Who would you guess authored a 250-page report which begins with this Preface?
This report marks the culmination of an intensive four-year review of quackery and its impact on the elderly. . . As this report details, quackery has traveled far from the day of the pitchman and covered wagon to emerge as big business. Those who orchestrate and profit from the sale and promotion of these useless and often harmful “health” products are no longer quaint and comical figures. They are well organized, sophisticated and persistent. [We estimate] the cost of quackery – the promotion and sale of useless remedies promising relief from chronic and critical health conditions – exceeds $10 billion a year. The costs of quackery in human terms, measured in disillusion, pain, relief forsaken or postponed because of reliance on unproven methods, is more difficult to measure, but nonetheless real. All too frequently, the purchaser has paid with his life. While the impact of quackery on our lives has been increasing and growing in sophistication, public and private efforts designed to address and control this problem have diminished, been redirected or disbanded.
The author defines quackery as:
The promotion of medical remedies known to be false or which are unproven for a profit, usually by means of false representations that they will “cure” or aid in the cure of various diseases and problems. Quackery is pseudoscience at its best.
And offers the same observation we’ve made here at SBM that:
one of the most appalling elements of quackery [is that it amounts to] uncontrolled tests on human guinea pigs . . . Humanity as well as science demand that new remedies be tested and proven safe and effective before wide dissemination.
The author goes so far as to suggest that this:
is reminiscent in its callous disregard for human life of some of the worst atrocities of World War II.
The report concentrated on quackery’s effect on the elderly, and consequently focuses especially on cancer and arthritis. Yet the author makes clear that quackery defrauds all ages and extends to many other diseases and conditions. In an exhaustive search for information, the author’s investigators gathered information from federal agencies, such as the FDA, the FTC and the Department of Justice, as well as state and local sources, like state Attorneys General and law enforcement. They also contacted charitable organizations focused on specific diseases, like the American Cancer Society, consumer advocates and individual victims. Health claims were evaluated by medical and scientific experts and their conclusions included in the report.
The author found many quack beliefs and practices that will be familiar to SBM readers.
- The idea that many diseases are caused by vitamin and mineral deficiencies and a “more is better” approach to vitamin and mineral supplementation.
- An unwarranted belief by the public that the health field is rigorously policed, which gives undue credibility to quack claims.
- The appeal of quack remedies for diseases for which medicine sometimes offers limited options and no absolute cures, as well as conditions which result in chronic pain.
- The claim that food allergies are the cause of diseases that have nothing to do with allergies.
- The putative value of plants and herbs to prevent, mitigate or cure disease, even in cases where these remedies are unproven or disproven, and sometimes dangerous.
- The idea that the body stores “toxins” which must be eliminated by enemas and herbal products including colon, gall bladder, liver and kidney “cleanses” or “flushes.” The colon is depicted as particularly vulnerable: “death begins in the colon” and the colon is incapable of proper operation without various interventions to “detoxify” the body.
- Copper or magnetic bracelets as a cure or preventative for arthritis.
- Treatment consisting of “adjusting the segments of the spine to correct vertebral distortions interfering with the nerve supply necessary for normal functioning of the organs and tissues of the body, i.e., correction of ‘vertebral subluxations.’”
- A seemingly endless variety of weight-loss schemes.
- Improper “energy flow” and other nebulous “imbalances” as the cause of disease.
- Quack cancer clinics (in the U.S. and abroad) and treatment methods, including Hoxey treatment and Gerson therapy, as well as accounts of parents who opted for quack therapies for their children in lieu of conventional care.
- Bogus diagnostic devices, including computerized nutrition analysis, boxes of colored lights, non-standard blood diagnostics and galvanometers.
- The idea that “your disease is your fault” and that a better attitude, happy thoughts or a more positive outlook would improve the patient’s condition.
- Surgery, radiation and chemotherapy as “unnatural” therapies to be avoided, and outright advice to cease prescribed medical treatments.
