For the intriguing details of this SNAFU, Dynamic Chiropractic has called on Howard Wolinsky, noted Chicago Sun-Times reporter and long-time AMA investigator, to relate his findings.
Mr. Wolinsky co-authored the 1994 expose on "the unhealthy politics of the American Medical Association," The Serpent on the Staff. The book is a perfect backdrop for this latest episode.
The Serpent on the Staff is still in stock at a number of chiropractic college bookstores, but if you'd like a signed copy, it's available for $17 postage paid from Howard Wolinsky at
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On August 12, 1997, Dr. P. John Seward, executive vice president of the American Medical Association, left his downtown Chicago office and attended a large meeting at McCormick Place. It wasn't the scientific meeting of the American College of Surgeons or the American Academy of Family Physicians. It was the National Hardware Show, a huge gathering of the people who sell the nuts and bolts and appliances that help us keep hearth and home together.
Seward, former chairman of the AMA Board of Trustees, who has been in the chief executive's role for about a year, didn't have science on his mind. He was attending the meeting wearing a business hat to announce an exclusive, five-year contract with Sunbeam, the Del Ray Beach, Florida-based manufacturer of personal health products such as blood-pressure monitors, heating pads, thermometers and small appliances. The two organizations were making public a trademark licensing agreement they had signed on Aug. 5. (Sunbeam's stock closed that day at $39 15/16, up 5/16.)
Seward stepped up to the podium: "We're glad that you could join us here for what is a truly significant day and landmark occasion for the American Medical Association." He said the "unprecedented alliance" with Sunbeam would allow the AMA as "the world's largest producer of medical information" to make consumer information available to even more people through Sunbeam's Health@Home product line. The products also would carry the AMA's serpent-on-the-staff logo.
At the moment, with record reserves, the AMA wasn't hurting for cash. But the millions it could rake in with the Sunbeam deal were attractive in the face of stagnant, if not declining, membership figures. The AMA now counts 40 percent or fewer of American medical doctors as members. Money from the exclusive Sunbeam deal could be used to fund the AMA's public health efforts, such as anti-smoking and anti-violence campaigns, as well as its support for medical education and research. That way the AMA could build its image without dipping into its own revenue streams from membership or drug advertising in its journals.
Seward said: "In Sunbeam, we have found a business that is as serious about maintaining America's health and well-being as we are." He then turned to Al Dunlap, Sunbeam's chairman and chief executive and also one of the best known and feisty of the titans of American business.
Albert J. Dunlap gained his notoriety from his no-nonsense approach to business. His proclivity to improve the bottom line through mass layoffs earned him the moniker "Chainsaw Al." However, the West Point graduate prefers "Rambo in Pinstripes."
Last year, he cut Sunbeam's 12,000 work force in half in one of the largest "downsizings" in the history of American business. Prior to that, at Scott Paper Co., he wiped out 70 percent of upper management and eliminated more than 35 percent of the 11,200 jobs on the payroll. He sold off other assets, cutting 6,000 jobs. Two years after he arrived, Scott's value had increased by $6.5 billion.
Among his cost-cutting secrets is cutting out perks, such as trade association memberships. "They don't get membership money out of my companies," he said in his best-seller, "Mean Business : How I Save Bad Companies and Make Good Companies Great." "What does any of this (trade associations) do to improve the bottom line?"
But Dunlap was in Chicago to make friends with the world's largest medical trade association. He expected that the AMA deal would sell a lot of products as the corporation traded on the good will and public respect -- deserved or not -- that goes with the AMA's name.
He also anticipated that the AMA relationship would be good for Sunbeam shareholders, with at least a 20 percent boost in the value of Sunbeam stock.
Dunlap said: "I expect that this alliance will further enhance our strong competitive position in the marketplace through expanding our current distribution and gaining new distribution." A beaming Dunlap and somewhat hesitant-looking Seward held up a Sunbeam product as Chainsaw Al put an arm around the AMA chief. The Associated Press shot the twosome and dispatched the photo around the country.
Sunbeam proposed and had available at the press conference packaging mock-ups that displayed the following statement: "The American Medical Association and Sunbeam have joined together to bring you products specially designed for healthier living." The statement was bracketed at the top by Sunbeam's name and logo and at the bottom by the AMA's name and seal. That day Sunbeam's stock closed at $39, down 1/16.
