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You're in the hospital. Your spouse has gone home to take care of the kids; the room is dark; you're disoriented and doped with painkillers. Medical personnel have been doing strange and inexplicable things to you all day. You wake up at 2 a.m. and find an unfamiliar white-clad figure injecting something into your iv line. Do you (a) close your eyes and drift back off in childlike trust, or (b) sit up and bellow, "Stop! Stop!"?

It depends on what you've been reading. If you are planning a hospital stay anytime soon, don't put a medical thriller in your overnight bag. The doctor as compassionate healer, worthy of unquestioning trust, has been taking a beating ever since Robin Cook's Coma hit the shelves in 1977, and the trend shows no sign of stopping.

"When a doctor does go wrong," Sherlock Holmes once remarked to Watson, "he is the first of criminals. He has nerve and he has knowledge." This view of the doctor as occupying a plane above common humanity (Holmes's opponent in "The Speckled Band," Dr. Grimesby Roylott, can bend a poker double with his bare hands) persists. But it is not the nerve or the poker-bending muscle that intimidates us layfolk; it's the knowledge. Only doctors know all the secrets of the body, including the ones they aren't telling us. We can only hope they put this knowledge to work for us instead of for themselves.

Greed: the great corrupter of the profession. Mainstream medical thrillers—those you are likely to find in what the book trade refers to as the "ABA market" (American Booksellers Association), in contrast to the "cba market" (Christian Booksellers Association)—are almost entirely centered on doctors who use their knowledge for gain. Cook, a physician who has been on leave from the Massachusetts Eye and Ear Infirmary since he hit the bestseller list, pops out a thriller every year or so, and his string of novels provides a useful sort of index to the depredations of greed.

In 1987's Outbreak, hemorrhagic fever appears in three separate chains of hospitals that provide an innovative service: managed care. Widespread panic and a sudden drop-off in business follow. Eventually, we discover that a right-wing group of private practitioners is to blame; they have conspired to spread disease in HMOs in an attempt to protect their own patient base. Marissa, Outbreak's perky CDC investigator, looks at the head bad guy and sees his "expensive silk shirt, the heavy gold cuff links, the tasseled Gucci loafers. … It all represented the conspicuous consumption of a wealthy doctor, now fearful of the new medical competition, of changing times, of medicine no longer being a seller's market."

Greed is also central to 1995's Contagion, which is practically the same novel in reverse. This time the good guys are the private doctors who've been driven out of business by the managed-care giants: specifically, one Jack Stapleton, who lost his ophthalmology practice to the huge for-profit chain AmeriCare. AmeriCare sweeps through Middle America, "gobbling up practices and hospitals with bewildering speed" and destroying the quality of patient care. When odd epidemics start appearing in AmeriCare facilities, Stapleton hunts down the villain: another managed-care chain, spreading germs to put the competitor out of business.

Medical thrillers go through fashions—fetal-tissue research, euthanasia, Ebola, genetic tinkering, managed care—and the current fashion appears to be illegal transplant organs. Take, for example, the most recent novels of doctors-turned-writers Tess Gerritsen and Leonard Goldberg. In Gerritsen's Life Support, doctors grow genetically altered embryos in the wombs of hired prostitutes. The embryos turn into blobs of tissue studded with dozens of pituitary glands; the doctors abort the pregnancies and then transplant these glands (for a substantial fee) into rich elderly patients who want their youth back. This would work fine, except that Gerritsen's greedy doctors eventually step over the line by killing a couple of adults, which leads to their detection by a perky female doctor named Toby. And in Goldberg's Deadly Harvest, a perky female doctor named Joanna goes searching for a liver for her critically ill sister. Instead, she discovers an organization that grows babies for organ donation. "Oh, my God!" screams Joanna. "The children … are being kept like animals, to be sacrificed when needed?" The villain, a greedy doctor, shrugs: "It's a moneymaker." Fashions come and go; greed always remains.

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October 5 1998, Vol. 42, No. 11