- Fasting and complicated diets as a preventative and cure, such as macrobiotic and raw food diets, including copious servings of wheatgrass juice. One practitioner’s view was that “doctors are murderers and hospital food is poison.” (OK, maybe he was onto something with that last one.) Certain foods are to be avoided altogether, even if the patient is not allergic to them: coffee, those with food additives and flour, among others. Two popular myths that underlie these diets are that all diseases stem from a faulty diet and that sub-clinical deficiency diseases abound in our populations.
- Exorbitant prices charged for worthless cures.
- The use of testimonials and case studies as evidence of effectiveness.
- Water as a cure all: “One of the most prominent themes in the mythology is that water is a cure for arthritis and/or other diseases. This applies to water which is consumed by mouth, taken by injection, sprayed with a nozzle on parts of the body or in which the joints are to be immersed. There is virtually no limit to the permutations. It can be hot water, lukewarm water, cold water, ice cold water or solid water the form of ice and can be salt water, mineral water, distilled water, spring water – the list is endless.”
- Other treatments such as reflexology, bee pollen, coffee enemas and glandulars.
And the author is . . .
It wasn’t us, although we consistently make many of the same points.
This comprehensive report, entitled “Quackery: A $10 Billion Dollar Scandal” was issued by the Subcommittee on Health and Long-Term Care of the House of Representatives Committee on Aging in 1984. The effort was promoted by the Subcommittee’s Chairman, Claude Pepper (D-Florida), who made advocacy for the elderly the centerpiece of his political career. The report is significant not so much for its findings, as interesting and as seemingly contemporary as they are, but rather for its attitude toward pseudoscienctific health care products and practices. What thirty years ago was called “quackery” is known today as alternative, complementary and integrative medicine and promoted by the very government that was so deeply concerned about its deleterious effects on the American public in 1984.
And it is not only the government that has devolved from science to pseudoscience since the report came out. The medical experts who evaluated and roundly criticized quack practices came from the very institutions that have allowed these same practices to infiltrate their operations: Georgetown University Medical School, the Cleveland Clinic, the University of Maryland, Harvard, and the Mayo Clinic. Compare, for example, the Report’s conclusion on acupuncture with integrative medicine’s current enchantment with this “ancient” Chinese remedy.
There has been a great deal of skepticism in the United States among the traditional medical community as to the effectiveness of acupuncture. Western experts have traveled to China to study the ancient art. For a while, acupuncture seemed to be finding support within the medical community, but the results of carefully controlled tests have turned the experts away from it. For more than a dozen years the Arthritis Foundation did not take a position on acupuncture. Its position now is as follows: We now have enough data from solid scientific work to express a view about acupuncture. Three studies – one on chronic shoulder pain, one on osteoarthritis and one on rheumatoid arthritis – have demonstrated that the beneficial effects of acupuncture are: (1) only on the symptoms of arthritis and not on the disease process itself; (2) due entirely to the placebo effect; and (3) are short lasting.
The Report then goes on to describe these studies, which compared real acupuncture given to one group with a control group, for whom the needles were “placed only lightly on the skin and, instead of being inserted in the traditional points, were positioned all over the body.” The result? The amount of pain relief was the same. Thus, “there is no good evidence that acupuncture is of any specific value in treating any form of arthritis.” Of course, as the Report noted, there are nevertheless “promoters who have sought to seize on the oriental mysticism of acupuncture.” With these results, one wonders why acupuncture continued to be studied in trial after trial (including additional studies on osteoarthritis) for the next 30 years, all with the same result. Can you imagine that over 30 years of studies of a particular surgical procedure, all negative, would nevertheless result in continued promotion of the very same procedure?
Some devices covered in the report seem like caricatures of quack inventions. No longer available (to my knowledge) are the Dynatone Facial Exerciser (for wrinkles), Rado Pad and Uranium Wonder Gloves (radioactive gloves for the cure of arthritis), the Radon Generator (produces radon gas, to be mixed with water), Zerret Application (a dumbbell-shaped device filled with “zerret water,” to be held for 30 minutes while the “healing rays expand all the atoms of your being,”) or the Mark Eden bust developer (“a clam-shaped tension device that supposedly exercised the breast” to make it bigger). (Remember ubiquitous ads for these in women’s magazines of the day?) I would note, however, that none of these devices are any more implausible than reiki, therapeutic touch or homeopathy.
