By O. Delazar. Florida A & M University.
But we also know that there are less conventional factors at work purchase prothiaden 75 mg otc, factors that are unlikely to be assessed quality prothiaden 75 mg, or in some cases allowed into the healing equation in the first place buy prothiaden 75mg fast delivery. Some of these are the scale o f the facility in which care is rendered; the nature and behavior o f health personnel; the setting for care—home 75 mg prothiaden mastercard, outpatient, hospital; the powers of healing of those who claim to be healers; and the role o f the family and of the patient. Unless the barriers to practice are lowered to allow the interplay of new m ixtures of personnel and facilities and interpersonal interactions, these factors are un likely to be fully assessed. T he theories and practices on which contem porary medicine is premised are not the only ones. And there is evidence, some of which has been discussed, that these systems of medicine are effective. T he rigorous professionalization o f m odern medicine has succeeded in barring, or at least constraining practitioners employing alternative therapies and tech niques, such as acupuncture and chiropractic. T he opportu nity to learn from alternative practices should not be lost, The Obstacles 225 but will be if the prevailing barriers to practice remain. One example: Sister Justa Smith, a biochemist, has isolated a factor that may be associated with healing. Since her hypothesis is that enzyme activity is related to the healing process, she examined persons who claimed to be healers to determ ine w hether they could accelerate enzyme activity. Some of those who claim to be healers and appear to have had success in heal ing can dramatically elevate enzyme activity in controlled experim ents. First, as inform ation becomes available linking the processes o f care with patient outcomes, inform ation will be available to aid people in making choices about healers. Second, that same inform ation will make it possible to bar some prac titioners from practice at regional health centers, when it is clear that harm is being done to patients. T hird, com munities may also choose to bar some practitioners from association with neighborhood hospitals. T he argum ent is that the reform s I propose are hopelessly unrealistic because they are inconsistent with pre vailing social, political, and economic realities. In addition, it is argued that since some o f the proposals have m erit, they might be achieved step by step, particularly if appropriate incentives to change are utilized. It is true that change oc curs in this gradualist way, and some proposals, such as the regionalization of costly medical care equipm ent and ser vices, could be im plem ented without a titanic struggle. But if the reform s I propose are viewed as a whole, the conclusion is inescapable—a revolution is needed. If we start to think differently about health, the reform s will follow in due course. T he accumulation of “bits” o f data that do not fit the old predictions, or old explanations. T he fact that the change is preceded by widespread dissonance and is followed, when the transform ation takes place, by widespread change. T he change is very sudden and is consum m ated in a relatively short period o f time, contrasted with the “life” of the system which is replaced. The change is often in the direction of “simpli fication”; m ore simple explanations and practices. Finally, and m ore subtle, is the occurrence of interac tions “leaping” across the system level between the old sys tem and the new system in the process o f formation, which precede the transform ation. It is far from self-evident that medicine will change dramatically in the next few years, but there are enough signs and signals to make it a possibility. Finally, it will be argued that insufficient resources would be saved from the truncation of the existing medical care system to establish the program s that are proposed. This may be true in the initial conversion o f the system because of pending commitments and sunk costs, and because existing needs must be met before the long-range benefits of the new program s are experienced. If prevention works, the dem ands on a frozen and partially retreaded personal health care system will T he Obstacles 227 gradually lessen, perm itting reallocation of resources to new program s until some reasonable equilibrium is reached. It will also be argued that we will have enough revenue to preserve medicine and launch new program s as well. T he press o f existing social and domestic needs is so great that substantially more money will be dem anded. T he current system is likely to consume 10 percent or m ore o f the gross national prod uct by the year 2000. But even assuming that sufficient monies could be com m andeered, why should the existing system be preserved at the expense of am elioration o f other problems? As Ivan Illich has said: Each car w hich B razil puts on the road denies fifty people good tran sp o rtatio n by bus. Each m erchandized re frig e rato r reduces th e chance o f building a com m unity freezer. Every dollar