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Pietro Longhi:
The Charlatan, 1757Quackery is a derogatory term used to
describe 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 (spelled kwakzalver in
contemporary Dutch), meaning "boaster who applies a
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 this use can be problematic, since quackery can
exist without fraud, a word which implies deliberate
deception.
Definition
Since there is no exact standard for what constitutes
quackery, and how to differentiate it from experimental
medicine, protoscience, religious and spiritual beliefs,
etc., accusations of quackery are often part of polemics
against one party or other, and sometimes in polemic
exchanges.
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 — in order to be both a quack and a fraud, the
quack has to know that he/she is misrepresenting the
benefits and risks of the medical services offered
(instead of, for example, promoting an ineffective
product which the quack honestly believes is effective).
Stephen Barrett, who runs the alternative medicine
watchdog website, Quackwatch, a consumer information
organization with several websites dedicated to exposing
quackery, 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.
The quacksalver
Unproven, usually ineffective, and sometimes dangerous
medicines and treatments have been peddled throughout
human history. Theatrical performances were sometimes
mixed with purported medicine to enhance credibility.
Quack medicines often had no effective ingredients,
while others, such as morphine and the like, made the
patient feel better without curative properties. Some
did have medicinal effects; for example mercury, silver
and arsenic compounds may have helped some infections,
willow bark contained salicylic acid (substance very
similar to aspirin), and quinine from bark was an
effective treatment for malaria. Knowledge of
appropriate use and dosage was poor. Revalenta Arabica
was sold in the 18th century as an empirical diet for
invalids, extraordinary restorative virtues being
attributed to it.
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.
The publication was composed of 20 chapters, organising
the work into sections representing the different
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.” 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
(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.
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 which used
claims that their exotic ingredients were responsible
for the supposed results or benefits. Those who sold
them were called "snake oil peddlers", 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
travelled as a road show from town to town, leaving
quickly before the falseness of their medicine could be
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 USA 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" (W.
Radam, 1890) 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. Radam's
publicity material, particularly his books (see for
example Radam, 1890), provide an insight into the role
that pseudo-science played in the development and
marketing of "quack" medicines towards the end of the
19th century.
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.
February 21, 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. 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.
Quackery 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". Considered by many an archaic term, 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 1900s.
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.
Presence and acceptence
Opponents of quackery have suggested several 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.
¦The placebo effect:
Medicines or treatments known to have no pharmacological
effect on a disease can still affect a person's
subjective 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.
The regression fallacy:
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.
Distrust of conventional medicine:
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 Food and Drug Administration (FDA) or the major drug
corporations).
Conspiracy theories:
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, ruling
that the AMA had engaged in an unlawful conspiracy in
restraint of trade "to contain and eliminate the
chiropractic profession."
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.
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.
Pride:
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.
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.
Notable historical persons accused of quackery.
Thomas Allinson (1858–1918), founder of naturopathy.
His views often brought him into conflict with the Royal
College of Physicians of Edinburgh and the General
Medical Council, particularly his opposition to doctors'
frequent use of drugs, his opposition to vaccination and
his self promotion in the press.His views and
publication of them led to him being labeled a quack and
being struck off by the General Medical Council for
infamous conduct in a professional respect.
Lovisa Åhrberg (1803–1866), the first Swedish female
doctor.
Årberg was met with strong resistance from male doctors
and was accused of quackery. During the formal
examination she was acquitted of all charges and allowed
to practice medicine in Stockholm even though it was
forbidden for women in the 1820s. She later received a
medal for her work.
Johanna Brandt (1876–1964), a South African naturopath
who advocated the "Grape Cure" as a cure for cancer.
Hulda Regehr Clark (1928–2009), was a controversial
naturopath, author, and practitioner of alternative
medicine who claimed to be able to cure all diseases and
advocated methods that have no scientific validity.
Samuel Hahnemann (1755–1843), founder of homeopathy.
