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Miller Lite, Bud Lite, Alternative Lite.
It was bound to happen. It was so predictable. Many of us saw this one coming a mile off.
The booming popularity and acceptance of holistic therapies in the past few years have given rise to a field we all know as Alternative Medicine. It includes herbal remedies, homeopathy, chiropractic, holistic supplements, massage, acupuncture, colon therapy, chelation therapy, live cell analysis, you get the idea – anything that is not surgery and drugs. Disillusioned by getting the standard five-minute evaluation and prescription from their HMO doctor, seeing examples of the thousands of failed surgical procedures in their families and friends, watching people pick up infections they never had before while in the hospital, watching the rates of cancer deaths increase year by year, watching parents die of the same diseases their grandparents died from, it is finally occurring to thousands and thousands of Americans that they actually must be responsible for their own health.
Alternative Medicine is certainly not new. In fact, before the dawning of the pharmaceutical age, alternative was all there was. So it’s just a word game. Which one’s the alternative?
Suddenly we’re pretending it’s all new. Classically, when new theories of anything come onto the scene, they go through three stages
I. totally rejected and ridiculed as unscientific
II. admitted as having some possible value
III. accepted as self-evident
With Alternative Medicine, we are now in Stage II. It is amusing to see the posturing that so closely follows these classical phases. Alternative methods that were on the AMA’s hit list, targeted by the secret Committee on Quackery during the 50s, 60s, and 70s, are now suddenly being evaluated in the Journal of the American Medical Association.
Although still dwarfed by the $1.5 trillion mainstream medical budget, Alternative Medicine is making very fast economic inroads, and is now in excess of $30 billion per year. An estimated 40% of the population uses some form of alternative therapy. (JAMA , Nov 98, Jonas).
But a very funny thing is happening. Because Alternative Medicine is coming so quickly to the forefront, many factions are claiming Alternative Medicine for their own, as if they thought of it first. Some are so good at it, that they even have many of the Alternative Medicine practitioners themselves believing their claims. But in this chapter we won’t be fooled. We can tell the difference between Alternative and Alternative Lite.
VANILLA, CHERRY VANILLA, OR FRENCH VANILLA?
Alternative Lite comes in three main flavors:
– Standard Medical
– Standard Medical Fringe
– Holistic Practitioners
I. Standard Medical
It comes as no surprise that so much public attention (and money) would be noticed by mainstream medicine. 3% of the total medical budget may not seem like much, but it’s growing fast. Not missing a trick, many medical doctors and pharmaceutical company bureaucrats are scrambling to get in on the action.
I’m talking about TV commercial spots which hawk drugs and potions at us every 10 minutes on every major channel, magazine ads, billboards, radio spots, newspaper ads, newspaper articles, direct mail – all this and more. This giant vacuum cleaner is being diverted to one little corner they almost missed – Alternative Medicine. And now they’re going to tell us they were there first and they understand our need for an “alternative” to drugs, and what have they got brand new, just down the chute that’s gonna fix us right up? Synthetic vitamins. Symptom-specific herbs. New “natural” hormones. Of course all of these are to be taken ALONG WITH standard medications. Of course.
Maneuvering the most sophisticated communications and marketing network in history into position, regular medicine is cranking up for some major Hooverage.
JAMA MISSES THE MARK
The November 11, 1998 issue of the Journal of the American Medical Association, with much fanfare, decided to dedicate itself to a look at Alternative Medicine. The editors congratulate themselves about reviewing some 200 articles prior to publication. (Fontanarosa) Not exactly a review of the literature, considering that alternative medicine has been around since the dawn of time, while organized medicine has only been at it for the past century. Such tunnel vision perhaps would be like a history of world music written by Madonna.
The journal featured a brief first look at a few alternative therapies:
– moxibustion (smoking herbs) for breech births
– Chinese herbs for Irritable Bowel
– acupuncture for HIV pain
– acupuncture for cocaine addiction
– saw palmetto herb for enlarged prostate
– yoga for carpal tunnel
– herbs for weight loss
– leeches, spiders, and astrology
Hardly a comprehensive list of alternative medicine, by any standards, and that’s really the point. The journal issue was all very tongue in cheek, and with an overall condescending tone. The message was clear throughout: all these freaky little side trips are amusing fun to write about and sometimes may even have some temporary value, as long as the patient is not distracted from “real medicine”: drugs and surgery. Some examples:
the terms energy and energy medicine are used with increasing frequency. However, given the scientific definition of energy, this designation is misleading since nothing is known of the nature of this hypothetical entity.” (Eskinaz)
” the capacity of humans to fool themselves by making claims of truth, postulating unfounded explanations, and denying the reality of observations they cannot explain is endless. Science has emerged as one of the few truly powerful approaches for mitigating this self-delusional capacity.”