The AMA-Sunbeam honeymoon wasn't destined to last long. A chain of events was set into motion that shook the AMA at its very foundations: Criticism from MDs and ethicists erupted; an effort by the AMA to wriggle out of the deal; a suit by Sunbeam to recover $20 million in estimated losses; exposes in the Chicago Sun-Times revealing other questionable AMA business deals; an emergency meeting of the AMA Board that led to the firing of three top AMA executives; and plans for the usual blue-ribbon committees to prevent a recurrence and anger from the AMA's grass-roots. There also were rumblings that the AMA was paralyzed and perhaps beginning a potentially fatal meltdown.
After word got out, the AMA immediately caught heat for product endorsements. Dr. Quentin Young, president-elect of the American Public Health Association, said in the Aug. 25 edition of Time: "The AMA is cashing in on its debilitated reputation as a guardian of American health and becoming straightforward feather merchants."
Dr. Sidney Wolfe, executive director of the Public Citizen Health Research Group, described the deal as "a lunatic idea" and called on the AMA to "kill the thing." Consumers Union pointed out that Sunbeam's blood-pressure monitors were not the highest ranked among those it had tested. (The AMA itself had no plans to test the products the way Consumers Union or even the American Dental Association puts products through their paces.)
Ironically, in the Those-Who-Forget-History-Are-Condemned-To-Repeat-It Department, the AMA from 1930 until 1955 had a Seal of Acceptance program instituted by the famous/infamous editor of the Journal of the AMA, Dr. Morris Fishbein. The AMA Board in 1955 dropped the program because of fears about personal injury lawsuits involving products with their seal.)
The New York Times in an Aug. 14 editorial headline, "The AMA's Appliance Sale," said the deal "reeks of conflict of interest" and "casts suspicion on the AMA's credibility." The Times called on the AMA to evaluate the effectiveness of health products, instead of trying to collect lucrative royalties under an exclusive arrangement with a single manufacturer. "The physicians' word descends to that of any other celebrity huckster," said the Times.
The Times concluded: "Physicians rarely pass up an opportunity to bemoan the corrosive impact of commercialized medicine on the sacred bond between doctor and patient. These sanctimonious pronouncements would sound more convincing if the AMA had not itself been so brazenly self-serving."
Dr. Thomas Reardon, chairman of the AMA's Board of Trustees, claimed he first learned of the deal in the New York Times editorial on August 14th (nine days after the deal was signed and two days after it was announced). But Larry Jellen, the AMA marketing vice president, told the Times that the Board had approved the deal. This was just the beginning of confusion and contradictions.
It is clear, however, that the AMA Board wanted out.
On Aug. 21, the AMA formally requested Sunbeam to release it from the contract. "We did make errors of judgment and errors of process, and, on top of that, we got a second opinion from the American people," said AMA spokesman Lew Crampton. A contrite AMA said "any mistakes that were made were our (AMA's) own."
But the AMA, known for its own version of hardball in Congress, now was going mano a mano against a legendary hard ass of American business, Chainsaw Al.
Dunlap said: "We have a contract with the AMA, and we expect them to honor it as well. If they are willing to meet with us to discuss any issues that concern them -- without putting preconditions on the results of such a meeting -- we continue to be willing to meet with them. If not then we will not hesitate to take all necessary actions to ensure that the rights of Sunbeam and its shareholders continue to be protected."
On Aug. 22, when the news of the falling out hit, Sunbeam closed at $43 9/16, up 9/16 on the day and up more than $3 a share since the AMA deal had been announced. Sunbeam, which may be best known for its grills, toasters and other small appliances, was now getting attention for its health products.
The AMA still had its fingers crossed that Sunbeam would go away. Two top AMA executives were heard on an elevator a little over a week later discussing how attention might be diverted from the AMA and Sunbeam deal by the death of Diana, Princess of Wales, and the Labor Day weekend.
(The AMA even sent out a statement regarding the Princess. In an amazing stretch for an organization that often doesn't respond directly to its own critics, the AMA, through President Percy Wootton, said: "Although we never worked with Princess Diana directly, the AMA is nevertheless proud of our mutual commitment to the campaign for a worldwide ban on anti-personnel land mines. The Princess' hard work as an advocate for land mine victims was the latest and, sadly, the last entry on her distinguished list of international public health causes that included AIDS and cancer. As the world mourns this stunning loss, the AMA urges physicians everywhere to remember Princess Diana as a woman of courage, compassion and grace; and for her inspirational commitment to the ill and injured that is, likewise, medicine's resolve." What do you suppose would be the AMA's response to the Royals' partiality to homeopathy? (Editor's note: Not to mention Diana being "Royal Patron" of the Anglo-European Chiropractic College.)