Hahnemann believed that all diseases were caused by "miasms",
which he defined as irregularities in the patient's
vital force.He also said that illnesses could be treated
by substances that in a healthy person produced similar
symptoms to the illness, in extremely low
concentrations, with the therapeutic effect increasing
with dilution and repeated shaking.
Lawrence B. Hamlin (in 1916), was fined under the 1906
Pure Food and Drug Act for advertising that his Wizard
Oil could kill cancer.
L. Ron Hubbard (1911–1986), was the founder of the
Church of Scientology. He was an American science
fiction writer, former United States Navy officer, and
creator of Dianetics.
John Harvey Kellogg (1852–1943), was a medical doctor in
Battle Creek, Michigan, USA who ran a sanitarium using
holistic methods, with a particular focus on nutrition,
enemas and exercise. Kellogg was an advocate of
vegetarianism, and is best known for the invention of
the corn flake breakfast cereal with his brother, Will
Keith Kellogg.
D.D. Palmer (1845–1913), was a grocery store owner that
claimed to have healed a janitor of deafness after
adjusting the alignment of his back. He founded the
field of chiropractic based on the principle that all
disease and ailments could be fixed by adjusting the
alignment of someone's back. His hypothesis was
disregarded by medical professionals at the time and
despite a considerable following has yet to be
scientifically proven. D.D. Palmer established a
magnetic healing facility in Davenport, Iowa, styling
himself ‘doctor’. Not everyone was convinced, as a local
paper in 1894 wrote about him: "A crank on magnetism has
a crazy notion that he can cure the sick and crippled
with his magnetic hands. His victims are the
weak-minded, ignorant and superstitious, those foolish
people who have been sick for years and have become
tired of the regular physician and want health by the
short-cut method…he has certainly profited by the
ignorance of his victims…His increase in business shows
what can be done in Davenport, even by a quack."
Ignac Semmelweis (1818–1865), was a Hungarian physician
described as the "savior of mothers". Despite
discovering the importance of what later became hand
disinfection thus reducing the incidence of puerperal
fever, his theory was regarded with suspicion by many
fellow scientists, including his supervisor in the
Vienna General Hospital and later his peers in Budapest
as well. Since it happened several decades before the
explanation of the germ theory of disease, many of
Semmelweis' contemporaries viewed his theories as
unscientific, baseless speculation not unlike of those
of earlier decades.He did not gain recognition in his
life (for which he became rather bitter) nor his death:
hardly any medical periodicals took note of his death,
only a few people attended his funeral and the Hungarian
Association of Physicians and Natural Scientist has
failed to even mention his death.He was vindicated only
after the confirmation of the germ theory of disease by
Pasteur and others.
Louis Pasteur (1822–1895), was a French chemist best
known for his remarkable breakthroughs in microbiology.
His experiments confirmed the germ theory of disease,
also reducing mortality from puerperal fever (childbed),
and he created the first vaccine for rabies. He is best
known to the general public for showing how to stop milk
and wine from going sour - this process came to be
called pasteurization. His hypotheses initially met with
much hostility, and he was accused of quackery on
multiple occasions. However, he is now regarded as one
of the three main founders of microbiology, together
with Ferdinand Cohn and Robert Koch.
Linus Pauling (1901–1994), a Nobel Prize winner in
chemistry, Pauling spent much of his later career
arguing for the treatment of somatic and psychological
diseases with orthomolecular medicine. One of his most
famous claims was that the common cold could be cured
with massive doses of vitamin C. Together with Ewan
Cameron he wrote the "1979 book Cancer and Vitamin C,
which was again more popular with the public than the
medical profession, which continued to regard claims
about the effectiveness of vitamin C in treating or
preventing cancer as quackery." A biographer has
discussed how controversial his views on megadoses of
Vitamin C have been and that he was "still being called
a 'fraud' and a 'quack' by opponents of his
'orthomolecular medicine'".
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