Why Quackery Persists
James Harvey Young, Ph D.
Americans, generally being an optimistic people, have believed that problems are for solving. Early in this century, when quackery came to be recognized as a major problem in the health field, many observers predicted its certain death. Common sense, increasing education, the truths of science, and laws aimed at securing honest labeling would drive quackery from the marketplace. Especially as modern medicine developed and conquered one disease after another, anything so outmoded and unneeded as quackery would shortly wither away.
But this has not happened. Quite the contrary! Health quackery today is a multibillion-dollar business, and its future prospects look brighter still. Why does quackery persist in our modern scientific era? Let's seek an explanation for this disturbing fact by examining the roles of four parties involved: the patient, the scientific practitioner, the quack, and the regulator who enforces antiquackery laws.
The field of health is extremely complicated. The common man—whom we shall call John Doe—has absorbed a great mass of information about it. What he knows, however, is likely a jumble of chance facts learned from a variety of sources, sound and unsound, including the folklore of family tradition and the self-serving pitch of current advertising. Statistically, perhaps, most people may be nearer right than wrong, but few people escape blind spots and areas of error that make them vulnerable to deception under suitable circumstances. This goes even for some John Does of mighty intellect with various degrees after their name.
When an episode of ill health looms, John Doe faces it by self-reliance, by seeking help from a health authority, or by doing both. If he chooses self-treatment, he tries some remedy from folk tradition or from recent reading or television viewing. He may try garlic from the garden, a huge dose of vitamin C, or a trade-named tonic. He tends to judge results by the same rule-of-thumb common sense by which he judges everyday cause-and-effect sequences: Did the axe cut? Did the suit fit? Did the motor run? He asks: Did the symptoms go away? Did my digestion settle down? Did my nerves calm? Did my sniffles stop?
John Doe does not usually realize that most ailments are self-limiting and improve with time regardless of treatment. When a symptom goes away after he doses himself with a remedy, he is likely to credit the remedy with curing him. He does not realize that he would have gotten better just as quickly if he had done nothing! He may also fail to distinguish between cure and temporary symptom relief. Thousands of well-meaning John and Jane Does have boosted the fame of folk remedies and have signed sincere testimonials for patent medicines, crediting them, instead of the body's recuperative powers, for a return to well-being.
Nor does John Doe take the "placebo" effect into account when he judges remedies. Worry has a great effect upon how we feel when we are ill. The more we are worried about being sick, the more uncomfortable our symptoms will seem. Conversely, the less we are worried, the better we may feel. When John Doe takes a remedy that he thinks will help, he will often feel less pain or discomfort. Feeling better when the doctor walks into the room is another example of this mechanism. The placebo effect can work in a second way. Some ailments that are bodily reactions to tension subside when the feeling that a person is taking an effective treatment lessens the tension.
A considerable element in the success of the legitimate proprietary remedies purchased at the drugstore undoubtedly resides in the placebo effect. Spokespersons for the proprietary industry have occasionally acknowledged this. Exaggerated claims made in advertising may build up consumers' expectations even more and so enhance the placebo effect. Yet such a slim benefit does not justify exaggeration. Overuse of occasionally useful drugs poses health hazards. Youth's readiness to experiment with dangerous drugs may owe something to the attitude, conditioned by constant advertising, that a drug exists to banish almost any problem. A good deal of advertising implies that common remedies are somehow able to do more than relieve simple symptoms, that they can make a person socially desirable or can solve undesirable behavior like "snapping at your wife." Moreover, too much or too long a reliance on self-dosage, in violation of label warnings, may lead people to delay getting more appropriate treatment for serious ailments before it is too late. Outright quackery, of course, operates without any of the restraints under which the proprietary industry abides and hence poses a danger far greater.
The John Doe whom I have been describing so far turns to self-treatment occasionally when his normally healthy life is disrupted. Some of his unhappy cousins, however, live in constant fear of imminent health disaster. They seem governed by an all-consuming anxiety that leads to continuous self-treatment, often with bizarre "preventive" programs. An example might be taking twenty-five food supplement pills per day. Some beleaguered patients go so far as to follow all-inclusive systems that mix diet practices, exercises, gadgetry, and mystical philosophies. Such life-style combination approaches, indeed, represent a growing segment of unscientific therapy. Such troubled people provide an important reservoir for quack exploitation.
