How Quackery Sells
Stephen Barrett, M.D.
William T. Jarvis, Ph.D.
Modern health quacks are supersalesmen. They play on fear. They cater to hope. And once they have you, they'll keep you coming back for more . . . and more . . . and more. Seldom do their victims realize how often or how skillfully they are cheated. Does the mother who feels good as she hands her child a vitamin think to ask herself whether he really needs it? Do subscribers to "health food" publications realize that articles are slanted to stimulate business for their advertisers? Not usually.
Most people think that quackery is easy to spot. Often it is not. Its promoters wear the cloak of science. They use scientific terms and quote (or misquote) scientific references. Talk show hosts may refer to them as experts or as "scientists ahead of their time." The very word "quack" helps their camouflage by making us think of an outlandish character selling snake oil from the back of a covered wagon—and, of course, no intelligent people would buy snake oil nowadays, would they?
Well, maybe snake oil isn't selling so well, lately. But acupuncture? "Organic" foods? Hair analysis? The latest diet book? Megavitamins? "Stress formulas"? Cholesterol-lowering teas? Homeopathic remedies? Magnets? Nutritional "cures" for AIDS? Products that "cleanse your system"? Or shots to pep you up? Business is booming for health quacks. Their annual take is in the billions! Spot reducers, "immune boosters," water purifiers, "ergogenic aids," systems to "balance body chemistry," special diets for arthritis. Their product list is endless.
What sells is not the quality of their products, but their ability to influence their audience. To those in pain, they promise relief. To the incurable, they offer hope. To the nutrition-conscious, they say, "Make sure you have enough." To a public worried about pollution, they say, "Buy natural." To one and all, they promise better health and a longer life. Modern quacks can reach people emotionally. This article shows how they do it.
Appeals To Vanity
An attractive young airline stewardess once told a physician that she was taking more than 20 vitamin pills a day. "I used to feel run-down all the time," she said, "but now I feel really great !"
"Yes," the doctor replied, "but there is no scientific evidence that extra vitamins can do that. Why not take the pills one month on, one month off, to see whether they really help you or whether it's just a coincidence. After all, $300 a year is a lot of money to be wasting."
"Look, doctor," she said. "I don't care what you say. I KNOW the pills are helping me."
How was this bright young lady converted into a true believer? First, an appeal to her curiosity persuaded her to try and see. Then an appeal to her vanity convinced her to disregard scientific evidence in favor of personal experience—to think for herself. Supplementation is encouraged by a distorted concept of biochemical individuality—that everyone is unique enough to disregard the Recommended Dietary Allowances (RDAs). Quacks won't tell you that scientists deliberately set the RDAs high enough to allow for individual differences. A more dangerous appeal of this type is the suggestion that although a remedy for a serious disease has not been shown to work for other people, it still might work for you. (You are extraordinary!)
A more subtle appeal to your vanity underlies the message of the TV ad quack: Do it yourself—be your own doctor. "Anyone out there have 'tired blood'?" he used to wonder. (Don't bother to find out what's wrong with you, however. Just try my tonic.) "Troubled with irregularity?" he asks. (Pay no attention to the doctors who say you don't need a daily movement. Just use my laxative.) "Want to kill germs on contact?" (Never mind that mouthwash doesn't prevent colds.) "Trouble sleeping?" (Don't bother to solve the underlying problem. Just try my sedative.)
Turning Customers into Salespeople
Most people who think they have been helped by an unorthodox method enjoy sharing their success stories with their friends. People who give such testimonials are usually motivated by a sincere wish to help their fellow humans. Rarely do they realize how difficult it is to evaluate a "health" product on the basis of personal experience. Like the airline stewardess, the average person who feels better after taking a product will not be able to rule out coincidence (spontaneous remission)—or the placebo effect (feeling better because he thinks he has taken a positive step). Since we tend to believe what others tell us of personal experiences, testimonials can be powerful persuaders. Despite their unreliability, they are the cornerstone of the quack's success.
Multilevel companies that sell nutritional products systematically turn their customers into salespeople. "When you share our products," says the sales manual of one such company, "you're not just selling. You're passing on news about products you believe in to people you care about. Make a list of people you know; you'll be surprised how long it will be. This list is your first source of potential customers." A sales leader from another company suggests, "Answer all objections with testimonials. That's the secret to motivating people!"
