I know it is common to speak of the 'good old days' of snake oil and soothing syrup as though they were gone forever. The amazing fact is that to a very great extent those good old days, so-called, are still with us.
-- Commissioner George P. Larrick,
Food and Drug Administration, 1955 
Prior to 1906, the only inhibition upon American patent medi-cine proprietors, except for an occasional critical article, was self-restraint. This did not prove an adequate force for the protection of the medicine-consuming public. In the half-century since 1906, the Pure Food and Drugs Act and subsequent legislation have provided agencies of the federal government with increasingly rigorous controls over drugs and devices for self-medication. Henry T. Helmbold and his 19th-century competitors would be astounded at the restraints placed upon the freedom of action of their successors. Yet, despite all the differences between the 1860's and the 1960's in the science of medicine and in the laws of medication, there are, in pseudo-medicine, disturbingly strong continuities. Quackery is not only not vanquished; never in previous history -- regulatory officials are the first to say it -- has medical quackery been such a big business as now.
This sad fact does not minimize the significance of federal regulation. There is today a vast proprietary industry that operates within the law. Before 1906 the most respectable proprietors considered it not improper to market medicines containing unmentioned narcotics-like Mrs. Winslow's Soothing Syrup -- or a high proportion of alcohol -- like Hostetter's Bitters. Nor did they feel any great compulsion to restrain curative claims. One of Lydia E. Pinkham's sons, surveying the possibilities of a New York market, wrote home suggesting that "Kidney Complaints" be added to the ailments listed in their pamphlets, "as about half of the people out here are either troubled with . . . [them] or else they think they are."  Today major producers of remedies for over-the-counter sale would not think of including powerful drugs not mentioned on the label, or of letting the state of the market dictate the diseases for which their remedies are treatments. To be sure, when Asian flu reached epidemic proportions several years ago, the Food and Drug Administration and the Federal Trade Commission did find it necessary to issue a public warning to advertisers of aspirins, cough syrups, and ointments not to exaggerate how firmly these American proprietaries could close with the Oriental invader. But kidney disease or cancer would not find its way into the advertising of large-scale proprietary manufacturers today.
The Proprietary Association, which had fought during the first years of the century the enactment of stringent legislation, came to boast that few of its members had lost contests with the government . Voluntary compliance was proving profitable. Sales were booming. The public, encouraged by the existence of a law to think self-medication safe, were buying more proprietaries than ever. By battling the unscrupulous nostrum maker, the government agency was an ally of the more respectable proprietor, reducing his competition. What happened in the aftermath of 1906 was to happen again after the extensive revision of the law in New Deal days. Major producers, opposed to a new law at first , were to accept the 1938 act and find it profitable. There still sometimes appears a lack of circumspection in the advertising practices of some of the most respectable firms in the proprietary industry. There are occasional differences of opinion between major proprietors and regulatory officials about interpretations of the various laws. The head of the FDA's Division of Medicine, in addressing the Proprietary Association during 1958, could state: "There are still too many proprietary products not acceptable for advertising in first-rate medical journals."  But federal agencies and major proprietors are today both on the same side in decrying the really vicious practices of unmiti-gated quacks.
Another difference between 1906 and today is that the unscrupulous nostrum promoter could not then be caught and punished for his transgressions, and now he can be. In their constant warfare against quackery, the Food and Drug Administration, the Federal Trade Commission, and the Post Office Department do win significant battles.
The FDA can act against drug, device, food, or cosmetic label-ing if it bears misleading therapeutic claims, and the courts have approved the agency's ever more elastic definition of what labeling means. Posters in a drugstore may become labeling, and the oral claims of door-to-door salesmen may cause their wares to be misbranded. An important weapon against quackery is the 1938 law's provision that drug labels must bear adequate directions for use. Again because of elastic interpretation, this provision permits the FDA to exercise some influence over drug advertising, a province which Congress in 1938 withheld from the FDA and gave for policing to the FTC. Nonetheless, if a proprietor's advertisement should claim that his pill can cure arthritis, the label on the pillbox must stat -- as, of course, cannot be genuinely done -- just how the pills are to be taken to accomplish the cure. The law also forbids the marketing of a new drug until the FDA has approved tests by the producer demonstrating its safety: this clause has helped the agency to squelch promotions like the vending of pega palo, a Dominican vine, for restoring virility. Many drugs are so powerful that they are considered safe for use only upon the prescription of a physician; a proprietor who includes such a drug in his formula for direct sale to the public violates the law and runs into trouble with the FDA .