– Jonas, p 1617
Worlds of controversy in these two little paragraphs. With prescription drugs now as the fourth leading cause of death in the U.S., with 2.5 million hospitalizations per year – the finished product of a century of “science” – as well as our low ranking in world health, disparaging comments like this that complain about alternative therapies’ lack of “science” – such posturing seems a bit disingenuous.
And then to make light of the energy of healing – this simply shows lack of awareness of mainstream medical studies by Becker, Hans Berger, and dozens of others who studied and measured different types of energy as they related to healing. Becker healed bone fractures with electric energy. Berger invented the EEG. The JAMA issue was so poorly researched that the editors didn’t even bother to look very deep within their own data base.
Yet a third editorial does its best ostrich impersonation:
“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data .”until solid evidence is available that demonstrates the safety, efficacy, and effectiveness[sic] of specific alternative medicine interventions, uncritical acceptance of untested and unproven alternative medicine therapies must stop.”
Yeah, we know. Tell us all about it. Inability to edit is not this guy’s only problem. First he says there is no alternative medicine, then spends the rest of the paper putting limits on it. Using the word “interventions” after alternative medicine is an oxymoron that shows the depth of this author’s lack of information. Alternative therapy by definition does not intervene with anything; it only reinforces the body’s own healing ways.
Even though they seem nervous, the contributing authors take refuge in the usual totems:
– the scientific method
– randomized clinical trials
– controlled evidence studies instead of “anecdotes”
These articles were blatantly superficial, not well researched at all, and written by people with no clinical expertise in the disciplines that were featured. It was like a narrative by a tour bus driver taking passengers through a zoo. Or like a history of black America written by the Ku Klux Klan. The illusion is that now JAMA has “reviewed” the alternative field and has made its “decisions” from the tiny bit of research they did in preparation for this one issue. JAMA has spoken. The ambiance of self-congratulation was a little over-the-top with this comment:
” the publication of this issue of JAMA illustrates that quality scientific research can be conducted and published on alternative medicine topics.”
You don’t say? And exactly where is the clinical research and ‘evidence-based data’ to support that conclusion?
The bottom line with the JAMA issue featuring alternative medicine was predictable: the authors want to subject Alternative Medicine to standards much more rigorous than mainstream medicine itself. The constant harping on “rigorously conducted scientific testing” makes you wonder why so many people die from prescription drugs for which all this scientific testing was supposedly done. That topic gets some coverage in the Holistic vs. Allopathic chapter (www.thedoctorwithin.com) when we discussed the problems with reporting of scientific data.
Following JAMA’s lead, other medical offices and institutions went scrambling to assure us they too are well-informed and up-to-date as far as Alternative Medicine is concerned. The Office of Alternative Medicine within the National Institutes of Health was recently upgraded to a Center: The Center for Alternative Medicine, and given a budget of $50 million of your money. Don’t expect much from the new federal bureaucracy; the acorns likely won’t fall far from the tree. Standard Medical thinking is calling the shots here, and no matter how broadminded they try to come across, they’re programmed for two main sentiments when it comes to Alternative Medicine:
Both are neatly displayed in an article by the former editor of the New England Journal of Medicine about Alternative rockstar Andrew Weil. This nervous article appeared in The New Republic, in an issue where they really took a chance. The author muses:
“Alternative methods are often based on notions totally at odds with science, common sense, and modern conceptions of the structure and functions of the human body. In keeping an open mind, the medical establishment must not lose its scientific compass on balance, the good done by modern pharmaceuticals far outweighs the harm..”
Open mind? Tell that to the hundreds of thousands who die every year from prescription drugs or the millions hospitalized by their side effects. (JAMA Apr 98) Same broken record, skipping CD – about the rules of evidence, scientific methods, objective studies, clinical trials We’re scientific; you’re not.
