4 questions | Applied Sciences homework help

1. Fleiger K. A skeptic’s guide to medical “breakthroughs.” FDA Consumer 21(9):13, 1987.

Part One Dynamics of the Health Marketplace32 Frauds and Quackery There is nothing men will not do . . . to recover their health and save their lives. They have submitted to being half-drowned in water, and half-choked with gases, to being buried up to their chins in earth, to being scarred with hot irons like galley slaves, to being crimped with knives like codfish, to having needles thrust into their flesh, and bonfires kindled in their skins, to swallowing all sorts of abominations, and to pay for all this, as if to be singed and scalded were a costly privilege, as if blistering were a blessing and leeches a luxury. oliver wendell holmes The most outrageous lies that can be invented will find believers if a man only tells them with all his might. mark twain There’s a sucker born every minute. often attributed to p.t. barnum There’s also a crook born every hour who can take care of sixty suckers. anonymous Chapter Three © 1 99 6 St ep he n Ba rr et t,

M .D

. Quackery stands in science’s shadow. Most effective remedies have a bogus counterpart. Part One Dynamics of the Health Marketplace34

• Anecdotes and testimonials are not trustworthy evidence that a product or service is effective.
• Spontaneous remissions and the placebo effect can make it difficult to determine whether treatments are effective.
• Quackery is far more widespread and pervasive than most people realize.
• The best way to avoid being tricked is to stay away from tricksters. Don’t base your health-related decisions on the advice of people who exhibit the signs of quackery described in this book.
• Many quacks try to divert attention from the worthlessness of their methods by using deceptive language, promoting conspiracy theories, and talking about “freedom of choice.”

