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These can be used for fast visualization of the lymphatic channels and sentinel nodes provided the patient is due to enter the operating room soon buy minomycin 100mg lowest price. The first node seen after injection is the sentinel node and this should be properly marked on the skin minomycin 50mg on line. The following procedure should be observed: (a) Route of injection: —Intradermal injections cheap minomycin 100mg with amex, within 1 cm of the edge of the lesion or the scar at four corners and 90o apart, can be used. Markers over the site of the sentinel node should be attempted using a point 57Co source, and an ink mark on the skin should be performed. Most probes are currently covered by disposable, sterile plastic tubing for use in the operating room, usually supplied by the manufacturer or obtained commercially. Principle Radioimmunodetection or radioimmunoscintigraphy uses tumour targeting antibodies or antibody fragments, labelled with a radionuclide suitable for external imaging, for the detection of specific cancers. Monoclonal antibodies have been developed against a variety of antigens associated with tumours and have been shown to target tumours with minimal side effects. Numerous radionuclides suitable for external imaging have been conjugated to antibodies, or antibody fragments, and the radioimmunoconju- gates have been shown to be stable in vivo. Antibody fragments have been conjugated with 99mTc, allowing same or next day imaging. Intact immunoglobulin conjugated with 111 In permits imaging as late as a week after administration. Clinical indications Radioimmunoscintigraphy has been shown to be of benefit in the detection of occult disease, in the management of patients with potentially resectable disease, and for the evaluation of lesion recurrence and therapeutic response. Radiolabelled antibody imaging in prostate cancer has been shown to be useful in risk stratification and in patient selection for loco-regional therapy. Contraindications The following points should be borne in mind: —Pregnancy and/or lactation is an absolute contraindication. Radiopharmaceuticals 99m Currently approved antibodies for imaging are conjugated with Tc and 111In. Both 99mTc and 111In have been labelled to immunoglobulins, while 99mTc has also been labelled to Fab´ fragments. Protocols It is important to obtain at least two, and preferably three, sets of images. The time interval between image sets is longer for 111In labelled antibodies, typically from the day of administration to 4 days after. To evaluate the abdomen optimally, it is advisable to clear the bowel, usually by administration of 10 mg of bisacodyl taken orally, four times a day, but this may increase non-specific intestinal uptake. An enema on the day of delayed imaging is useful for 111In labelled antibody imaging. Whole body images at 8 cm/min with a high resolution acquisition matrix are optimal for the early image sets; delayed images should be acquired at a slower speed, typically of 6 cm/min. Spot images of at least 1 000 000 counts are also useful, in addition to whole body images. For 99mTc labelled antibodies, these are carried out on the day of administration and at 24 hours. These should be acquired in a matrix of 64 ¥ 64, for o 40 seconds per angle for a minimum of 64 angles over 360. Interpretation Specific uptake increases with time over 24 hours, whereas non-specific uptake after the initial distribution decreases with time as the antibody or fragment clears from the blood. The use of change detection analysis, comparing the early and late images as a probability map of significant changes, allows the detection of lesions down to 3. Background information The high level expression of peptide receptors on various tumour cells as compared with normal tissues or normal blood cells has provided the molecular basis for the clinical use of radiolabelled peptides as tumour tracers in nuclear medicine. It is no longer frequently used but may be produced in a functional radiopharmacy laboratory. Clinical results are not as good in the abdomen as those with the 111In labelled compound, due to higher hepatobiliary clearance. It should also be used in the follow-up of cancer patients known to bear a tumour which 356 5. Patients should be informed that they will have to come for the scinti- graphic acquisitions at several time points, usually at 4–8 and 24 hours post- injection. When abdominal activity is present, acquisitions may also become necessary after 48 hours. If there is marked intestinal activity, the