The Literature of Quackery: Amusement and Understanding
A display from the library of
Loren Pankratz, Ph.D., Clinical Professor
Department of Psychiatry
The National Council against Health Fraud suggested this definition: Quackery is the promotion of health products, services, or practices of questionable safety, effectiveness, or validity for financial gain.
Using the term "health" includes promotions aimed at enhancing beauty, physical performance, disease prevention, or health wellbeing, not simply treatments and cures.
Your mother is not engaged in quackery when she tells you to eat her chicken soup. She does not say it will cure you—only that you will feel better. She does not sell it to the neighbors as a panacea for disease. She does not say her recipe is being suppressed by the medical establishment. She does not say it contains secret ingredients discovered by an aboriginal tribe or a Swedish chemist. Your mother's chicken soup—and folk medicine—are not quackery.
Medical care should be based on procedures and treatments shown to be safe and effective through a process of scientifically sound investigations. We can easily be fooled by our theories, desires, and fears. Trustworthy medical management emerges in the context of good science.
Consumers can choose any treatments they wish. But they have the right to know the facts. Quacks rely on feigned effectiveness by using testimonials and declaring that "it works." They want you to try it and make up your own mind—bypassing the steps for establishing effectiveness and safety. They use words like "natural," "wholistic," and "complementary." Freedom of choice should not be promoted as a substitute for freedom from accountability. The burden of proof rightly belongs on the product's proponent.
Some historically significant books.
1. The first blow against quackery in America, 1905.
The first quack attack on American patent medicines was launched in Collier's Weekly by a news reporter named Samuel Hopkins Adams. Adams addressed the problem of drunkenness and addiction caused by the alcohol and opiates in patent medicines that contained no indication of the content. Alcohol sold in this way was free from taxation and was promoted through advertisements in magazines and newspapers throughout the country. Effectiveness was presumed through personal testimonials, including clergy, temperance advocates, and physicians, although many endorsements were nothing more than creative writing.
Adams wrote 10 articles from 1905 into 1906, confronting by name some 264 popular medicines, individuals, and clinics. The impact was overwhelming. Newspapers reported his findings—and the threats against him—while concerned about their own role in promoting these dangerous nostrums. The American Medical Association organized a Council on Pharmacy and Chemistry to investigate and recommend ethical standards for physicians. In 1907, Congress passed the Pure Food and Drug Act, with only a few negative votes by representatives who were fearful of Federal encroachment on the constitutional powers of the states.
Adams ruefully noted that Americans are more cautious when buying a horse or a box of cigars than they are when attending to their health. If you want a health hero, Samuel Hopkins Adams would be hard to beat.
Adams, S. H. (1906). The great American fraud. NP: Collier & Son.
2. The British Medical Association publishes the content and cost of common medicines.
The British Medical Association published their chemical analyses of patent medicines in 1909 and 1912. They believed that the idea of a "secret" remedy was inappropriately appealing to the gullible public, so they reported the ingredients—and cost—of commonly advertised medical products. They disclosed that the bottles, boxes, and packaging were often more expensive than the contents.
The second volume continues the work of the first but also includes the work of a Berlin physician who analyzed nostrums sold in Germany.
British Medical Association. (1909). Secret remedies: What they cost and what they contain. London: British Medical Association.
British Medical Association. (1912). More secret remedies: What they cost and what they contain. London: British Medical Association.
3. The American Medical Association begins a crusade against quackery.
The fight against quackery by the AMA was directed by a tireless young physician, Arthur Cramp, who had lost a daughter treated by a quack. He published the results of chemical analysis of proprietary and patent products in JAMA, and some were issued as pamphlets, as displayed in the case. As this work grew, these articles were published in the books from 1910 to 1936, displayed here.
Products promoted to physicians by pharmacies were of as much concern as those made in bathtubs and sold from covered wagons. Cramp established a monumental collection of information on products, manufacturers, and promoters, which he tirelessly used to assist the medical profession and individual consumers.