The trouble may be of various kinds, for the FDA has a choice of weapons which it may ask the Department of Justice to wield. A nostrum or gadget may be attacked directly, by seizing one or more interstate shipments and lodging a libel against them. If the manufacturer fails to contest the seizure, the misbranded or adulterated product is destroyed, or brought into compliance, as it may be if the proprietor does contest and loses the legal action. Multiple seizures are a means by which the FDA affords prompt protection of the public against an unusual hazard to health. An egregious or persistent violator may be personally prosecuted in a criminal suit, with fine or possibly imprisonment as penalties upon conviction. Or the charlatan may be taken to court and enjoined from continuing his quack promotions, with civil and criminal remedies available to the government should he violate the injunction and continue in wrongdoing. More phony operators are in jail for vending drugs and devices labeled with false curative claims than ever before in history .
The Federal Trade Commission keeps a watchful eye on drug advertising in newspapers and magazines and on radio and television. A medicine proprietor who engages in deceptive practices, like exaggerating the curative potency of his product, may find himself confronted with an FTC complaint. He may consent to abandon the shady practice, or he may decide to fight the matter, first through hearings within the Commission, then by appeal to a circuit court. Victory for the FTC means a cease-and-desist order to the advertiser, demanding that he stop the misrepresentation complained of. Violation of the order can result in contempt proceedings and the risk of a fine .
Early in the century Dr. Wiley's laboratories had analyzed "lost manhood" remedies for the Post Office Department. Through its Mail Frauds Division, the Department continues policing medical quackery. The main weapon is a fraud order, issued after an administrative proceeding, which forbids the quack to ship his nostrum through the mail and decrees further that all letters addressed to the quack's address be returned to their senders stamped "Fraudulent." Since a 1949 Supreme Court decision, Reilly v. Pinkus, the Department has confronted a demanding burden of proof to secure a fraud order: unless scientific opinion universally condemns the promoter's claims, his intent to deceive must be established. In rare cases of outrageous fraud, the Post Office asks the Department of Justice to undertake criminal actions, which may send charlatans to jail .
Besides the federal statutes, there are state and local laws aimed at medical quackery . The legal environment today, therefore, is fraught with perils to the unscrupulous or careless proprietor which Swaim selling his Panacea and Radam his Microbe Killer did not confront. The scientific environment is also different. Many medical matters fuzzy in Swaim's and Radam's century have been clarified by modern research. Many quack claims that then could not be combatted with scientific certainty can now be shown to be ridiculous. Pseudo-medical promotion of remedies for diabetes or syphilis, for example, cannot today possess the specious plausibility that their predecessors once enjoyed. Modern medical science, of course, is an indispensable bulwark to effective governmental regulation.
Despite laws and science, however, medical quackery contin-ues to flourish. Indeed, according to former Postmaster General Arthur Summerfield, more money is being made today in medical quackery than in "any other criminal activity." No precise, reliable statistics exist to measure its magnitude. The "take" each year to promoters of specious medication certainly exceeds a billion dollars. Half a billion alone goes into the nutrition racket, wasted on foods and food supplements promoted with therapeutic overtones. Another quarter billion is spent for medicines and gadgets falsely purporting to promote recovery from arthritis and rheumatism. A hundred million goes for ineffective reducing remedies, fifty million for fake cancer cures, and millions more for other panaceas that hold out the vain promise of curing ailments ranging from the common cold to heart disease .
One reason for this astounding state of affairs is that there are shortcomings in legal regulation. Many states and cities lack adequate laws, and others tend to leave the matter of quackery to federal agencies. The Food and Drug Administration, the Federal Trade Commission, and the Post Office Department have many tasks to perform besides seeking to keep proprietors of drugs and devices respectable. The budgets and staffs of these agencies are limited. The FDA, even though its operations have recently been augmented, has been given added responsibilities, and the bulk of its efforts goes into protecting the nation's food supply. So expensive is litigation, and the arduous preparation for it, that the FDA can afford only a few major anti-quackery cases at once. Court contests are protracted, sometimes taking years, for legal processes intended to safeguard the innocent can postpone punishment for the guilty. The FDA may halt a quack's activity by injunction while the merits of the charge are being tried. The FTC may also appeal for an injunction to curtail especially risky advertising pending the adjudication of the issue, but very seldom does. A 1960 law provides the Post Office Department with similar authority to seek an injunction, not yet used. Thus proprietors of questionable medications continue to reap profits while legal maneuvering proceeds along its weary way .