patient may be asked to take laxatives. The peptide tracer can also be injected in the afternoon, and acquisitions performed the next morning. Planar images should be obtained at two time points: —Early acquisition at 4–8 hours post-injection; —Late acquisition at 24–48 hours post-injection. Planar images (thorax and abdomen) should be gathered in the anterior, posterior and lateral views (matrix at least 128 × 128 pixels, (150 000–300 000 counts, scanning time 10–20 min). Both energy peaks are used for scanning (set at 173 and 247 keV) with a 20% window. This should be either early or delayed, at 6 or 24 hours post-injection, respectively. The scintigraphic data should be filtered with a Wiener filter and recon- structed in three planes (with a slice thickness of about 7 mm). Other indications such as endocrine orbitopathy associated with the thyroid are under investigation. It is recommended that acquisition should start not earlier than 1 hour post- injection and should be completed within 3 hours post-injection. Planar images (thorax and abdomen) should be gathered in the anterior, posterior and lateral views (a matrix of at least 128 × 128 pixels, 300 000 counts, scanning time 10 min). The scintigraphic data should be filtered with a Wiener filter and recon- structed in three planes (with a slice thickness of about 7 mm). In a few patients, however, antibodies have been demonstrated which may interfere with octreotide scintigraphy. Introduction The role of nuclear medicine in haematology covers the following: (a) Determination of blood volume, both red cell volume and plasma volume; (b) Mean red cell lifespan; (c) Sites of red cell destruction; (d) Megaloblastic anaemias, especially the vitamin B12 absorption test (Schilling test); (e) Iron metabolism; (f) Radiolabelled platelets; (g) Radiolabelled granulocytes; (h) Splenic function; (i) Bone marrow imaging. Principle Total blood volume consists of separate plasma and cellular compart- ments. However, more accurate results are obtained if the total blood volume is determined by separate measurements of plasma and red cell volume. In clinical situations, the ratio between total body haematocrit and peripheral haematocrit often varies widely. Plasma and red cell volumes are determined using the dilution principle, where the volume in question is calculated from the concentration of a tracer added in an accurately measured amount, mixed homogeneously within the compartment to be measured, using the following formula: V = Q/C where V is the volume of the compartment; Q is the quantity of tracer added; and C is the concentration of diluted tracer after equilibrium. The following conditions must be fulfilled for the formula to be valid: —The tracer must be homogeneously distributed within the compartment. Clinical indications The main indications for the test are in the diagnosis of polycythaemia (erythrocytosis). This condition is diagnosed by finding elevated haemoglobin, haematocrit and red cell counts, and may be absolute (increased red cell volume) or relative (haemoconcentration). The availability of erythropoietin determinations has decreased the use of blood volume determinations, perhaps because of the uncertain accuracy of the latter. To improve the reliability of blood volume determinations, it is imperative to pay attention to technical details, including adjustment of normal and/or reference values for the patient’s body build, especially in obese patients. Patient preparation Since radioactive iodine is taken up by the thyroid, 200 mg of potassium iodide should be given orally per day for two days before and eight days afterwards, in order to block thyroid uptake. Timed blood samples should be drawn from the opposite arm at exactly 10, 20 and 30 min post-injection. The disadvantage of Tc is its fairly high elution from red cells, making this method unsuitable for delayed sampling as in splenomegaly or congestive cardiac failure. Using a fixed reference range in mL/kg does not take into account the fact that obese individuals will have relatively lower values when expressed in mL/kg. It is more accurate to use individualized reference values for each patient, using tables based on the patient’s weight and height or body surface. The sample taken at time zero cannot be obtained earlier than 24 hours, because approximately 10% of the label is lost on the first day. Alternatively, they can be heated at 49°C for 15 min and used for spleen scintigraphy. Interpretation Normal and abnormal findings can be characterized as follows: (a) Normal findings: —The spleen-to-liver ratio is 1:1.

