Quackery

William Hogarth's The Inspection, the third canvas in his Marriage à-la-mode (The Visit to the Quack Doctor)

Psychiatrist and author Stephen Barrett of Quackwatch defines quackery "as the promotion of unsubstantiated methods that lack a scientifically plausible rationale" and more broadly as:

Pietro Longhi's The Charlatan (1757)

"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.[1]

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 given by the "quack".[5][6][7]

American pediatrician Paul Offit has proposed four ways in which alternative medicine "becomes quackery":[8]

1. "by recommending against conventional therapies that are helpful."
2. "by promoting potentially harmful therapies without adequate warning."
3. "by draining patients' bank accounts ..."
4. "by promoting magical thinking ..."

Since it is difficult to distinguish between those who knowingly promote unproven medical therapies and those who are mistaken as to their effectiveness, United States 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).

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. Some would have addictive qualities to entice the buyer to return. The few effective remedies sold by quacks included emetics, laxatives and diuretics. Some ingredients did have medicinal effects: mercury, silver and arsenic compounds may have helped some infections and infestations; willow bark contains 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.

The evidence-based medicine community has criticized the infiltration of alternative medicine into mainstream academic medicine, education, and publications, accusing institutions of "diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology."[9][10]

For example, David Gorski criticized Brian M. Berman, founder of the University of Maryland Center for Integrative Medicine, for writing that "There [is] evidence that both real acupuncture and sham acupuncture [are] more effective than no treatment and that acupuncture can be a useful supplement to other forms of conventional therapy for low back pain." He also castigated editors and peer reviewers at the New England Journal of Medicine for allowing it to be published, since it effectively recommended deliberately misleading patients in order to achieve a known placebo effect.[9][11]

The Extraction of the Stone of Madness by Jan Sanders van Hemessen, c. 1550

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.[12] 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, which, while presumably not curing the diseases for which they were sold as a remedy, did make the imbibers feel better and confusedly appreciative of the product.

The number of internationally marketed quack medicines increased in the later 18th century; the majority of them originated in Britain[13] and were exported throughout the British Empire. By 1830, British parliamentary records list over 1,300 different "proprietary medicines",[14] the majority of which were "quack" cures by modern standards.

A Dutch organisation that opposes quackery, Vereniging tegen de Kwakzalverij (VtdK), was founded in 1881, making it the oldest organisation of this kind in the world.[15] It has published its magazine Nederlands Tijdschrift tegen de Kwakzalverij (Dutch Magazine against Quackery) ever since.[16] In these early years the VtdK played a part in the professionalisation of medicine.[17] Its efforts in the public debate helped to make the Netherlands one of the first countries with governmental drug regulation.[18]

Dalby's Carminative, Daffy's Elixir and Turlington's Balsam of Life bottles dating to the late 18th and early 19th centuries. These "typical" patent or quack medicines were marketed in very different, and highly distinctive, bottles. Each brand retained the same basic appearance for more than 100 years.

In 1909, in an attempt to stop the sale of quack medicines, the British Medical Association published Secret Remedies, What They Cost And What They Contain.[19][lower-alpha 1] This publication was originally a series of articles published in the British Medical Journal between 1904 and 1909.[21] The publication was composed of 20 chapters, organising the work by sections according to the ailments the medicines claimed to treat. Each remedy was 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."[19]^: vi The book did lead to the end of some of the quack cures, but some survived the book by several decades. For example, Beecham's Pills, which according to the British Medical Association contained in 1909 only aloes, ginger and soap, but claimed to cure 31 medical conditions,[19]^: 175 were sold until 1998. The failure of the medical establishment to stop quackery was rooted in the difficulty of defining what precisely distinguished real medicine, and in the appeals that quackery held out to consumers.

British patent medicines lost their dominance in the United States when they were denied access to the Thirteen Colonies markets 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.[13][22] 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.

Clark Stanley's Snake Oil

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.

