More Useful Stuff
Quackery. Think Groucho Marx in A Day at the Races. Think Dr Nick on The Simpsons. Quack: it’s just a funny word. Why does someone trying to pass himself off as a doctor strike us as funny? It’s been a source of comedy as far back as the 17th century, when the French playwright Molière lampooned quack doctors and their gullible patients in The Imaginary Invalid. Molière himself played the title character in the play’s brief run, which ended the night he collapsed on stage. He died a few hours later from a pulmonary haemorrhage. There’s a moral in there somewhere.
Quackery entered the European scene not long after medicine began to organise as a profession. For Molière, writing during a time when no cures for any of the fatal diseases existed, the joke was on everybody: legitimate doctors were as fraudulent as any quack. But – as Molière’s own end suggests – the diseases were real. The need to treat them drove a centuries-long search for medicine as real as those illnesses, something that would make the difference between it and quackery more than an ironic joke. Today, the difference is (or ought to be) clear.
A doctor’s drugs can cure you. Quack medicines are a con. But the story is much more complicated than that, of course – particularly for men.
He’s lying there in a hospital bed, a patient I’ve known for about two years. A little anxious about his health, he sees me frequently to find out if he has some condition he’s read about. A couple of months ago it was fibromyalgia. I told him he didn’t have fibromyalgia. Now he’s in the hospital, but not with fibromyalgia: he’s in acute renal failure [ARF]. In an otherwise healthy person, ARF is usually caused by dehydration. After that, the usual cause is drugs – the prescription kind.
But I know his prescription meds, and there’s nothing on the list that should have done this. Which is why, after he doesn’t respond to the usual treatment of IV saline, I ask him if he’s been taking anything else lately.
He looks embarrassed, guilty and scared. The answer, of course, is yes.
“What was it?”
Quinine. It makes sense. A hefty dose of quinine can mess up your kidneys. But why is he taking quinine? It’s still used for malaria sometimes and babesiosis (don’t ask). Some people prescribe it for restless legs syndrome despite the lack of evidence that it works. But I haven’t heard any of these on his list of imaginary diagnoses.
“For my fibromyalgia,” he explains. He had ordered it on the advice of some guy on an infomercial. That was six weeks ago. He still doesn’t have fibromyalgia, but now he does have chronic kidney disease.
By the start of the 19th century, medicine wasn’t much better than it had been in Molière’s day. Bloodletting was still the standard of care, and what bleeding couldn’t treat, strong laxatives were sure to cover.
It wasn’t until the 20th century that medicine finally took on the mainstream form we know today. As scientific method increasingly shaped medical practise, the questionable freewheeling trade that had characterised it up to that point went into eclipse. This divide deepened over the next several decades, when scandals involving tainted food and drugs led to the establishment of agencies like the US Food and Drug Administration (FDA), which were charged with regulating drugs and medical devices for safety and efficacy.
Still, contraptions and compounds that promised way more than they could deliver – and delivered more harm than good – persisted despite the any type of regulation. They were underground, impossible to stamp out. Part of the problem was that regulation had had a curious side effect. The medical establishment itself became a target: with the growth of procedure-oriented, overly technological treatment that valued the billable over the humane, it’s hardly surprising that people began to wonder if doctors were really to be trusted at all.
The eventual explosion of whole industries devoted to marketing alternatives to conventional medicine led to legislation in the early 1990s. But this compounded the problem: as long as marketers offered a product not as a drug but as a “supplement,” they no longer had to demonstrate the efficacy or even the safety of what they were selling. In some cases, these supplements are actually drugs. A recent study in JAMA Internal Medicine noted that between 2004 and 2012, the FDA recalled 237 dietary supplements because they contained pharmaceutical ingredients, which created “a reasonable probability” that using the products would “cause serious adverse health consequences or death”. While the researchers don’t know whether men or women bought more of these quack products, we can guess: the top three supplement categories recalled were listed as “sexual enhancement”, “bodybuilding” and “weight loss.”
