Quackery

Works Progress Administration

Quackery [kwak-uh-ree] is the promotion of unproven or fraudulent medical practices. Random House Dictionary describes a ‘quack’ as a ‘fraudulent or ignorant pretender to medical skill’ or ‘a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan.’ The word ‘quack’ derives from the archaic word ‘quacksalver,’ of Dutch origin, literally meaning ‘hawker of salve.’ In the Middle Ages the word ‘quack’ meant ‘shouting.’ The quacksalvers sold their wares on the market shouting in a loud voice.

‘Health fraud’ is often used as a synonym for quackery, but quackery’s salient characteristic is aggressive promotion (‘quacks quack!’) rather than fraud, greed or misinformation. ‘Pseudo-medicine’ is a term for treatments known to be ineffective, regardless of whether their advocates themselves believe in their effectiveness.

Since there is no exact standard for what constitutes quackery, and how to differentiate it from experimental medicine, protoscience (new fields of inquiry), religious and spiritual beliefs, etc., accusations of quackery are often part of polemics against one party or other. In determining whether a person is committing quackery, the central question is what is acceptable evidence for the efficacy and safety of whatever treatments, cures, regimens, or procedures the alleged quack advocates. Because there is some level of uncertainty with all medical treatments, it is common ethical practice (and in some cases, a legal requirement) for pharmaceutical companies and many medical practitioners to explicitly state the promise, risks, and limitations of a medical choice.

Since it is difficult to distinguish between those who knowingly promote unproven medical therapies and those who are mistaken as to their effectiveness, U.S. courts have ruled in defamation cases that accusing someone of quackery or calling a practitioner a quack is not equivalent to accusing that person of committing medical fraud. To be both quackery and fraud, the quack must know they are misrepresenting the benefits and risks of the medical services offered (instead of, for example, promoting an ineffective product they honestly believe is effective).

In addition to the ethical problems of promising benefits that can not reasonably be expected to occur, quackery also includes the risk that patients may choose to forego treatments that are more likely to help them, in favor of ineffective treatments. Stephen Barrett, who runs the alternative medicine watchdog website, Quackwatch, defines the practice this way: ‘To avoid semantic problems, quackery could be broadly defined as ‘anything involving overpromotion in the field of health.’ This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word ‘fraud’ would be reserved only for situations in which deliberate deception is involved.’

Unproven, usually ineffective, and sometimes dangerous medicines and treatments have been peddled throughout human history. Theatrical performances were sometimes given to enhance the credibility of purported medicines. Grandiose claims were made for what could be humble materials indeed: for example, in the mid-19th century ‘Revalenta Arabica’ was advertised as having extraordinary restorative virtues as an empirical diet for invalids; despite its impressive name and many glowing testimonials it was in truth only ordinary lentil flour, sold to the gullible at many times the true cost.

Even where no fraud was intended, quack remedies often contained no effective ingredients whatsoever. Some remedies contained substances such as opium, alcohol and honey, which would have given symptomatic relief but had no curative properties. The few effective remedies sold by quacks included emetics, laxatives and diuretics. However, some ingredients did have medicinal effects: mercury, silver and arsenic compounds may have helped some infections and infestations; willow bark contained salicylic acid, chemically closely related to aspirin; and the quinine contained in Jesuit’s bark was an effective treatment for malaria and other fevers. However, knowledge of appropriate uses and dosages was limited.

With little understanding of the causes and mechanisms of illnesses, widely marketed ‘cures’ (as opposed to locally produced and locally used remedies), often referred to as patent medicines, first came to prominence during the 17th and 18th centuries in Britain and the British colonies, including those in North America. ‘Daffy’s Elixir’ and ‘Turlington’s Balsam’ were among the first products that used branding (e.g., using highly distinctive containers) and mass marketing to create and maintain markets. A similar process occurred in other countries of Europe around the same time, for example with the marketing of ‘Eau de Cologne’ as a cure-all medicine by Johann Maria Farina and his imitators. Patent medicines often contained alcohol or opium.

The number of internationally marketed quack medicines increased in the later 18th century; the majority of them originated in Britain and were exported throughout the British Empire. By 1830, British parliamentary records list over 1,300 different ‘proprietary medicines,’ the majority of which were ‘quack’ cures by modern standards. In 1909, in an attempt to stop the sale of such medicines, the British Medical Association published ‘Secret Remedies, What They Cost And What They Contain.’ Numerous remedies were tested thoroughly; the preface stated: ‘Of the accuracy of the analytical data there can be no question; the investigation has been carried out with great care by a skilled analytical chemist.’ The book did lead to the end of some of the quack cures, but others survived the book by several decades. For example, Beecham’s Pills (identified as containing only aloes, ginger and soap, but claiming to cure 31 medical conditions) were still on sale in 1997.