keep These poinTs in Mind as you sTudy This chapTer Key Concepts D espite the tremendous advances in medical sci- ence, health frauds and quackery are still com- mon. Newspapers, magazines, radio, television, and the Internet provide entrepreneurs with enormous opportunities to promote their wares to the public. Laws intended to control fraud and quackery have not been particularly successful. This chapter provides practical definitions of health fraud and quackery, explains why people are vulnerable, and tells how to identify and avoid quack practices. Many other chapters provide detailed information and examples of quackery’s harmful impact on individuals and society. Antiquackery organizations and activities are described in Chapter 25. deFiniTions “Quackery” derives from the word quacksalver (some- one 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 U.S. Food and Drug Administration (FDA) defines health fraud as “the promotion, for profit, of a medical remedy known to be false or unproven.” This can cause confusion because in ordinary usage—and in the courts—the word “fraud” connotes deliberate decep- tion. Moreover, unproven methods are not necessarily quackery. Those that are consistent with established scientific concepts and are under clinical investigation may be considered legitimately experimental. Dr. William T. Jarvis,1 former president of the National Council Against Health Fraud, stresses that quackery’s paramount characteristic is promotion rather than fraud, greed, or misinformation. Ethical researchers and practitioners do not promote unproven procedures in the marketplace but engage in responsible studies with proper protocols (see Chapter 2). They may try methods that have not been completely tested, but they should not peddle them to build their practice. Methods not compatible with established sci- entific concepts should be classified as nonsensical or disproven rather than experimental. Homeopathy’s claim that infinitesimally dilute solutions can exert powerful effects is the epitome of health nonsense (see Chapter 8). Promoters of quackery often use euphemisms like “alternative” and “holistic” to describe their methods. However, the terms unscientific, nonscientific, pseudo- scientific, or dubious are more appropriate. This book generally uses these terms and places the word “alter- native” in quotation marks when using it to describe Quacks Quack! Why should a critter as cute and harmless-looking as a duck be used to symbolize the vicious social menace of quackery? A vulture would seem to be more appropri- ate. But vultures actually wait until death occurs before engaging their targets. Thus their conduct is too benign to symbolize quackery, which preys on the weak, the helpless, and the desperate. Other birds of prey behave more like that of quacks, but the bald eagle, which is a national symbol, would not be suitable for derision. An ostrich might be ap- propriate, because of its reputation for hiding its head in the sand, thus symbolizing the denial so often seen in both quacks and their victims. The word quack is short for “quacksalver,” which literally means to quack like a duck about one’s salves. The duck personifies quackery because it makes a lot of noise about nothing. William T. Jarvis, Ph.D. Historical Perspective Chapter Three Frauds and Quackery 35 unscientific methods. Chapter 8 describes how some methods are labeled “complementary” or “integrative” to make them seem more respectable. Most people think of quackery as something pro- moted 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 that they are effective. Pharmacists profit from the sale of nutrition supplements that few customers need. In most cases pharmacists do not cham- pion the products but simply profit from the misleading promotions of others. Much quackery involves telling people something is bad for them (such as food additives) and selling a substitute (such as “organic” or “natural” food). Quack- ery is also involved in misleading advertising of dietary supplements, herbal and 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, prod- ucts 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 quackery. 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 meth- ods of care. Leaving a surgical instrument in a patient’s abdomen or operating on the wrong part of the body are examples of malpractice that are unrelated to quackery. To avoid semantic problems, some experts suggest that quackery be broadly defined as “anything involving overpromotion in the field of health.” This definition would include questionable ideas as well as question- able 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. scope Many billions of dollars are spent yearly on products and services that are falsely claimed to prevent or alleviate health problems. Billions are wasted annually for “al- ternative” treatments, spurious food remedies, weight- reduction schemes and products, fad diets, “organic” and “natural” foods, and unnecessary vitamins and minerals (see Chapters 10 and 11). Billions more are wasted on exercise equipment (see Chapter 13), worthless and possibly harmful cancer remedies (Chapter 16), unneces- sary and ineffective drug and beauty products (Chapters 17 and 18), and magnets and other health devices (see Chapter 20). However, no reliable figures exist on the total amount spent on quackery each year The California Medical Association3 has listed the following widely promoted modalities as questionable: acupuncture, acupressure, applied kinesiology, bogus Defrauding the Desperate2 Gregory Earl Caplinger (1953–2009) claimed to be a distinguished and widely published medical doctor and researcher. However, his “medical degree” and many of his other “credentials” came from diploma mills or sources he himself invented. For several years Caplinger operated a clinic in the Dominican Republic that offered treatment to desperate patients. In 1999 he victimized a 60-year-old woman who had undergone surgical treatment for colon cancer. Although follow-up tests had found no evidence of can- cer, she contacted Caplinger because she thought that a nonstandard treatment might boost her immune system to reduce the odds of recurrence. Caplinger persuaded her to come by stating that a small nabothian cyst men- tioned in an ultrasound report “could go either way” and therefore required immediate treatment. The estimated cost was $80,000 to $90,000, with a $40,000 advance deposit. Terrified that the cyst could become malignant, she mortgaged her home, wired the deposit, and went for treatment. Nabothian cysts are plugged glands on the uterine cervix that pose no health threat and have nothing whatsoever to do with cancer. Shortly after she arrived at Caplinger’s clinic, her husband read an article on the Quackwatch Web site exposing Caplinger as a fraud. She demanded a refund but got back only $20,000. A few months later, Caplinger was indicted on charges of wire fraud and money laundering related to investments in his bogus remedy. He was convicted in July 2000 but did not show up to hear the verdict and became a fugitive wanted by the FBI. In 2001 he was apprehended, sentenced to 14 years in prison, and ordered to repay more than $1 million to his victims. Personal Glimpse Part One Dynamics of the Health Marketplace36 arthritis treatments, “cellular therapy,” cellulite removal, chelation therapy, clinical ecology, colonic irrigation, cytotoxic testing, DMSO (dimethyl sulfoxide), enzymes and “glandular extracts,” faith and psychic healing, figure enhancers, hair analysis, homeopathy, immune system protectors, iridology, Laetrile (amygdalin) treat- ment for cancer, live cell analysis, nutrition remedies for cancer, polarity therapy, reflexology, Touch for Health, vitamin megadoses, and youth prolongers. A 1984 Congressional subcommittee report4 detailed numerous fraudulent and quack endeavors including: (a) clinics inside and outside the United States that provided bogus treatments for chronic and terminally ill patients using diet, drugs, and enemas for arthritis, cancer, heart disease, and other ailments; (b) foundations that encour- aged the use of unproven remedies; and (c) phony healers who used a religious healing image or claimed to have powers generated by Satan or witchcraft. In 1989 the FDA5 listed the following as the top 10 health frauds: (a) fraudulent arthritis products, (b) bogus AIDS cures, (c) instant weight-loss schemes, (d) fraudulent sexual aids, (e) spurious cancer clinics, (f) quack baldness remedies and other appearance modifiers, (g) false nutritional schemes, (h) unproven use of muscle stimulators, (i) chelation therapy (claimed to clean out clogged arteries), and (j) treatment for nonexistent yeast infections. VulnerabiliTy Despite the advanced state of medical science, many people with health problems turn to dubious methods. Faced with the prospect of chronic suffering, deformity, or death, many individuals are tempted to try anything that offers relief or hope. The terminally ill, the elderly, and various cultural minorities are especially vulnerable to health frauds and quackery. Many intelligent and well- educated individuals resort to outlandish procedures with the belief that anything is better than nothing. Former Arthritis Foundation official Jerry Walsh, who was stricken at age 18 with rheumatoid arthritis, admitted that during the early years of his illness he spent thousands of dollars on quack remedies—everything from radium gadgets to magic buckeyes. Beyerstein6 has noted: Subtle forces can lead intelligent people (both patients and therapists) to think that a treatment has helped someone when it has not. This is true for new treatments in scientific medicine, as well as for nostrums in folk medicine, fringe practices in “alternative medicine,” and the ministrations of faith healers.

