The Psychic Wounds of Being a Whistleblower
On November 14, 2003, a University of Minnesota psychiatrist named Stephen Olson advised a judge that Dan Markingson, a 26-year-old patient who believed that a secret world order was calling him to be part of a killing “storm,” was incapable of making decisions for himself and should be committed to a state treatment center. Less than a week later, Olson reversed his recommendation—a decision that allowed Markingson to take part in an antipsychotic-drug trial. If Markingson completed the trial, Olson’s employer would receive more than $15,000 from the pharmaceutical giant AstraZeneca for his participation alone. (Olson has denied that any financial incentives were involved in the decision to keep Markingson in the study.)
Over the next six months, Markingson’s mother, Mary Weiss, tried multiple times to pull her son from the trial so that he could receive other forms of treatment. In April, she left a frantic voicemail for the study’s coordinator, asking, “Do we have to wait until he kills himself or someone else before anyone does anything?”
Three weeks later, Markingson died by suicide in the bathroom of a halfway house.
The circumstances surrounding Markingson’s death didn’t receive much attention until 2008, when a series of stories about the case in St. Paul’s Pioneer Press caught the attention of Carl Elliott, a University of Minnesota bioethicist who had trained as a doctor before getting a Ph.D. in philosophy. Elliott’s self-professed obsession with holding his employer publicly accountable for its role in Markingson’s death consumed much of the next decade of Elliott’s life, and he uses his experiences to bookend The Occasional Human Sacrifice, his examination of medical-research scandals and the whistleblowers who expose them.
Elliott’s decision to foreground his own story is, at first blush, a curious one. He didn’t bring the circumstances of Markingson’s death to light or lose his job as a result of his advocacy. (In fact, his involvement with the case appears to have raised his profile, attracting admiring coverage from news outlets including The New York Times and Science, and landing him a year-long Guggenheim Fellowship and a $60,000 National Endowment for the Humanities Public Scholar grant to support the work that turned into this book.) Although the arc of Elliott’s story may not look like that of a traditional whistleblower, Elliott identifies as one because of the emotions he experienced during what he describes as the darkest years of his life: despair and disillusionment, isolation and rage, and the trauma that results from discovering that an institution you belong to and believe in is engaged in unethical behavior.
Small clues, however, indicate that something else is upsetting Elliott as well. He seems inattentive to what should be important details of the case that was such a focus of his life: He gets the year of Markingson’s death wrong the first time he mentions it, and, in one of the book’s most startling passages, he displays a total lack of curiosity about the fact that Markingson’s mother donated her body to the University of Minnesota after her death, a piece of information that he includes as an aside without any further comment. And the intensity of Elliott’s reactions often seems at odds with what circumstances warranted. He describes himself as being a pariah at work, despite receiving widespread support from his colleagues at Minnesota and bioethicists from around the world. He had experienced no similar feelings of betrayal when, the same year he was hired, a clinical faculty member at the university was deemed responsible for the injuries or deaths of 46 mentally ill patients. He laments the “staggering” amount of time he wasted on the Markingson case while downplaying his impressive successes, which include helping ensure that the Minnesota state legislature passed a law designed to protect patients like Markingson and spearheading campaigns that ultimately led to the university taking the highly unusual step of suspending enrollment in psychiatric-drug trials.
I don’t doubt the potency of Elliott’s emotions—clearly he was deeply affected by his experiences—but also clear throughout The Occasional Human Sacrifice is that his anger has roots that extend back to his own time in medical school. His seeming inability to acknowledge this keeps him from reaching the conclusion and call to action that his book cries out for.
The bulk of The Occasional Human Sacrifice comprises case studies of the whistleblowers who helped bring to light half a dozen of the previous century’s most horrific medical-research scandals. Some, such as the Tuskegee syphilis study, where hundreds of Black men infected with syphilis were left deliberately untreated even after safe and effective treatment was available, are widely known. Others, such as the fatal Department of Defense–funded radiation experiments conducted on cancer patients at the University of Cincinnati Medical Center, should be.