The AMA Board during a Sept. 4-6 meeting at McDonald's U, the hamburger company's campus in Oak Brook, Ill., outside Chicago, ordered General Counsel Kirk B. Johnson to prepare a report on the Sunbeam episode. Johnson called in his old law firm and long-time outside AMA counsel, Sidley & Austin. (Both Johnson and Sidley & Austin should be familiar to students of the Wilk vs. AMA anti-trust case.)
Negotiations between the AMA and Sunbeam were going nowhere. The courts were becoming the only resort. It was to be Chainsaw vs. Sawbones.
On Sept. 8, Sunbeam fired a shot across the AMA bow, filing suit in U.S. District Court in Chicago for breach of contract and claiming damages in excess of $20 million.
Crain's Chicago Business noted that Sunbeam's damages "would wipe out" the AMA's 1996 net earnings of $14.4 million from $220.7 million in operating revenues. But Sunbeam General Counsel David Fannin said $20 million "is the lowest amount we would want."
The suit also noted that the AMA's efforts to back out had "diminished the value of the rights secured by Sunbeam" because of the AMA's claim that the relationship was "inconsistent with AMA's reputation and high standards, and with the relationship of trust and confidence that currently exists between patients and AMA." In other words, Sunbeam was being painted as not being "worthy" of a relationship with the AMA.
Dunlap said: "If the AMA is to stand for integrity and honoring commitments, then it must honor its contract with Sunbeam." Reardon again said that the Sunbeam contract, signed by Kenneth E. Monroe, AMA's chief operating officer, and affixed with the seal of the AMA legal department, had never been seen let alone been approved by the AMA Board. Sunbeam's stock closed down at $45.
As the AMA was still licking its wounds, the Chicago Sun-Times ran a series of articles by Robert Manor and myself revealing new wrinkles on the Sunbeam deal, and that also exposed some other questionable deals involving the nonprofit AMA and corporate America.
Some high-level AMA Board members claim a vague awareness that the organization was dealing with Sunbeam, but stress that the AMA Board had never reviewed or approved the multi-million dollar Sunbeam deal.
However, in an article on Sept. 15, the Sun-Times revealed the internal memo that had been mailed to AMA Board members just before their June 1997 meeting. Some have described this memo as "the smoking gun".
The memo states: "Another company currently under consideration for a partnership arrangement is Sunbeam. This arrangement would be co-branding a product line called Health@Home, which includes health-related products such as scales, heating pads and humidifiers. Under this type of arrangement, the AMA would provide health information related to the products for either package inserts or point of sale dissemination. We hope to bring this agreement to completion within the next few months."
So did the AMA Board know about the Sunbeam deal? If they read their memos, they did.
One high-level executive characterized the information on Sunbeam as matter of a routine briefing, rather than a "cover-your-ass memo." The memo said that the Sunbeam deal was on track."
The Board didn't call off the salesmen. Furthermore, past members of the AMA Board said they routinely shot down such proposals.
The memo also mentions plans for Chevrolet to buy AMA/First Aid Only first-aid kits and to send them to purchasers of 1998 Lumina models. "The relationship with First Aid Only is an example of co-branding, that is, both the AMA's name and the company's name appear on the product. In addition to First Aid Only, (a Vancouver, Wash.-based, first-aid kit maker), we continue to pursue opportunities to co-brand other manufacturers' products," the memo states.
Co-branded AMA products had been available since February at Target, American Drug, Cosco, K-Mart and Wal Mart stores. The business executives who wrote the memo stress that the value of these programs to gain the AMA visibility among doctors and patients, to generate non-dues revenue for special programs and to promote the betterment of the public health through appropriate products.
"Market research indicates the item's credibility is enhanced in the public's view when the AMA's name is added," the memo notes.