He’s a guy in his mid-40s, an outdoorsman to the bone. I don’t see him often because he’s healthier than any other guy I know of that age. And also because he doesn’t trust doctors. He told me this at his first appointment, just after explaining that his wife “dragged” him in for the infected barbed-wire wound he’d acquired on his last hunting trip. He’d tried hot compresses and a few other folk remedies, but when those didn’t work, his wife had put her foot down. I’ve seen him only two or three times since then.
All of this flashes across my mind when I find him in an examining room looking… not so good.
He doesn’t exactly look sick. He looks scared. The reason becomes apparent when, in answer to my startled “What’s wrong?” he turns away, pulling up his shirt to reveal, between his shoulder blades, an angry red wheal as big as my hand. In the middle of it is a heaped-up, black, fungating mass that can only be advanced melanoma.
You don’t diagnose cancer without a pathology report, however, so I keep that thought to myself. Grappling for a way to begin, I ask about the red wheal: melanoma doesn’t usually come with that.
He growls something I don’t quite get.
“Bloodroot!” He says again, loudly, angrily. When I don’t say anything for a minute after that, he explains, in a quieter voice, “I thought it would make it go away.” At the very end of that sentence, he’s as close to sounding vulnerable as I think I’ll ever hear him.
As I get the history, it’s clear he’s been harbouring this for a while. At first he ignored it. When it didn’t go away, he tried a few poultices that he knew of. And when they didn’t work, he went online and found a “natural healing” site that recommended bloodroot for skin cancers.
Because he knew, by then, what it was. He just thought bloodroot would cure it.
The World Wide Web has been a bonanza for medical quackery. To judge by what you can find there, we live in an age of miracles. A few taps on your tablet and you’re rewarded with remarkable accounts of revolutionary discoveries, photographs of heroic men in lab coats and testimonials from people claiming their cancer disappeared in two weeks. There is fine print, of course, in the same compressed monotone you hear in television ads for conventional drugs: “This isn’t medical advice/consult a qualified physician/the authors are not doctors/the accuracy of the information provided cannot be guaranteed/the reader must assume full risk.” Larger print trumpets a different kind of warning: “Big Pharma, the AMA, and the World Health Organization are plotting to keep this miracle a secret!” It’s entertaining reading, if you’re entertained by bad faith, anger and despair. If you’re not, then it’s just tragic.
It’s not hard to see contemporary medicine as a dead end. We read time and again about some laboratory breakthrough promising to conquer an ancient enemy – but then somehow that breakthrough never makes it out of the lab. We in the press have also played our role in this. When a new antiviral drug was submitted to the FDA for testing over a decade ago, hundreds of news stories hailed it as the cure for the common cold. When the FDA rejected it, barely a hundred brief notices appeared. This kind of overhype often seems to blur the line between mainstream medicine and quackery.
Now, as in the past, quacks tend to zero in on diseases that are common, often deadly, and beyond the reach of conventional medicine – certain cancers, Alzheimer’s and multiple sclerosis, for example. Basically, any illness with a foundation working to raise money for research also has quacks hovering nearby.
And that’s where the stakes in this get high. It’s bad enough to think that charlatans are fleecing people suffering from disease, but there is also the risk of being poisoned or mangled in some vital spot. Worse, for many people, the quack remedy replaces legitimate medical treatments that might prolong life, relieve suffering or even cure. Quacks don’t simply rob the desperate and unwary: they can kill them.
His wife brings him in. He can’t come by himself, ever since the accident five years ago. He was a healthy 32-year-old the day a drunk driver crossed the median and hit him head-on, leaving him quadriplegic, with a broken neck and a devastating brain injury.
With his head propped up on its padded rest, he goggles in random directions. Sometimes he tries to speak; mostly he just drools. Once, when I asked his wife why she’d brought him to see me, she snapped, “Because he’s still alive.” She gasped and covered her mouth as soon as it came out, but I couldn’t blame her. Anyone in her place would have despaired long ago.