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If correctly applied there should be an instant order minomycin 100 mg visa, This is a particularly non-invasive mobilization and lasting cheap minomycin 100mg overnight delivery, functional improvement safe minomycin 100 mg. Mulligan (2003) contends that many symptoms Validation of efficacy = 5 (see Table 7. The key word and torsion’ in their passage over highly mobile joints, here is ‘assist’ – ‘force’ has no place in Mulligan’s through bony canals, intervertebral foramina, fascial vocabulary. This articular track – incor- Stewart (2000) notes that neural damage can result porating spin, slide, glide, rotation, etc. To facilitate controlled, free movement conditions, vasculitis, irradiation and marked tem- while minimizing compressive forces is the overall perature change such as intense cold. Thus the therapist is guided as to what is produce abnormalities in, or interference with, free normal movement by its symptom-free status. Morris (2006b) notes: ‘Restricted neural mobility can occur anywhere along the neuraxis, nervous tissue Neural tension tests selectively tension, compress and supporting structures housed within the axial and attempt to glide tissue along a selected nerve skeleton, and also continuing into the periphery. By adding and subtracting various form of assessment and treatment as involving ‘mobi- differentiating movements it may be possible to infer lization’ of the neural structures, rather than stretch- the relationship that part of the nervous system has ing them, and that these methods be reserved for with its interfacing structures. As the leg straightens, the movement of the tibial nerve in relation to the tibia and femur is indicated by arrows. No neural movement occurs behind the knee or at levels C6, T6 or L4 (these are the tension points). Reproduced with permission from Chaitow (2003) 240 Naturopathic Physical Medicine Questions that are being asked of the patient (or The therapeutic aspect of this approach requires that indeed, the tissues) when slack is being taken out once mechanical interference has been established, during the process of placing neural structures, and the physiological barriers should be carefully engaged their mechanical interfaces, under tension include: for a few seconds at a time. Are these symptoms that you recognize as being neural mobilization, muscles through which affected part of your problem? When connective tissue elements, either Neural structures are vulnerable to irritation and external or internal to the nerve, are damage requiring that these procedures are per- responsible for symptoms, these may produce formed slowly, cautiously and responsively to local/general ache, and/or sensations of reported symptoms. Butler & Gifford (1989) report on research indicating Morris (2006b) explains variations possible when that 70% of 115 patients with either carpal tunnel syn- introducing the straight leg raising procedure: drome or lesions of the ulnar nerve at the elbow showed clear electrophysiological and clinical evi- With regard to low back syndromes, the most dence of neural lesions in the neck. Flexing, internally which a primary and often long-standing disorder, rotating, and/or adducting the hip, extending the knee, perhaps in the spine, results in secondary or ‘remote’ dorsiflexing and/or inverting the foot/ankle all cause a dysfunction at the periphery. Superiorly, cervical extension being altered as well as its biomechanics (Upton & reduces the length of the neural canal, allowing for McComas 1973). Combinations of these manoeuvres Alternatives therefore effectively increase the neural mobilization There are no obvious alternatives that can be seen to inferiorly, while the sequence in which joints are specifically replace these methods; however, physical moved isolates the regional neural tensioning. If the knee is then flexed grams such as are found in Pilates, Thai yoga massage this reduces nerve root and hip region tension, while and yoga (as examples). Enhanced functionality that ankle dorsiflexion and internal rotation will increase leads to reduced stress effects on somatic structures neural tension to the lower leg, allowing the clinician should also emerge from postural and breathing to isolate various target branches, as desired. Once the target neural tissues have been isolated and tensioned a 2000) repetitive, oscillating sequence of caudalward or Neural stretching is designed to stretch and release cephalward movements creates the desired neural adhesions within a nerve, either between fascicles or mobilization. Chapter 7 • Modalities, Methods and Techniques 241 When a nerve is stretched, the wavy course of fasci- Box 7. Connective tissue between and within test (Butler 1991c) the fascicles is tensioned and the axons themselves may be stretched. This level rose to 35% of those referred for hospital Therefore, before any stretch is performed as a treat- attention (Troup 1981). Patient lies supine, arms at the side and legs should be measured at an initial motion barrier to together. The head and neck are supported as the head is lifted and the chin is taken toward the chest to its Cautions (Butler 1991b) end of range. In a normal neck the chin should approximate the neurological signs sternum without force or symptoms. If symptoms appear during this test, sensitizing • Spinal cord injuries movements or positions should be added to evaluate their effect on the symptoms (do the • Disc pathology symptoms increase or decrease? Sensitizing elements might include (while the head • Acute inflammatory infection is held in full neck flexion): • Pain or other neural symptoms that persist • straight leg