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Methods that are not based on established scientific knowledge have been called many things. Their critics most often choose among unproven, unconventional, unorthodox, unscientific, nonscientific, questionable, dubious, cult, faddism, fraudulent, quack, and quackery. Their proponents prefer the terms nontraditional, complementary, holistic, alternative, and integrated. Although these terms are often used interchangeably, they have significant differences.
Quack originated during the Renaissance when quicksilver or mercury was a popular remedy for syphilis. Wandering peddlers known as "quacksalvers" sold mercury ointment. They would claim that their agents would cure all diseases. The term was later shortened to "quacks," who became a symbol of evil medical practice. Dictionaries generally define "quack" as a pretender to special health-related skills. This definition implies an intent to deceive, which would not fit promoters of unproven methods who believe in what they are doing. In 1984, the late Congressman Claude Pepper and his staff defined "quack" as "anyone who promotes medical schemes or remedies known to be false, or which are unproven, for a profit." This definition eliminates the question of intent.
Quackery is the promotion of an unproven product or service. The operant word is promotion rather than intent. (Quacks quack!)
Fraud is defined in dictionaries as an intentional perversion of truth for gain. The FDA has defined health fraud as promotion of an unproven remedy for profit. Although the FDA definition eliminates the question of intent, some people object to its use because ordinary use of the term fraud implies an intent to deceive.
Unscientific means contrary to scientific evidence.
Nonscientific means not based on a scientific approach.
Unconventional and unorthodox are used to avoid denunciation of the method under consideration. Both of these words may falsely imply that medical science is wed to established doctrine and is too rigid.
Cult is a health system based on dogma set forth by its promoter.
Faddism is a generic term used to describe nutrition nonsense. Food faddists are characterized by exaggerated beliefs in the role of diet and nutrition in health and disease.
Unproven has fewer negative connotations than most of the other terms. It correctly implies that, under the rules of science, proponents have the burden of proving that their methods work. Unproven methods that appear logical and consistent with established knowledge carry no connotation of quackery. However, methods that appear illogical and in conflict with established knowledge should be regarded with great suspicion and labeled more harshly.
Questionable and dubious generally mean unproven but inconsistent with established facts. The word "dubious" is used by critics who wish to make it clear that they have a low opinion of the method under consideration.
Nontraditional incorrectly suggests that an unscientific method is innovative, while falsely suggesting that the scientific community is traditional (meaning staid, rigid and close-minded). Actually, science is an antagonist of traditional medicine as it destroys old myths and establishes new approaches to healing. "Traditional" is correctly used in reference to folk medicine. Folk healers, not scientific healers, are the traditional ones. A considerable amount of quackery stems from the commercialization of traditional folk medicine and ancient dogma.
Complementary and integrative are claimed to synthesize standard and alternative methods, using the best of both. However, no published data indicate the extent to which practitioners who use these labels actually use proven methods or the extent to which they burden patients with useless methods. Typically these practitioners employ a "heads-I-win, tails-you-lose" strategy in which they claim credit for any improvement experienced by the patient and blame standard treatments for any negative effects. The result may be to undermine the patient's confidence in standard care, reducing compliance or having the patient wish to abandon it altogether.
Holistic implies that an approach is special and more complete because it treats the "whole patient" and not just the disease. However, good physicians have always paid attention to patients' social and emotional concerns as well as their physical problems.
Alternative has two possible meanings. Correctly employed, it refers to methods that have equal value for a particular purpose. (An example would be two antibiotics capable of killing a particular organism.) When applied to unproven methods, however, the term can be misleading because methods that are unsafe or ineffective are not reasonable alternatives to proven treatment. To emphasize this fact, we place the word "alternative" in quotation marks throughout this book whenever it is applied to methods that are not based on established scientific knowledge.