The Sun-Times also reported on other deals that had been at various points negotiated with such corporate giants as 3M, Hoffmann-La Roche and Procter & Gamble. Through a catalog, Tools for Healthy Living, the AMA sold products, such as vibrators, gelatin molds shaped like human brains, and a self-help tape for better sex. The catalog, which some delegates at the AMA's annual meeting in June had questioned as too commercial and inappropriate for a professional medical association, brings in about $8 million a year for the AMA.
Clearly, the AMA was hardly the babes in the woods when it came to retailing that it might have outsiders believe. Meanwhile, Crain's Chicago Business on Sept. 15 and the Chicago Tribune on Sept. 17 speculated about which AMA executive's heads were going to roll.
On Sept. 15, under the headline "AMA's investigation targets top executives," Crain's Chicago Business suggested that "reprisals" could be taken against any AMA staffers from the marketing executives on up to Monroe and Seward.
Two days later, under the headline, "Sunbeam deal may cost jobs at AMA," the Chicago Tribune continued the speculation on where the ax would fall in the aftermath of Seward's folly and the Monroe doctrine. The Tribune read, "Sources said several top executives may be asked to resign."
Dr. Raymond Scalettar, former AMA Board chairman, said: "We need to know in what direction is this organization heading? Are these activities truly in the interest of the public health. Or are they in the financial interest of the AMA?" The Tribune also noted that an emergency meeting of the AMA board had been scheduled for the next day.
Crain's quoted Reardon as stressing how the investigation would not be a whitewash and how Johnson, who headed the investigation of the Sunbeam deal, "had not been personally involved" in the deal even though his department had signed off on it. In an ironic way, the comments foreshadowed an investigation under way at the Chicago Sun-Times.
Manor and I were working on a story regarding a series of other deals involving Kirk Johnson, the AMA's general counsel who also serves as its top policy vice president, his wife Wendy Borow Johnson, a former AMA executive, the AMA and several major corporations. We were exploring Johnson's involvement as the point man on business deals involving his spouse, and also pointing out how he was the executive charged with investigating the Sunbeam deal.
Johnson and the AMA staff did everything they could to try to persuade us not to run the story on Sept. 18 because they did not want the AMA Board to know about it. Johnson said he couldn't speak for himself because only the board chairman Thomas Reardon would have any credibility. He also urged us to talk to his wife.
But he said neither Reardon nor Borow Johnson was reachable until the next day. He said he didn't know if his wife had a pager. He also told me that he was very "vulnerable," depending on what our story said.
Steve Duke, Sun-Times business editor, called the AMA's bluff and said in any case we would be going with the story. Suddenly, an AMA statement appeared and Reardon was available to be interviewed. The AMA also produced a disclosure statement in which Johnson had told of his wife's involvement.
The next day, Sept. 18, we broke the front-page story: "New AMA controversy: Top exec, wife in other deals."
The story described how Johnson in 1996 worked with his wife Wendy Borow Johnson, who had been president of the AMA's failed venture American Medical Television, a joint project with CNBC and well-known TV doctor Art Ulene to reel in some big-name clients for a sponsorship program with the U.S. Olympic Committee. Johnson, the attorney, said he was proud of being a salesman on behalf of the AMA to promote what the AMA called its fitness program that would have included consumer literature, cable TV programs, and segments on NBC's "Today" show to promote exercise.
Vitamin and pharmaceutical maker Hoffmann-LaRoche Inc. had coughed up $2.5 million to join the program. Procter & Gamble, consumer product maker, had sent in $800,000. The AMA also was trying to involve such companies as McDonalds, M&M/Mars, LA Gear and Neutrogena soap.
Reardon, the AMA Board chairman, said, high-level AMA officials had approved the involvement of the general counsel and his wife. He said steps had been taken to ensure that Johnson did not handle any money. EVP Seward, COO Monroe and Dr. Nancy Dickey, then AMA Board chairman and now president-elect of the AMA, had all been informed of Johnson's potential conflicts.
Reardon said Kirk Johnson was not supposed to play any role in the budget process for the program. Wendy Borow Johnson would not be paid directly by the AMA, but with corporate sponsor funds through her company.
An internal AMA memo from April 25, 1996 revealed: "Congratulations to Wendy Borow Johnson and Kirk Johnson for getting a contract from Hoffmann-LaRoche for $2.5 million. (800,000 to Wendy; 1.6 million to AMA; 100,000 to unknown." The AMA has yet to explain the $100,000 for "unknown," though presumably Borow Johnson's firm, a subsidiary of the giant medical marketing firm, Medicus Group International, would have been the recipient of most of that money.