It may be questioned also, in the regulation of medical quackery, if the penalty fits the crime. At the worst, under FTC regulations, when the case is over and the advertiser is defeated, he is told that at long last he must stop disseminating the offending claims. There are no other sanctions. The Commission says, in effect, "Go and sin no more." If the proprietor is foolish enough to repeat the same sin, his fine may reach five figures. But a somewhat different sin requires a new beginning. A more serious deterrent is the denial of mail privileges, coming at the end of a mail fraud action, but this is not necessarily ruinous to the quack. He may continue with over-the-counter sales. But often the wily proprietor, caught in this trap, changes his product's name and address and launches a new campaign. The Mail Frauds Division, like the other regulatory agencies, finds itself involved over and over again with men who make medical quackery a lifelong career .
The FDA's multiple seizure weapon is a grave threat to the medicine proprietor, not so much because he may lose the shipments seized, as because his entire interstate operations are quickly and effectively halted. But only when the hazard to health is significant can the agency employ this decisive action. In a criminal suit, the FDA, unlike the Post Office Department, does not need to prove fraudulent intent. Therefore its legal task is easier. For the most part, however, convictions have brought only modest fines, and prison sentences, when given, have been short. More than that, prison sentences are more often than not suspended, so long as the convicted violators abstain from promoting their useless remedies. One recent judgment decreed a fine of $750 and five days in jail-this was the penalty for vending a magnetic ray device in deliberate violation of a permanent injunction. The heaviest prison sentence ever given as result of court action undertaken by the FDA was nine years. The customary lighter penalties, it has been suggested, are regarded by quacks as a sort of license fee for doing business. FDA efforts to force restoration of the purchase money spent by the gullible for fraudulent wares have so far not been granted by the courts .
Another reason for the persistence of quackery lies not in the nature of legal restrictions but in the nature of man. As he did in the 19th century, so does man still yearn desperately for things that cannot be. If the science of medicine could ever win a total victory over disease, then the pseudoscience of medicine might wither away. Medical advances during the 20th century, remarkable as they have been, have not abolished illness and ended death. The pattern of disease has been much modified, the advent of death delayed. But fear of cancer, say, in a man of seventy brings the same anguish that fear of cholera once brought to a man of thirty-five.
Today's physician, despite his greater knowledge and his more effective drugs, is almost as handicapped, in competition with the quack, as was his 19th-century predecessor. The doctor must still confess that disease is a complex phenomenon. The quack continues to say that it is simple. The doctor must often state that treatment will be protracted. The quack says his is speedy. The doctor may have to tell a patient that much expense will be involved. The quack says his remedy is cheap. The doctor must warn of suffering. The quack terms his treatment painless. The doctor, all too often, must confess defeat and admit that all his skill and all the new products of pharmaceutical chemistry are inadequate to the task of restoring health. The quack says his cure is sure. It is the old story over again.
In the last quarter of a century, the medical profession has forsaken virtual therapeutic nihilism and has resumed extensive drug therapy, as pharmaceutical science has produced wonder drugs in an accelerating and -- to the layman -- bewildering array. This great boon to health has been, perversely, a help to quackery. Just as in William Radam's day, it is hard for John Doe to keep from confusing hopeful headlines about new antibiotics and hopeful advertising about "new" nostrums. "That so much is written and published regarding health topics generally," states Wallace F. Janssen, the FDA's Director of Public Information, "seems to create a climate that is favorable to the spread of quackery -- or perhaps one should say, new forms of quackery. More and more people believe in miracles, not only the real miracles of scientific achievement, but also the fake miracles of promoters and charlatans .
