Reading Carl Elliott's disarming exposé of the effects of big pharmaceuticals on medical practice in America, I initially could not avoid thinking of Bernie Madoff, the epitome of deception and greed who came to characterize an era of financial excess and deregulation. certainly, some of the characters described in the book could have called Madoff an inspiration. And the documentation in this book of ethical abuses in clinical trials research—including at the university of Minnesota, Elliott’s employer—brought immediate associations with John le c arré’s nov el The Constant Gardner (2001), in which western pharmaceutical companies with the complicity of their governments exploit- atively recruited Nairobi slum dwellers as trial subjects for commercial and national gains. But there is something elsein this complex history that made me think of tin miners in Bolivia. In We Eat the Mines and the Mines Eat Us (1979), June Nash describes how poor miners, resentful of the exploitation they endured and fearful of the risks of deep mining, regularly paid tribute to “El Tio,” a devilish mine spirit they believed caused the accidents that routinely killed them. Miners felt that, under capitalist relations of production, they were wrongly invading the domains of nature in their relentless pursuit of tin and profits and that, in turn, “El Tio” (sometimes repre- sented as the mine’s owner) punished them for doing so. The workers were aware that they were taking something out of the mine, but they also recognized that they were being consumed in the process of extraction.