Quackery: How Should It Be Defined?

by Stephen Barrett, M.D.

"Quackery" derives from the word quacksalver (someone who boasts about his salves). Dictionaries define quack as "a pretender to medical skill; a charlatan" and "one who talks pretentiously without sound knowledge of the subject discussed." These definitions suggest that the promotion of quackery involves deliberate deception, but many promoters sincerely believe in what they are doing. The FDA defines health fraud as "the promotion, for profit, of a medical remedy known to be false or unproven." This also can cause confusion because in ordinary usage -- and in the courts -- the word "fraud" connotes deliberate deception. Quackery's paramount characteristic is promotion ("Quacks quack!") rather than fraud, greed, or misinformation.

Most people think of quackery as promoted by charlatans who deliberately exploit their victims. Actually, most promoters are unwitting victims who share misinformation and personal experiences with others. Customers of multilevel companies that sell health-related products typically have been persuaded by friends, relatives, and neighbors who use the products because they believe them effective. Pharmacists also profit from the sale of nutrition supplements that few customers need. In most cases pharmacists do not champion the products but simply profit from the misleading promotions of others. Much quackery is involved in telling people something is bad for them (such as food additives) and selling a substitute (such as "organic" or "natural" food). Quackery is also involved in misleading advertising of dietary supplements, homeopathic products, and some nonprescription drugs. In many such instances no individual "quack" is involved -- just deception by manufacturers and their advertising agencies.

Quackery is not an all-or-nothing phenomenon. A practitioner may be scientific in many respects and only minimally involved in unscientific practices. Also, products can be useful for some purposes but worthless for others. For example, vitamin B12 shots are lifesaving in cases of pernicious anemia, but giving them frequently to "pep you up" is a form of medical fraud.

Quackery and malpractice overlap but are not identical. Quackery entails the use of methods that are not scientifically accepted. Malpractice involves failure by a health professional to meet accepted standards of diagnosis and treatment. It includes situations in which the practitioner was negligent while using standard methods of care. Leaving a surgical instrument in a patient's abdomen or operating on the wrong part of the body are examples of malpractice unrelated to quackery.

To avoid semantic problems, quackery could be broadly defined as "anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word "fraud" would be reserved only for situations in which deliberate deception is involved.

Unproven methods are not necessarily quackery. Those consistent with established scientific concepts may be considered experimental. Legitimate researchers and practitioners do not promote unproven procedures in the marketplace but engage in responsible, properly-designed studies. Methods not compatible with established scientific concepts should be classified as nonsensical or disproven rather than experimental.

-- Copyright Stephen Barrett; reprinted with permission.

Stephen Barrett, M.D., a retired psychiatrist in Allentown, Pennsylvania, is a nationally renowned author, editor, and consumer advocate. His 43 books include The Health Robbers: A Close Look at Quackery in America. Dr. Barrett is a board member of the National Council Against Health Fraud, a Scientific Advisor to the American Council on Science and Health, and a Fellow of CSICOP. You can find the Quackwatch homepage at www.quackwatch.comExit and you may contact him by e-mail at sbinfo@quackwatch.com.

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