One hope of early anti-nostrum crusaders has not been borne out. Education has not made Americans impervious to quackery. In the age of the common man, many physician-reformers believed that honest labeling would sound the death-knell of the nostrum business. This optimism was shared by journalists, doctors, and public officials who waged the successful campaign to put patent medicine provisions into the 1906 law. The goal has never been reached, in that enforcement of this and later laws has not succeeded in making all labeling and advertising honest. Nor has education been adequate, in that anti-quackery propaganda has not come close to equalling patent medicine advertising in its impact upon public attention. Of more basic concern, even the optimistic premise of earlier years is today regarded as too simple. Man's conduct is not so rationally motivated as once seemed true. The state of his psyche, a momentous factor in the state of his health, influences how he pursues well-being. His efforts may be quixotic, anti-rational, contrary to "better" judgment, against the counsel of medical science. Even when panic is not present as a major disorienting factor, many people hope for -- and pay for -- a cheap, sure protection or relief that does not and cannot exist. Nor is it merely a matter of the nostrum's customers. On grounds that can hardly represent rational conviction, juries, and even judges, turning their backs on scientific evidence and expert opinion, have accepted as true, outlandish claims of impossible cures .
This non-rational bent sometimes leads even men and women with much formal education to the charlatan's door. It has not been uncommon to find the clergyman using and recommending nostrums, the business tycoon espousing a weird religion, and the physician seeking quack counsel on how to invest his gains. "University towns," opined a physician on the staff of the Mayo Clinic, "are hot-beds of quackery." An experienced advertising agent, back in the 19th century, gave this advice on the promotion of patent medicines to a novice in the profession: "You are starting out on a long up-hill journey, and you must write your advertisements to catch damned fools -- not college professors." Then, after a moment, he added, "and you'll catch just as many college professors as you will of any other sort." 
Education remains a major treatment of choice against quack-ery, but experience has shown it to be less specific therapy for the malady than once was thought.
If the hopes and fears impelling people to irrational therapy are ancient and deep-rooted, so too are the quack's appeals. Now as always he must confront his would-be customers with a mes-sage that allays their suspicions and fulfills their expectations. To help him in his task he has available a whole assortment of time-tested lures. Indeed, it would be hard to find a type of appeal pioneered in the 19th century that is not still being put to work -- perhaps in modified form -- even by reputable proprietary advertisers. Certainly the testimonial is much with us; men and women continue to send voluntary letters of appreciation to medicine makers which they dare not use, so extreme are the curative claims jubilantly reported. The distinction between advertising and non-advertising, that once was hard to detect in newspaper columns, is sometimes blurred on television. Viewers are not always sure when a master of ceremonies is starting to introduce another guest and when he is launching a pitch for some remedy. Television has brought back, too, some of the symbols of evil from the devil's dark domain, and now the fiendish creatures wiggle. Spectators have peered inside the body, watching the race of pain-relievers from stomach to brain. They have seen stomach acid removed, concentrated, and thrown at a napkin with ominous results. They have observed actors impersonating doctors, who report on exciting experiments, lauding in frenetic tones the marvels of scientific progress, of which the product advertised is the prime example. Seldom in polite advertising are physicians debunked-the real quacks continue this ancient war -- -although there is an occasional sly dig like, "So safe you don't need a doctor's prescription," implying that what the doctor orders is generally risky .
A glance through recent Notices of Judgment from the Food and Drug Administration reveals echoes of other traditional appeals. Religion is represented by Father Francis' Herb Formul -- and by the operator who put the Doxology upon his label. Hercules Tonic Tea reveals the symbol of strength. The noble red man continues active in the interest of the white man's health. Capon Springs Water, a gift of the Catauba Indians, caused FDA officials a great deal of trouble. A case in litigation since 1943 had to be terminated in 1954 because "it was discovered that the article under seizure had disappeared." Electricity retains its fascination, and Elisha Perkins' metallic tractors continue to have heirs. One recent gadget bore the name Galvanic Five-in-One Shortwave Oscillotron; another, called more simply Vitalitone, included among the ailments it would vanquish, paralysis, fallen arches, and bags under the eyes -- it would also rejuvenate the busts .
Old lures, as always, continue to be supplemented by new approaches, for the ancient adaptability of the quack has lost none of its suppleness. Ask what is exciting public attention, and there you will find the medicine man adjusting his mask. For the hoary question, "Are You Looking for the Fountain of Youth?" there was recently proffered a very modern answer, a device called Atomic-Nu-Life. The atomic age was quick to come to quackery, with uranium tunnels-some lined with ore from the Merry Widow mine -- radioactive bath salts, U-235 drinking water, and assorted fission panaceas. One "radioactive" gadget, shaped like an inkwell, could "cure," among other ailments, cancer, diabetes, and arthritis. It operated by enclosing for twenty-four hours a sample of the sufferer's blood which was then reinjected .