The Standard Medical version of Alternative Lite offers variations on the same shaky theme: Alternative medicine may have some value but it
– isn’t proven
– isn’t objectively scientific
– has no evidence-based studies
– hasn’t been tested by clinical trials
– isn’t reproducible
OK, here’s a simple question: if regular medicine itself meets all these scientific standards, why is the 4th leading cause of death in the U.S. now prescription drugs? (Lazarou) Prescription drugs have met all the requirements of science, right? How scientific was the decision to inject all 696,000 Gulf War personnel with 3 totally untested vaccines? (Rockefeller) Or how scientific is it to give antibiotics for viral infections, as routinely done in U.S. hospitals, to the tune of $23 billion per year? (Levy) Or for that matter, why give American women $20 billion worth of synthetic estrogen every year, when the best medical research has shown that these drugs actually increase osteoporosis, as well as heart attacks? (Lee) That sounds very scientific.
How much medical research is just smoke and mirrors, as long as money and politics controls the outcome of scientific studies? That undeniable fact dilutes the scientific value of any studies, making the pompous claims of the superiority of regular medicine sound a bit hollow. Anyone who’s done the slightest research into modern American health care is immediately confronted with this conflict. The false reporting of data, the cooked data, the termination of studies which are not turning out as the drug companies planned, the under-reporting of adverse reactions – all that was referenced in the Holistic vs. Allopathic chapter (www.thedoctorwithin.com).
What did Darwin say – Great is the power of persistent misrepresentation. Say anything long enough and often enough, and people will believe it. I think Johnny Cochran said that.
Complementary medicine is a term that is becoming popular as another word for Alternative. This is mainstream medicine assuring themselves that all these herbs and vitamins and tarot cards are OK as long as they’re an after-market add-on to the “real” medicine: drugs, surgery , and procedures. Anything but admit to the reality that Alternative is a stand-alone lifestyle which can nourish and support the body’s systems with no outside interference from chemicals or politics. Complementary medicine is a term that generally assumes the primacy of regular medicine, with a side-order of Alternative Surprise.
II. Standard Medical Fringe
Renegades all the way to the bank, these MDs have seen the light – usually after a very successful career in mainstream medicine. Alternative Lite is represented by some famous medical-doctors-turned-entrepreneurs. We’re all familiar with their names and faces. We get junk mail from many of them every week. They’re marquee speakers at the big health expos. We see articles in magazines and bestsellers in bookstores written by them. Easy to recognize them: every article or brochure ends with an Order Form.
Now the famous ones, whose names we all know, are being imitated by a second group of Mendelsohn hopefuls, who spend thousands of dollars mailing bright expensive flyers and booklets featuring them on the front page with stethoscopes draped over their shoulders, with headlines like
“Block Fat with Doctor’s New Stomach Shrinking Secret”
“CoQ Gel For a New Prostate”
“Make an Attack Dog Stop in His Tracks”
“Put an End to Intestinal Gas”
“Block Herpes with Doctor’s Secret Herb”
“Secret Exercises Prevent Incontinence”
“Miraculous New Medical Breakthroughs”
“Secrets to Jumpstarting Your Love Life”
“Fight Yeast Infections With Yogurt”
These are actual titles from medical flyers that came in the mail – you’ve seen them. ER meets the National Enquirer. Why didn’t JAMA do a study of the Mail-order MDs – the pretenders to the Alternative Lite title?
These guys are really smart. They’re riding the crest of the wave of dissatisfaction that was the natural backlash to Managed Care in this country. You know, that’s when health care programs formerly run by doctors were taken over by MBAs and corporate execs with salaries in the hundreds of millions. That’s when insurance companies decided to pay only for visits to doctors who are On The List.
These Alternative Lite medical entrepreneurs have their own products: books, tapes, vitamins, minerals, and herbs. They seem to be in a race with each other to see who can renounce their own medical profession the fastest. Some have formed network marketing companies to sell the products. They ought to form a skydiving club, and call it the Flying Robert Mendelsohns.