Specific reasons why people turn to questionable methods include the following:

• Individuals may underestimate the degree of illness or believe they cannot afford standard care.
• Religious and cultural beliefs can foster acceptance of faith healers, prayer, magic, sorcery, and the like. For example, some Chinese people consider acupuncture and herbal remedies as standard forms of treatment and regard the scientific medicine practiced in the United States as totally foreign.
• Physicians may be unable to communicate in an effective manner so that their patients understand. Patients may be unable to question their physicians; they may lack knowl- edge or fear that they will be criticized.
• Patients may distrust physicians or question the quality of their care. Doctors sometimes appear more concerned with treating illnesses than with helping the patient.
• Some people harbor extreme distrust of the medical profes- sion, the food industry, drug companies, and government agencies. Some feel deeply antagonistic toward scientific medicine but are attracted to methods that are “natural” or otherwise unconventional.
• People fear social unacceptability, pain, death, and growing old (wrinkles, loss of hair and sensory acuity, decreased sexual potency, and incontinence). Elderly individuals are particularly vulnerable in this regard.
• Faced with a serious health problem that physicians can- not solve, many people become desperate enough to try almost anything that arouses hope. Many patients with cancer, arthritis, multiple sclerosis, and AIDS fall prey to unscrupulous entrepreneurs. Some squander their life’s savings searching for a “cure.”
• Many people suffer from chronic aches, pains, or other discomforts for which medicine cannot offer clear-cut diagnoses or effective treatment. The more persistent the condition, the more susceptible the sufferer may be to promises of a “cure.” Many people in this category fall into the hands of doctors who make fad diagnoses such as hypoglycemia, “candidiasis hypersensitivity,” or “multiple chemical sensitivity” (see Chapter 8).
• Many practitioners have difficulty in helping people whose symptoms are the result of emotional problems or are bodily responses to stress.
• Many people are gullible because of their ignorance of health matters. People also tend to believe what others tell them about personal experience. Many people believe that any health-related claim in print or in a broadcast must be true, and many are attracted by promises of quick, painless, or drugless solutions to problems.
• The mass media provide much false and misleading infor- mation via advertisements, news reports, feature articles, books, radio and television programs, and the Internet. News reports are often sensationalized, stimulating false hopes and arousing widespread fears. Many radio and television producers who promote unsubstantiated health

Chapter Three Frauds and Quackery 37 claims say they are providing entertainment and have no ethical duty to check the claims.

• People fail to realize that some serious illnesses (even cancer and arthritis) have ups and downs. Temporary improvement may be mistakenly attributed to whatever product or service was used before it occurred.
• Many people do not understand the nature of the placebo effect (discussed later in this chapter).
• Self-confidence, which quacks tend to exude, is a powerful persuader. The “Self-Confidence Sells” Personal Glimpse box contains the condensed testimony of a defense witness in the 1990 trial of a Canadian couple whose infant daughter had died of malnutrition under the care of an unlicensed naturopath. The couple were charged with criminal negli- gence, but they were acquitted when a judge ruled that the problem was not neglect but misplaced trust.