American Medical Association. . Nostrums and quackery: Articles on the Nostrum evil and quackery reprinted from the Journal of the American Medical Association. Chicago: American Medical Association. [Volume I]
American Medical Association. (1912). Nostrums and quackery: Articles on the nostrum evil and quackery reprinted, with additions and modifications, from the Journal of the American Medical Association. Chicago: American Medical Association. [Volume I, with addenda]
American Medical Association. (1916). The propaganda for reform in proprietary medicines. NP: American Medical Association.
Cramp, A. J. (1921). Nostrums and quackery: Articles on the nostrum evil, quackery and allied matters affecting the public health; reprinted, with or without modifications, from the Journal of the American Medical Association. Chicago: American Medical Association. [Volume II]
Cramp, A.J. (1936) Nostrums and quackery and pseudo-medicine. Chicago: American Medical Association. [Volume III]
4. Dr. Morris Fishbein continues the fight against quackery.
Morris Fishbein was an editor of JAMA and a colleague of Cramp. Fishbein also edited Hygeia, a magazine designed to educate the public about the problems of quackery. His lively articles from that magazine were published in the books displayed here.
Fishbein extended his evaluations beyond the traditional quack medicines into a broader range of health promotions. For example, he reviewed the advertising of health cultures, strong men, faith healers, diet promotions, and beauty aids. Once curious readers sent for the usually "free" information, they were badgered to purchase exercise devices, lessons, and secret knowledge. Even more, they were promised disease avoidance, long life, financial success, and sexual vigor. And if a correspondent failed to respond, follow-up letters offered more promises and health gadgets for less cost.
The targets of Fishbein's pen were furious with him because of the impact on their business. See next:
Fishbein, M. (1925). The medical follies. New York: Boni & Liveright.
Fishbein, M. (1927). The new medical follies. New York: Boni and Liveright.
Fishbein, M. (1932). Fads and quackery in healing. New York: Blue Ribbon.
5. Fearing loss of advertising revenue, Bealle fights the anti-quackery campaign of the AMA and Fishbein.
Morris Bealle was a newspaper editor who got caught in the conflict between advertisers and the public good. This gave him a new slant on the idea of a "free press," a press that was free to print any advertisement that would pay his bills.
Bealle took to attacking the AMA—and Morris Fishbein in particular—with some nasty insinuations, as his title illustrates. Beware the wrath of a quack, especially one like Bealle who is big on conspiracy theories while avoiding the specific concerns of critics: does this product provide a safe and effective solution as advertised?
Bealle, M. A. (1939). Medical Mussolini. Washington, D.C.: Columbia Publishing.
6. The definitive history of quackery in America.
Toadstool Millionaires offers a review of quackery from the founding of our nation until the passage of the Pure Food and Drug Act of 1906. As a sequel, the Medical Messiahs follows the history from the first court challenge of this legislation through the next half century.
These two books provide a comprehensive consideration of proprietary and patent medicines, written in a scholarly yet entertaining way. Young considers this dark aspect of American history within the larger context of social trends, health education, medical advancement, advertising, journalism, and attempted government regulation.
Young, J. H. (1961). The toadstool millionaires: A social history of patent medicines before federal regulation. Princeton: Princeton University Press.
Young, J. H. (1967). The medical messiahs: A social history of health quackery in twentieth-century America. Princeton: Princeton University Press.
7. Quackery is alive and kicking the elderly for $10 billion a year.
Florida representative Claude Pepper conducted a four-year investigation of quackery and its impact on the elderly. And the picture was not pretty, as the "$10 billion" title suggests. The quaint pitchman in his covered wagon was replaced by quacks that were organized, sophisticated, and persistent. Indeed, a former FDA commissioner excused the agency's "imperceptible" control of quackery by saying they were "simply overmatched . . . There are too many quacks [who are] too skillful, and the quick change of address and the product name [are too much] for the cumbersome FDA."