spent in L atin A m erica on doctors a n d hospitals costs a h u n d re d lives. H ad each dollar been sp en t on providing safe d rin k in g w ater, a h u n d re d lives could have been saved. In the face o f sharp criticism o f medical care, a solution to the ills of the system is now being sought through the enactm ent o f a national health insurance program. Enactment o f a na 228 The Transform ations of Medicine tional health insurance plan in the United States can proba bly be expected within the next few years. Although the plans differ in their approaches to the means of financing care, the total num ber o f federal and state dollars to be appropriated, and the nature and degree o f public regulation, they all have three things in common. First, all tend to build upon the existing delivery system, although many o f the plans propose further industrializa tion o f the system. Second, they share a failure to address a m ajor alternative to the existing delivery system—a national health service—along the lines o f the medical care systems in Great Britain and Sweden and some other W estern nations. And third, there is no recognition of the limitations of m edi cal care to engender health. And, irrespective of the argum ents for and against a national health service—the second o f the points—its viability in the United States is doubtful. T he reason why there has been no debate about the third point—the limits of medicine—m ust be sought outside the policy-making process. Observers and practitioners o f medi cal care have failed to grasp the implications o f the evidence. As a result, the burning issue of the day is national health insurance, not the end o f medicine. We have tolerated tiers of medical practice paralleling class structure and even have created classes o f medical untouchables. T heir logical exten sion has always been some form o f comprehensive national health insurance that would greatly expand public support of medical care while leaving the delivery system intact. The Obstacles 229 National health insurance was a m ajor issue in the 1972 presidential election, and the debate has continued in Con gress since then. Thus, the assault proposed against inequi table access to care in this country will be m ade with dollars rather than with structural reform. T he solution being ad vanced, despite differences in details, is to increase purchas ing power to a level that presumably would be relatively uniform throughout the population. But when m easured against the argum ents made here, the plans are all o f a piece. A nd failure to engage these issues will have two profound and irreversible conse quences. T he first is that m ajor expansion in the financing system will lock in the current system for delivery of care for the indefinite future. This is the pitfall o f the otherwise salutary means being taken to assault inequities in medical care through an expansion of purchasing power. T he issue m ust be so stated as to make it possible for those who wish to limit the scope o f the existing system to fix on that goal and not be deflected by the benefits that comprehensive health in surance will ostensibly provide. T he second is that underw riting the costs of medical care through a com prehensive health insurance plan will inevita bly result in even steeper escalations in the cost of care and a m ore disproportionate consum ption of the gross national product by medical care. Enoch Powell, based on his years of experience in adm inistering England’s health service (and leaving aside his animadversions on other subjects), has m arveled at the capacity o f patients to consume large doses 230 The Transformations of Medicine of care. T he passage of a national health insurance plan will dissolve the last consum ption constraint—the lack of uni form purchasing power. As a nation we will have then de cided to further feed an already bloated system and in so doing divert monies that could otherwise be spent to ameliorate social and environm ental conditions that have a dem onstrably greater impact on health, such as poor hous ing and m alnutrition. And, most tragically, we will deepen the dependency of consumers on services and providers. Because we are on the verge of putting public monies to the task that private money and health care professionals have not accomplished, the prospects for a new medicine are dim.