Which is why, today, I’m surprised. He hasn’t changed, but she’s practically bubbling over with excitement, thrusting a sheet of paper into my hands. It’s a printout of a web page. Some outfit promises to use stem cells to cure: “Alzheimer’s, Arthritis, Autism, Chronic Fatigue, Brain Damage, Cancer, Cerebral Palsy, Chronic Pain, Cystic Fibrosis, Diabetes, Epilepsy, Fibromyalgia, Irritable Bowel, Heart Disease, Liver Disease, Lung Failure, Lyme Disease, Lupus, Multiple Sclerosis, Muscular Dystrophy, Parkinson’s, Seizures, Spinal Cord Injury, Stroke – and others!”
The “and others!” almost makes me laugh.
But when I look up from the sheet and find her gazing at me, tears rimming her eyes, it no longer seems funny.
She’d seen it on TV. There’d been video of a patient before the treatment. He couldn’t walk, couldn’t feed himself, just like – she nodded at her husband’s quivering head – but three months after the treatment, they showed him getting up out of his wheelchair and walking! By this point she was sobbing. She’d called them and they’d asked for a swab of cells from inside his cheek, “to make sure his genes were the right kind.” And they’d accepted him! She was taking him across the country next week to start his treatment.
As gently as I can, I explain that there is no stem cell therapy that can do this. Not now. Maybe in a few years, but not now.
I will never forget the way she looked at me as she wheeled her husband out the door.
Ordinary forms of human travail are also the quack’s stock in trade. Baldness, erectile dysfunction, and that nagging suspicion that size might really matter after all – these are profit centres for enterprising charlatans. No one knows how many men are taken in by this kind of thing – most victims aren’t eager to advertise it – and claims by quacks to have “cured thousands” are about as reliable as everything else they say.
But if you think about the money spent just on the legitimate treatments, the potential pool of suckers here is huge.
Why would anyone, especially a man, prefer a quack cure to the real thing? Lots of reasons. Simple fear is one. (Women are much better at facing illness-related anxiety.) Plus, men aren’t supposed to succumb to sickness – it interferes with our stoic self-image. And if what’s troubling a man is something that runs distinctly against the tough-guy grain, such as ED or PE, it’s even more difficult to bring to his physician. The great thing about the quack trade is that for the most part it’s anonymous. As long as you’re willing to believe (in miracles or conspiracy theories, take your pick), you can order a cure for anything. An Internet connection, a credit card and a postal address are all you need. No admissions of weakness or embarrassing personal revelations required.
Extravagant claims – “The only instant antidote to ED!” or “Reverses baldness in 95% of men!”– are the quack’s most potent marketing tools. You might think science would get in the way here, but in the world of quackery, science becomes a two-edged sword. Nothing is as sciencey as a quack. The typical website hawking a miracle cure supports its claims with paragraph after paragraph full of terms like “phlogiston-enabled oxygen deradicalizers.” Such flimflam exploits the mysteriousness of biomedicine. Left to puzzle it out for ourselves, we’re easily lost: we’re sure we’ve heard of “phlogiston” somewhere, and we know free radicals are bad…
Peeling back the facade of this sort of fake science is hard. And few people – especially the desperate, the trusting and those who are convinced the medical establishment is The Man – are going to have the capacity or the will to do the investigating, much less go out and get a degree in biochemistry.
But it turns out you don’t need to understand the science to know when you’re looking at a quack. The secret is that quacks quack. The sound is unmistakable. If you want to stay out of their clutches, just look for these easily identifiable field marks.
It’s selling something. This ought to be a no-brainer: if a website is selling something, it’s an ad. Do you really want to trust your health to an advertisement?
It’s an echo chamber. Do a Google search for the name of the treatment. If most of your hits lead back to that treatment’s site (quoting it, linking to it, referring to it), move on. Real treatments based on real science are going to be mentioned in numerous independent places, including reputable news outlets and medical journals.
It flocks with other quacks. Same tip here, different emphasis. If the other sites you find when you search are similarly quacky, stay away.
It has an organisation. Not many legitimate non-profit groups sponsor a commercial product. Unless you can confirm that the organisation is legit, give it a pass.