Often, of course, these worriers abandon self-treatment and join a guru-led group—just as less extreme John and Jane Does might give up self-reliance and seek help from someone touted as an "expert" in the media. A great deal of public confusion exists about who is a competent health authority.
Some patients have an authority problem and tend to reject the orthodox merely because it is orthodox. Others turn to unscientific practitioners under a miss-no-bets philosophy. They believe in family doctors as treaters of physical ailments and prescribers of drugs; however, they also believe in chiropractors as manipulators of bones and perhaps as operators of "healing" machines. They likewise follow the gospel of food faddists. And they sense nothing wrong with using several such forms of treatment at the same time, science and pseudoscience having equal validity in their minds.
One last point about the patient: When his health is seriously threatened, he obviously hopes something may be done to cure him. His desires may outrun what responsible orthodoxy can accomplish, however. Confronted with the possibility of chronic suffering or death, many people who never before strayed from orthodox treatment are not able to accept orthodoxy's grim verdict and so turn elsewhere. Such desperation has fattened quackery related to cancer and to AIDS.
The Scientific Practitioner
The medical profession has always believed its current knowledge valid and has sometimes exhibited a tendency toward smugness. On occasion—though rarely in recent years—true scientific breakthroughs have been regarded as quackery. Conversely, many treatments that were once highly regarded have been abandoned as worthless. As medical science improves, of course, it becomes easier to draw the line between orthodoxy and quackery. Ignoring this fact, quacks parade medicine's old mistakes and portray themselves as scientists ahead of their time who are being suppressed by a greedy establishment.
Many people have suffered side effects from modern "miracle" drugs. This circumstance, added to the overprescribing of antibiotics, tranquilizers, and stimulants, has helped foster a stereotype of our nation being "drugged," thereby giving "natural" healers a promotional boost. In the early nineteenth century, quacks termed the doctor a butcher; today they call him a poisoner.
Scientific physicians, moreover, have a problem because of their power and status. Many laypersons feel ill at ease in the presence of an expert. The patient is upset because he is sick and worried. Perceiving the physician as busy and under pressure, the patient may feel like an intruder. Doctors may be brusque, fail to take the time to listen, or neglect to explain; their prognoses may be discouraging, their therapy prolonged and unpleasant. They charge hefty fees, earn more money, and live better than the patient, perhaps causing irritation and envy. Some patients are just plain frightened away from reputable doctors whose amiability falls below that which quacks are able to muster. Even patients who think well of their own doctors may think ill of doctors as a group. The power side of establishment medicine has alienated many people. Organized medicine, they have felt, works for its own economic and political self-interest more than for the common good. Such an image in the popular mind aids and abets quackery. Indeed, throughout history, any criticism of the power or the science of orthodox medicine has been pounced upon by the quack, magnified, and loudly trumpeted abroad.
The unscientific healer does not need to observe the restraints of reputable medicine. Where true medical science is complex, the quack can oversimplify. All diseases are "imbalances," and whatever the quack does restores "balance." Where ailments are self-limiting, the quack makes nature his secret ally, crediting his tonic with curing tuberculosis when in fact nature has alleviated the patient's postnasal drip. Where the placebo effect may operate, the quack prescribes it adeptly. It may be something for arthritis as ancient as a copper bracelet or as modern as "moon dust."
The quack pays more attention to the person than to the ailment, seeking to convince the patient that the treatment is necessary. A dose of fright can be an effective persuader. Ralph Lee Smith, in his book At Your Own Risk, tells of infiltrating a school run by a Texas chiropractor aimed at teaching other chiropractors how to increase their incomes. "If the patient has a pain in his left shoulder," the professor said, his pupils should ask, "Has the pain started in your right shoulder yet?" [The so-called "Yet Disease."]
Along with fright go tenderness and self-confidence. Most quacks manage a superb "bedside manner." Since they can't really provide a cure if major disease is present, they specialize in promises, sympathy, consideration, concern, and reassurance. The patient responds to such attention. This helps explain one of the odd paradoxes relating to quackery—that failure seldom diminishes patient loyalty. When regulatory agencies seek to prosecute quacks, the agencies have a difficult task getting hapless patients to testify in court. Partly this results from the desire to avoid public exposure as a dupe; but often this objection to testifying rests on an inability to realize that deception has taken place. Many quacks do such a good job of exuding sincerity that their explanations seem all too plausible. Even patients faced with death believe in the "kindly" person who says the special remedy would have worked if treatment had only begun a little sooner.