Atten- borough (2002 cheap prothiaden 75 mg on-line, 2003) purchase 75 mg prothiaden mastercard, De Waal & Lanting (1997) and • True mastery of the transverse plane requires Morris (1982) support the Homo aquaticus theory signiﬁcant computational demands discount 75 mg prothiaden fast delivery, and this may with observation of wading behavior in chimpanzees buy prothiaden 75mg with mastercard, be why learning difﬁculties (e. This provides a possible explanation for how Gra- top-down voluntary axial rotation/ covetsky’s (1988) model of gait – the spinal engine – direction speciﬁc could have developed, and the subsequent realization To brachiate is to move by using the arms to swing that movement emanates from the core (Cresswell from branch to branch (Anderson 2000). Overcoming such aquatic resistance to chiate is a rare feature even within primates, though forward propulsion of the lower limbs would neces- by and large all primates are able to rotate their upper sitate development of spinal strength in the transverse (cranial) limbs through nearly 360° of motion – some- plane during gait, which most primates lack. Indeed any actor trying to mimic an greater number of hunting and/or escape possibilities ape-like gait will always incorporate more of side-to- in an arboreal environment, than having claws and side gait sway, which is instantly recognizable as ‘ape- limited range of forelimb motion. Experiments where chimpanzees have been allows for movement via vines and under branches, trained to walk bipedally have sadly resulted in heart as well as on them. How this pertains to human development Nevertheless, predation from many of the big cats and movement rehabilitation was presumably a problem for our ancestors – as it still is for our primate cousins today (Anderson 2000, • Efﬁcient human bipedal gait requires strength in Morgan 2001). To help to gested, the migration from the shrinking canopy to a retrain dysfunctional gait patterns, exercises which more land-dwelling existence would have brought teach integration, while building strength in upper with it an increased risk of predation from our alto- and lower limbs, may be useful (see ‘Standing cable gether larger, stronger and ‘toothier’ feline counter- pull’ below). As Morgan (2001) points out, although critics of the Humans (3rd dimensional mastery) – axial aquatic ape theory might suggest that the aquatic environment is altogether as dangerous as the savan- rotation/direction speciﬁc/bottom-up nah, many of the hominid fossils have been found Certainly, it would seem that controlled long-axis around lakes whose crocodilian inhabitants – even to rotation of the spine from the ﬁnely controlled, high- 328 Naturopathic Physical Medicine amplitude axial rotation is a specialization that has Lovejoy et al (2003) go on to describe that within any only evolved in animals that have already mastered given embryological ﬁeld of development (limb, bone, sagittal ﬂexion-extension (P Ahlberg, personal com- muscle, tendon) each is controlled by a structured munication, 2000). To bring about change in an This brought with it some signiﬁcant advancements, adult structure – such as those we might anticipate if including: we could watch hominid evolution unfold – must therefore involve altering the positional information • increased efﬁciency in gait over long distances of the developmental ﬁeld. Lovejoy et al (2003) • decreased surface area for the sun to strike, suggest, then, that it is this ‘ﬁeld’ – not the bone or the resulting in less energy wasted on muscle – that is the selective force driving the adapta- thermoregulation tion. Expression, therefore, of new anatomies is not • greater hunting opportunities (the big cats – the result of the genes so much as the regulatory ﬁeld. Such struc- The rapid expansion of the human brain didn’t begin tural adaptations to use are discussed further in until less than 2 million years ago – millions of years Chapter 2. Bipedalism there- This is in line with Ingber’s (1999) evidence that gene fore was the forerunner of neocortical development – expression alters when structural features are modi- rather than the result of it. Because human gait ﬁed as in the weightlessness affecting astronauts pre- demands alternating contraction of the anterior venting normal metabolism in cells whose cytoskeleton oblique slings for forward propulsion (see sling tensegrity structures have warped in zero-gravity systems below), across time this would have remolded conditions. Recent studies conﬁrm that alterations in the cellular In his classic paper on human gait, Lovejoy (1988) force balance can inﬂuence intracellular biochemistry demonstrates how the pelvic anatomy has adapted within focal adhesion complexes that form at the site over millions of years from our closest living relatives, of integrin binding as well as gene expression in the the chimpanzees, through to ‘Lucy’ our ﬁrst known nucleus. These results suggest that gravity sensation bipedal ancestor, and on to modern-day human pelvic may not result from direct activation of any single design (Fig. Instead, gravitational forces However, Lovejoy (2005, Lovejoy et al 2003) goes on may be experienced by individual cells in the living to describe how it may not be correct to assume that organism as a result of stress-dependent changes in evolutionary stressors remolded the musculoskeletal cell, tissue, or organ structure that, in turn, alter architecture. Lovejoy suggests that developmental extracellular matrix mechanics, cell shape, cytoskeletal biology may hold more accurate clues as to how our organization, or internal pre-stress in the cell-tissue connective tissues have been determined principally, matrix. In other words, the control of This seems to have implications for other forms new anatomic designs may be purely down to geneti- of structural distortion via age, adaptation, etc. It is interesting then, to