III. Holistic health practitioners who lack confidence in their own profession
The third purveyors of Alternative Lite really should know better. These are non-medical health practitioners who have never seen alternative medicine, of which they are representatives, as a viable lifestyle, but rather as some warm and fuzzy add-on to Real Science. They have been so thoroughly indoctrinated in Regular Medicine their whole lives that they simply cannot defect. Alternative Lite holistics may not have the information or the certainty that it’s OK to go through life without subjecting one’s blood to an assortment of experimental chemicals which are ordained by politics and big business. Or they still may entertain the possibility that the body may have been created with some extra, nonessential frills which may need removing. Type IIIs are very hard to pin down; it’s hard to tell what they stand for, or what they’re really saying. That’s because they really aren’t sure. Yes, they have some credentials in an alternative health field, and may even have a genuine regard for their patients’ well being. But somewhere along the way, they never picked up on how much healing power their field really is tapped into, or what the body can actually do for itself once it’s set free to do so.
A good screening test to ID the Alternative Lite holistic practitioner is to ask simple questions like:
what drugs does your family take, and when?
how often do your children get sick?
under what conditions would you allow surgery on your body?
when was your last spinal adjustment?
how many colds do you get per year?
do you bring soft drinks into your home?
how many eliminations per week do you have?
do you carry a lighter?
You’ll get a feeling by the answers you get. If the physicians have not healed themselves, you’re talking to the Alternative Lite crowd. Time to skate.
THE PILLS OF ALTERNATIVE LITE are prescribed in the same way that regular drugs are prescribed: allopathic. Symptom-specific. This pill for that problem. Prostate bothering you? Saw palmetto. Can’t remember where you put your Viagra? Ginko biloba to jog that memory. Eyesight dimming? Synthetic Vitamin A – retinoic acid. Coming down with a cold? Colloidal silver to the rescue. Stressed out? St. John’s Wort is your chill pill. Colon problems? Cascara sagrada will blast through. High fat diet? No need to cut down: the new fat-sponge pills have got you covered. Bodybuilding? Do it in a week with 25 mg of creatine per day. Tired and run down, and never took a supplement in your life? Colloidal 88-mineral toddies will turn the trick. Overweight? Cancel your appetite with the latest thermogenics; you’ll be so wired that food will be the last thing on your mind. Middle-age droop at 29? How about a spray human growth hormone to replace your pituitary. Getting the feeling that you’re not alone when you really are? Parasite killers can give you your tract back, Jack.
See the pattern? Match the symptom with the pill that takes care of that symptom. Total allopathic thinking. We just substituted the herb or vitamin for the pharmaceutical, that’s all. JAMA was all over this idea; it made perfect sense to them. Instead of drugs we’ll have supplements, if only we can work out two problems: potency and purity. We’ll do tests, yeah that’s the ticket, clinical trials to prove that we get the finest and purest and strongest ascorbic acid, or calcium, or una del gato.
THE POTENCY TRAP
There’s the fatal flaw – our vitamin’s stronger than your vitamin. Vitamins don’t need to be potent or pure, especially synthetic vitamins. As we saw in the chapter “Ascorbic Acid is Not Vitamin C,” vitamins cannot be isolated, by their very nature. The body does not need vitamins as much as it needs vitamin activity, and fractionated vitamins like retinoic acid and alpha tocopherol do not enhance vitamin activity. No one ever recovered from scurvy by taking ascorbic acid, as Szent-Gyorgi, the discoverer of Vitamin C, himself stated. Vitamins and minerals are by definition required in tiny amounts by the body. We just need a little for optimum performance. One potato per day containing only 20 mg of vitamin C is enough to reverse full-blown scurvy, as we saw from Richard Dana’s work in the Ascorbic Acid chapter (www.thedoctorwithin.com). Too much or too strong vitamins are a burden.
Same with minerals: ‘Our minerals have more milligrams than your minerals.’ In the minerals chapter we saw that excess minerals burden the kidneys. We only need a little, if they are optimally chelated. Minerals are cofactors to thousands of biochemical reactions in the body, some known and some unknown. What is not used must be dealt with, and that takes energy.
Also with herbs; they’re just plants. They don’t need to be refined or have the “active ingredient” isolated and fractioned out for “purity.” Because to do that is to pretend that we know much more than we do. In order to know which element in an herb produces a desired health benefit, we would have to have complete knowledge of the complex biochemistry of the body, which we don’t. We only have the crudest insight into a few of the more obvious workings of the body. The subtle stuff is a secret.
