Understanding why patients are susceptible to dubious health claims begins with an examination of the rhetoric used.
By Rebecca M. Widder B.A., B.S.P.S.
School of Pharmacy
Cedarville University
By Douglas C. Anderson Pharm.D., D.Ph.
Clinical Pharmacist Specialist
Oscoda (Mi) VA CBOC
From patent medications and nostrums to super-foods and miracle supplements, medical fraud, often referred to as “quackery,” has historically been a pressing and emotionally charged issue for health care professionals. Much like today, historical analysis of 18th century English quackery shows that those making dubious medical claims excelled at 3 things: taking advantage of new market opportunities, building a brand name, and advertising their product.1 In fact, as reported by Huisman, the founders of the Dutch Society Against Quackery first wrote a book in the late 1800’s aiming to combat quackery by analyzing the techniques charlatans used to sell their remedies.2 Like in the past, assessing the advertising of today’s pseudo-medicine can provide an understanding of what makes those seeking alternative medicine susceptible to dubious medical claims. This understanding can provide health care practitioners with new ways to address misleading health care claims with their patients.
Today’s quackery is defined by the National Council Against Health Fraud as “promoting health products, services, or practices of questionable safety, effectiveness, or validity for an intended purpose,” and further clarified as therapy that provides risk of harm without providing offsetting benefit.3, 4 It often takes the form of alternative medicine, marketed under the umbrella of the Complementary and Alternative Medicine movement.3, 5 Since there has been evidence supporting the safety and efficacy of some forms of complementary medicine (i.e. the use of zinc for the common cold, yoga for chronic lower back pain, or peppermint oil for irritable bowel syndrome), this is not a claim that all forms of CAM constitute quackery.6, 7, 8 Rather, it is an acknowledgment that the overarching definition of CAM includes treatment modalities that have historically been a feeding ground for quack medicine.3, 5 Organizations such as the National Center for Complementary and Alternative Medicine (NCCAM) and the Cochrane Collaboration recognize the difficulty in providing a definitive definition of CAM outside of an exhaustive list of current CAM therapies.
However, it is agreed that CAM consists of treatments that originated outside of conventional Western medicine, are not a part of standard treatment for a disease state, and not generally delivered by conventional medical personnel.9, 10 A particular CAM therapy is considered “complementary” if it is used alongside Western medicine, and “alternative” if it used instead of Western medicine.9 The term “integrative medicine” has also been used for the use of conventional medicine along with CAM therapies backed by high-quality evidence.9 Evidence of efficacy is not a part of the consideration in a CAM classification, and therefore CAM includes both “proven” and “unproven” therapies.10 This unfortunate ambiguity may lead to a tension between CAM rhetoric and conventional medicine throughout this paper. Since it is not the intention to deepen the schism between Western medicine and efficacious CAM, the term “integrative medicine” will be used to refer to evidence-based CAM and the term “CAM” or “alternative medicine” will be used to refer to the broader field from which quackery tends to come. Developing a classification scheme that clearly separates the quackery from the legitimate therapies is beyond the scope of this paper. For clarity, NCCAM’s categorization of different therapies classified as CAM have been summarized and provided in Table 1.9 This paper seeks to provide a brief rhetorical analysis of the historical and current advertising of quackery in the form of CAM rhetoric in order to build an understanding of what makes a consumer or patient more likely to fall prey to quack medicine.
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