Don't be surprised if one of your friends or neighbors tries to sell you vitamins. Millions of Americans have signed up as multilevel distributors. Like many drug addicts, they become suppliers to support their habit. A typical sales pitch goes like this: "How would you like to look better, feel better and have more energy? Try my vitamins for a few weeks." People normally have ups and downs, and a friend's interest or suggestion, or the thought of taking a positive step, may actually make a person feel better. Many who try the vitamins will mistakenly think they have been helped—and continue to buy them, usually at inflated prices.
The Use of Fear
The sale of vitamins has become so profitable that some otherwise reputable manufacturers are promoting them with misleading claims. For example, for many years, Lederle Laboratories (makers of Stresstabs) and Hoffmann-La Roche advertised in major magazines that stress "robs" the body of vitamins and creates significant danger of vitamin deficiencies.
Another slick way for quackery to attract customers is the invented disease. Virtually everyone has symptoms of one sort or another—minor aches or pains, reactions to stress or hormone variations, effects of aging, etc. Labeling these ups and downs of life as symptoms of disease enables the quack to provide "treatment."
Some practitioners claim to detect "deficiencies" (or "imbalances" or "toxins," etc.) before any symptoms appear or before they can be detected by conventional means. Then they can sell you supplements (or balance you, or remove toxins, etc.). And when the terrible consequences they warn about don't develop, they can claim success.
Food safety and environmental protection are important issues in our society. But rather than approach them logically, the food quacks exaggerate and oversimplify. To promote "organic" foods, they lump all additives into one class and attack them as "poisonous." They never mention that natural toxicantsare prevented or destroyed by modern food technology. Nor do they let on that many additives are naturally occurring substances.
Sugar has been subject to particularly vicious attack, being (falsely) blamed for most of the world's ailments. But quacks do more than warn about imaginary ailments. They sell "antidotes" for real ones. Care for some vitamin C to reduce the danger of smoking? Or some vitamin E to combat air pollutants? See your local supersalesperson.
Quackery's most serious form of fear-mongering has been its attack on water fluoridation. Although fluoridation's safety is established beyond scientific doubt, well-planned scare campaigns have persuaded thousands of communities not to adjust the fluoride content of their water to prevent cavities. Millions of innocent children have suffered as a result.
Hope for Sale
Since ancient times, people have sought at least four different magic potions: the love potion, the fountain of youth, the cure-all, and the athletic superpill. Quackery has always been willing to cater to these desires. It used to offer unicorn horn, special elixirs, amulets, and magical brews. Today's products are vitamins, bee pollen, ginseng, Gerovital, pyramids, "glandular extracts," biorhythm charts, aromatherapy, and many more. Even reputable products are promoted as though they are potions. Toothpastes and colognes will improve our love life. Hair preparations and skin products will make us look "younger than our years." Olympic athletes tell us that breakfast cereals will make us champions. And youthful models reassure us that cigarette smokers are sexy and have fun.
False hope for the seriously ill is the cruelest form of quackery because it can lure victims away from effective treatment. Even when death is inevitable, however, false hope can do great damage. Experts who study the dying process tell us that while the initial reaction is shock and disbelief, most terminally ill patients will adjust very well as long as they do not feel abandoned. People who accept the reality of their fate not only die psychologically prepared, but also can put their affairs in order. On the other hand, those who buy false hope can get stuck in an attitude of denial. They waste not only financial resources but what little remaining time they have left.
The most important characteristic to which the success of quacks can be attributed is probably their ability to exude confidence. Even when they admit that a method is unproven, they can attempt to minimize this by mentioning how difficult and expensive it is to get something proven to the satisfaction of the FDA these days. If they exude self-confidence and enthusiasm, it is likely to be contagious and spread to patients and their loved ones.
Because people like the idea of making choices, quacks often refer to their methods as "alternatives." Correctly employed, it can refer to aspirin and Tylenol as alternatives for the treatment of minor aches and pains. Both are proven safe and effective for the same purpose. Lumpectomy can be an alternative to radical mastectomy for breast cancer. Both have verifiable records of safety and effectiveness from which judgments can be drawn. Can a method that is unsafe, ineffective, or unproven be a genuine alternative to one that is proven? Obviously not.