British patent medicines started to lose their dominance in the United States when they were denied access to the American market during the American Revolution, and lost further ground for the same reason during the War of 1812. From the early 19th century ‘home-grown’ American brands started to fill the gap, reaching their peak in the years after the American Civil War. British medicines never regained their previous dominance in North America, and the subsequent era of mass marketing of American patent medicines is usually considered to have been a ‘golden age’ of quackery in the United States. This was mirrored by similar growth in marketing of quack medicines elsewhere in the world.

The Dutch Society Against Quackery was established in 1880. Within a short time the Society grew to more than 1,100 members. Initially, quackery mainly consisted of the unauthorized practice of medicine and the peddling of ‘secret remedies.’ By the 1950s, their energy mostly shifted to magnetizers. Since the 1980s the society has fought against so-called alternative medicine. Their primary targets are Chinese acupuncture, homeopathy, manipulative therapy, anthroposophical medicine, and naturopathy.[10]

In the United States, false medicines in this era were often denoted by the slang term snake oil, a reference to sales pitches for the false medicines that claimed exotic ingredients provided the supposed benefits. Those who sold them were called “snake oil salesmen,” and usually sold their medicines with a fervent pitch similar to a fire and brimstone religious sermon. They often accompanied other theatrical and entertainment productions that traveled as a road show from town to town, leaving quickly before the falseness of their medicine was discovered. Not all quacks were restricted to such small-time businesses however, and a number, especially in the United States, became enormously wealthy through national and international sales of their products.

One among many examples is that of William Radam, a German immigrant to the US who, in the 1880s, started to sell his ‘Microbe Killer’ throughout the United States and, soon afterwards, in Britain and throughout the British colonies. His concoction was widely advertized as being able to ‘Cure All Diseases’ and this phrase was even embossed on the glass bottles the medicine was sold in. In fact, Radam’s medicine was a therapeutically useless (and in large quantities actively poisonous) dilute solution of sulfuric acid, colored with a little red wine. Radam’s publicity material, particularly his books, provide an insight into the role that pseudoscience played in the development and marketing of quack medicines towards the end of the 19th century.

Similar advertising claims can be found throughout the 18th, 19th, 20th and 21st centuries. ‘Dr.’ Sibley, an English patent medicine seller of the late 18th and early 19th centuries, even went so far as to claim that his ‘Reanimating Solar Tincture’ would, as the name implies, ‘restore life in the event of sudden death.’ Another English quack, ‘Dr. Solomon’ claimed that his ‘Cordial Balm of Gilead’ cured almost anything, but was particularly effective against all venereal complaints, from gonorrhoea to onanism. Although it was basically just brandy flavored with herbs, it retailed widely at 33 shillings a bottle in the period of the Napoleonic wars, the equivalent of over $100 per bottle today.

Not all patent medicines were without merit. ‘Turlingtons Balsam of Life,’ first marketed in the mid-18th century, did have genuinely beneficial properties. This medicine continued to be sold under the original name into the early 20th century, and can still be found in the British and American Pharmacopoeias as ‘Compound tincture of benzoin.’ It can be argued that for some of these medicines this is an example of the infinite monkey theorem in action.

The end of the road for the quack medicines now considered grossly fraudulent in the nations of North America and Europe came in the early 20th century. 1906 saw the passage into law of the ‘Pure Food and Drug Act’ in the United States. This was the result of decades of campaigning by both government departments and the medical establishment, supported by a number of publishers and journalists (one of the most effective of whom was Samuel Hopkins Adams, whose series ‘The Great American Fraud’ was published in ‘Colliers Weekly’ starting in late 1905). This American Act was followed three years later by similar legislation in Britain, and in other European nations. These laws removed the more outrageously dangerous contents from patent and proprietary medicines, and put limits on blatantly dishonest claims associated with them.

In contemporary culture, ‘Quackery is the promotion of false and unproven health schemes for a profit. It is rooted in the traditions of the marketplace,’ with ‘commercialism overwhelming professionalism in the marketing of alternative medicine. It can be found in any culture and in every medical tradition. Unlike other advertising mediums, rapid advancements in communication through the Internet have opened doors for an unregulated market of quack cures and marketing campaigns rivaling the early 20th century. Most people with an e-mail account have experienced the marketing tactics of spamming—in which modern forms of quackery are touted as miraculous remedies for ‘weight-loss’ and ‘sexual enhancement,’ as well as outlets for unprescribed medicines of unknown quality.