raising (one and then the other) after the first assessment of the effects of • cervical side-flexion and/or rotation producing neural tension during tests • knee flexion (prone knee bend) with patient in • Malignancy involving the nervous system side-lying, neck fully flexed, or in full side-lying • Degenerative or progressive neural pathology slump position. Therefore, if symptoms are the result, entirely or partially, of mechanical interference with neural structures, and if mobilization of these restric- tions between the neural structure and its interface can applied by finger or thumb contact. These digital con- be achieved by these methods, we have an example of tacts can have either a diagnostic (assessment) or the removal of an obstacle to self-regulation, and this therapeutic objective and the degree of pressure is in line with naturopathic principles. Further reading Neuromuscular therapy in general, and neuromus- cular technique in particular (both abbreviated as 1. Churchill Livingstone, Edinburgh local and reflexogenic sources of pain and dysfunc- 2. These are the loci known as myofascial Neuromuscular technique, as the term is used in this trigger points. It is important to tial assessment is made of all tissues, from the acquire with practice an appreciation of the ‘feel’ of subocciput to the mid-thigh, in order to locate areas normal tissue so that one is better able to recognize of dysfunction and, where appropriate, to treat abnormal tissue. The whole secret is to be able to recognize the Neuromuscular therapy techniques emerged in both ‘abnormalities’ in the feel of tissue structures. Having Europe and North America almost simultaneously become accustomed to understanding the texture and over the last 50 years. The level of the pressure applied should not as well as from physical culture approaches advo- be consistent because the character and texture of cated by Macfadden (1916). Nimmo and his ‘receptor-tonus’ greater sense of diagnostic feel, and be far less likely to work seems to be a common link between European bruise the tissue. North American-style neuromuscular therapy framework and useful starting and ending points but uses a medium-paced thumb or finger glide to uncover the degree of therapeutic response offered to the contracted bands or muscular nodules, whereas various areas of dysfunction encountered varies, European-style neuromuscular techniques use a slow- depending on individual features. They also have slightly different emphasis on the method of application of ischemic compression in treating trigger points. Both versions emphasize a home care program and the patient’s participation in Safety the recovery process. Chapter 7 • Modalities, Methods and Techniques 243 Validation of efficacy = 3 (see Table 7. The produced a statistically significant change subjects were randomly placed into one of two on muscle strength (p <0. The study included 21 subjects (12 on week one, followed by a ‘rest’ period on females and 9 males) who were treated on week two, followed by neuromuscular three separate visits over 5 weeks. This should allow a straight arm position • Bone fractures or acute soft tissue injuries: wait (when the thumb contact is being used), as well as for full healing (6–12 weeks) the ability to transfer weight in order to increase pressure without arm muscle strength being used. This uncomplicated series of strokes allows assessment tool, its ability to revert to a therapeutic access to the soft tissues at the base and side of mode during assessment, particularly in relation to the cervical spine. Note that the direction of strokes localized dysfunction, has made it, for many practi- need not follow arrow directions. The objective is to tioners, a modality of choice in dealing with myofas- obtain information without causing discomfort to the cial pain problems. An additional role is seen to relate patient and without stressing your palpating hands. In time, with practice, treatment and assessment meld seamlessly together, with one Further reading feeding the other. Chaitow L 2001 Modern neuromuscular once you have mastered the concept of meeting, and techniques. Churchill Livingstone, Edinburgh not overriding, tissue tension with the palpating finger 2. Here again the physical treatment would be This soft tissue technique, perhaps inappropriately enhanced by naturopathic dietary and other advice. The soft tissue sites has largely validated – for example: were mainly muscular attachments, viz. Thus, for example, digestive problems recommendations for dietary changes, exercise, breathing could be helped by treating those spinal (osseous and re-education, relaxation and short fasting episodes, as soft tissue) areas that shared the same neural origin, appropriate to the individual’s needs. It had, and interventions, designed to impact on total health – a has, its devotees on both sides of the treatment divide, veritable personalized holistic recipe! A trigger point is identified by palpation methods It employs a position of ease as part of a sequence (see Chapter 6). When referred or local pain begins to diminish, the too sensitive), followed by the introduction of positional tissues housing the trigger point are taken to a release. The patient assists in the stretching movements (whenever possible) by activating the antagonists and facilitating the stretch. B The pain is removed from the tender/pain/trigger point by finding a position of ease which is held for several seconds, following which an isometric contraction is achieved involving the tissues that house the tender/pain/trigger point. C Following this, the muscle housing the point of local soft tissue dysfunction is stretched.