Some points I have made suggest that doctors might improve their human relationships. Other aspects of vulnerability may be so inherent in human nature that they can never be eliminated. While physicians seek to help their patients if they can, they must sometimes confess that they cannot. Quacks need make no such confession, for honesty is not contained in their code of ethics. This gives charlatans a great advantage in competing with physicians for the kind of patient I have described. For quacks can promise anything—tailoring their appeals to all the susceptibilities, vulnerabilities, and curiosities which human nature reveals.
A fabric of laws aimed at circumscribing the quack has been created during this century. Regulators wielding these laws have won significant victories. The Federal Trade Commission has quashed much deceptive advertising. The Food and Drug Administration and the Postal Service have driven many fraudulent drugs and devices from the marketplace and have put some charlatans in jail. The Kefauver-Harris Act of 1962 requires that new drugs be proven effective as well as safe before they can be marketed. As a result of this law, many quack ventures have failed to see the light of day or have been quickly suppressed.
But regulation has not stifled quackery. In order to act against a deceptive health promotion, the regulator must first learn of its existence and then determine whether regulatory action is practical. Some forms of quackery escape detection and others evade prosecution because the overall budget of regulators is insufficient to attack all of the illegal activities they observe. Matters of major public concern other than quackery clamor for their attention. Frauds that threaten only the purse, not the health, of the victims get low priority on the regulatory scale. Though some quack promotions are quickly stopped, others can result in lengthy court battles while the promotions continue.
Many times the regulator must compromise, allowing a wrongdoer to escape severe penalty because full prosecution would overtax the limited resources of the regulator. At other times, the regulator must suffer the leniency of the courts. While the average judge may become duly outraged when a victim of quackery is seriously harmed, in the majority of cases, no such victim is in sight. The con artist who peddles phony "reducing belts" for $9.95 is unlikely to be sent to prison even if his total take amounts to millions of dollars. For small sums of money, the courts seem to feel, fools must be allowed to suffer the consequences of their folly.
The regulator's task would be eased greatly if victims of quackery would rally to his support. But an opposite trend is evident: many victims are so thoroughly deceived that they engage in political activities that oppose regulation. During the 1970s, when the FDA tried to limit false claims and dangerously high doses of vitamins, a coalition of vitamin sellers and their brainwashed customers persuaded both Congress and the courts to limit FDA jurisdiction over this matter (see Chapter 28). When the FTC considered banning commercial use of the words "natural" and "organic," another avalanche of protest persuaded the agency to back down. The health-food industry continues to lobby fiercely to prevent the FDA from strengthening labeling regulations to curb the industry's deceptions.
In some instances the regulator has been so cleverly labeled a villain in the quack's promotion that the very existence of regulation has been made to enhance quackery's appeal. Events like Vietnam and Watergate created widespread disillusionment with government. Inflation, the filling-out of tedious forms, and other irritating circumstances evoked widespread assertions of overregulation. Quacks profit from such distrust. It makes them sound credible when they charge that health regulators are not interested in the welfare of the individual but are conspiring selfishly with the medical profession, the drug industry, or the food industry.
Antigovernment feeling certainly helped the promoters of laetrile, an unproven and ultimately discredited cancer remedy, to generate the greatest public furor over an unorthodox remedy in our nation's history. Crying "freedom of choice," supporters of this quack remedy pressed mightily to persuade state legislators and the courts to legalize its use. Half the states passed laws giving laetrile special status, and one federal judge authorized its importation by "terminal" cancer patients, a ruling that lasted for a dozen years until higher courts forced its reversal.
Close inspection of the "freedom of choice" slogan is in order. Freedom, one of the glorious words in our lexicon, can arouse powerful sympathy. But freedom of choice cannot operate in a vacuum; the easier it is to market unproven health products, the easier it will be to mislead people into trying them. What quacks really wants is freedom from government interference with their promotions. Laws that require proof of efficacy before marketing make it too easy, as the shady promoter sees it, to remove their products from the marketplace. The National Health Federation, an alliance of quackery promoters and their followers, has for years tried to persuade Congress to repeal the 1962 law. Repeal of the efficacy requirement would put back on the regulator's shoulders the burden of proving that each worthless product lacked value—a task far more demanding than the present law requires. The resultant "freedom" would benefit only quacks whose chicanery is too sophisticated for the average citizen to recognize.