While the technology of pseudoscience may have changed since 1984, the toolkit of the quack is remarkably similar. These guidelines from the Arthritis Foundation are offered for spotting the unscrupulous promoter :
- He may offer a “special” or “secret formula” or device. . .
- He advertises . . . “case histories” and testimonials from satisfied “patients.”
- He may claim to know the “cause” of arthritis and talk about “cleansing your body of “poisons” and “pepping up” your health. [Today the language would likely be “eliminating toxins,” “increasing your energy” or “boosting your immune system.”] He may say surgery, x-rays and drugs prescribed by a physician are unnecessary.
- He may accuse the “medical establishment” of deliberately thwarting progress, or of persecuting him . . . but he doesn’t allow his method to be tested in tried and proven ways.
The report displays none of the reverence for alternative practitioners that you find in government or in integrative medicine practices today. In fact, it puts them on a continuum that includes witches:
The tradition of healing which combines elements of religion, magic and medicine has probably always existed in various parts of the world. In modern times, these techniques range from the practices of medical mountebanks and “alternative” health professionals to witches, faith healers, nutritional faddists and spiritual healers.
Unfortunately, in the current “modern times,” “these techniques” are found in academic medical centers which form “integrative practices” with the very same alternative health professionals and nutritional faddists, except that we now call the latter naturopaths. Speaking of nutritional faddists/naturopaths, who claim they invented prevention through healthy lifestyle practices, look at these thirty-year-old (at least) dietary guidelines from the American Cancer Society, reprinted in the report:
- Avoid obesity.
- Cut down on total fat intake.
- Eat more high-fiber foods, such as fruits, vegetables and whole-grain cereals.
- Include foods rich in vitamins A and C in the daily diet.
- Include cruciferous vegetables such as cabbage, broccoli, Brussel sprouts, kohlrabi and cauliflower.
- Be moderate in consumption of alcoholic beverages.
- Be moderate in consumption of salt-cured, smoked and nitrite-cured foods.
The Subcommittee made several suggestions to alleviate victimization of the public by quacks: increased government enforcement efforts, increased criminal penalties, more funding for research into diseases (such as cancer) which make patients particularly vulnerable to offers of miracle cures and other pseudoscience, more consumer education, strengthening medical licensing statutes to make practice of medicine without a license a felony and more patient protection when non-standard therapies are offered.
The only suggestion for reform apparently taken up by future Congresses was to establish a federally-sponsored mechanism to evaluate evolving medical technologies and procedures for safety, efficacy and cost-effectiveness. Unfortunately, the purpose of the “federal mechanism” actually created by Congress, the National Center for Complementary and Alternative Medicine, was to “validate” alternative medicine. All in all, you’d almost think the state and federal governments spent the last 30 years in a deliberate attempt to thwart Rep. Pepper’s and the Subcommittee’s goals. They certainly did a good job of it.
In its conclusions, the Report takes on a criticism often directed at those who support science-based medicine: that we automatically reject anything that doesn’t originate with conventional medicine. It responds in almost the same terms we have used.
Does that mean that the Committee condemns each unproven remedy mentioned in the report?
No. Many of the so-called “cures” listed in this report have been proven false. Others are so ludicrous that the commonsense indicates they cannot be of much value. Others have a scintilla of credibility. It may be that the next major breakthrough in medical science is listed in this report, although that is highly doubtful. What the Committee is saying [is] that a cure or remedy, before it can be proclaimed as such, must be proven to be so through the established procedures of the scientific method. There must be unbiased, scientific evidence that a remedy is helpful and that it does not provide harm or untoward side effects before society can allow its widespread use by the general public.
We have gone terribly astray in the last 30 years. What went wrong?