about taking a volunteer job as key grip? It doesn't pay shit, but it could be your big chance!" Anything like that?

MP/DM: "We" collaborate together on all of our documentary work, it started with "October Country", a doc that came out in 2009 that also features witches, ghosts and gun factories, in addition to the social ills that plague the working poor in Central New York. Sadly Bigfoot didn't make it into that film, he ended up on the cutting room floor after a long argument about the direction of the content of that film. But "we" enjoy working with one another because we come at things from different perspectives, often fighting for weeks on end over an edit only to find out the compromise we reach is almost always better than our individual take on things. Donal's background was as photographer and writer first and foremost, and I've been a filmmaker and spotlight-craving whore my whole life, so that's probably why I chose to write back to you first. Just think of me as the documentary version of Sally Field accepting her Academy Award in this clip at the 3:20 mark.  Donal cares less for these non-productive interviews, he has busy photo career, sort of like Faye Dunaway in The Eyes of Laura Mars.

But just because our responses are coming from my email address doesn't mean we aren't both poring over your questions/attacks at length. Suffice it to say Donal finds your tone really acerbic, and he seriously questions your intentions at all in interviewing us. He did notice that you ducked our inquiry on the all-too-overused word-press template design for whitecoatblackhat.com. Don't think WE aren't both waiting to hear back about that.

E: We're back to that WordPress template again? OK, once more, with feeling: I don't get paid for this shit. Sometimes, those of us in the creative professions are asked to create something out of nothing. Some people buckle under the challenge, but the more visionary types will take ordinary, freely available materials from our everyday life and impart new meaning to them. To wit: My brother bullies me into setting up a promotional website for a budget of jack shit. I then take an ordinary, colorless WordPress theme and transform it into a viral sensation, the bioethics world's most successful blog. That's what other people call resourcefulness. Innovation. Thinking outside the box. Not that I really expect you to understand my process, but let's just say I can't just cut to a car chase or throw in some fancy CGI whenever things get boring.

Now, if YOU're done interviewing ME: I think my readers will want to know about your Bigfoot movie.  Why Bigfoot, and why now? Are you doing voiceover narration like Leonard Nimoy , or acting it out like Andre the Giant did? And why the medication angle? Was it Carl's idea to medicate Bigfoot? Because it doesn't sound ethical to me.

MP/DM: Car chases? Fancy CGI? We make documentaries on shoestring budgets, so we also have to be resourceful in our creative strategies. In fact, we have a Bigfoot re-enactment in this film but we couldn't get Andre the Giant to play Bigfoot, so we did it from Bigfoot's POV instead. No one can replace Andre, and Bigfoot deserved the best to bear his likeness, so we came up with that solution. Ultimately our credibility as filmmakers rests on the effectiveness of such re-enactments so we had to tread carefully down that road. But it is really insightful that you mentioned the Andre the Giant clip from the Six Million Dollar Man. The subtle use of slow-motion and sound effects was way before its time. These kinds of artistic strategies are instrumental for us in our work to draw an audience in with the limited material we gather in the field. See, Ethicator, it seems like we have more in common than I actually thought. We're both resourceful. I can't ask Donal whether he likes this Steve Austin reference or not because he's off photographing the working class for a hard-hitting story about those who can't afford designer jeans, but he said he'd be back in a few minutes.

As for the medication angle, the whole film was actually proposed to us by our producers, Anish Savjani and Vincent Savino of filmscience. (filmscience.com)  They became interested in a story about human guinea pigs by Josh McHugh in Wired Magazine called "Drug Test Cowboys", as well as the article that Carl wrote for the New Yorker. We ended up reaching out to Carl and he kindly met up with us in Minneapolis. We kind of hit it off instantly, and spent numerous hours at The Bad Waitress discussing the possibilities of shaping a different kind of film about health care where everyone is implicated - not just the drug companies, but drug sales agents, doctors, and especially patients. The problem of overmedication is systemic; we don't aim to say all that drugs are bad, because we need medicine, but there are certain aspects of the drug industry that are dubious, where ideas and actions collide in complex and associative ways that a consumer may not necessarily be aware of. We think that's worth exploring in a film. We'd even go so far as to say it's the ethical thing to do.

E: OK, I think I'm understanding now. You made a Bigfoot movie, but couldn't do any CGI or car scenes, so you just got a tall guy to walk around with a camera. Fine. But out of respect, could you at least call him a Sasquatch? Bigfoot is the racist term, and it's making me uncomfortable.