There is another aspect of the freedom theme to consider. Desperate victims and their families, having just heard a diagnosis of cancer or AIDS, may soon find themselves pressed by zealous promoters to try an unorthodox remedy for which glowing promises are made. Under the double stress of fear and salesmanship, many sick persons are unable to exercise sensible freedom of choice. Such sufferers especially need the protection of experts who can evaluate alleged remedies honestly.
A special case has been made that patients with ''terminal'' disease should have ready access to quack remedies. The argument is appealing but specious. Should swindlers be allowed to "comfort" terminal patients by selling them phony stock—telling them it will make them rich before they die—on the theory that they don't need their money anyway? Moreover, even if it were possible to pinpoint the terminal state (which it usually is not), there is no way to open the door for one group of patients without opening it for others. The Supreme Court recognized this fact when it ruled unanimously in 1979 in a laetrile case that no exception to the 1962 efficacy law should be made for so-called terminal cancer patients. Congress, the high court ruled, had not intended to protect only those suffering from curable diseases.
"Freedom of choice" in this context turns out to be a way of manipulating a cherished symbol so as to free quacks from the law's restraints. We need strong antiquackery laws enforced by dedicated regulators.
What of the Future?
Efforts to educate against the dangers of quackery have met with modest success. But the future of quackery remains bright because many people have attitudes that make them highly vulnerable. Fears of dread diseases hold high priority on the list of our citizens' worries. They have, moreover, become skeptical of gigantic institutions, including big science, and many look askance at reason as a way for seeking truth. Whatever merit may lie in suspecting reason's inadequacies, the reaction has often gone to an extreme of deliberate flirtation, if not open liaison, with wild varieties of unreason. The acceptance of astrology has soared, not merely as a pastime but as a legitimate "science," even in high places. Publishing houses have made millions from it. During the 1960s, almost every college campus had a peripheral course in "reading the stars." Spiritualism made a comeback, with "spiritual churches" blossoming in almost every city. Tarot cards, palmistry, and numerology flourished. Witchcraft and devil worship made an appearance. Paperbacks on these themes were among the hottest items in university bookstores. Many among the young turned their backs on civilization and its discontents, displaying a new primitivism, sometimes retreating into communes remotely located, sometimes merely buying "organic" foods at the nearest health-food store.
The decade of the 1970s witnessed an enormous boom in the self-help search for health. Though wholesome in many ways—if, for example, exercise and dieting are governed by prudence—a passionate dedication to self-help can be wasteful of money and harmful to health if guided by wrong counsel. With respect to eating, wrong counsel abounded—and still does—much of it aimed at selling books or special dietary wares. During the 1980s, "channeling" and the "New Age" became household words, dubious weight-loss ventures boomed, bogus "immune boosters" and "ergogenic aids" found a ready market, and the health-food industry continued to exploit public concern about "chemicalization" of our society. In the 1990s, the promotion of "alternative" methods has appealed to a public hungry for choices and control over its destiny.
One may strongly sympathize, I hope, with criticisms of the disorders of our world. But those who embrace irrational creeds fervently, who throw themselves headlong into self-help regimens, furnish a fertile recruiting ground for unscientific health wares. For, as we have seen, quacks are agile. They sense quickly and rush in to exploit people's real concerns. Thus, for many timeless reasons, and for current reasons too, quackery may be expected to continue, to expand, and to remain a challenge to scientific health care.
Quacks never sleep. But education and regulation can reduce the toll they take in wasted resources and human suffering.
James Harvey Young (1915-2006), a professor of history at Emory University, was a social historian whose special interest was the development of food and drug regulation in America. He was a member of the FDA National Advisory Food and Drug Council. His books, The Toadstool Millionaires, The Medical Messiahs, and American Health Quackery, trace the history of quackery in America and efforts to control it. This article is reprinted from The Health Robbers: A Close Look at Quackery in America (Prometheus Books, 1993).This article was posted on December 7, 2001.