In 1875, the Pacific Medical and Surgical Journal complained:

If Satan has ever succeeded in compressing a greater amount of concentrated mendacity into one set of human bodies above every other description, it is in the advertising quacks. The coolness and deliberation with which they announce the most glaring falsehoods are really appalling. A recent arrival in San Francisco, whose name might indicate that he had his origin in the Pontine marshes of Europe, announces himself as the "Late examining physician of the Massachusetts Infirmary, Boston." This fellow has the impudence to publish that his charge to physicians in their own cases is $5.00! Another genius in Philadelphia, of the bogus diploma breed, who claims to have founded a new system of practice and who calls himself a "Professor," advertises two elixers of his own make, one of which is for "all male diseases" and the other for "all female diseases"! In the list of preparations which this wretch advertises for sale as the result of his own labors and discoveries, is ozone!

— Pacific Medical and Surgical Journal Reprinted in the Boston Medical And Surgical Journal, vol. 91, p. 373

One among many examples is 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 advertised as being able to "cure all diseases",[23] 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, coloured with a little red wine.[22] Radam's publicity material, particularly his books,[23] provide an insight into the role that pseudoscience played in the development and marketing of "quack" medicines towards the end of the 19th century.

Cartoon depicting a quack doctor using hypnotism (1780, France)

Similar advertising claims[24] to those of Radam 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 gonorrhea to onanism. Although it was basically just brandy flavoured with herbs, the price of a bottle was a half guinea (£sd system) in 1800,[25]^: 155[lower-alpha 2] equivalent to over £38 ($52) in 2014.[20]

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". In these cases, the treatments likely lacked empirical support when they were introduced to the market, and their benefits were simply a convenient coincidence discovered after the fact.

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. 21 February 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 was Samuel Hopkins Adams, who wrote "The Great American Fraud" series in Collier's in 1905).[26] This American Act was followed three years later by similar legislation in Britain and in other European nations. Between them, these laws began to remove the more outrageously dangerous contents from patent and proprietary medicines, and to force quack medicine proprietors to stop making some of their more blatantly dishonest claims. The Act, however, left advertising and claims of effectiveness unregulated as the Supreme Court interpreted it to mean only that ingredients on labels had to be accurate. Language in the 1912 Sherley Amendment, meant to close this loophole, was limited to regulating claims that were false and fraudulent, creating the need to show intent. Throughout the early 20th century, the American Medical Association collected material on medical quackery, and one of their members and medical editors in particular, Arthur J. Cramp, devoted his career to criticizing such products. The AMA's Department of Investigation closed in 1975, but their only archive open to non-members remains, the American Medical Association Health Fraud and Alternative Medicine Collection.[27]

"Medical quackery and promotion of nostrums and worthless drugs were among the most prominent abuses that led to formal self-regulation in business and, in turn, to the creation of the" Better Business Bureau.[28]^: 1217

Electro-metabograph machine on display in the "Quackery Hall of Fame" in the Science Museum of Minnesota, St. Paul, Minnesota, US

"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".[29] Quackery is most often used to denote the peddling of the "cure-alls" described above. Quackery continues even today; 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 medicines of unknown quality.

United States

"Tho-radia powder" box, an example of radioactive quackery

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[60] 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 1992, the president of The National Council Against Health Fraud, William T. Jarvis, wrote in Clinical Chemistry that:

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.[61]

Scientology's E-Meter, a quack device for measuring 'engrams'[62][63]

For those in the practice of any medicine, to allege quackery is to level a serious objection to a particular form of practice. Most developed countries have a governmental agency, such as the Food and Drug Administration (FDA) in the US, whose purpose is to monitor and regulate the safety of medications as well as the claims made by the manufacturers of new and existing products, including drugs and nutritional supplements or vitamins. The Federal Trade Commission (FTC) participates in some of these efforts.[64] To better address less regulated products, in 2000, US President Clinton signed Executive Order 13147 that created the White House Commission on Complementary and Alternative Medicine. In 2002, the commission's final report made several suggestions regarding education, research, implementation, and reimbursement as ways to evaluate the risks and benefits of each.[65] As a direct result, more public dollars have been allocated for research into some of these methods.

