Tuesday, June 17, 2008


Quackery is defined as the fraudulent pretension to medical skill, in which the practitioner of quackery, often referred to as a charlatan or imposter or quack, knowingly gives or prescribes inaccurate or inappropriate or false or deceptive medical information or treatment, for the purpose of making money. The quack often takes advantage of the medical ignorance of his "patients" and of the confidence they have come to build up in him.

The term quackery can apply to a host of different situations, but there is an overall definition which applies to all: namely, that quackery is the practice of intentionally dispensing false medical information to those seriously ill, or not ill at all, for the purpose of acquring wealth.

There is no doubt that the practitioner of quackery must be regarded as a reprehensible human being in today's society--despicable, loathsome, odious, repugnant--a vampire, eager to squeeze the last dollar from a patient's illness or his/her yearnings for better health.

However, there are two types of quackery: authorized and unauthorized. It is the unauthorized kind that we commonly talk about when we speak of quackery: the snake-oil salesman, the purveyor of fake nostrums that purportedly cure all ailments from "dementia" to sexual inadequacies. Illustrating this kind of quackery is Pope Brock's new book Charlatan (Crown Books, 2008), detailing the case of John Brinkley who during the first half of the 20th century established clinics across America for surgically implanting goat's testicles in men to restore "sexual vigor." Brinkley, who received a medical degree, became enormously wealthy, dying in 1942, before he could be brought to trial on charges of mail-fraud.

Today there are legitimate, well-credentialed doctors who act as "quackbusters." These doctors attempt to alert society to the dangers of what they perceive as "quackery" and who they perceive as "quacks." However, the targets of these "quackbusters" often turn out to be legitimate, well-credentialed physicians or scientists themselves who have come up with unconventional or unpopular (to the medical establishment) treatments. Illustrative of these quackbusters was the late, well-known physician (and attorney) Victor Herbert, M.D., J.D. Herbert, often declaiming against the use of vitamin treaments as part of conventional medical therapy--he called this "quackery"--was himself the target of lawsuits alleging incompetence, malfeasance and professional misconduct (Racketeering in Medicine, J. Carter, 1993).

As detailed in a front page article from a recent Sunday edition of The New York Times, "Cancer doctors are pocketing hundreds of millions of dollars--often the majority of their practice revenue...by selling drugs to patients--a practice that almost no other doctors follow....Typically oncologists [cancer doctors] buy chemotherapy drugs themselves, often at prices discounted by the drug manufacturers trying to sell more of their products, and then administer them intravenously to patients in their offices. They can make huge sums...from the difference between what they pay for the drugs and what they charge for them, a practice known as the 'chemotherapy concession'....The practice creates a conflict of interest for these doctors, who must help patients decide whether to undergo or continue chemotherapy if it is not proving to be effective....The [chemotherapy] concession [i.e., the profit motive] may lead some doctors to recommend chemotherapy when patients may not benefit. In a 2001 study of cancer patients in Massachusetts a team of [National Institutes of Health] researchers found that a third of those patients [in the study] received chemotherapy in the last six months of their lives. even when their cancers were considered unresponsive to chemotherapy" (emphasis added). Some doctors argue that their motivations for this practice are not money, but solely "to provide patients a chance, no matter how slim, of living longer or suffering less." But use of chemotherapy in unresponsive patients is known to frequently result not in longer life or suffering less, but in shorter life and greater suffering and sometimes abrupt death. " 'All the evidence suggests that doctors do respond to money,' " Dr. Susan D. Goold, a professor at the University of Michigan School of Medicine states in the Times article.

But treating hapless (late stage, unresponsive) patients with known, useless therapy--and gaining wealth therefrom (the chemotherapy concession)--isn't that the exact definition of quackery? To the extent that cancer doctors recommend that advanced, refractory patients with only a short time to live undergo or continue ineffective chemotherapy (one-third of even study patients)--with the profit motive in mind--these doctors cannot be told from their more aggressive and obvious "brethren" selling ineffective nostrums in order to gain wealth. Nor is this practice, filling the exact definition of quackery, without harm. Frequently enough cytotoxic chemotherapy given to patients with but a short time to live results in their untimely deaths. In the United States alone there are thousands of authenticated chemotherapy deaths annually. (One of these was Jackie Kennedy, wife of the late president John F. Kennedy, who reportedly received chemotherapy in the very advanced states of lymphoma, dying shortly--within days--thereafter.)

Thus there is a second type of quackery--one that I term 'authorized' quackery. Less recognizable and more socially accepted than the 'flim-flammery' of the nostrum peddler, it is every bit as diabolical. And that is the practice by physicians--many upstanding and well-credentialed--of recommending and instituting treatments known to be useless and ineffective in certain cases, but for which the physician knows he will be well compensated. He imparts 'confidence' to the patient, 'hope' to the family when he knows that the only certain outcome--his true motivation for recommending the treatment--will be a gain in his own wealth. We don't call that quackery. We call it 'courage.' We call it 'heroic.' But it is quackery.

Are there other types of physician-induced medical treatments--where the treatment is useless, ineffective or not necessary, and not without harm--that are done with only a fee in mind? To name a few: hysterectomies, physician-run vitamin mills ("every patient who comes through my door gets a B-12 shot"), tonsillectomies, mastectomies ("they took my breast--but thank God it wasn't cancer"), breast augmentations, lobectomies, prostatectomy "factories" ("I'm moving my urology practice to Florida--where there are lots of old men with money"). The list is endless. For there is hardly a medical or surgical procedure that is not infrequently recommended and performed with only a fee in mind.

The question is: Which is quantitatively greater in our society? The occasional hawker of fake nostrums? Or the purveyor of unnecessary, useless, ineffective, sometimes harmful medical or surgical procedures? Which causes more economic chaos, more disappointment, more personal heartache? The easily identifiable snake-oil salesman? Or the pharmaceutical or medical pitchman invading the cavities of our minds and our pocketbooks? The 'unauthorized,' unlicensed quack? Or the licensed 'pillar of society' knowingly recommending and performing useless, unnecessary procedures for the sake of accumulating wealth? I think you will find that the John Brinkleys of today's society are a drop in the bucket compared to the 'authorized' medical fraud perpetrated by elements of our medical establishment.

For the above reason it is almost preposterous for a doctor to hang a sign on himself as an "expert" exposing the "quackery" of "others" without calling attention to the medical fakery of fellow physicians.

And it is almost obscene for the professional "quackbuster" to single out as "quacks" those who are the innovators of new treatments--new directions in medical research and management--almost anything that changes/upsets the medical status quo. Historically scientists and physicians who are the heroes of tomorrow's medicine are routinely labeled as "quacks" in the early part of their careers.

Those who don the garb of professional "quackbusters" are in reality dangerous elements to our society who, under the 'window dressing' of protectors of society are in actuality more frequently the agents of unspeakable harm to medical progress, managing in their usually long careers to clip the wings of many birds before they can fly.

My advice is to run from these beastly individuals. From those who have taken their careers in medicine--their many long years of arduous study and training--to become little more than beacons exposing fraud from without the medical profession without beaming their lights on the medical profession itself.

Even books like Charlatan, interesting and historic as they are, serve to divert attention away from the quantitaively greater "quackery" that confronts society today--not the outlandish implantation of goat testicles in human beings to restore their sexual vigor, but that accomplished every day in the recommendation and performance of thousands of useless, unnecessary, ineffective medical procedures by avaricious, money-obsessed individuals within the medical profession itself.