MAGAZINES AT THE NEWSSTAND – LOT OF OYSTERS
Seems like there’s a magazine for everything these days – walking, coin collecting, fish lures, automatic weapons, skateboarding, hamster care – you name it. So naturally, an area as big as Alternative Medicine would not be missed. But there’s some sleight-of-hand here: beautiful, glossy magazines that seem to be about so many topics are actually controlled by just a few big publishers, whose names you can see on the inside cover page. These publishers exist primarily to serve their advertisers. Turns out that the biggest advertisers in the area of health supplementation are the companies who are mass-producing synthetic vitamins and “potent” herbal formulas, in the symptom-specific allopathic manner described above: you know, this herb for that pain, etc. This is Alternative Lite, by definition. Read it and it dawns on you that it’s just like going to the HMO doctor when you’re sick. Only difference is, the magazine articles want you to take a “natural” synthetic instead of a drug. Or maybe a potent single herb.
This is not health care; it’s still just chasing symptoms, trying to cover them up, one by one. The body doesn’t work that way; health doesn’t work that way. Healthy people don’t get sick. By the time symptoms appear, an underlying general imbalance has been brewing for awhile.
Real alternative medicine doesn’t have glossy fanzines, leering at you from the racks of the mall bookstore. It’s an economic signpost – the glitzy stuff is from the billion dollar drug and publishing empire. Sorry to be the messenger of unfortunate reality, but you have to go through a lot of oysters to find the pearls of true holistic medicine.
ALTERNATIVE LITE DOES THE MALL
The huge vitamins chain stores in every mall in America have very little that could actually be called holistic or really natural. They may even call it Alternative, but it’s faux-Alternative: Alternative Lite.
What’s wrong with the products in these stores? Two of the most obviously fake things right off the bat are synthetic vitamins and “thermogenic” weight loss. A handful of pharmaceutical companies produce all the synthetic vitamins sold in this country. They warehouse them to their distributors and the individual vitamin companies then all buy the same synthetics, and sell them each under its own label, each claiming superiority.
Of equal worthlessness are the thermogenics – weight loss supplements that simply make you so wired you can’t eat. Mah huang, ephedra, guarano – I call them Chinese caffeine – speed up the heart rate till you don’t feel hungry. Appetite suppressants like these wear you down and reduce the overall health index. That’s why they don’t work – as soon as you stop taking them the weight comes back. But hey, what’d you expect? That was the design – keep coming back, like rats hitting the bar for a pellet. At least it’s better than fen-phen, you say. At least thermogenics aren’t drugs. Neither is Drano.
ANY BETTER IDEAS?
An Alternative method to weight loss would be a product that actually nourishes the body, providing some missing nutritional component. It would involve a lifestyle change and be permanent, with no side effects whatsoever. Most overweight people are really starving: the malnutrition of the affluent. They’re always hungry because the body is craving and continually hoping for some real nutrients to come down the hatch instead of the constant river of the “foods of commerce”.
And that brings us round to the holistic view: support the body so that it can do what it does.
The holistic model, which looks toward the real Alternative Medicine, has two requirements for supplements:
take only what’s needed
nothing left over
That means forget about mega-dosing on supplements. If A Little Is Good More Is Better only works in the stock market. The body’s requirements for supplements are modest. It just needs a little, and when the nutrient has been utilized, there should be nothing left over from the exchange – no metabolic debris.
THE GENUINE ARTICLE
The real Alternative Medicine doesn’t need to be evaluated or trivialized or summed up or given permission to exist. The real Alternative Medicine has always been around, because it is needed and people know it works. This game of pharmaceutical Junk Science political shuffle is new – only about a century old. Authors will say any clever thing, like there is no Alternative Medicine, or it’s really Holistic Medicine or it’s really complementary or integrative Medicine – but that’s all just words. More and more people instinctively know the score: they can go a very long way with Alternative Medicine. This is their alternative to regular medicine, which they’ve chosen because of the results they get. If something restores their health, people don’t need to wait for years of “cooked data” or Drug Cartel-funded studies to prove it to them. (Braithwaite) They want it now, and will pay cash for it, even if their Plan doesn’t cover it.
