Quackery

File:Pietro Longhi 015.jpg

Pietro Longhi: The Charlatan, 1757

Quackery is a derogatory term used to describe questionable medical practices. According to Random House Dictionary, a "quack" is considered 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." It is defined as the "medical practice and advice based on observation and experience in ignorance of scientific findings. The dishonesty of a charlatan."

The word "quack" derives from "quacksalver," an archaic word originally of Dutch origin (spelled kwakzalver in contemporary Dutch), meaning "boaster who applies a salve." The correct meaning of the German word "quacksalber" is "questionable salesperson (literal translation: quack salver)." In the Middle Ages the word quack itself 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 always implies deliberate deception.

The quacksalver

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William Hogarth: Marriage à-la-mode: The Visit to the Quack Doctor

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 (aspirin), quinine from bark was an effective treatment for malaria. Knowledge of appropriate use and dosage was poor.

History of quackery in the United States

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 to make use of branding (for example, by the use of highly distinctive containers) and mass marketing, in order 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.

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Dalbys Carminative, Daffy's Elixir and Turlingtons 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 over 100 years.

The later years of the 18th century saw an increase in the number of internationally marketed quack medicines, the majority of which were British in origin, and which were exported throughout the British Empire as well as the (by then independent) United States. So popularly successful were these treatments that by 1830 British parliamentary records list over 1,300 different "proprietary medicines", the majority of which can be described as "quack" cures today.

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 sulphuric 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.

Similar advertising claims to those of Radam can be found throughout the 18th, 19th and 20th 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 flavoured 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. 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

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 — touting the newest current trend for miraculous remedies for "weight-loss" and "sexual enhancement," as well as outlets for unprescribed medicines of unknown quality.

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 these new and existing products, including drugs and nutritional supplements or vitamins. 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. As a direct result, more public dollars have been allocated for research into some of these methods. According to Norcross et al (2006) several authors have attempted to identify quack psychotherapies; (e.g., Carroll, 2003; Della Sala, 1999; Eisner, 2000; Lilienfeld, Lynn, & Rohr 2003; Singer and Lalich 1996). The evidence based practice (EBP) movement in mental health emphasises the consensus in psychology that psychological practice should rely on empirical research. There are also "anti-quackery" web sites that consumers can access to help evaluate particular claims as well.

Reasons quackery persists

There are several reasons quackery continues to be a part of healthcare:

• Ignorance: An uneducated consumer is more likely to fall victim to implausible treatments.
• The placebo effect: Medicines or treatments known to have no effect on a disease can still affect a people's perception of their illness. People report reduced pain, increased well-being, improvement, or even total alleviation of symptoms. Both the practitioner and consumer can draw the wrong conclusion that the treatment was effective.
• 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 treatments with recovering, when recovery was inevitable.
• Post hoc ergo propter hoc fallacy: One recovers after taking a specific medicine or treatment, and therefore it is assumed the recovery is caused by the medicine or treatment. In reality, however, it is not necessarily caused by the specific medicine or treatment.
• Distrust of conventional medicine: Many people have a distrust of conventional medicines, government regulatory organizations, or major drug corporations.
• Fear: The perception that a great variety of pharmaceutical medications and medicinal herbs can have very distressing side effects, and many people fear surgery and its consequences, so they may opt to shy away from these treatments.
• Price: There are some people who simply cannot afford conventional treatment, and seek out a cheaper alternative.
• 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: Manufacturers, fully aware of the ineffectiveness of their medicine, may intentionally produce fraudulent scientific studies and medical test results, thereby confusing practitioners and consumers as to the effectiveness of the medical treatment.
• Anti-elitism: Quacks often portray themselves as members of the "common people" who care about those in need. The medical establishment is cast as an insular elite that cares more about financial gain than healing the sick. In this case the quack's lack of medical certification is a valuable asset.

Notable historical persons accused of quackery

• Albert Abrams (1863–1924) was a quack and a fraud, posing as a doctor in San Francisco, whose tool for gaining profit from the gullible was a variety of "electricity therapy" he called ERA, or Electronic Reactions of Abrams.

• John R. Brinkley (1885–1942), (later John Richard Brinkley), was both a controversial medical doctor who experimented with goat glands as a means of curing male impotence and a radio pioneer who created the age of Mexican border blasters.

• Ruth Drown (1891–1965) built a radionic device constituted of several adjustable resistors connected in series. An extremity was connected to ground, the other extremity was connected to a metallic plate having on it a specimen of the patient.