Psychologist Anthony R. Pratkanis, Ph.D.7, has iden- tified nine strategies used to sell pseudoscientific beliefs and practices. They include setting phantom goals (such as better health, peace of mind, or improved sex life), making statements that tend to inspire trust (“supported by over 100 studies”), and fostering granfalloons (proud and otherwise meaningless associations of people who share rituals, beliefs, jargon, goals, feelings, specialized information, and “enemies”). Multilevel sales groups, nutrition cultists, and crusaders for “alternative” treat- ments fit this description well. hazards Consumers should be aware of quackery’s dangers. Financial harm can range from minor expense to loss of one’s life savings. Improper diagnosis can lead to a deterioration of health. Unsafe procedures and delay in getting proper treatment can have serious or fatal consequences. Psychologic harm can also occur.8 The following well-publicized cases illustrate quackery’s serious potential for harm. In 1961, the parents of 8-year-old Linda Epping charged that a chiropractor had bilked them out of $739 by promising to cure her of cancer of the eye. Linda had been scheduled for surgery to remove her left eye and surrounding tissue. Her doctors thought cure was pos- sible because it appeared that the tumor had not spread. But shortly before the operation was to be performed, Linda’s parents met a couple who said that a chiropractor had cured their son’s brain tumor without using surgery. After the chiropractor agreed to help by “balancing” Linda’s body, her parents removed her from the hospital and took her for treatment with “spinal adjustments,” vitamins, food supplements, and laxatives (up to 124 pills plus 150 drops of iodine solution daily). Despite the Self-Confidence Sells The herbalist was a very impressive man. He just glowed with health and was very charismatic, very jovial, charming, friendly, very nice, very knowledgeable. There was not a question that you could ask that he would not have an answer for. And he told a lot of stories about people who had come to see him and been cured by following his course of treatment. It’s a very difficult thing to communicate just how mesmerizing this man was. He was so good, so positive. He just exuded this powerful aura about him. He told my father that his cancer was completely curable. He had to change his diet because this was the cause of the cancer. He would have to eat strictly fruits and vegetables, raw, or juices of those fruits and vegetables, and by doing this, the tumor would be dissolved. When my father lost weight, the herbalist said this was just the body ridding itself of toxins and poisons. During his final two weeks, my father developed a hole near his rectum and a lesion that grew bigger each day. The herbalist said it was just the radiation coming out, which was a good thing. I now know it was a gangrenous tumor. I look back now and can’t believe that I fell under this man’s spell. Testimony of Magaly Bianchini11 Personal Glimpse new “treatment,” the tumor grew quickly. Within three weeks it was the size of a tennis ball and had pushed Linda’s eye out of its socket. She died within a few months. The chiropractor was subsequently convicted of second-degree murder and sentenced to prison.9 Ruth Conrad, an Idaho woman, consulted one of the state’s many unlicensed naturopaths. While seeking treatment for a sore shoulder, she also complained of a bump on her nose. The naturopath stated that it was cancer and gave her a black herbal salve to apply di- rectly. Within a few days, her face became very painful and she developed red streaks that ran down her cheeks. Her anxious phone call to the naturopath brought the explanation that the presence of the lines was a good sign because they “resemble a crab, and cancer is a crab.” He also advised her to apply more of the black salve. Within 1 week, a large part of her face, including her nose, sloughed off. It took 3 years and 17 plastic surgery operations to reconstruct her face. Caroline Copeland,10 an Arizona journalist, con- sulted a leading “holistic” physician who seemed very attentive to her concerns. During most of the 16 years she remained under his care, his recommendations ap- peared logical and effective. Her initial diagnosis was Part One Dynamics of the Health Marketplace38 hypoglycemia (low blood sugar). Later she was told she had hypothyroidism and was treated with thyroid hormone. Then she developed a “stubborn case” of iron-deficiency anemia that was treated with very high oral doses of iron and several vitamins plus injections containing iron, liver extract, and vitamin B12. She also developed persistent constipation with bouts of ab- dominal pain. When additional symptoms developed, she sought help elsewhere and learned that all of the previous diagnoses had been wrong and that her symp- toms were caused by iron and vitamin poisoning, thyroid hormone overdose, a grapefruit-sized ovarian cyst, and endometriosis (which, undiagnosed, had prevented her from bearing children). When she complained, the state licensing board concluded that her care had been inadequate, but it permitted the doctor to remain in practice. coMMon MisconcepTions There are many misconceptions about quackery. The following are among those identified by Jarvis and Barrett12: Quacks are frauds and crooks. Most promoters of quackery sincerely believe in what they do. Their decep- tion of others may not be deliberate. Most quackery is dangerous. Most victims of quack- ery are harmed economically rather than physically. Sometimes a bogus approach will relieve emotionally related symptoms by lowering a person’s tension level. Although such an experience is likely to be perceived as beneficial, it can prove harmful in the long run if the individual decides to rely on unproven approaches for future health problems. The media are reliable. Most media are willing to publicize sensational viewpoints they believe are news- worthy and likely to increase their audience. Radio and television talk shows abound with promoters of nutri- tion quackery. General magazines that carry vitamin ads almost never publish articles advising