It has “expert” endorsements. If a treatment is touted by a “renowned” expert, it’s probably a fake. Real medicine doesn’t need endorsements. Search for the expert on PubMed (pubmed.gov). If his or her name doesn’t appear dozens of times as a study author of articles in medical journals, then that person is no expert.
It has testimonials. Quack sites often offer testimonials from patients claiming to have been cured. First, many conditions clear up on their own (warts, for instance). Second, just because someone thinks he was cured of cancer doesn’t mean he had cancer in the first place. Testimonials, no matter how heartfelt, prove nothing. What they can do, however, is exert a powerful emotional tug on your judgment.
It’s full of mumbo jumbo. The more sciencey-sounding jargon you encounter in what is essentially an ad, the less likely it is to be real.
It’s paranoid. Quack sites will tell you that their discovery relies on principles unknown to science and that establishment forces are trying to suppress it. They will revel in accounts of their persecution at the hands of the powers that be.
It cures everything. If it claims to treat more than one condition, forget about it.
It’s only natural. What does “natural” mean, anyway? One of the most abundant natural substances in the universe is cyanide, but I wouldn’t recommend you take any.
It has vitamins. Ever since Linus Pauling started pushing vitamin C, there’s been a lot of loose talk about vitamins, very little of it based on sound research. The truth? Few vitamins “cure” disease. Not many people need more vitamins than they consume in an ordinary diet. Large doses of vitamins can be harmful.
It cures the incurable. We can’t cure Alzheimer’s, multiple sclerosis, Lou Gehrig’s disease, rheumatoid arthritis, cystic fibrosis, lupus, HIV, diabetes or the common cold, among other things. Organ failures – liver, heart and kidney – are curable by transplant. Cancer is treatable in some cases; but “cures” are rare and hard. Responsible people speak in terms of “remission” and will warn you about side effects
It’s not covered. Not that insurance companies always cover necessary treatment, but if insurers are avoiding something you’ve found online (and it’s surprising how many of these sites let you know this), then you should avoid it too.
We go back to high school. I haven’t seen my friend in a couple of years, and now he looks like hell: he’s lost about 25 kilograms, his expression is haggard. He looks old. The last time we were together, he was the same loud, sanguine guy I’d known for years. He’d been even more excited than usual: after more than 20 years in the same job, he was striking out on his own.
Now I don’t hear anything about his career. All he can talk about is his pain. It’s in his back, his legs, his arms, his hands. He wakes up with it, goes to sleep with it. He can’t eat, can’t sleep, he’s exhausted. He’s just getting by from day to day, and his wife – his voice starts to crack at that point, and he doesn’t finish the thought.
I ask what his doctor thinks.
“He did tests. They all came back negative. I’ve stopped going.”
“What are you going to do?”
“I’ve already done it. I found this guy. He specialises in treating cases like mine. He says I have a chronic infection and my lead levels are high.”
I can feel my eyebrows start to rise too.
“So I’m getting chelation treatments.” He pulls down his shirt collar to show me the tunnelled catheter burrowing under his collarbone.
I think very carefully before I reply. I’m not his doctor.
“How’s it going?” I say, finally.
His face sags. I can see he’s about to cry.
But I am his friend. “You want to talk about it?”
We go off to find a quiet corner.
People seek out quacks, much of the time, out of some emotional need that is assuaged by the quack and his treatment. The quack might say he’s chelating toxins from your blood, but what he’s really doing is palliating loneliness, abandonment or fear. As palliation, this kind of thing seems to work – except that the real problem is never addressed.
If you or someone you know is tempted by the quick fix of quack medicine, try to figure out what’s going on. Even if the problem is something real and inescapable – such as cancer – having a chance to name your fear, to speak it into a sympathetic, non-judgmental ear, can do more good than any medicine on earth.
With the exception of those identified by name, the individuals and treatments described in this article are composites. Any resemblance between them and any actual individual, living or dead, or treatment, real or fraudulent, is a coincidence.
– By Dr. T.E. Holt
Photography by John Midgley