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Nurse Jessie Thompson felt stressed discount minomycin 100 mg on line, so she bought some herbal relaxation pills from a health food shop buy minomycin 50mg line. She took 30 pills — and suffered jaundice minomycin 100mg without prescription, kidney failure and such serious liver damage she spent 10 weeks in hospital. Professor Bender has worked, throughout his life, for the processed food manufacturers. He was head of research at Farley Infant Foods, head of research at Bovril, and has received 33 research funding from Cadbury Schweppes, Heinz and Kelloggs. The mind boggles, and just think, if they found these things in health food shops, what would they find in any of the major food retailers? Perhaps the most amazing thing about articles of this kind is that it makes one realise that the Medicines Act should cover the licensing of journalists, some of whom can of course seriously damage your health. Chapter Thirty Two Wellcome, Part Four : Colonising the Voluntary Sector Illness, a central concept of medicine, is not a matter of objective scientific fact. If illness is a judgement, the practice of medicine can be understood in terms ofpower. After a drug has been granted a licence, there is still competitive pressure from other manufacturers. The large sums invested in the research and development of most drugs mean that the product has to run the full course of its licence without competition in order to ensure maximum profits. The later years of the licence are the most important because it is only then, when research and development costs have been cleared, that the product begins to make a profit. Firstly, few illnesses are community-specific and rarely do people with specific illnesses form cohesive communities unless compelled by social pressure. Would doctors be able to persuade these patients to trust to the apparent benefits of orthodox medicine as quietly as cancer patients had succumbed? Rare contemporary examples of community-based illness, such as the site-specific aluminium pollution at Camelford, gave Wellcome a glimpse of how volatile and politically conscious a community assaulted by illness could become. The marketing of a new pharmaceutical by specialised advertising and public relations companies begins long before it is granted a licence. A subsidiary of Collier and Waring, Colloquium, was employed to organise meetings, conferences and symposia. Kingsway had organised many campaigns for the processed food and chemical companies. When Kingsway became Kingsway Rowland and was then taken into Rowland International, Crouch continued to be a consultant, until he moved on to the Westminster Communications Company. See Chapter Twenty Three The wider shores of public relations work are rarely revealed,!! Each drug produced by Wellcome has a marketing team which works with advertising agencies and public relations companies organising the sales campaign. In fact, Wellcome would have really liked to deal directly with the patient population and completely cut out possibly critical, medical professionals. Experience in America had shown that, there were doctors within the gay community who had worked with alternative therapies for years. It needed maximum propaganda to counter accusations of profiteering which would inevitably be levelled at Wellcome. It takes up to twelve years to develop, test and then gain a licence for a new drug. Such a treatment programme might emerge quickly from any number of doctors working in the field of alternative medicine. Obviously, in its own publications, Wellcome would make little reference to adverse side effects or toxicity. Possible licensing approval for a competitor company is again something which does not happen overnight. Wellcome was confident of controlling the apex of the system, with highly placed individuals, agreements with the DoH and influence inside the Committee on the Safety of Medicines. At the early stages of the journey to a licence, any competitor drug would have to go through trials. After 1988 and the beginning of the Anglo-French Concorde Trials, the majority of cohort subjects came under the control of Wellcome. Official figures were the principal guide to this projection, and these were in the main collated by official sources, then re-presented in the press or via a populist interpretation through spokespersons for the voluntary agencies. With many new drugs, the drug company has first to persuade the general practitioner of the efficacy of the treatments. This is done by using marketing techniques which range from persuasive arguments to persuasive golfing holidays in the Caribbean. To captivate and colonise the patients, and their organisations, Wellcome used sophisticated marketing arguments and a seemingly endless stream of financial donations. So covert and well organised was this infiltration and usurpation that large numbers of workers in the sector were completely oblivious of the fact that they were doing the bidding of Wellcome. To some extent, the relationship was also based upon the creation of financial insecurity. In 1989, however, the Wellcome Foundation senior management agreed the idea of a Corporate Donations Executive. The first staff appointee of this group was Ron Sutton, while the chair of the Committee went to Wellcome Foundadon director, David Godfrey. A speaker