In joining the AMA program, Hoffmann-LaRoche explained in an internal memo that the AMA "is willing to share its brand equity with developing sponsors."
Ultimately, the deals fell apart. The USOC, for unexplained reasons, dropped out. Hoffmann-LaRoche asked for and received its money back. P&G's $800,000 check sat uncashed in a drawer at the AMA for several months before it was finally returned.
The wheeling and dealing did not sit well with some AMA affiliates. Is disclosure of a conflict of interest enough? Is it enough, if the Board knows?
Robert D. Johnson (no relation to Kirk), chief executive of the South Dakota Medical Association, which had been raising concerns about the AMA's business dealings, said, "Disclosure would be terribly important for Kirk. If he did disclose it, and the Board had all the facts and authorized it, then I guess you can't hold Kirk responsible. But I think a number of AMA members in our state would question the appropriateness of the deal."
That story hit the AMA Board as it went into a half-day closed session on Sept. 18. AMA officials looked grim as they came out of the meeting room. They had escorts as they went to the bathroom. At one point a local TV reporter grabbed Seward as he went by. The doctor spun around and suddenly found himself in an ambush interview. After an AMA PR man phoned in a complaint, the TV crew was pulled. As the day dragged on, AMA Board members cancelled their plane reservations and made hotel reservations to hash things out.
Nothing happened officially that day. The Board heard oral reports and received a written report on the Sunbeam deal.
According to a memo later written by Seward that describes the meeting, Board members were told how the AMA marketing department introduced the Sunbeam deal. (In contrast, the Olympic Committee/fitness campaign was started by Johnson through a public health committee he chaired.)
The Sunbeam agreement bypassed the required review by the New Business Development Committee, made of several AMA vice presidents and chaired by James F. Rappel, the group vice president for business. "The Board must approve all extraordinary matters and any departure from AMA policy. The Sunbeam arrangement was never presented to the Board," according to Seward.
He also acknowledged the memo describing the Sunbeam proposal. But he noted that the memo "did not contain pertinent details, i.e., that the program was exclusive...that the AMA's logo would go on the product packaging or that an endorsement would be express or implied, that a large number of products would be covered by the program, or that the AMA would be compensated through royalties based on gross sales."
Seward stressed that the memo mentioning Sunbeam was "an information-only item, and it was not presented or discussed at the Board meeting."
Seward also noted that the contract had been drafted and reviewed by attorneys in the corporate law division, of the office of the general counsel. That's Johnson's staff.
"They recognized the Sunbeam transaction as an endorsement arrangement and advised that the Board must be informed. Prior to signing off on the contract, the attorneys were led to believe, incorrectly, that the Board had approved the arrangement, and they did not inform the general counsel of the transaction until after it had been announced," Seward said.
Seward conceded that Rappel had briefed him about the deal. There also had been a recommendation to postpone movement on the Sunbeam deal in May while a new staff task force, known as the Brand Equity Group, hashed out standards on using the AMA name. However, Monroe, COO and deputy EVP at the AMA, chose to keep the Sunbeam deal on track.
Following two executive sessions and a meeting with only outside counsel, the Board concluded that "there was a systemic breakdown of the AMA's internal systems," and that top staffers were responsible to varying degrees. Seward "accepted his responsibility and is being held accountable," according to the report signed by Seward himself.
The Board decided on some corrective actions, including forcing the resignations of top business executives, halting any new transactions involving the AMA name, and setting up a committee on inside and outside experts to establish policies for corporate affiliations for approval by the House of Delegates, the ultimate policy-setting body that meets twice a year.
The bloodletting was postponed to the next day. The Board forced the resignations of three top officials: Monroe, the COO and the highest ranking nonphysicians in the AMA, Rappel, group vice president for business, and Jellen, vice president of marketing and chief architect of the Sunbeam deal.
It was the biggest shakeup since 1989-90 when revelations of financial irregularities at the AMA by the Sun-Times led to the resignations of Dr. James H. Sammons, AMA EVP, and two other top officials.
After the dust settled, Seward and Johnson were still standing, but the rumor mill at the AMA had them gone soon depending on what happened at the AMA's mid-year meeting.