consider that, ﬁrstly, the Form following function period through which this process of ﬁeld develop- ment occurs is the ﬁrst 8 weeks of gestation. During To build on Lovejoy’s commentary, the assertion that this embryonic period, there is huge cellular differen- anatomic adaptation may be down to biochemical tiation and the developing embryo is relatively small events at the genotypic and/or phenotypic level still and therefore freer to move within the womb (Bradley does not explain what the stimulus was to drive these 2001). The implications of this are that: events – the implication, it seems, being that it is pure chance. Reproduced with permission from Lovejoy (1988) 330 Naturopathic Physical Medicine 2. Backster (2003) also be affected to some degree by the movements describes similar processes involving identiﬁcation of of the mother pulses in the unfertilized chicken egg – implicating an 4. There are several similarities in behav- ior between the developing human and chick. By halfway through the prenatal period, The genes are more responsible for the hardware human fetuses can suck their thumbs and chicks chew of the nervous system while extrinsic factors (such as their toes. Both begin to generate breathing move- the mother’s movement patterns) contribute to ments in the ﬁnal third-stage of prenatal develop- the trillions of ﬁner connections between nerve cells ment, and both as neonates can make alternating (Haywood & Getchell 2005). This process includes, in its rudimentary state, second half of development as body size increases, the entire locomotor system. Hence, it is in this ﬁrst 8 buoyancy diminishes, plus the rigid shell wall (similar, weeks of gestation that the pattern formation of the though not identical, to the muscular human uterine musculoskeletal system Lovejoy (2005, Lovejoy et al wall) increasingly constrains movement, eventually 2003) describes is at its most proliﬁc and signiﬁcant. It seems that as the cells of a body part – a limb, for The human fetus experiences similar changes relative example – begin to develop, each cell is able to recog- to its environment during development. Work by nize and respond to positional information within the Bradley (2001) sought to determine whether these limb which instructs it to proliferate, or to migrate, or movement experiences play an instructive role as to change shape, or to commit ‘suicide’ – cellular motor control is established. Bradley’s (2001) research has shown that parameters This means that, even if a clump of cells is severed of embryonic movement are altered by environmental or removed from the developing limb, other cells in perturbations, such as a reduction in buoyancy and the locality are able to recognize the changes and fully ﬁxation of a single limb joint. Two lines of evidence restore the limb to its original, pre-speciﬁed dimen- were identiﬁed to suggest that alterations in moti- sions (Lovejoy et al 2003). How the cells know lity patterns are attributable to more than transient their role is not yet fully understood, but is believed mechanical phenomena: (1) mechanical constraint of to be based on an informational map formed by leg motions signiﬁcantly alters the patterns of wing deployment of chemical signals and cell-to-cell movement, and (2) physical constraint can yield a net communication. Interestingly, this assertion bears striking resem- Lovejoy and colleagues (2003) conclude their discus- blance to observations made by physicists, such as sion by describing an important consequence of the Brennan (1988), who have used Kirlian photography genetic regulatory function in evolution – a phenom- to document the effects of severing or removing a enon known as ‘transcriptional heterochrony’. The remaining portion of the leaf, (1996) concurs that the prevalent view is that hetero- and the area that the removed portion formerly occu- chrony is the most common mechanism for evolution- pied, remain intact on Kirlian photography, as if the ary changes of animal form. In other words, small energetic matrix holding the leaf together remains in differences in timing and spatial expression patterns place even when the physical leaf tissues have been of developmental loci – as controlled by cis-regulatory Chapter 9 • Rehabilitation and Re-education (Movement) Approaches 331 architecture – can account for signiﬁcant differences Homo sapiens arrived at this juncture may be at least in the entire morphology of the organism. If bipedalism brought with likely that an adaptation-inducing piezoelectric it some advantage – such as being able to intimidate stressor from maternal movement patterns will affect potential predators, to hunt or gather more effectively, the cis-regulatory elements. Simply put, it is the cis- and to carry foods back to a home base (Lovejoy 1988) regulatory elements that can inﬂuence phenotypic – then surely the ﬁrst apes within a tribe (or troop) to expression of the gene – and it is they that are most hone this skill would be the most desirable for the adaptable or ‘plastic’. Since, in the When one considers that the entire organism is world of sexual attraction it is known that like