• Samuel Hahnemann (1755–1843), founder of homeopathy. Hahnemann believed that all diseases were caused by psora (itch), and that illnesses could be treated by extreme dilutions of substances that — in a healthy person — produced similar symptoms to the illness suffered.

• Harry Hoxsey (1901–1974), founder of Hoxsey Therapy, was a vaudevillian with no medical or scientific education who marketed a mixture of herbs as a purported cure for cancer in the 1920's.

• 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 an American medical doctor in Battle Creek, Michigan 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.

• Franz Anton Mesmer (1734–1815) discovered what he called magnétisme animal (animal magnetism) and others often called mesmerism. The evolution of Mesmer's ideas and practices led James Braid (1795–1860) to develop hypnosis in 1842.

• Daniel David Palmer (1845–1913), also known as DD Palmer, was the founder of Chiropractic. He was a spiritualist and practitioner of magnetic healing beginning in the mid-1880s in Burlington and Davenport, Iowa.

• 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. He is regarded as one of the three main founders of microbiology, together with Ferdinand Cohn and Robert Koch. His hypotheses initially met with much hostility, and he was accused of quackery on multiple occasions.

• Ignaz Semmelweis (1818 - 1865), was an Austrian-Hungarian who discovered that the incidence of puerperal fever could be drastically cut by use of hand washing standards in obstetrical clinics. His unconventional ideas and methods led to him being banned from some hospitals. Puerperal fever (or childbed fever) was common in mid-19th-century hospitals and often fatal, with mortality at 10%-35%.

• Dr. C. J. Thacher was a practitioner of magnet therapy. In the 1920s his "Chicago Magnetic Company" promised "health without the use of medicine." He was dubbed the "King of the magnetic quacks" by Collier's Magazine.

• Royal Rife Invented the "Rife machine", a machine produces Radio waves at a frequency of 10-100mhz, and claimed that it was able to cure cancer[1].

Quackery in popular media

• In Metal Gear Solid 3, Para-medic's nickname is Quack, which Snake finds out after Asking Para-Medic about her reputation.
• In one episode of Scrubs, the Janitor doctors a picture of Dr. Cox to show him with a duck's bill, "because you're a 'quack.'"
• The 1977 Walt Disney film Pete's Dragon features a quack doctor named Dr. Terminus (Jim Dale) as its main villain. He brings his traveling medicine show to town and tries to capture Elliott the dragon and use his parts to sell phony medicines.
• Dr. Nick Riviera on The Simpsons is a quack physician. He claims to be as good as Dr. Hibbert, however, is obviously not. This is represented when he tries to perform a Bypass surgery on Homer and does not know where to make the incision, among other things.

References

• Carroll, 2003. The Skeptics Dictionary. New York: Wiley.[2]
• Della Sala, 1999. Mind Myths: Exploring Popular Assumptions about the Mind and Brain. New York; Wiley
• Eisner, 2000. The Death of Psychotherapy; From Freud to Alien Abductions. Westport; CT; Praegner.
• Lilienfeld, SO., Lynn, SJ., Lohr, JM. 2003; Science and Pseudoscience in Clinical Psychology. New York. Guildford
• Norcross, JC, Garofalo.A, Koocher.G. (2006) Discredited Psychological Treatments and Tests; A Delphi Poll. Professional Psychology; Research and Practice. vol37. No 5. 515-522
• Radam, W. (1890) Microbes and the microbe killer. Privately published. New York. 369pp.

See also

• Charlatan
• Consumer protection
• Crank (person)
• Debunker
• Conventional medicine, alternative medicine and evidence-based medicine
• False advertising in health care
• Medical ethics
• Pseudoscience
• Scientific skepticism

Anti-quackery organizations

• Quackwatch
• National Council Against Health Fraud

External links

• Checklist for identifying dubious technical processes and products by Rainer Bunge, PhD
• Cures and Quackery: The Rise of Patent Medicines at McCord Museum
• "The Medical Messiahs: A Social History of Health Quackery in Twentieth-Century America" - James Harvey Young, PhD.
• Museum of Questionable Medical Devices at Science Museum of Minnesota
• Dr. Renckens' Quackiness Scoring System
• Quackery at Skeptic's Dictionary
• DC's Improbable Science - Professor David Colquhoun, FRS.
• Gallery of water-related pseudoscience Very extensive list and classification of water-related pseudoscience and quackery.

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