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When Should We Call A Quack A Quack?

It is not uncommon for Science Based Medicine to receive complaints about the tone of our writing. Some people feel that it is indelicate to use the “q” word (for the uninitiated, “q” is for “quack”) when describing practitioners who promote disproven therapies with jubilant fervor. Others believe it unkind to lump “well meaning” alternative medicine experts in with those who are engaged in overtly illegal activities.

We are all affected by the tension between wanting to call a spade a spade and respecting our cultural need to be polite. Perhaps one of the clearest examples of this inner conflict is Orac’s Respectful Insolence blog. As the name implies, Orac is both thoughtful and brutally honest – he expresses our communal reticence to make waves, but follows up with a reasoned hostility that is quite understandable, given the circumstances described in each post. Respectful Insolence is fun to read because it is educational, persuasive, and expressive – and it captures how many of us feel about various forms of hucksterism. However, snake oil salesmen and their sympathizers are unlikely to enjoy the blog.

Here at Science Based Medicine, readers find a wide range of expression with a common commitment to science and reason. Just as physicians have different practice styles (some are more nurturing in temperament, others offer “tough love”) so too do we authors vary in tone. For those readers who favor one style over another – I hope you’ll find the voice that suits you and return regularly for more. Please don’t assume that one particular post is representative of the entire blog, and please don’t be offended by the legitimate exasperation of writers who have suffered through decades of observing swindlers swindle.

As for me – I learned that one approach doesn’t fit all.  In his recent book, “Quit Digging Your Grave With A Knife And Fork,” Mike Huckabee attributes his extraordinary weight loss to the brutal honesty of his primary care physician. His physician sat him down one day and explained exactly how he would most likely die from diabetes if he did not radically change his lifestyle. He described the vascular disease that would (if left unchecked) cause vision loss, kidney damage, skin ulcers and potential limb amputations, heart attacks and stroke. He was so shocked by this message that he embarked on a new way of life – and lost over 100 pounds with diet and exercise. His blood sugar levels returned to normal, and he is not currently at risk for diabetes-associated health complications. Quite amazing.

Several years ago I had an obese patient who was in a similar predicament. I sat her down and explained how serious her condition was, and how she had the ability to make a brighter future for herself through weight loss and regular exercise. I pleaded with her to lose weight, and counseled her on how to do so safely and effectively. I was firm with her, but encouraging. She left my office that day and never returned. Apparently my advice was not appreciated. I was crestfallen.

Tough love doesn’t work for everyone, and calling out pseudoscience and quackery is not always welcomed. But for those who have ears to hear, the message is important and powerful – and in some cases, life-saving.

Dr. Emil Freireich, winner of a recent lifetime achievement award for his contributions to leukemia research, told me that Houston, Texas is home to a cottage industry of alternative medicine practitioners who sell expensive miracle cures to patients who have not found success at MD Anderson Cancer Center. The practitioners prey on the hopes of dying patients, fleecing their families out of thousands upon thousands of dollars with potions that include everything from mere water to concentrated urine. I’m not sure what we should call such individuals, but “quack” seems awfully kind.

Science Based Medicine is committed to encouraging honesty, integrity, and scientific accuracy in healthcare. We shine a light on misleading claims and explore areas of ethical conflict wherever pseudoscience is found. Some of us do this with bold strokes, others with gentle persuasion. The goal is to empower patients, enlighten our peers, and move us all towards better health via sound science and thoughtful analysis.

And if you doubt that we’re actually a very affable bunch, why not join us at the upcoming Science Based Medicine conference?

Happy reading…

Posted in: Cancer, Science and Medicine

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27 thoughts on “When Should We Call A Quack A Quack?

  1. Peter Lipson says:

    From an ethical standpoint (and the link eludes me at the moment but it’s on SBM), a well-meaning quack is still behaving unethically. The good intentions perhaps mitigate some of the bad acts, but the fact is a doctor who practices quackery and believes it should know better.

    That is all.

  2. DevoutCatalyst says:

    I wasted much time with orthomolecular medicine back in the 80′s. An internist finally called the stethoscope-wearing smily MD I was seeing a “quack”. It certainly put a chill on what had been represented to me as cutting edge healthcare. But it took me a long while to come around.

    Of course, alternative medicine does not hesitate to deride conventional medicine, their practitioners slyly second guess YOUR diagnoses, their patients are let in on your craft’s dirty little elephantine secret, you little pill-pimping “treat the symptoms only” white smocked ignorami .

    Whether it is wise to use electrically charged language as a counterstrategy is beyond me, but you’d better read the graffiti on the bathroom walls of alternative medicine — seems you’ve got something of a defamation problem in there, Houston.