attracts formed of interwoven chains of piezoelectric dipolar like – an athletic male most commonly attracts an ath- molecules – each capable of oscillation due to its spiral letic female – in this way a simple precursor of bipedal nature – it is of little surprise that alterations in the gait may have driven mating selection and successful functional capacity of this three-dimensional, ubiqui- hunting, defending and reproduction. Indeed this is the premise for how athlete requires that you pick your parents well’, it manual techniques applied to adult tissues may facili- is the expression (phenotype) of these genes that is tate change in the polarity potential of the tissue, pro- dependent on what the individual is or isn’t exposed ducing a therapeutic effect (Oschman 2000, Schleip to in their ontogenetic development. Vital force and tissue organization To summarize the above discussion, if a primitive hominid found itself able to stand upright and, with Discussing the properties of the living matrix of an some practice, to walk, it doesn’t mean that this skill organism – which would include the developing is automatically encoded in that individual’s genetic embryo – Oschman (2000) states that connective hardware. More likely, however, this skill may exert tissues form a mechanical continuum, extending a mating preference (especially amongst those who through the animal body, even into the innermost desire or who have this skill) and may additionally parts of each cell. Each tension, each compression, result in phenotypic expression in progeny of females each movement causes the crystalline lattice of the able to walk bipedally during pregnancy – similar to connective tissues to generate bioelectronic signals the wading chimps of the Congo delta (Attenborough that are precisely characteristic of those tensions, com- 2002). Interestingly, a naturopathic slant on this discussion is that Claude Bernard, who famously stated that the Beneﬁts of bipedalism terrain was more important than the seed, also had Arguably, the most signiﬁcant beneﬁt of bipedal the foresight in 1839 to state: ‘The genes create struc- adaptation was the ability to be able to defend (and tures, but the genes do not control them; the vital force to hunt) from a distance. Tetrapods have to rely on does not create structure, the vital force directs them’ teeth and claws – which are both somewhat found (Oschman 2000). The ability to stand brought with it the ability to punch and with that, the ability Ontogenic adaptive loads to stab, and with that, the ability to throw. As Morris In an ape, such as a chimp not proﬁcient in bipedal (1982) points out, that what started quite literally as gait, the side-to-side lurching would have a very dif- an ‘arms’ race has simply grown metaphorically with ferent effect on the developing embryo than in a slings, bows and arrows, guns and now long-range modern-day human, for example. Our arms have literally and metaphori- against looking at the bony or muscular arrangement cally grown longer and/or bigger – putting a greater of the human body to understand more about how gap between us and our adversaries. Inner unit function in pain conditions and effect cognition on the part of the infant. More gross motor movements based on intention, such as Aside from the phylontogenetic relevance of the pre- reaching for an object, or moving from position ‘a’ to conscious state, the signiﬁcance to the clinician is that position ‘b’ only become predominant after 7 months although research has shown that inner unit function of postnatal life (Goldﬁeld 1995). Aside from egy, the patient responds by retreating to ‘what they the physiological explanation regarding threshold to know’ and, in doing so, can only revert to muscle stimulus (see Table 9. This would explain why ‘bracing’ of the area occurs When the body is threatened, it has two options, to using the inefﬁcient faster twitch, outer unit muscles ﬁght, or to ﬂee. More ﬁguratively, when challenged, and, subsequently, why it is these muscles that go on the individual has two comparable options: to move to develop trigger points (Lee 2003). How this pertains to human development The former option – move forward into growth – may equate to the individual learning about his or her pain and movement rehabilitation condition, what may have caused it and how to treat • True mastery of the transverse plane has brought and prevent further episodes. The latter option – retreat with it efﬁcient gait, the ability to make tools, to to safety – is what most people under stress will opt hunt with more than what nature has provided, for as an initial strategy, as reliable information may and to carry food, water and implements wherever not be readily available – this normally takes the form we travel. Since both the transversus abdominis and the multiﬁdus exert an extensor moment on the lumbar spine, they understanding of why they’re here, and how to may be shut down as part of the neural mechanisms involved return them, safely, to the environment of their in the ﬂexor response. Chapter 9 • Rehabilitation and Re-education (Movement) Approaches 333 Overriding