Quackery: How Should It Be Defined?
Stephen Barrett, M.D.
"Quackery" derives from the word quacksalver (someone who boasts about his salves). Dictionaries define quack as "a pretender to medical skill; a charlatan" and "one who talks pretentiously without sound knowledge of the subject discussed." These definitions suggest that the promotion of quackery involves deliberate deception, but many promoters sincerely believe in what they are doing. The FDA defines health fraud as "the promotion, for profit, of a medical remedy known to be false or unproven." This also can cause confusion because in ordinary usage—and in the courts—the word "fraud" connotes deliberate deception. Quackery's paramount characteristic is promotion ("Quacks quack!") rather than fraud, greed, or misinformation.
Quackery is not a label automatically applied to methods that are labeled "natural," or alternative," or nonstandard. Judgments about individual methods should be based on whether or not there is scientific evidence of effectiveness.
Most people think of quackery as promoted by charlatans who deliberately exploit their victims. Actually, most promoters are unwitting victims who share misinformation and personal experiences with others. Distributors who market the health-related products of multilevel companies typically have been persuaded by friends, relatives, and neighbors who believe the products are effective. Pharmacists also profit from the sale of nutrition supplements that few customers need. In most cases, pharmacists do not champion the products but simply profit from the misleading promotions of others. Much quackery is involved in telling people something is bad for them (such as food additives) and selling a substitute (such as "organic" or "natural" food). Quackery is also involved in misleading advertising of dietary supplements, homeopathic products, herbs, and some nonprescription drugs. In many such instances no individual "quack" is involved—just deception by manufacturers and their advertising agencies.
Quackery is not an all-or-nothing phenomenon. A practitioner may be scientific in many respects and only minimally involved in unscientific practices. Also, products and procedures can be useful for some purposes but worthless for others. For example:
- Vitamin B12 shots are lifesaving in cases of pernicious anemia, but giving them frequently to "pep you up" is a sign of poor judgment, greed, or both.
- Spinal manipulation may be effective for relief of appropriately selected cases of low back pain, but manipulation to correct chiropractic's imaginary "subluxations" is quackery.
Quackery and poor medical care overlap but are not identical. Quackery entails the use of methods that are not scientifically accepted. Malpractice involves failure by a health professional to meet accepted standards of diagnosis and treatment. It includes situations in which the practitioner was negligent while using standard methods of care. Leaving a surgical instrument in a patient's abdomen or operating on the wrong part of the body are examples of malpractice unrelated to quackery.
Quackery can 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 methods are not necessarily quackery. Those consistent with established scientific concepts may be considered experimental. Legitimate researchers and practitioners do not promote unproven procedures in the marketplace but engage in responsible, properly-designed studies. Methods not compatible with established scientific concepts should be classified as nonsensical or disproven rather than experimental. Methods that sound scientific but are nonsensical can also be classified as pseudoscientific.
Folk medicine, even when known to be erroneous, is not generally considered quackery so long as it is not done for gain. Thus, self-treatment, family home treatment, neighborly medical advice, and the noncommercial activities of folk healers should not be labeled as quackery. However, folk medicine and quackery are closely connected because folk medicine often provides a basis for commercial exploitation. For example, herbs long gathered for personal use have been packaged and promoted by modern entrepreneurs, and practitioners who once served their neighbors voluntarily or for gratuities may market themselves outside their traditional communities.
All things considered, I find it most useful to define quackery as the promotion of unsubstantiated methods that lack a scientifically plausible rationale. Promotion usually involves a profit motive. Unsubstantiated means either unproven or disproven. Implausible means that it either clashes with well-established facts or makes so little sense that it is not worth testing.
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