Also, like Carl, you think people take too many pharmaceuticals. Is that why you're medicating a Sasquatch instead? What kinds of drugs did you test, and did Carl design the research protocol? As an ethicist, I find that deeply troubling. I could really nail Carl over that one.

MP/DM: Wait, what? We weren't testing any drugs, and we weren't medicating Sasquatch either. We made a film about people who are implicated by the pharmaceutical industry in numerous ways. Carl didn't have anything to do with testing anything! What's your beef with this guy?

E: OK, so now you're confusing me. First you're telling me about a racist, drug-addled Sasquatch movie, and now it's just a movie about doctors and drugs and bad guys.  It all sounds hard to follow. No offense, but I think you need to work on this interviewing thing. Focus your message, is all I'm saying. Just some friendly advice.

That said, have you ever thought about making a movie about a Sasquatch on psychoactive drugs? Maybe with social anxiety meds? If you do make this movie, I would expect you to put my name in the credits like you did for Carl.

MP/DM: We'd very much like to make that film. Do you have any thoughts on how we could convince Bigfoot to try Risperdal?

E: Again, Sasquatch. Bigfoot is the racist term.

I am not sure about administration, but in my professional opinion, an anti-psychotic would likely make the Sasquatch more docile and less socially phobic.  Also, unfortunately, less skilled at karate.

Still, let's not put the cart before the horse.  There's a lot of legwork to do.  For a project like this, you'll need a media-savvy bioethics geek, somebody who can navigate the waters between Big Pharma and Big Ethics.  Just blue-sky thinking here, but I believe we'll need to fire up a mission statement, bang out some research protocols, get an IRB, the works.  As a crossover type, I think I could work that out for you, but we'll need some face time to iron out the numbers.

MP/DM: Sounds like you're gonna get a producer credit for sure.

E: Thank you. Carl can be the key grip, if he'll work for free.

The Ethicator: Do you have a conflict of interest?

Posted by B Elliott

Dear Ethicator:

I have been reading your blog, and although you seem to be an eminent bioethicist, I am troubled by your scholarship.  You seem to hold a grudge against your brother, which seems to make you oppose everything he says and attack him every chance you get.  Are you really able to do your job properly, or is there a permanent conflict of interest at work here?

Signed,
Concerned

Dear concerned,

You are committing a fatal, disabling logical fallacy by conflating two distinct and separate roles I occupy: First, my role as an internationally recognized bioethicist and viral sensation, and second, my role as a younger brother to a bigshot bioethicist asshole. The two roles are distinct. By conflating them, you show a serious failure in the most basic principles of scholarly integrity, principles which have been with us since the time of Socrates. Indeed, if you were a student of mine, I would flunk you for the semester, demand your expulsion and perhaps recommend your involuntary commitment to an institution. The burden of proof is on you, not me, to demonstrate that I am not discharging my duties according to the requirements of the field. Otherwise, through your reckless accusations and serial failure in scholarship, you tarnish the field of bioethics, which you are not free to do.  You are obligated to withdraw your comments immediately, cry “uncle”, and declare your public admiration for my work.

Sincerely,

The Ethicator

My Open Letter to the Chronicle

Posted by B Elliott

To the Editors of the Chronicle of Higher Education:

In his March 1 blog post on your web site, Carl Elliott makes a number of defamatory comments about “Internet trolls” who harass him online and are “occasionally funny.”   Although he does not mention my name, it is clear to everyone that he is referring to me.   This characterization is malicious and false.

According to Google’s accepted definition, trolls are “mythical, cave-dwelling beings depicted in folklore as either a giant or a dwarf, typically having a very ugly appearance.”  Fact: I am not a troll.  I am a real person, a conventionally handsome, middle-aged man of medium height and build – a far sight from being a troll.  I live in a house, not in a cave, or under a bridge.  That is a matter of public record, and Carl Elliott knows this.  Any attempt characterize me as a troll is demonstrably false, malicious, and by definition, defamatory.

Equally false and malicious is the characterization of me as “occasionally funny.”  Fact:  Among bioethicists today, I am widely recognized as one of the five funniest commentators on the Internet.  As such, I am more than occasionally funny. This is easily measured, and again a matter of public record -- but again, Carl has simply chosen to ignore the facts.