extrinsic forces inﬂuencing The efﬁciency of bipedalism, originally believed to evolutionary development be less efﬁcient than tetrapedalism, is now broadly recognized as being the most efﬁcient way to loco- Compressive mote on land (see ‘Gait, Primal patterns’ below). In The compressive effects of the water of the oceans many ways more efﬁcient than the wheel, the unique would have been the ﬁrst adaptive force imposed on arrangement of human biomechanics allows the body the earliest single-celled living organisms – hence to move using elastic recoil (Gracovetsky 1997, 2001) their ability to resist compression (i. A wheel, for example, would struggle to roll up manipulate their shape away from danger or toward a steep hillside laden with boulders and fallen trees, nutriment meant that radial contraction would have or to climb a tree or rock-face – yet these are not such been the most likely movement pattern to develop signiﬁcant barriers for a set of legs. Larger organisms that had a sense of desire to move Most commonly, this takes the form of an upper or a against the lateral force of ocean currents (whether for lower crossed syndrome – see ‘Muscle imbalance food, to escape predators, to stay ‘safe’ within the physiology’ and ‘Gravity patterns’ below.
Like many such journals discount prothiaden 75mg, it has on occasions been through sloughs of despond generic prothiaden 75 mg with amex, near bankruptcy and collapse order 75mg prothiaden with amex. In 1978 buy 75 mg prothiaden otc, when the magazine was in dire straits, its management brought in the first of a long series of new editors. In the late seventies and early eighties, Campbell covered a number of stories which attracted attention, including one which detailed the routine occurrence of police and intelligence telephone tapping. It was not until February 1984, however, that he was again thrown into the fall glare of publicity. Whilst he was cycling in Islington, a loose front light caught in the wheel of his bike and he was catapulted over the handlebars. According to The Times, it was Mason who later alerted the government to the fact that Campbell knew about Zircon, a secretly-funded spy satellite. Campbell was to later expose the fact that the £500 million cost of Zircon had been illegally kept from Parliament. Besides the Zircon issue, he had prepared programmes on computer data banks, emergency powers, radar systems, the Association of Chief Police Officers and the Cabinet Office. Between January 1987 and autumn 1988, when the Zircon programme was finally shown, Campbell toured the country showing the film privately to appreciative audiences. All journalistic investigators tread a narrow line between exposing powerful wrongdoers and systems, and being in receipt of information from those who have helped them but are not entirely innocent. This is the case whether the subject under investigation is a criminal network or a government agency. No investigative reporter can do without sources and sometimes such sources are contaminated. When, however, the investigator begins to police his sources, handing information on to prosecuting agencies, he or she is in danger of becoming a policeman rather than a reporter. In January 1989, seven men went on trial in Winchester Crown Court accused, under the Official Secrets Act, of misusing information on the Police National Computer. This trial, which was to last three weeks and end with all the defendants being found guilty, was the first of its kind in Britain. The defendants at Winchester, all of whom pleaded not guilty, were two police officers and five private detectives. The police officers were charged with breaking Section Two of the Official Secrets Act, by conspiring to obtain information about criminal records or vehicle ownership. The five private detectives were all charged with conspiracy to receive information in contravention of the Official Secrets Act. The company had been set up with the sole purpose of obtaining information from the Police National Computer through private investigators. Murray claimed that Bartlett said: I give my contacts 20 criminal record checks a week. Murray later gave evidence at trial, that in May and June 1986 he had rung Bartlett, posing as an investigator, and told him that his client, an employer in Glasgow, wanted criminal checks carried out on staff. Murray and Campbell, using the name Sinclair, set up a meeting in a Basingstoke hotel in June 1986. It did not suit the prosecution, however, to hand Bartlett a ready-made defence by putting such obvious agents provocateurs, in the dock with him. On November 16th 1987, Duncan Campbell was a guest of the Center for Investigative Reporting in California. Here was a man who could bring to the gay world the resources of an investigator and commentator previously used to fight the State. History will show that Duncan Campbell failed to take sufficient care in analysing what discrimination against gay men really entailed. In January 1988, Jad Adams, author and film maker, attended an international conference of health ministers in London. In 1988 Campbell set up Stonewall, an organisation