During a briefing at the Sun-Times, AMA Board Chairman Reardon was asked why Seward was not fired for the Sunbeam episode. He said: "After our investigation, after our analysis, we looked at all the facts, we felt that Dr. Seward did not have enough information. Neither the Board nor Dr. Seward had any reason to ask, 'Is this an endorsement?' We haven't done one for 40 years." (This in contrast to the announcement made by Seward and Dunlap at the National Hardware Show.)
Physicians' Weekly and Modern Healthcare both reported that Seward's wings had been clipped. Physician's Weekly said Seward was "considered on "probation." Modern Healthcare said Seward "may not have escaped the hangman just yet. The AMA's Board effectively put Seward, 58, on probation."
Reardon, however, denied Seward was on probation. He said the Board was reviewing Seward's post-Sunbeam behavior, but "the word probation was not used."
Whatever the right word was, Seward, who was a family physician and coroner for Winnebago County, Ill., before he took on the AMA job, was in trouble and one more slip would likely be his last.
Meanwhile, he served as a human shield for a nervous Board of Trustees who potentially faced the wrath of the delegates at the AMA's interim meeting in Dallas starting on Dec. 7, Pearl Harbor Day.
According to the Oct. 6 edition of American Medical News, the AMA weekly newspaper, Johnson's activities also had been somewhat curtailed: "As for Kirk Johnson's ability to conduct an internal probe, Dr. Reardon was confident he could do the job, but because questions were raised, outside counsel assisted in the investigation."
In addition to the firings, the AMA announced plans to have an internal review of all its business dealings and to invite a panel of distinguished ethicists to help the AMA develop a "gold standard" for balancing business ethics and medical ethics. Its own AMA Ethics Institute, which was organized to investigate the big medical issues of the day, was drafted help police the AMA itself.
Modern Healthcare magazine said in a biting Oct. 6 editorial on the AMA's plans for a gold standard: "The truth is no one needs rules, regulations or guidelines from the AMA on ethics. That would be like Marv Albert writing guidelines for dating etiquette."
The editors also compared the AMA's investigation to Capt. Louis Renault's police work in the movie, "Casablanca." "When the group's reputation has been shot, the Board rounds up and dismisses the obvious, if not usual suspects. The investigation effort to date is not very convincing."
"The evidence suggests there is a galaxy-size ethical blind spot at the AMA, one that merits an in-depth, third-party investigation of the top echelons of the organization, including the Board of Trustees." In fact, the grass roots were starting to call for just that.
(Footnote: On Oct. 8, Sunbeam's stock reached its 52-week high of $47 5/8, the 20 percent boost in price Chainsaw Al had set as his target when the AMA deal was announced.)
Oct. 14, the AMA answered the Sunbeam suit, contending that despite what the COO Monroe had done that the Board had never approved the contract and that it would be unethical for the AMA and against its tradition to be part of an endorsement deal. The AMA argued that Monroe had no right to sign the deal.
Furthermore, it claimed that Sunbeam should have known better: "Although the agreement was executed by the AMA's then-COO, Sunbeam knew or should have known that the agreement constituted an extraordinary and unprecedented transaction that required the approval of the AMA's Board of Trustees. It said the Sunbeam deal was unenforceable and asked the federal court to rescind the contract."
It was legal chutzpa at its best since the CEO Dr. Seward himself described the deal as a landmark. Was the AMA trying to persuade the federal court that devil Chainsaw Al made them do it?
Meanwhile, the AMA natives at the grass roots were restless.
Resolutions calling for further interventions, including independent investigation of the Board, were making the rounds in September and early October at the Minnesota Medical Association, Chicago Medical Society, the Nebraska Medical Association, and the South Dakota State Medical Association. Many others were expected as the AMA House of Delegate's mid-year meeting.
Dr. Ann Marie Dunlap (no relation to Chainsaw Al), an officer of a branch of the Chicago Medical Society, said in the Oct. 6 edition of the American Medical News, "Firing three people is quite remarkable because we have reason to believe the fiduciary responsibility was with the Board. Many of us are ready to ask for their impeachment."
Howard Wolinsky
Chicago, Illinois
Howard Wolinsky is the Chicago Sun-Times medical writer who covered the historic Wilk, et al., v the AMA, et al., case and authored two detailed books on the subject: The Serpent and the Staff: The Unhealthy Politics of the American Medical Association (1994); and Contain and Eliminate: The AMA's Conspiracy to Destroy Chiropractic (2021).