Finally, Carl Elliott has failed to disclose a Conflict of Interest (COI).   Fact:  For the past year and a half, I have been operating the White Coat, Black Hat website, where I routinely ridicule him for stealing my ideas, failing to pay for his website, and being a bad older brother.  I have photoshopped his picture several times, once to look like a werewolf and another time to look like Nixon.  The characterizations obviously left him embittered, vindictive, and humorless -- Certainly in no position to render judgement on my physical appearance or my sense of humor.

I expect the post to be removed by COB Sunday, March 4, or I will take the appropriate action.

Yours sincerely,

The Ethicator

PS  Carl:  You've been served, fucker.

Some doodles

Posted by B Elliott

Click to enlarge

Just some random doodles I did in my spare time. I do that kind of thing.  I hear a lot of leaders do.

The Ethicator Interview: Misha Angrist

Posted by B Elliott

Note: This is the first of what I expect to become a series of interviews with various writers and academics seeking to utilize my fame. If you are important and would like to be interviewed by the Ethicator, feel free to send me an email.

Misha Angrist interviewed Carl a couple of weeks ago. In the interview, Carl called me "disturbed" and ridiculed my groundbreaking academic writing as "hilarious." Courageously, Angrist agreed to make amends by facing me for an interview. We communicated by email.

E: Thank you for facing the Ethicator.  First question:  Please state your name, profession, and the book you are attempting to sell us.

MA: Hi, Ethicator.  My name is Misha Angrist. I am an Assistant Professor in the Duke University Institute for Genome Sciences & Policy. My book is called Here is a Human Being: At the Dawn of Personal Genomics.

E: Interesting.  And you wrote this book yourself?  I'm just asking because, you know, there are some academics out there who can be cavalier about this sort of thing (authorship), if you get my drift . . .

MA:  I'm not sure I follow you. Anyway, yes I wrote it myself, although I couldn't have done it without the generosity and talent of a lot of other people. And by the way, your brother's terrific article, " Guinea-Pigging," is mentioned in the book.

E:  You mean the New Yorker article allegedly written by my brother?  Right, I know all about that.  A lot of familiar stuff there.  Reminds me a lot of these "jobs" he kept enrolling me in at the U, back when we were living in Chicago.  ("Hyde Park rent is expensive, you know." "It won't hurt," "I'm just a post-doc, I don't make that much - Gotta pull your weight!" and so on).  Strangely, my name does not appear in the article at all.  Anyway, water under the bridge.

Your book is on genetics.  I've heard it said there is a genetic basis for cruelty and bullying behaviors,  such as those we often encounter with siblings.  Is this true, and what are your thoughts about this?

MA: Aggressive behavior in humans almost certainly has some hereditary basis, but it's not clear how important genes are in these types of traits. They are terribly hard to study and in most cases whatever genes are involved are probably interacting in ways we don't understand yet. It's a tough nut to crack. My colleagues Terrie Moffitt and Avshalom Caspi are among those who've been trying to unravel this stuff for a long time...I love them and admire their intelligence and doggedness, but I worry about them.

I should say that there's also a pretty strong evolutionary argument to be made for niceness. In any case, I think most geneticists expect most of these sorts of behaviors to be the product of the action of many genes plus a huge environmental component.

E:  Well, that's where you're wrong. I hadn't given this  matter any thought until just now, but my brother and I obviously share some genetic material.  He is an overly aggressive, bullying pharmascold with no moral compass whatsoever -- damn near a full-on psychopath, according to many in the field.  Yet, I share none of these repulsive traits.  How can that be?  So I disagree with you that it has a hereditary basis.

But OK, for the sake of argument, I'll play along. I understand you had your own personal genome mapped.  Do you carry any of those bullying genes you apparently believe in?

MA:  I don't think so. That said, my brother would say that I do, just as you do about your brother.

I can't claim to know your brother very well, but I will say that he is deeply concerned about you. He thinks you need to be on medication.

E: Yeah, I read that quote in your interview.  Yes, Carl is concerned:  Concerned that one of these days, I'm going to show up at his house with an invoice for all the work I've been doing.  He'll be all, "Oh, no! Where's Nurse Ratched?  My brother won't do shit for free!"

But enough about me. You're in the genetics game, right?   There's big money in that, I hear.  Have you found a good corporate sponsor?