  3. David Gorski says:

    From an ethical standpoint (and the link eludes me at the moment but it’s on SBM), a well-meaning quack is still behaving unethically. The good intentions perhaps mitigate some of the bad acts, but the fact is a doctor who practices quackery and believes it should know better.

    Indeed.

    There are two types of quacks, those who are scammers and those who truly believe the pseudoscience they are hawking. Sometimes the lines blur, and sometimes there is a mix of the two in any one quack, but in general I think my characterization is accurate. Over the last few years, I’ve been coming to the conclusion that it is the well-meaning quacks who truly believe they’re doing God’s work “healing people whom ‘allopathic’ medicine can’t heal” who do the most damage.

  4. David Gorski says:

    Whether it is wise to use electrically charged language as a counterstrategy is beyond me, but you’d better read the graffiti on the bathroom walls of alternative medicine — seems you’ve got something of a defamation problem in there, Houston.

    Very true; “alternative” medicine practitioners have no qualms whatsoever about representing “allopathic” doctors as either evil mini-Mengeles in cahoots with the big pharma conspiracy for world domination to control you (think Mike Adams of NaturalNews.com) or deluded fools too blinded by science and big pharma to see the One True Wholistic Healing Practice.

  5. John Snyder says:

    I have to agree that the true believers may be even more dangerous than the pure snake oil salesmen. Their furvor, dogama, and conviction can be extremely effective at spreading mass delusion. Just think of Andrew Wakefield. His charisma and credentials combined with a blind, dogmatic faith in his beliefs sparked one of the most pervasive medical myths in modern times. This is a truly fascinating and dangerous individual. His particular brand of quackery should be studied closely, so that we might better counter it in the future.

  6. “the link eludes me at the moment but it’s on SBM”

    Voila:

    http://www.sciencebasedmedicine.org/?p=235#comment-10074

    There are a couple of others as well. Just as in criminal proceedings “ignorance of the law is no excuse,” so it is with science and the laws of nature.

  7. qetzal says:

    I think Wakefield is much more of a scammer than a true believer. His apparent willingness to fake data, failure to disclose financial conflicts of interest, unethical clinical trials, etc., paint a pretty clear picture of someone who’s really only in it for their own benefit.

    Sure, he probably finds ways to justify his actions to himself. But I suspect that somewhere inside, he knows he’s full of sh*t.

    IMHO, of course.

  8. I’m not a physician nor do I pretend to be one on TV, so I can be much more pointed in my comments to CAM users and pushers. I tell them that they are full of sh*t. I stand on scientific evidence to support my attitudes towards CAM, creationism, or alien abductions.

    CAM supporters have faith that their systems work, which isn’t testable (of course), and since the scientific evidence doesn’t support that unfounded faith, it then becomes a scam. I think that many of us have that scientific nuanced communications style that prevents us from being absolutist in our conversations. Sadly, the CAM pushers, creationists and alien abduction conspiracists use that nuance to state that science hasn’t studied it sufficiently.

    So, if it does look like a duck, walks like a duck…well, you know, quack quack.

    But what do I know, I’m a shill for Big Pharma.

  9. Regarding who does more harm, true believers or con artists, I would not be so quick to conclude it’s the true believers. Think of Kevin Trudeau. Perhaps con artists are much more crafty and deliberate in what they do.

    Regarding the distinction, while I think there are pure con artists out there, I think things are much more fuzzy at the other end of the spectrum. I think most true believers are guilty of overstating claims, sloppy thinking, and accepting BS because it fits their belief. They rationalize their cons, but there is still some con in the mix.

  10. Harriet Hall says:

    I think the most dangerous ones are doctors like Andrew Weil who combine good scientific medicine with nonsense in such a way that patients can’t tell the difference.

  11. John Snyder says:

    I agree with those above that the line is very blurry between true believers and total scammers. I think Wakefield began as a true believer and devolved into a false prophet (to quote Paul Offit), and used car salesman. He’s an example of someone with an enormous amount of drive who started down this road with the belief that crohn disease was linked to wild measles infectin of the gut. When his data was unreproducible by others, he found himself over-invested and unable to accept the reality of the science pouring in around him. He continued to work his hypotheses and to find supporting data where there was none. In short, he is a total failure as a scientist because he is unable to live by its rules, and he is the worst kind of huckster because his guile knows no bounds.

  12. hatch_xanadu says:

    It is SO hard to distinguish the true believers from con artists. I must say, though, I don’t think I’ve ever encountered a true believer who didn’t resort to a bit o’ muddled language and fact twisting when challenged, and I don’t think I’ve ever encountered a con artist who didn’t seem to believe his scamming folks was justified by some distorted “principle”.