to raise money for the gay cause. The libel action was brought by Wellcome over a September cover story alleging that Wellcome had declined to invest in developing safer vaccines for diphtheria and whooping cough. That is because the government make doctors use an old fashioned British vaccine, 7 even though safer vaccines are made abroad. According to the writ, the New Statesman article had suggested Wellcome was guilty of improperly paying scientific experts to procure favourable evidence, improperly vetting studies written by government scientists, sacrificing concern for the safety of its products to the pursuit of profit and concocting a sham defence for its product. Despite the evident seriousness with which the Wellcome Foundation began the action against the New Statesman, the matter was quickly settled out of court for a sum apparently close to £10,000. He was particularly angry that a left-of-centre journal had capitulated so easily to a multi-national company. This world of high level medical research, with its political power blocs and its tentacles reaching into the major teaching hospitals, government agencies, voluntary organisations and the scientific milieu, was undoubtedly a tempting subject to a journalist who had previously sniped at the State. But here in this network, as in all powerful social situations, there also existed the seductive influences of fame and fortune. Here, in this area of science, were all the glittering prizes: the glory of being present at the reverse of the most serious disease in recent history, a chance to mingle with the gods on the brink of life-saving discoveries, science in the service of humanity. All his later writing suggests that he re-orientated himself and turned his talents loose on those who under other circumstances might have appeared to be his natural allies. Such a change of mind would not be very like Campbell, who had previously maintained an unshakeable conviction of his correctness on most subjects which he had investigated. There was also the matter of his socialism; few socialists would wish to defend a multi-national pharmaceutical company, which controlled a monopoly share of drug distribution to the National Health Service. And any gay socialist would have to think long and hard before supporting the commercial production of a drug which, in 1988, had not been thoroughly tested. Duncan Campbell reports on the scramble for profits which leaves promising treatments out in the cold and creates disturbing alignments 9 between leading researchers and the drugs industry. However, when he addresses the question of marketed treatments, it is clear to which company he is referring. Drug companies have kept the results of drugs trials confidential, have released information selectively, or have even delayed trials, in the 10 interests of profitability. Campbell deals with the important issue of positive new drugs and their research being pushed onto the margins by products which already have a patent and a licence. The article tackles the way in which research workers are aligned with the major drugs companies. Many medical researchers are demonstrably aligned through financial support with the drugs companies, whose efforts they are supposed to police. At the same time, red tape and lack of 12 research funds or staff have delayed important drug trials for months or years. The industry is permanently biased 15 towards making new drugs, even if they work no better, or even worse, than existing drugs. For the medical profession, on the other hand, the seminar 17 was seen as necessary to convince us of the need for the trial. Following the meeting, Campbell wrote a piece for the New Scientist, which had the 19 meeting as its starting point. So it was that over the next two years, these doctors, salaried and trained by the tax-payer, would effectively work for a private pharmaceutical company, defending its unproven product. The article broaches difficult moral dilemmas from the point of view of an elite of university trained doctors. He sees such people as driven by altruism and the bourgeois quest for scientific discovery. By the introduction of Dr Weller as a hero in the first paragraph, the reader is blinded to the nature of his role as a scientific doctor, and the treatment he is giving. Weller and his patients are all seen as passive victims, carried along by the tide. The new approach is already being tried, successfully, by pioneer clinics in the United States and Europe. It is not primary, and it is rarely expansive, but some space is given to the development of community treatments and alternatives. Not bogus pharmaceutical treatments, engineered by powerful companies, making hundreds of millions of pounds profit, but those offered by therapists and practitioners on the fringe. Suddenly Campbell had friends in high places, and was privy to the inner circles of the medical profession. This they did principally through the Campaign Against Health Fraud and as soon as the organisation was officially launched, Duncan Campbell joined. Criticism of Professor Baum had first been raised in an Observer article by Adam Raphael.