Quacks don't always limit themselves to phony treatment. Sometimes they offer legitimate treatment as well—the quackery is promoted as something extra. One example is the "orthomolecular" treatment of mental disorders with high dosages of vitamins in addition to orthodox forms of treatment. Patients who receive the "extra" treatment often become convinced that they need to take vitamins for the rest of their life. Such an outcome is inconsistent with the goal of good medical care which should be to discourage unnecessary treatment. Another clever trick is to include their product or procedure in a list of otherwise commonly-accepted practices in order to promote it by association. They may say, for example that their method works best when combined with lifestyle changes (which, quite often, will produce tangible benefits).
The one-sided coin is a related ploy. When patients on combined (orthodox and quack) treatment improve, the quack remedy (e.g., laetrile) gets the credit. If things go badly, the patient is told that he arrived too late, and conventional treatment gets the blame. Some quacks who mix proven and unproven treatment call their approach complementary or integrative therapy.
Quacks also capitalize on the natural healing powers of the body by taking credit whenever possible for improvement in a patient's condition. One multilevel company—anxious to avoid legal difficulty in marketing its herbal concoction—makes no health claims whatsoever. "You take the product," a spokesperson suggests on the company's introductory videotape, "and tell me what it does for you." An opposite tack—shifting blame -- is used by many cancer quacks. If their treatment doesn't work, it's because radiation and/or chemotherapy have "knocked out the immune system."
Another selling trick is the use of weasel words. Quacks often use this technique in suggesting that one or more items on a list is reason to suspect that you may have a vitamin deficiency, a yeast infection, or whatever else they are offering to fix.
The disclaimer is a related tactic. Instead of promising to cure your specific disease, some quacks will offer to "cleanse" or "detoxify" your body, balance its chemistry, release its "nerve energy," bring it in harmony with nature, or do other things to "help the body to heal itself." This type of disclaimer serves two purposes. Since it is impossible to measure the processes the quack describes, it is difficult to prove him wrong. In addition, if the quack is not a physician, the use of nonmedical terminology may help to avoid prosecution for practicing medicine without a license.
Books espousing unscientific practices typically suggest that the reader consult a doctor before following their advice. This disclaimer is intended to protect the author and publisher from legal responsibility for any dangerous ideas contained in the book. Both author and publisher know full well, however, that most people won't ask their doctor. If they wanted their doctor's advice, they probably wouldn't be reading the book in the first place.
Sometimes the quack will say, "You may have come to me too late, but I will try my best to help you." That way, if the treatment fails, you have only yourself to blame. Patients who see the light and abandon quack treatment may also be blamed for stopping too soon.
The "money-back guarantee" is a favorite trick of mail-order quacks. Most have no intention of returning any money—but even those who are willing know that few people will bother to return the product.
Another powerful persuader—something for nothing—is standard in ads promising effortless weight loss. It is also the hook of the telemarketer who promises a "valuable free prize" as a bonus for buying a water purifier, a six-month supply of vitamins, or some other health or nutrition product. Those who bite receive either nothing or items worth far less than their cost. Credit card customers may also find unauthorized charges to their account.
Another potent technique is cultural association, in which promoters ally themselves with religious or other cultural beliefs by associating their product or service with an article of faith or prejudice of their target audience.
In a contest for patient satisfaction, art will beat science nearly every time. Quacks are masters at the art of delivering health care. The secret to this art is to make the patient believe that he is cared about as a person. To do this, quacks lather love lavishly. One way this is done is by having receptionists make notes on the patients' interests and concerns in order to recall them during future visits. This makes each patient feel special in a very personal sort of way. Some quacks even send birthday cards to every patient. Although seductive tactics may give patients a powerful psychological lift, they may also encourage over-reliance on an inappropriate therapy.
Psychologist Anthony R. Pratkanis, Ph.D., has identified nine strategies used to sell pseudoscientific beliefs and practices [Pratkanis AR. How to sell a pseudoscience, Skeptical Inquirer 19(4):19-25, 1995.]. They include setting phantom goals (such as better health, peace of mind, or improved sex life), making statements that tend to inspire trust ("supported by over 100 studies"), and fostering grandfalloons (proud and otherwise meaningless associations of people who share rituals, beliefs, jargon, goals, feelings, specialized information, and "enemies"). Multilevel sales groups, nutrition cultists, and crusaders for "alternative" treatments fit this description well.