MA: Not yet, though not for lack of trying. Unfortunately most of the small startups I take an interest in end up in Chapter 11. But since a WalMart VP suggested a few years ago that the company try to avoid hiring fat people in order to reduce its health care costs, I was thinking they might be able to use my services in Bentonville.

E: Wal-Mart!  That shows some pretty impressive, out-of-the-box thinking on your part.  Yet, I suspect there are some dinosaurs out there in the bioethics industrial complex who would love to ruin your plans.  Seriously, though, isn't it hard for an independent-minded visionary like you to get by without eventually giving in to pious, overweening pharmascolds?  How do you do it?

MA: Dude, you're breaking my heart. Was there something that went awry in your childhood that led you to have such contempt for your brother? Is there no way to heal this rift? I mean, the Everly Brothers got back together.  Will the Elliott brothers not share Christmas together?

E: Hey, water under the bridge.  Unlike some people, I've moved on.  When you speak hard truths to stubborn people, as I do, you just have to expect some resentments and petty jealousy to come back your way.  It's just the nature of the game. 

Speaking of bold truth-telling: Have you been following my website and twitter feed?  What do you think of it?

MA: I do look at your website. The production values are high and the graphics impressive. That said, I might argue that it's hard to read that and your twitter feed and then conclude that you've "moved on."

E:  Do I remind you of Steve Jobs?

MA:  Um...I don't know. The turtleneck and the petulance maybe?

BE:  Well, I'm just thinking of the effusive praise you had for the user interface on my website, plus the runaway viral success of my work thus far.  And of course the fact that Jobs and I are both considered renegades and trailblazers. I sometimes think of myself as the Steve Jobs of bioethics.  Not that I would put words in your mouth or anything.

MA: Well, I guess if the shoe fits, right? But I imagine that that's quite a heavy burden, no?

BE: Yes, a heavy burden indeed -- but not as heavy as Carl's burden, which is being known only as the brother of the Steve Jobs of bioethics.  I'm sure he can manage that, though.

On to your book.  What is it about -- genetics or something? I forget

MA: Yes, my book is about genetics or something. More important, it is about ME. And even more important than that, it is available in hardback, paperback, e-book and large-print-Sanskrit formats.  And it makes a swell gift for any occasion! And since it's published by HarperCollins, you can rest assured that most of the money from every copy sold will go directly into the Rupert Murdoch Defense Fund.

E: Sounds interesting.  If the library has copies on the shelf, maybe I'll look at it.  Thank you for your kind, effusive praise of my work, and congratulations on being the first interview on the most popular site in bioethics.

MA: I trust that you and Carl will bury the hatchet--it's the bioethical thing to do, after all. Thanks so much for having me on The Ethicator! It's been a dubious honor!

Building Your Brand the Ethicator Way

Posted by B Elliott

A recent article in Inside Higher Ed offers some handy advice on how to build and enhance your academic brand.   Titled "The Value of Self-Promotion", the article has generated some controversy by suggesting that new academics should cite their colleagues' work for professional gain:

You should be citing all of the senior people in your field, even if their work is tangential to your own. Citation is a way of demonstrating that you know your field and you know who the key thinkers are. It is amazing how often the same person will be asked to referee your work.

Now, I can’t say I’ve spent a lot of time advancing myself in academic circles (unlike one bootlicking, sycophantic assclown whose book you may  remember); however,  as an Internet-based bioethics expert, I'll say this sounds about right.  What's academic publishing for, anyway, if not for advancing your career?  Do it right, I say.

But there's also another side of me, the Internet marketing expert, that asks the obvious questions:  Citations? Peer-reviewed journals?   Does anybody read these anymore, let alone write for them?  Seriously, what decade is this?

Listen to me:  If you want some bang for your buck, take to the Internet. And don't just cite your colleagues; any milquetoast can make nicey-nice with the boss-man.  You need to find out who your colleagues' enemies are, then  start firing away in the online forums.  Take to the comments section of the newspapers and the online media (hell, take two or three screen names if you want, and trade insults off one another).  Rack up 2500 Facebook friends, including your senior colleagues, and start wailing away at the bad guys.   All this you can do in a third of the time it takes you to write a paper proposal, yet you will reach thousands more people and leave a permanent, lasting impression on the people you want most to impress.  It's quick, it's cheap and it's unfiltered:  That's the Ethicator way.

Got a moral issue you just can't solve?  Send your questions to the Ethicator: info@whitecoatblackhat.com