The 1929 Revigator (sometimes misspelled Revigorator) was a pottery crock lined with radioactive ore that emitted radon.

Individuals and non-governmental agencies are active in attempts to expose quackery. According to John C. Norcross et al. less is consensus about ineffective "compared to effective procedures" but identifying both "pseudoscientific, unvalidated, or 'quack' psychotherapies" and "assessment measures of questionable validity on psycho-metric grounds" was pursued by various authors.[66]^: 515 The evidence-based practice (EBP) movement in mental health emphasizes the consensus in psychology that psychological practice should rely on empirical research.[66]^{: 515, 522} There are also "anti-quackery" websites, such as Quackwatch, that help consumers evaluate claims.[67] Quackwatch's information is relevant to both consumers and medical professionals.[68]

The pee looker (Piskijker), David Teniers the Younger (1660)

A quack selling cards with a verse from the Quran which is supposed to protect the wearer from snakebites. Tabant, Aït Bouguemez valley, Central Morocco (2009).

The Quack Doctor, Jan Victors (c. 1635)

There have been several suggested reasons why quackery is accepted by patients in spite of its lack of effectiveness:

• 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.
• 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."[72] 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.
• Regression fallacy: Lack of understanding that health conditions change with no treatment and attributing changes in ailments to a given therapy.[73]
• Confirmation bias: The tendency to search for, interpret, or prioritize information in a way that confirms one's beliefs or hypotheses. It is a type of cognitive bias and a systematic error of inductive reasoning.
• Distrust of conventional medicine: Many people, for various reasons, have a distrust of conventional medicine, or of the regulating organizations such as the FDA, or the major drug corporations. For example, "CAM may represent a response to disenfranchisement [discrimination] in conventional medical settings and resulting distrust".[74]
• Conspiracy theories: Anti-quackery activists ("quackbusters") are often falsely 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. This idea is often held by people with antiscience views.
• 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.
• Cost: There are some people who simply cannot afford conventional treatment, and seek out a cheaper alternative. Nonconventional practitioners can often dispense treatment at a much lower cost. This is compounded by reduced access to healthcare.
• 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. Despair may be exacerbated by the lack of palliative non-curative end-of-life care. Between 2012 and 2018 appeals on UK crowdfunding sites for cancer treatment with an alternative health element have raised £8 million. This is described as "a new and lucrative revenue stream for cranks, charlatans, and conmen who prey on the vulnerable."[75]
• Pride: Once people have endorsed or defended a cure, or invested time and money in it, they may be reluctant or embarrassed to admit its ineffectiveness and therefore recommend a treatment that does not work.
• Fraud: Some practitioners, fully aware of the ineffectiveness of their medicine, may intentionally produce fraudulent scientific studies and medical test results, thereby confusing any potential consumers as to the effectiveness of the medical treatment.

A form of quackery common in the 21st Century is laypeople using online sites, such as WebMD to find diagnoses. The best way to avoid falling victim to this is to make an appointment with a certified physician at a local hospital. Writing in The New York Times Magazine, Virginia Heffernan criticized WebMD for biasing readers toward drugs that are sold by the site's pharmaceutical sponsors, even when they are unnecessary. She wrote that WebMD "has become permeated with pseudomedicine and subtle misinformation."[109]

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Look up quackery in Wiktionary, the free dictionary.

• Chisholm, Hugh, ed. (1911). "Quack" . Encyclopædia Britannica (11th ed.). Cambridge University Press.
• Quackery at Curlie
• Quackwatch
• Medline Plus – entry on Health Fraud
• 'Miracle' Health Claims: Add a Dose of Skepticism Article at the Federal Trade Commission