Pepper, C. (1984) Quackery: A $10 billion scandal. Subcommitte on Health and Long-Term care of the Select Committee on Aging, 98th Congress. Washington DC: U.S. Government Printing Office.
8. Much of what is known as "complementary" or "alternative" medicine has no proven benefit.
The author admits that introducing himself as a research methodologist is sufficient to glaze the eyes of anyone who asks what his job entails. However, medical science advances only as we honestly examine our beliefs in light of carefully controlled experiments.
Enter Bausell, our research methodologist, empirical philosopher, and discerner of what works—and whether for the reasons that people believe.
Far from being dull, this book takes the reader through the fascinating world of belief, placebo effects, and misunderstood research. Science is not for sissies. Get ready for the body blow—and don't count on pain relief with acupuncture. Bausell evaluated acupuncture as a NIMH-funded researcher at the University of Maryland's Complementary Medicine Program.
Bausell, R. B. (2007). Snake oil science: The truth about complementary and alternative medicine. New York: Oxford University Press.
9. Quackery addressed on the internet: Quackwatch.com.
Stephen Barrett, MD, was a psychiatrist who became fascinated by health frauds in the late 1960s. In 1977, he searched 500 magazines for advertisements of mail-order health products. Not one lived up to its claims. The results were published in Consumer Reports, which became the basis for a law that strengthened enforcement by the Postal Service. In 1985, he showed that hair-analysis laboratories gave wildly different results to the same hair samples. Many closed their doors. By 1993, he closed the door to his own practice of psychiatry to devote full time to the investigation of health claims.
Since his launch of Quackwatch in 1996, Dr. Barrett has received numerous awards for this website that provides clear information about individuals, institutions, laboratories, products, services, and health theories. He also publishes a weekly (free) e-mail newsletter that reviews scientific reports, enforcement actions, and consumer protection issues. His website and newsletter show that quackery is alive and well.
I began with Samuel Hopkins Adams, and it is fitting to end with Stephen Barrett. Both have demonstrated a razor-sharp ability to expose unproven health claims. Check the following books for further help in understanding the history of quackery and the role of scientific thinking.
Some books of entertainment and understanding of quackery.
1. Quacks stood out even in the days of superstition and medical ignorance.
Thompson was the curator of the museum of the Royal College of Surgeons, and he displays here the panorama of quackery in London from the earliest times. Although medicine was previously riddled with ignorance and superstition, these quacks stand out for their exaggerated claims, misrepresentations, deceptions, and disregard for the welfare of their dupes. Thompson noted that London has been the center of civilization, yet quacks flourished because they exploited astounding gullibility and credulity. London was the place to separate the sick—and the fearful—from their money.
Thompson, C. J. S. (1928). The quacks of old London (1st ed.). London: Brentano's.
2. The great deceivers of the western world.
de Francesco is a master at analyzing the social and psychological factors that drive the quack, alchemist, and charlatan. He explains how the quack flatters his victim into thinking that he has the solution to his problems. de Francseco said of one charlatan who arrived in an Italian city promising the alchemical production of gold: "He was immediately recognized, precisely because everyone had been looking for him so earnestly."
This is a book with spectacular insights about deceivers and deception.
de Francesco, G. (1939). The power of the charlatan. New Haven: Yale University Press.
3. The bandwagon, the press, and the airwaves—it's everywhere.
Holbrook moved to Portland in 1923 as a 30-year-old unemployed logger without a high school diploma. But his dozens of books, mostly about the Pacific Northwest, became nationally popular because of his witty raconteur style. In this book, Holbrook lives up to his reputation, as convincing as any quack selling tonic out of the back of his wagon, rumbling through the history of American medical frauds. Beware of counterfeits and imitations! Holbrook is the real deal.
Holbrook, S.H. (1959). The golden age of quackery. New York: Macmillan.