    I just keep thinking back on all I’ve heard and read about people like the truly ghastly Hulda Clark, who not only subject(s)/ed her “patients” — who are often already exhausted and suffering — to especially torturous procedures like tooth scraping, but also takes great pains to forbid them from seeking conventional treatment or radiologic examinations. No matter how utterly bewitched those practitioners become by their own absurd ideas, there nearly always seems to be a little element of that “But you must never, ever look behind this door; otherwise your cure will not work and you will be DOOMED!”

  13. shadowmouse says:

    Dr. G wrote:

    “There are two types of quacks, those who are scammers and those who truly believe the pseudoscience they are hawking. Sometimes the lines blur, and sometimes there is a mix of the two in any one quack, but in general I think my characterization is accurate. Over the last few years, I’ve been coming to the conclusion that it is the well-meaning quacks who truly believe they’re doing God’s work “healing people whom ‘allopathic’ medicine can’t heal” who do the most damage.”

    The worst quack is the one that knows better, but refuses to consider the what/when/how/why realities of sCAM modalities and continues the self-deciept by only regurgitating the false promises, and subsequently passing the ignorance onto the trusting patient. The patient often will not investigate on their own, accepting the practitioner’s recomendations as honest.

    Magical thinking at it’s, ummm, ‘finest’.

  14. James Fox says:

    The worst quack is the successful one.

  15. Dr Benway says:

    Have to agree with Harriet Hall.

    “Integrative medicine” cranked the problem up to a whole new level. Patients began insisting there was respectable research from leading academic centers to back up their dodgy ideas.

    I believe quackery is here to stay. It’s part of the human condition. Let adults experiment with it to their heart’s content, provided I don’t have to pay for any of it.

    But there has to be a clear line separating science-based, standards-based medicine and pretend medicine. Otherwise I waste too much time arguing with people to do my job.

  16. David Gorski says:

    Regarding the distinction, while I think there are pure con artists out there, I think things are much more fuzzy at the other end of the spectrum. I think most true believers are guilty of overstating claims, sloppy thinking, and accepting BS because it fits their belief. They rationalize their cons, but there is still some con in the mix.

    While I agree that things can be fuzzy at the “true believer” end of the spectrum, I would still argue that the true believers are more dangerous. First off, ask yourself: Has Kevin Trudeau caused any health scares on the order of Andrew Wakefield? Or lured people into quackery on the level of the Laetrile scam? No, he hasn’t. That’s because, as Dr. Snyder points out, Wakefield was a true believer and is fairly charismatic and driven. His belief drove him to do what he did, as does the belief of many of the “true believer” variety of CAMsters.

    Another factor is that true believers may start to turn into scammers, but it’s because of their belief that they do. So, citing the Wakefield example again, he had an idea that somehow the measles virus from the MMR vaccine resulted in gut problems and autism, and his dogged clinging to that idea led him down the slippery slope of first bad science, then hooking up with trial lawyers suing vaccine manufacturers, and ultimately to scientific fraud. Once he was too far down that road, he was so invested in his idea and the hero status that it brought him that he could no longer give it up.

    To the believer the ends justify the means, and they tend to be the ones who start a quack therapy or movement and popularize it. Pure scammers like Kevin Trudeau then take advantage by taking that quack therapy and then using it just to make money. Look at it this way. Wakefield believes he’s saving the world from autism due to “vaccine injury,” so much so that the ends justify the means. Kevin Trudeau couldn’t care less about whether he’s curing cancer or any other disease; he’s just in it to make as much money as he can before either the law or his marks force him to move on. And move on he did, as he’s now into financial scams.

  17. Kimbo Jones says:

    I think the most dangerous ones are doctors like Andrew Weil who combine good scientific medicine with nonsense in such a way that patients can’t tell the difference.

    Agreed. It can be difficult enough for a health care professional to sort through all the information and literature out there, let alone a patient who has other things on their mind and who may not have the education level necessary to synthesize all of the information anyway.

  18. James Fox says:

    Gorski: “While I agree that things can be fuzzy at the “true believer” end of the spectrum, I would still argue that the true believers are more dangerous.”

    I’d agree especially when you still have the Laetrile Clinics in Tijuana making money had over fist. Surely at this point they would have to realize that they don’t provide any benefit for the cancer patients they see aside from excising large amounts of money.

  19. pmoran says:

    The advantage of the words quackery/quack are their inclusiveness. They can apply to any kind of inflated medical claim, whether generated by frank fraud, true belief, or plain old rat-baggery. It is often impossible to tell how much of each of these is involved in any instance.

    I am wary how I use it with medical practitioners who also appear to be true believers. It is a little unfair to lump them in with the fraud and lunacy. There are powerful illusions in everyday medical practice, along with probable “real” effects from placebo and other non-specific influences. I have had some of my own fond beliefs later proved false.