While quackery is often aimed at the aged or chronically ill, it can be aimed at all age groups, including teens, and the FDA has mentioned some areas where potential quackery may be a problem: breast developers, weight loss, steroids and growth hormones, tanning and tanning pills, hair removal and growth, and look-alike drugs. In a 1992 article in the journal ‘Clinical Chemistry,’ then president of The National Council Against Health Fraud, William T. Jarvis, wrote: ‘The U.S. Congress determined quackery to be the most harmful consumer fraud against elderly people. Americans waste $27 billion annually on questionable health care, exceeding the amount spent on biomedical research. Quackery is characterized by the promotion of false and unproven health schemes for profit and does not necessarily involve imposture, fraud, or greed. The real issues in the war against quackery are the principles, including scientific rationale, encoded into consumer protection laws, primarily the U.S. Food, Drug, and Cosmetic Act. More such laws are badly needed. Regulators are failing the public by enforcing laws inadequately, applying double standards, and accrediting pseudomedicine. Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist.’

Zhang Wuben, a quack who posed as skilled in traditional Chinese medicine in the People’s Republic of China, based his operation on representations that raw eggplant and mung beans were a general cure-all. Zhang, who has escaped legal liability as he portrayed himself as a nutritionist, not a doctor, appeared on television in China and authored a best-selling book, ‘Eat Away the Diseases You Get from Eating.’ Zhang, who charged the equivalent of $450 for a 10 minute examination, had a two-year waiting list when he was exposed. Investigations launched after a run on mung beans revealed that contrary to his representations, he did not come from a family of accomplished traditional practitioners and did not have a medical degree from Beijing Medical University. His only education was a brief correspondence course or night school course, completed after he was laid off from a textile factory. Zhang, despite negative publicity on the national level, continues to practice, but has committed himself to finding a cheaper cure-all than mung beans. His clinic, Wuben Hall, adjacent to Beijing National Stadium, was torn down as an illegal structure. Much of Zhang Wuben’s success was due to the efforts of Chinese entrepreneurs, including one government-owned company, who promoted him.

Opponents of quackery have suggested several reasons why quackery is accepted by patients in spite of its lack of effectiveness. Firstly, they point to ignorance: those who perpetuate quackery may do so to take advantage of ignorance about conventional medical treatments versus alternative treatments, or may themselves be ignorant regarding their own claims. Mainstream medicine has produced many remarkable advances, so people may tend to also believe groundless claims.

Next they address the placebo effect: medicines or treatments known to have no pharmacological effect on a disease can still affect a person’s perception of their illness, and this belief in its turn does indeed sometimes have a therapeutic effect, causing the patient’s condition to improve. This is not to say that no real cure of biological illness is effected—though we might describe a placebo effect as being ‘all in the mind,’ we now know that there is a genuine neurobiological basis to this phenomenon. People report reduced pain, increased well-being, improvement, or even total alleviation of symptoms. For some, the presence of a caring practitioner and the dispensation of medicine is curative in itself.

Another issue at play is regression fallacy (ascribing cause where none exists): certain ‘self-limiting conditions,’ such as warts and the common cold, almost always improve, in the latter case in a rather predictable amount of time. A patient may associate the usage of alternative treatments with recovering, when recovery was inevitable.

In addition, many people, for various reasons (including the risk of side effects) have a distrust of conventional medicines (or of the regulating organizations themselves such as the FDA or the major drug corporations). Anti-quackery activists (‘quackbusters’) are accused of being part of a huge conspiracy to suppress unconventional’ and/or ‘natural’ therapies, as well as those who promote them. It is alleged that this conspiracy is backed and funded by the pharmaceutical industry and the established medical care system – represented by the AMA, FDA, ADA, CDC, WHO, etc. – for the purpose of preserving their power and increasing their profits. In the case of chiropractic, the case for a conspiracy was supported by a court decision in an antitrust lawsuit, ‘Wilk v. American Medical Association,’ ruling that the AMA had engaged in an unlawful conspiracy in restraint of trade ‘to contain and eliminate the chiropractic profession.’

Other issues that encourage the use of quack medicine include the fear of side effects: a great variety of pharmaceutical medications can have very distressing side effects, and many people fear surgery and its consequences, so they may opt to shy away from these mainstream treatments. Also cost: nonconventional practitioners can often dispense treatment at a much lower cost. Another factor is desperation: people with a serious or terminal disease, or who have been told by their practitioner that their condition is ‘untreatable,’ may react by seeking out treatment, disregarding the lack of scientific proof for its effectiveness, or even the existence of evidence that the method is ineffective or even dangerous. And pride can also play a role: once a person has endorsed or defended a cure, or invested time and money in it, they may be reluctant to admit its ineffectiveness, and therefore recommend the cure that did not work for them to others.

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