4. Quacks and cranks examined up close and personal.
For 25 years, Martin Gardner (1914-2010) wrote the Scientific American column on recreational mathematics and games. Many scientists point to Gardner—and often to this very book—as a critical influence on their career. One tribute to him said, "In this book, somebody—clearly somebody very intelligent—was tearing one oddball belief system after another to shreds in a lucid, acerbic, yet at the same time humorous way. This "Martin Gardner" person was wielding common sense as a surgeon wields a knife—and occasionally twisting the knife with glee."
Here Gardner addresses how to think about questionable scientific claims. It is as fun as it is insightful, as only Gardner can write.
In 1952, Gardner published In the name of science, which evolved through various editions. In this book, Gardner reprints responses of those he had criticized—followed by his final words. Thus, the reader is able to track the history of claims and counterclaims, a history so fascinating that this book will probably remain in print as long as charlatans cloak themselves in the mantel of science.
Gardner, M. (1981). Science: good, bad and bogus. Buffalo: Prometheus.
5. The misleading power of personal endorsement.
In 1984, the Army Research Institute asked the National Academy of Sciences to form a committee to examine the potential value of certain techniques that had been proposed to enhance human performance. Many of the practices they studied were highly regarded by their practitioners and customers, but researchers have consistently rejected testimonials. The committee acknowledged that some regard research as a debunking enterprise of scientists who have little contact with consumers or patients. Therefore, the committee spent considerable space reviewing the purpose and methods of science, which aim to winnow out the real from the illusory through a self-correcting progression of experiments. They pointed out that there is a large body of research on testimonials, the vulnerability of personal beliefs, and mistakes in attribution.
These books, especially In the mind's eye, carefully explain how testimonials have repeatedly led reasonable people to wrong conclusions. Testimonials carry an amazing spectrum of biases, even in situations with high levels of conviction. In one amusing example, a man described how he got a new job and tripled his old salary after listening to a subliminal tape on wealth and prosperity. But the tape was blank; it had no detectable embedded message. Testimonials can have an overwhelming effect on personal judgment, which must be understood by anyone evaluating medical claims.
These books focus on performance enhancement, learning, and psychological quackery including "neurolinguistic programing," an unsupported theory that was influential in starting and maintaining the career of motivational expert Tony Robbins, who is mentioned below for his promotion of nutritional nonsense.
Druckman, D., & Swets, J. A. (1988). Enhancing human performance. Washington, D.C: National Academy Press.
Druckman, D., & Bjork, R. A. (1991). In the mind's eye: Enhancing human performance. Washington DC: National Academy Press.
6. Profusely illustrated.
Profusely illustrated with gadgets, apparatus, paraphernalia, and the advertising gimmicks of quackery—as succinctly stated by the subtitle. The dust jacket graphically illustrates how quackery has penetrated the culture. Here, British Prime Minister William Gladstone, in 1889, is depicted as selling his political agenda as a cure-all medicine to frightened and gullible citizens who are willing to swallow anything that promises an easy fix.
Helfand, W. H. (2002). Quack, Quack, Quack: The sellers of nostrums in prints, posters, ephemera and books. New York: Grolier Club.
Some books with quackery
1. Nutritional Nonsense
Nutritional misinformation is so ubiquitous that it is difficult to select a representative book. However, the book by Harvey and Marilyn Diamond is difficult to resist. Indeed, the American public could not resist its lure, placing it on the New York Times best seller list for months.
Stephen Barrett said it is one of the nuttiest books of all time. Another reviewer said "the book seems unprecedented in the amount of misinformation contained." He said it was a gauge of the nation's ignorance on health, nutrition, and physiology. He said its only value was to inform health educators on their failure to impart basic health knowledge to citizens.
The authors graduated from a diploma mill run by a high-school drop-out who claimed that viruses do not exist and that AIDS, polio, and cancer are inventions of the government and drug industry. The State of Texas described the Diamonds' alma mater as "a school for scoundrels, run by con artists to teach other con artists how to make a sting."