Quacks have paid particular heed to major developments in medical science and their impact on the nation's health. Unorthodox as well as orthodox medicine has had its "wonder drugs," and, as infectious diseases have given place to chronic and degenerative diseases in the mortality tables, quackery has increased its attention to arthritis, cancer, and the infirmities of aging.
When the tranquilizing drugs caught hold of national attention, proprietary manufacturers, like Radam before them, sought to make a profit from this medical advance. Advertising strove to create the impression of a distinct resemblance between the prescription tranquilizers, like reserpine and chlorpromazine, on one hand, and proprietaries like Tranquil-Aid, Sleep-eze, Sominex, and NervTabS, on the other. Some of the imitation tranquilizers were essentially the old-fashioned bromides. Others were antihistamines. This was an intriguing development. A decade ago a whole host of proprietaries burst upon the market, virtually promising that the antihistamines they contained would prevent and cure the common cold. The FTC took action against the most flagrant advertising. Medical observation revealed that a prominent side effect of antihistamine therapy was sedation, a feeling of drowsiness. Thus, as the old market waned, a new one opened up. The side effect was moved to center stage. Anti-histamines became non-prescription tranquilizers .
Fraudulent food supplement promotion, currently the major economic front in quackery, demonstrates the flexibility with which the unscrupulous adapt to new conditions. One type of enterpriser in this racket is a salesman who goes from door to door. His medicines are herbal mixtures or vitamin-mineral capsules, accurately labeled as to constituents and bearing no therapeutic claims. A Food and Drug agent, scrutinizing a bottle, can find no fault. Where the trouble arises is in the salesman's oral pitch. To the man or woman who answers the door, he tells a plausible tale of how ill health results from relying on foods grown by the methods of modern agriculture, which drain valuable nutriments from the soil and add poisonous fertilizers to it, or by modern food processing, with its additives and subtractives. There are genuine hazards to health in food about which people are justifiably concerned; Congress expanded the food law in 1958 to require that additives be tested for safety before being introduced to the public diet. However, the food supply of the American people is the best in all history. The quack, distorting the truth and grafting his message to fear, approaches the credulous with words like this, taken down by tape recorder: "You eat food to make blood. You send down junk, your body will be junk. Your body will wind up in the junk pile. You send down vital elements that are needed, you're okay. 'Whenever you get your body normalized, you won't have no condition. You can't even take a cold. I don't care how you're exposed to freezing temperature, wet feet and cold feet, you'll never take it if you get your blood stream up to par." 
The salesman's pulverized alfalfa or his bona fide vitamins, of course, ward off the danger or cure the complaint -- even if it is a broken leg . The court victories expanding FDA's jurisdiction to include control over such oral nonsense are in some ways frustrating. How to catch hold of, for policing, the fleeting words of a hundred thousand salesmen who are working at the nutrition racket?
The problem is so gigantic that the Food and Drug Administration, the American Medical Association, and the National Better Business Bureau launched in 1958 a joint campaign of counter-propaganda. Officials have made speeches and issued press releases. The AMA has urged local medical societies to fight food faddism, and has produced a film demonstrating by case example the dangers of nutritional quackery .
Allied to the food supplement business is the weight reduction craze. Prosperity has permitted the nation to eat high off the hog, with the inevitable result. To embarrassment on aesthetic grounds, as a motive for reducing, has been added fear, spurred by the wide circulation of medical reports showing the high correlation between too much weight and heart and circulatory ailments. Americans have been wealthy enough to pay for expensive drugs and devices which their promoters promise will take off fat without dieting or exertion. To stop the most dangerous and deceptive of reducing racketeers has been a high-priority concern of regulatory agencies. Numerous actions have been taken against "appetite suppressant" drugs, and, according to William W. Goodrich, head counsel for food and drug matters in the Department of Health, Education, and Welfare: "We have seized, I believe, every kind of shaking machine that the mind of man can devise." 