One of the through lines that Elliott uses to sew these accounts together is that, for many, “the act of blowing the whistle triggers a long slide into despair.” In 1972, a physician named Mike Wilkins helped expose atrocities at the Willowbrook State School on Staten Island, in New York, where children with developmental disabilities were sexually and physically abused and forced to drink “fecal milkshakes” infected with hepatitis; when Elliott meets Wilkins almost half a century later, he’d just begun treatment for PTSD and an “addiction to crack.” John Pesando was an up-and-coming cancer researcher when he raised the alarm in the mid-1980s about a long-term study at Seattle’s Fred Hutchinson Cancer Research Center that had a 99 percent fatality rate; after Pesando’s contract was not renewed in 1987, he briefly worked as a consultant, then spent the remainder of his career reviewing disability claims for the Social Security Administration.
Elliott has a reporter’s eye for expressive details, and his matter-of-fact approach is an effective way to write about stories that shock the conscience. The book takes on a much angrier tone when Elliott’s focus turns to one of its other major themes: the corrosive way medical school trains students to view patients as objects instead of people.
In some of the book’s most disturbing scenes, Elliott tells of his own “soul-destroying experience of medical school” and relates how he was too cowardly to object when instructed to do things that he knew were unethical. These included delivering a “gruesome serving of pain to an elderly Black veteran” by twisting “a large-bore metal needle into his iliac crest” while attempting to do a bone-marrow biopsy with the “trembling, unskilled hands of a medical student”; performing “lumbar punctures, episiotomies, arterial sticks, or any number of other invasive procedures” without proper instruction or supervision; and groping around “the cervix of an anesthetized woman lying on the operating table” despite being almost certain that she had not given consent to be used as “a clinical practice dummy.” Elliott’s ostensible explanation for including these vignettes is to show that he is not, by nature, a confrontational person, but the scenes feel more like fumbling attempts to come to terms with his past.
In one of The Occasional Human Sacrifice’s many digressions, Elliott talks about an alternative theory of the roots of post-traumatic stress experienced by Vietnam veterans. According to this view, PTSD wasn’t primarily caused by experiencing trauma or fear but by veterans “being placed in circumstances where they were commanded to betray widely held moral standards” by enacting a military strategy that sometimes included the deliberate killing of civilians. “Such moral betrayals can cause deep, lasting damage to a person’s character.” Though Elliott never explicitly makes the connection, it certainly sounds as if he views his time in medical school as his personal Vietnam, an experience that left him hardened and morally compromised: In the book’s introduction, he describes how his medical training was turning him “into a terrible human being,” one who was “harder, meaner, and more entitled”; in its conclusion, he writes, “A central aim of medical training is to change your sensibility, to transform you into a different person, one who doesn’t react to death and illness like a civilian anymore. The danger is not just that you will see other people do horrible things and feel too afraid to speak up, but that you will no longer see what they are doing as horrible. You will think: this is simply the way it is done.”
Elliott follows this distressing depiction with a curious about-face: “Or perhaps you won’t,” he writes, before recounting a story about his father, a beloved family doctor with “an unwavering faith in medical science” who began his career in South Carolina in the late 1950s. “Segregated waiting rooms were the norm. Yet when my father opened his office, he made sure it had a single waiting room where everyone sat together … He just saw the right thing to do and did it.”
Elliott is a nimble and probing thinker who doesn’t shy away from weighty subjects. But considering all that it covers, his book feels incomplete. Even after convincingly explaining how “organizations create social worlds in which disastrous moral choices seem normal and sensible” and giving full throat to his anger over being pressured to betray his moral standards in medical school, he seems incapable of meaningfully engaging with the conclusion that the book seems to demand: that the scandals medical whistleblowers expose will remain endemic until medical training is reformed.