from Burroughs Wellcome was always present to answer questions about treatment alternatives and correct mistaken impressions. It was a self-help group which differed radically from the prevailing groups which tended to be dominated by social workers and medics. Sally was nervous about writing the articles, considering it a major responsibility. Now, Susan Pearl said, she was helping Wellcome to get to know more about what different organisations and workers in the voluntary sector wanted. The lunch at a wine bar was a peculiar occasion for Sally, who was not used to the blandishments of pharmaceutical companies. The two voluntary sector organisations credited with help in its production are the Terrence Higgins Trust and Body Positive. Such a donation inevitably entitled Wellcome to an interest on the Trustees Committee.! It was specified that half of the donation should go towards a fund then being set up to establish a mother and child unit at the Mildmay Mission Hospital in London. The largest and most influential voluntary sector advice and help organisation is the Terrence Higgins Trust. The gay user community responded with such fury that the Trust was forced to withdraw the application. From the inception of the organisation in 1983, the Helpline has been run by the Lesbian and Gay Medical Association (previously the Gay Medical Association). Many of the practising doctors in this organisation are funded by pharmaceutical companies. This began to change around 1987, when Nick Partridge, who had joined the organisation in 1985, became the Press Officer. In 1992, he travelled to America, holding meetings and carrying out media interviews. Literature of a similar kind had already been produced by Wellcome working with the Middlesex Hospital. Chapter Thirty Three Fighting the Invisible Agenda This [book] is arrant and dangerous nonsense, there is no valid science in these claims, if people are foolish enough to believe this, then it will lead to more deaths. It causes distress in patients, they distrust doctors and they have nowhere to turn. It makes me angry, I will have to spend hours arguing them out of 1 this nonsense. While superficially the language of the health-fraud activists is clearly to do with morally reprehensible phenomena, such as charlatanism, criminal behaviour and quackery, the meta-language often relates to science and its predominant power within the belief system of advanced societies. He knew that some would find his book challenging; he had no idea that a handful of people would try to have it banned. Adams did not get a debate; rather, he ran straight into a personal attack which for a short period damaged his professional reputation as a writer and journalist.

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Three people worked on typing the manuscript quality minomycin 50mg, Victoria Colfox buy minomycin 50 mg on line, Becky Faith and Ann Webley buy generic minomycin 100 mg. All were efficient and aided the progress of the book more than in the simple typing of the manuscript. Lastly I have to thank all those who helped me with legal, business and financial advice. I would however like to particularly thank Phillip Harrison whose two small seeds of help returned such a fine harvest of support for me. Any mistakes which remain, and there are bound to be some, are entirely my responsibility. I asked who was speaking and the voice identified itself as Duncan Campbell - the investigative reporter who brought the Zircon affair to light. This was all news to me, Nearing the end of a year-long investigation into Campbell and his associates, I was all too aware of the portentous nature of these phone calls. On the following Monday afternoon, a well-respected firm of solicitors, whose partners I have occasionally worked for, received a two page fax from Campbell. The letter was rounded off with the threat that he would be writing about me in the New Statesman. In the week following the fax, Campbell incessantly rang the offices of the solicitors, seeking information about me. He rang the senior partner at home, Questioning him about a Broadcasting Complaints Commission hearing and one of his clients with whom I had worked. His researchers rang around medical journalists in London to find out whether I had talked to them. Another two doctors connected to the campaign are Dr Stephen Davies and Dr Alan Stewart, who run a luxury private laboratory off Harley Street, Biolab. The three doctors and others hired a private detective over the past six months to try to spread rumours about the sex, private life and alleged drug-industry connections of people who have exposed their malpractice. In the weeks following that first phone call from Campbell, Ifelt the campaign had become focused upon me. I checked back mentally on all the interviews that I had carried out with people who had been harassed and maligned by Campbell. For the first time I began to understand why his victims had been forced to move house, leave home, or had come near to breakdown. I too began to feel the deadening effect of the fear that had gripped those who had refused me interviews. Such people had referred to their periods of uninvited relations with Campbell as if they were times of tragedy: circumstances from which they had now recovered, but were still not strong enough to discuss. This was the investigative journalist