Real alternative medicine doesn’t get headlines and hype. Real alternative medicine doesn’t need to be explained to people. It’s been quietly chugging along in the background all these years, and will continue to do so. How do you tell the difference? Real alternative medicine involves
– whole food vitamins, not synthetic or “natural”
– focus on diet and digestion
– focus on spinal biomechanics
– the importance of water
– enzymes and antioxidants
– knowing the side effects of all drugs being taken
– knowing alternatives and success rates of any surgeries being proposed
– focus on the immediate impact of any therapy on the immune system
– immediate support for the natural healing systems of the body
Asking too much? This is the minimum, the least we can expect from a card-carrying Alternative health therapy. That’s the whole point of Alternative medicine – it really is an alternative to regular medicine. Most people are driven to it by the failure of regular medicine to help their problem, especially in the realm of chronic degenerative diseases. That’d be arthritis, cancer, colitis, diabetes, lupus, MS, chronic fatigue, osteoporosis, etc – which actually account for over 80% of American illness. The chronics. No matter what today’s breakthrough is in USA Today or the New York Times, people know that they and their family members often continue to suffer from these diseases year after year, despite the drugs and procedures that are tried. Many are the cases who are finding dramatic successes within the realms of the “new” Alternative Medicine, using holistic therapies that have been around for decades, that give the body some support, and then let it work its own inner magic. Afterwards, people say it was a “miracle.” Some miracle – just get out of the body’s way, so it can do its job. Again, standard media conditioning warns us not to trust our own bodies; all we hear is “see your doctor,” “see your doctor.”
ALTERNATIVE LITE SPINAL ADJUSTMENT
A natural magnet for Alternative Lite is the area of spinal manipulation. Since chiropractic is the largest Alternative health care system, it’s only natural to find Alternative Lite hoovering its way in. So what do we hear?
“Just do these exercises and a heating pad, and your back will get better.”
“It’s just muscular: let’s do a reading.”
“Your back is out; let’s put our minds together and visualize wholeness of the spine.”
“Here, these electrodes carry a special current called Czechoslovakian muscle stim. It’ll fix your back.”
“The disc may be herniated. A little work-hardening and we’ll power right through it. No pain, no gain.”
“The bones are locked. Let’s rebuild them with this special calcium made of Mexican coral and iguana ribs.”
“You have a subluxation. Here’s a new gel cream that will regenerate the DNA in those achy cells.”
There are no shortcuts to spinal adjustment. You have to go to the specialists, the guys with the training. Chiropractors have been around so long that it seems ridiculous to describe them as Alternative when it comes to spinal adjustment. If the actual problem is misaligned vertebrae, there simply is no alternative to correcting it.
SURVIVING THE EXPERIMENT
The real Alternative Medicine isn’t really an Alternative, for those who would restore the body to its natural condition of health. It’s more like the shortest distance between two points. But now with the growth of Alternative Lite, there’s a lot more clutter to sift through in order to get to what’s holistic, natural, nontoxic, and effective. Too bad – we didn’t really need more confusion in the area of health care. But that shows how desperate people really are to try something, anything, besides regular medicine. Disenchantment breeds experimentation, even to the extreme of accepting responsibility for one’s own health.
- Eskinazi, D – Factors That Shape Alternative Medicine JAMA 11 Nov 1998, vol 280:18 p1620
- Fontanarosa P – Alternative Medicine Meets Science JAMA 11 Nov 1998, vol 280:18 p1618
- Becker, MD – The Body Electric
- Berger, H MD – “Uber das Elektreukephalogramm des Menschen” 22 Apr 29 Freidrich Schiller University Jena, Germany
- Relman, A – A Trip To Stonesville The New Republic 14 Dec 1998
- Lazarou J, et al. – “Incidence of adverse drug reactions in hospitalized patients” JAMA 15 Apr 98, v279, p1200
- Rockefeller, JD IV- “Is Military Research Hazardous to Veterans’ Health? Lessons Spanning Half a Century” Staff Report for US Senate 8 Dec 1994 Senate Report 103-97 Committee on Veterans’ Affairs
- Levy, Stuart MD – The Antibiotic Paradox – Plenum Press NY 1992
- Lee, John, MD – What Your Doctor May Not Tell You About Menopause- Warner Books 1996
- Castelli W, MD – Prevention Magazine, Book Supplement- Apr 1999
- Atkins R, MD Health Revelations Apr 1999
- Braithwaite, J MD – “Corporate Crime in the Pharmaceutical Industry” – Routledge and Kegan Paul London 1984