Readers should have known they were being scammed merely by reading the dust jacket:
". . . it's not what you eat, but when and how!" Open the front flap where it says this book "crushes orthodox medical dogma about the basic four food groups and debunks myths about the importance of milk and protein in the diet." Or maybe the disclaimer on the copyright page should have warned the reader.
But dreams of perfect health and a pain-free existence are daily flaunted before us by quacks and drug-company ads alike. And we take the bait. Talk to your doctor about it.
One would hope that such nutritional quackery would have a short life, but the Diamonds' theories lived on. Next came Living Health in 1987 and then Fit for life II in 1988. Tony Robbins, the self-help guru, promoted the same nonsense in his Unlimited Power, 1987. But then, Robbins remains consistent by failing to acknowledge the science behind his fire walking stunts.
Diamond, H., & Diamond, M. (1985). Fit for life. New York: Warner Books.
Diamond, H., & Diamond, M. (1987). Living health. New York: Warner Books.
Robbins, A. (1987). Unlimited Power. New York: Ballantine Books
2. The Spectro-Chrome Hoax.
In 1925, Dinshah Ghadiali (1873-1966) was arrested in Portland after a pistol battle with police. He was sentenced to prison for violation of the Mann Act, which restricts the movement of minors across state lines for certain purposes. But his visits to prisons in most instances were related to his practice of medicine without a license. In fact, the AMA could not find that he ever graduated from an accredited medical school. To avoid prosecution, he relabeled "cure" as "normalating" the body. He did not "treat" patients but said he could "restore their Radio-Active and Radio-Emanative Equilibrium."
On the title pages of his books, Ghadiali identified his credentials as:
M.S-C. (honorary) M.D., M.E., D.C., Ph.D., LL.D., N.D., D.Opt., D.F.S., D.H.T., D.M.T., D.S.T., etc.
He listed himself as a metaphysician and psychologist, followed by a long list of memberships in associations, including one with "Orificial Surgeons." In 1931, Ghadiali was charged with grand larceny after someone complained that his machine did not perform as promised. In his defense, he produced satisfied patients and several physicians who claimed they had successfully treated numerous diseases with his gizmo. In the end, he was found not guilty because the prosecution failed to prove his intent to defraud.
Ghadiali proclaimed that success of his Spectro-chrome had been established for all time. His anti-establishment rhetoric and promise of non-invasive cures earned him a million dollars in Spectro-chrome sales by 1940.
However, the passage of the Food, Drug, and Cosmetic Act of 1938 gave the FDA new powers in regulation. In his 1945 trial, he had no supporting physicians. His fate was sealed when his star witness, whom he had cured of seizures, had one on the witness stand. He was fined and his books and lamps were seized, but he was out selling his lamps again with an attached label that said "no curative or therapeutic value." He was impossible to stop.
After his death, his sons established the Dinshah Health Society. Books promoting his theories and lights are still sold on the internet.
The OHSU Library owns the Spectro-chrome apparatus displayed here. Ghadiali sold these for $750, and his home treatment contraptions sold for $70 to $150. Treatment was based on theories that are nothing less than funny to read. His three-volume encyclopedia is rambling and incomprehensible it jumps from topic to topic and disease to disease.
His other books displayed in the case are transcripts of his trials, which he believed revealed his genius and the evil of the agencies out to get him.
Light is important for health, including for our psychological wellbeing and our biological clocks, as demonstrated by the distinguished career of OHSU scientist Dr. Al Lewy. However, Ghadiali is in a long tradition of quacks who have misunderstood or misrepresented the science of light.
Ghadiali, D. (1939). Spectro-chrome metry encyclopaedia. Malaga, NJ: Spectro-Chrome Institute. Second edition, three volumes.
These volumes are rare because the FDA destroyed all the copies they could find.
Ghadiali, D. P. (1944). Triumph of Spectro-chrome attuned color waves vindicated in New York Supreme Court. Malaga, NJ: Dinshah Spectro-Chrome Institute.
Ghadiali, D. (1947). One thousand years ahead. Malaga, NJ: Dinshah P. Ghadiali.