As geriatrics assumes greater importance in reputable medicine, so it does in quackery. "It is among the older group," states the report to the President from the Federal Council on Aging, "that the unscrupulous operator finds the greatest potential for his wares and services. It is in this age group that we find the diseases with which medical science is not fully capable of deal-ing-such as cancer, heart disease, arthritis, and others." Florida and California, meccas for the aged, are also the abode of many false medical prophets. Nearly half of America's 11,000,000 arthritis sufferers, according to the Arthritis and Rheumatism Foundation, are spending money for misrepresented drugs and devices. Cancer quackery has risen so alarmingly -- there are now some 4,000 practitioners-that it too has been the theme of national warning campaigns .
One of the more persistent operators in the cancer field has been Harry Hoxsey. For over thirty years, though four times convicted of practicing medicine without a license, he has vended his various remedies. In about 1936 Hoxsey set up a clinic in Dallas, promising cancer victims a painless cure without surgery, x-ray, or radium. There his staff gave patients superficial examinations -- rarely including biopsies -- and prescribed blackish brown or red liquids containing all or some of the following ingredients: sugar, red clover blossoms, prickly ash bark, pepsin, burdock, licorice, potassium iodide, and other substances equally ineffective in cancer therapy. The cost per patient was $400 plus other fees and expenses. Officials of the Food and Drug Administration did not think they could take effective action, since Hoxsey was careful not to ship his medicines across state lines. In 1948 the Supreme Court interpreted the labeling provisions of the 1938 law in a more elastic way so as to give the FDA hope, and in 1950 the agency brought suit for an injunction to stop Hoxsey's cruel deceptions. The District Court refused to grant the injunction, but the Circuit Court of Appeals stated that the evidence was overwhelming and ordered the District Judge to do so. When all the appealing was over, all the counter-suits quashed, the date was 1960. A Pennsylvania Hoxsey Cancer Clinic was closed, the operators of the Dallas clinic were enjoined from ever again selling the medications comprising the Hoxsey treatment, and Hoxsey himself was ordered to stop sharing directly or indirectly in the profits of the Dallas operation .
While waiting out the law's inevitable delays, the FDA put out a public warning which appeared in church and farm periodicals, suggesting that anyone planning to take the Hoxsey treatment should first write to Washington to get the facts. Letters of inquiry came in for months at the rate of 50 to 100 a day. To spread the warning even further, the FDA sent copies of a "Public Beware!" poster, lettered in red and black, for display in the 46,000 post offices and substations throughout the land. Hoxsey got out his own propaganda, a book entitled You Don't Have to Die, defending his procedures and condemning his enemies. In an ominous show of unity, the major quacks in the business conspired to bring pressure on the FDA. "Using specialists in mass psychology," Commissioner Larrick has said, "the promoters held numerous meetings under the guise of 'scientific lectures' to organize a protest movement among those prejudiced against recognized medical treatment. They used radio, television, circulars, 'religious' publications and even huge barn-side signs, to encourage the public to write to Congressmen and the President, demanding investigations of FDA 'persecution' of their leaders. Many of them did write, for we have had a torrent of belligerent letters to answer." 
After the Pennsylvania victory, Larrick had issued a statement
of somber import. "The public should know. . . ," he
said, "that such actions will not end the menace of this
treatment since the Federal Government does not have the power
to stop a clinic in any State from treating cancer patients within
that State with the nostrums which comprise the Hoxsey treatment.
Millions of copies of false promotional literature are still in
circulation; much of it reporting cures of persons who are now
So disturbing, indeed, is the magnitude of medical quackery in our disturbing times that a new anti-quackery crusade is well launched to combat it. Regulatory agencies are applying greater rigor to enforcement. Their officials, in collaboration with representatives from the health professions and reputable business, are seeking to warn the public by means of major educational campaigns. Muckraking in lay journals is reviving. Congressional committees are expressing concern. New laws are in the offing.
It is a sad fact that Nicholas Knopp, with his Scurvy Water in 17th-century Boston, and Monsieur Torres, with his Chinese Stones in 18th-century Philadelphia, and William Radam, with his Microbe Killer in 19th-century Austin, are not quaint figures representing outmoded traditions associated with medical ignorance of ancient days. They and their victims are, as it were, still alive, to cast a shadow on the medical 'brilliance of our own day.