Handling the Opposition
Quacks are involved in a constant struggle with legitimate health care providers, mainstream scientists, government regulatory agencies and consumer protection groups. Despite the strength of this science-based opposition, quackery manages to flourish. To maintain their credibility, quacks use a variety of clever propaganda ploys. Here are some favorites:
"They persecuted Galileo!" The history of science is laced with instances where great pioneers and their discoveries were met with resistance. Harvey (nature of blood circulation), Lister (antiseptic technique) and Pasteur (germ theory) are notable examples. Today's quack boldly asserts that he is another example of someone ahead of his time. Close examination, however, will show how unlikely this is. First of all, the early pioneers who were persecuted lived during times that were much less scientific. In some cases, opposition to their ideas stemmed from religious forces. Secondly, it is a basic principle of the scientific method that the burden of proof belongs to the proponent of a claim. The ideas of Galileo, Harvey, Lister and Pasteur overcame their opposition because their soundness can be demonstrated.
A related ploy, which is a favorite with cancer quacks, is the charge of "conspiracy." How can we be sure that the AMA, the FDA, the American Cancer Society, drug companies and others are not involved in some monstrous plot to withhold a cancer cure from the public? To begin with, history reveals no such practice in the past. The elimination of serious diseases is not a threat to the medical profession—doctors prosper by curing diseases, not by keeping people sick. It should also be apparent that modern medical technology has not altered the zeal of scientists to eliminate disease. When polio was conquered, iron lungs became virtually obsolete, but nobody resisted this advancement because it would force hospitals to change. Neither will medical scientists mourn the eventual defeat of cancer. Moreover, how could a conspiracy to withhold a cancer cure hope to be successful? Many physicians die of cancer each year. Do you believe that the vast majority of doctors would conspire to withhold a cure for a disease which affects them, their colleagues and their loved ones? To be effective, a conspiracy would have to be worldwide. If laetrile, for example, really worked, many other nations' scientists would soon realize it.
Claims of "suppression" are used to market publications as well as treatments. Many authors and publishers purport to offer information that your doctor, the AMA, and/or government agencies "don't want you to know about."
Organized quackery poses its opposition to medical science as a "philosophical conflict" or "paradigm shift," rather than a clash between proven versus unproven or fraudulent methods. This creates the illusion of a "holy war" rather than a conflict that could be resolved by examining the facts. Another diversionary tactic is to charge that quackery's critics are biased or have been bought off by drug companies.
Quacks like to charge that, "Science doesn't have all the answers." That's true, but it doesn't claim to have them. Rather, it is a rational and responsible process that can answer many questions—including whether procedures are safe and effective for their intended purpose. It is quackery that constantly claims to have answers for incurable diseases. The idea that people should turn to quack remedies when frustrated by science's inability to control a disease is irrational. Science may not have all the answers, but quackery has no answers at all! It will take your money and break your heart.
Many treatments advanced by the scientific community are later shown to be unsafe or worthless. Doctors also make mistakes. Such failures become grist for organized quackery's public relations mill in its ongoing attack on science. Actually, "failures" reflect a key element of science: its willingness to test its methods and beliefs and abandon those shown to be invalid. True medical scientists have no philosophical commitment to particular treatment approaches, only a commitment to develop and use methods that are safe and effective for an intended purpose. When a quack remedy flunks a scientific test, its proponents merely reject the test.
Each of these ploys represents a basic technique called misdirection -- analogous to what magicians do to shift the audience's attention away from what is important in order to deceive them. When faced with a criticism they cannot meet head on, quacks simply change the topic.
How to Avoid Being Tricked
The best way to avoid being tricked is to stay away from tricksters. Unfortunately, in health matters, this is no simple task. Quackery is not sold with a warning label. Moreover, the dividing line between what is quackery and what is not is by no means sharp. A product that is effective in one situation may be part of a quack scheme in another. (Quackery lies in the promise, not the product.) Practitioners who use effective methods may also use ineffective ones. For example, they may mix valuable advice to stop smoking with unsound advice to take vitamins. Even outright quacks may relieve some psychosomatic ailments with their reassuring manner.
This article illustrates how adept quacks are at selling themselves. Sad to say, in most contests between quacks and ordinary people, the quacks still are likely to win.
- Spontaneous Remission and the Placebo Effect
- Why Bogus Therapies Often Seem to Work
- Common Questions about Science and "Alternative" Health Methods
- Why Extraordinary Claims Demand Extraordinary Proof
- Response to an Alt-Muddled Friend
This article was revised on January 20, 2005.