  20. wertys says:

    Another (non-medical) doctor put it well

    ‘Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity. ‘

    Or on another slightly different topic

    ‘Nobody remembers the words of our enemies, but we do remember the silence of our friends’

    Dr Martin Luther King

    Supporters of SBM should not be silent friends to our patients and to the healthcare community at large…

  21. I believe the answer to the question is “Always”.

    Whether the sCAMster is a deluded true believer like some very nice people I know or an outright, conscious fraud like Hulda Clark the principles remain the same. Victims deserve the truth.

    The real issue is the matter of potential harm. If someone wants to believe it when they are told that some harmless potion or activity will improve their love life who am I to tell my wife to extinguish the scented candles and stop rubbing my back with essential oils? It’s a totally different matter if I find someone telling me that instead of surgery to remove the melanoma on my leg I should have eaten garlic and anointed the mole with oil of cloves or tells me that I can cure my diabetes by having all my fillings replaced and then eating nothing but beetroot and apple cider vinegar. Then I stop being polite.

  22. Sometimes I wonder if these quacks (I have no problem in describing them thusly) really want to have scientific support, so lacking that, they stay right at the fringe (word choice was intentional) of real science, combining the woo in just the right proportion. That’s how they intellectually scam the general population.

    The problem remains that although we call it pseudoscience, fringe science, junk science or quackery, the general public just thinks we dogmatically “believe” in science. In other words, we believe what we believe because we worship science.

    We pat ourselves on the back, and because most of the readers of this blog are probably, dare I say, above average intelligence, we all agree with each other (give or take one or two anti-vaccine, pro-homeopaths that cruise in here). So, how do we get the message out there? I’m still shocked that Jenny McCarthy has caused as much trouble as she has.

  23. soofry says:

    “Several years ago I had an obese patient who was in a similar predicament. I sat her down and explained how serious her condition was, and how she had the ability to make a brighter future for herself through weight loss and regular exercise. I pleaded with her to lose weight, and counseled her on how to do so safely and effectively. I was firm with her, but encouraging. She left my office that day and never returned. Apparently my advice was not appreciated. I was crestfallen.”

    Weight loss is not a behavior, it is a possible side-effect which may occur from certain behaviors.

    The scientific evidence is numerous and clear that there is no known safe weight loss method that results in a significant amount of weight lost and kept off in the long-term, for more than a very small proportion of obese patients. If you have evidence that you do indeed have a practical method of such weight loss, then you should publish it. You’d be famous and hailed as a hero.

    Even if your patient had been keen to lose weight, I’m not surprised you lost her as a patient. Being given repeated advice to do the impossible isn’t exactly convincing of a doctor having your best health interests in mind.

    Why do doctors continue, in the field of obesity, to practice non-science based medicine? Why not, when faced with an obese patient, focus on behaviors that are achievable and will likely result in health improvements, rather than castigation and exhortations to achieve the near-impossible?

    I really can’t get my head around how the typical doctor advice to the obese seems to be so at odds with the evidence of what is achievable.

  24. yeahsurewhatever says:

    If it ducks (responsibility) like a quack, it’s a quack.

  25. The Blind Watchmaker says:

    “And if you doubt that we’re actually a very affable bunch, why not join us at the upcoming Science Based Medicine conference?”

    See you there!

  26. LindaRosaRN says:

    I agree with Harriet Hall about the quack who feigns legitimacy persuasively. That would seem to be a big problem for nursing students, many of whom aren’t trained to evaluate research themselves, who have quack professors.

    There is, however, another category of quack. This is the quack who justifies sadism and sexually abusive with pseudoscience. This may be the rare chiropractor who does “breast and vaginal adjustments.”

    This sort of quack, however, is all too common in the pseudo-psychotherapy called “Attachment Therapy,” where therapists — usually licensed social workers or psychologists — literally torture and sexually abuse adopted and foster children. Children are restrained in the lap, or the therapist lies on top of the child, dominating and scaring the child on purpose. Some lick the child’s face or knuckle little rib cages. And some will tell children they are raping them. The therapists teach the parents to turn the child’s home into a concentration camp where “rewards are necessities like food and clothes.” Kids have been starved, caged, isolated, and killed.

    So for Attachment Therapists, the term “quack” is too good from them.

  27. DevoutCatalyst says:

    “This may be the rare chiropractor who does “breast and vaginal adjustments.”

    What about the more common chiropractor that does breast exams? Why is that even legal? Am I barking up the wrong tree here? I’d have thought that would be considered an outrage.

    The more I think about the title of this article the more I think that quacks should be called quacks always. In my fantasy, quacks would have received the same welcome Fleischmann and Pons received. Instead they parade about cocksure that there is absolutely nothing that can be done about them now.

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