Book Review · Buchbesprechung

‘Dirty Medicine. The Handbook’, the latest book from the British investigative writer Martin J. Walker, does a good job of summing itself up in its long subtitle: ‘Dirty Medicine. The Handbook. Of Doctors, Epidemiologists, Researchers, Advisers, Insurance Scammers, Quackbusters, Bad Journalists, Corporate Scientists, Industry Shills, and Other Agents Who Do Now, or Have in The Past Worked For, Sided With, Supported or Simply Been a Part of Corporate Interests, Manufacturing, Pushing, or Promoting, Products or Ideologies Antagonistic to The Private and Public Health of Workers, Consumers, Citizens, Patients, Alternative Practitioners and Science in The Public Interest; Who They Are, How to Recognise Them and Their Organisations, and What to Do About Them.’ The handbook, an extension and reworking of his previous book ‘Dirty Medicine. Science, Big Business and the Assault on Natural Health Care’, provides a who’s who of individuals, groups and websites with a history of attacking complementary and alternative medicine (CAM), particularly in Britain. Starting with an overview, he links the rise of the ‘health fraud’ movement, ‘quackbusters’ and ‘skeptics’ with the rise of corporate science, noting that science is no longer the domain only of scientists, but of public relation companies who provide ‘trained mercenaries to fight the sciences battles’. Continuing with the language of war, he describes the battle tactics of the pharmaceutical industry as akin to those initiated and perfected by the tobacco and asbestos industries. Writing of an organised plan against natural medicine, he states that, as there is no major profit in natural medicine, it has to be ‘controlled and destabilised’ to protect pharmaceutical profits, which increased when medical science became more focused on problems to be fixed rather than the patient as a person. In alphabetical order he gives background information ranging from a line to a page on what he calls ‘health corporatists’: individuals, organisations, ad hoc groups and websites. Pharmaceutical company, personal, and committee links, and their history in relation to attacks against individuals or groups involved in CAM, are outlined. Following these chapters he provides a counterbalance: the antidote groups and individuals historically and currently battling for freedom of treatment and exposing the tactics behind CAM censorship. Some have had their careers damaged or destroyed in the process. In the closing chapter, entitled ‘Organising and Fighting Back’ he pulls no punches in relation to how serious he considers the war against CAM, warning against underestimating the dangers and the lengths to which pharmaceutical companies are willing to go to protect their profits, stating ‘we can define our enemy very simply as those who consistently use lies and manipulation to put profits before people and corporations before communities’. I suspect there are those who will consider much of Walker’s writing as the ravings of a conspiracy theorist who sees apparent links everywhere and who demonises the pharmaceutical industry. In the current climate, however, his work is not so easy to dismiss. Welcoming genuine and honest scientific debate within the scientific community, his major objections are to the often undisclosed conflicts of interest which exist in the media, industry, academia and government, and the way in which the damage caused by allopathic medicine is swept under the carpet. A recent example of this was the failure of BMJ editor Fiona Godlee to disclose the journal’s financial relationship with Merck and GlaxoSmithKline (both measles, mumps and rubella (MMR) vaccine manufacturers) in relation to her editorial and commissioning of 3 articles by a journalist about the Andrew Wakefield case. Wakefield, an English research doctor, lost his licence to practice following a suggestion (in a co-authored paper) that further investigations were needed to see if there was a link between the MMR vaccine and gastrointestinal disease/developmental regression [1]. In her response to criticism, Godlee stated ‘We didn’t declare these competing interests because it didn’t occur to us to do so’ [2]. Her subsequent declaration of advertising and sponsorship income from Merck and GlaxoSmithKline still failed to disclose the partnership agreement between the BMJ and Merck providing online education. While it is within the realms of possibility that the failure of the BMJ to disclose their links to companies that benefitted from Wakefield being considered guilty was an innocent (albeit sloppy) mistake by a journal editor, it is this lack of transparency that, unfortunately, creates a need for research such as that found in the handbook. Anyone who has been confused by the constant rejection of a good research paper, who has been refused the opportunity to rebut criticism in the letters page, or whose comments in a public forum were deleted might better understand the reasons by following the money or political links, some of which are outlined there. Although every link to pharmaceutical companies cannot be automatically considered manipulative and some critics of CAM are driven by an