who had fought for years against the intrusive shadow of state surveillance. Now at the height of his career, he appeared to be carrying out an intrusive campaign of his own. In retrospect, I am glad that Campbell decided to harass me, if only briefly, and especially glad that he did so just as my investigation was coming to an end. Others, wary of apparent medical altruism, and previous iatrogenic disasters, began to organise self-empowering treatment and therapy programmes. In the main, they did this by making information available on non-pharmaceutical treatments. When I began to explore this wider landscape, keeping the Campaign Against Health Fraud firmly in sight, I found it difficult to orientate myself! Perhaps most confusing of all: should not a health-fraud campaign called Health Watch be critical of the food industry and agribusiness over such things as additives and pesticides? Why was Health Watch attacking those therapists and scientists who thought that the destabilisation of our natural environment was making us ill? In this book, I have tried to answer some of these questions, although even I have to admit that the route to my conclusions seems on occasions tenuous. This is not due to any lack of intellectual rigour on my part, but more to do with the fact that my investigation only scratched the surface of a powerful and extensive underworld spawned by big business. It will be some time before we are able to understand fully and record in detail the present period of crisis and the shifts in paradigm which have thrown up the surveillance, sabotage, harassment and fraud which are increasingly becoming an everyday part of commercial competition. In the last months of writing, three unrelated things affected me, forcing me to focus my mind more sharply on the importance of finishing the book. Clinic employees were made to raise their hands and stand against the wall, while officers covered them. Coincidentally, at around the same time, I received a call from a doctor and research scientist in Europe. Much of his work has concentrated upon chemical food additives and their effect upon the immune system. Anonymous letters to his local tax office falsely claimed that he had assets in Swiss accounts. In a re-run of the charges brought in the sixties against Dr Joseph Issels, the German cancer doctor, Naessens was charged with having caused the death of a woman to whom he gave treatment. His acquittal did not however diminish the terror, suffering or social destruction brought by such cases. I have tried to create a narrative running from beginning to the end, but I realise that in places it is interrupted and is unlikely to engage the attention of many readers from start to finish. Part One looks at the growth of scientific medicine and the history of health-fraud campaigns in America. It lays the basis for understanding the role of Rockefeller interests in defending orthodox medicine and scientific research. The lives of these practitioners are taken up again in Part Five of the book which details attacks upon them after 1989. Part Four traces the historical conflict between orthodox and complementary medicine in Britain, and deals with the beginnings and growth of the London-based Campaign Against Health Fraud. Part Five picks up on the stories of those practitioners whose work was discussed in Part Two. Given the relative complexity of the book, its large number of subjects and lack of continuous narrative, some readers may prefer to read sections separately. I structured the book as I did, because I felt that the information was most accessible when presented in this way. I reasoned that readers would want to become familiar with the individuals and practitioners involved in alternative medicine before they read about the attacks mounted against them. In this book, I have frequently found myself using terms which do not describe what I wish to say. Often this is not however a pure or noble science but a corrupted science, one which serves profit rather than truth. Scientific medicine does not always reflect the highest standards of medicine and is sometimes not at all scientific. On the other hand some of the research carried out into the basis of such things as homoeopathy and acupuncture has been high quality science. Naturally we are all against fraud of any kind, at the least it robs us of our expectations and at worst deprives us of our innocence. We might disagree about the prevalence of fraud in health care, but we are all against it. While investigating and researching this book, I came across very little deliberate health fraud amongst alternative or complementary practitioners. Those practitioners who are not effective in their work are rarely fraudsters, more often they are naive but sincere individuals who would accept regulation if the matter were discussed. On the other hand, very real fraud in science, industry, business and research is increasing. In these areas, the intent of the fraudster is often blatantly criminal and their actions utterly unaccountable. Part of this book is about the British Campaign Against Health Fraud and the American National Council Against Health Fraud. If anything, those whom they tar with the brush of fraud are involved in nothing more than fair competition with orthodox medicine or medical research.

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