readers not to waste their money on vitamins. Personal experience is the best way to tell whether a treatment works. When someone feels better after using a product or procedure, it is natural to credit whatever was done. However, this is unwise. Most ailments are self-limiting, and even incurable conditions can have sufficient day-to-day variation to enable quack methods to gain large followings. Taking action often produces temporary relief of symptoms (a placebo effect). In addition, many products and services exert physical or psychologic effects that users misinterpret as evidence that their problem is being cured. These “Dr. Feelgood” modalities include pharmacologically active herbal products, quack formulas adulterated with prescription drugs, colonic irrigations (which some people enjoy), bodywork, and meditation. Scientific experimentation is almost always necessary to establish whether health methods are really effective. Thus it is extremely im- portant for consumers to understand the concepts of spontaneous remission and the placebo effect. Spontaneous Remission Recovery from illness, whether it follows self-medica- tion, treatment by a scientific practitioner, or treatment by an unscientific practitioner, may lead individuals to conclude that the treatment received was the cause of the return to good health. Medical historian James Harvey Young, Ph.D.,14 has noted: John Doe does not usually realize that most ailments are self- limiting and improve with time regardless of treatment. When a symptom goes away after he doses himself with a remedy, he is likely to credit the remedy with curing him. He does not realize that he would have gotten better just as quickly if he had done nothing! Thousands of well-meaning John and Jane Does have boosted the fame of folk remedies and have Personal Glimpse A Traumatic Experience In The Faith Healers, James Randi tells what happened to a youngster with twisted legs who attended televan- gelist Peter Popoff’s “Miracle Crusade” with strong expectations that he would be made well: Following the . . . spectacle, I saw that little boy outside the Civic Center again, perched on his crutches and staring down at the pavement. At the service, the highly touted “healer” had not even come near the kid. . . . The boy looked up as I approached him. His smile was gone, and I saw tears running down his face. His eyes were red from weeping. I began to speak, intending to ask him what he now thought of Popoff and his promises. But I choked up and had to turn away. . . . I will never forget that terrible moment, as the child realized that he had witnessed a cruel cal- lous hoax. Hundreds of people at that meeting had believed they would see miracles performed. . . . Some few had been touched by the preacher, but none had been healed. Most had given cash or checks, some in envelopes sent to them by mail before they attended. One way or another, they were all swindled.13 Chapter Three Frauds and Quackery 39 signed sincere testimonials for patent medicines, crediting them instead of the body’s recuperative power for a return to well-being. . . . The unscientific healer does not need to observe the restraints of reputable medicine. Where true medical science is complex, the quack can oversimplify. . . . Where ailments are self-limiting, the quack makes nature his secret ally. It is commonly said that if you treat a cold it will disappear in a week, but if you leave it alone it will last 7 days. Even many serious diseases have ups and downs. Rheumatoid arthritis and multiple sclerosis are prime examples. On rare occasions even cancer can inexpli- cably disappear (although most testimonials for quack cancer remedies are based on faulty original diagnosis or concurrent administration of effective treatment). Quackery’s victims are not the only ones who can be fooled by the placebo effect, spontaneous remissions, and other coincidental events. The gratitude and adula- tion of people who think they have been helped can even persuade charlatans that their methods are effective! Placebo Effect You must know that the will is a powerful adjuvant of medicine. — paracelsus The power of suggestion has been demonstrated by many investigators in a variety of settings. In a classroom, for example, a professor sprayed plain water about the room and asked the students to raise their hands as soon as they detected an odor. Seventy-three percent managed to smell a nonexistent odor. Persons with a dominant or persuasive personality often have considerable impact on others through their ability to create confidence, which enhances suggest- ibility. Many individuals who are taken in by a charlatan later tell their doctors, “But he talked to me; he explained things; he was so nice.” Individuals who are psychologically susceptible to suggestion often feel better under the influence of counseling or reassurance. One woman remarked, “I take a multivitamin pill that Consumer Reports says is useless. But I don’t care. It makes me happy.” Gullibility and wishful thinking are common human characteristics. People are willing to believe in untrue things in varying ways and to varying degrees. Even scientifically sophisti- cated people may respond to the power of suggestion. In medicine the effect of suggestion is referred to as the “placebo effect” (Table 3-1). The Latin word placebo means “I shall please.” A placebo effect is a beneficial response to a substance, device, or procedure that cannot be accounted for on the basis of pharmacologic or other direct physical action. Feeling better when the physician walks into the room is a common example. A placebo may be used in medicine to satisfy a pa- tient that something is being done. By lessening anxiety, placebo action may alleviate symptoms caused by the body’s reaction to tension (psychosomatic symptoms). In certain circumstances a lactose tablet (sugar pill) may relieve not only anxiety but also pain, nausea, vomiting, palpitations, shortness of breath, and other symptoms. The patient expects the “medication” to cause improve- ment, and sometimes it does. placebo MyThs and FacTs Table 3-1 Myths 1. Placebos work on the imagination, not the body.