The former BMJ editor Richard Smith is writing about a new book by Carl Elliott “The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No” that is on backorder now. Most interesting  for me is not his book review but his own insights.

Over the years I’ve been rung by potential whistleblowers, and I say to them two uncomfortable things: you have a duty to act but you are likely to be badly damaged as a result… What I haven’t said to them but will now after reading Elliott’s book is that the damage you experience is likely to affect your whole life. It’s a matter of power: “doctors have it and their subjects don’t.” Elliott quotes John Pesando, a whistleblower in the Cincinnati case, who says “Every whistleblower is an amateur playing against professionals.” […]
Most of us don’t blow the whistle because we recognise where the power lies. The state, the university, our employer, or the professor will crush us. But some people do blow the whistle. What drives them? Elliott concludes that there is no whistleblower “type” but that they usually act for deeply held moral reasons. He invokes the somewhat old fashioned idea of “honour” as the best way to explain why they act. […]
An alternative explanation offered by political scientist Fred Alford is “narcissism moralised.” Perhaps that’s close to honour. When I think of whistleblowers I know I think of people with a much greater sense of right and wrong than most of us have. I could use words like “exaggerated” or even “pathological,” but I like the concept of honour. I certainly admire whistleblowers.