Epidemic Quackery

James Harvey Young, Ph.D.
January 17, 1978

There certainly must exist an old English proverb warning, "He who carries coals to Newcastle runs grave risk of being burned." I must admit that I have felt uncomfortably warm of late in contemplating my presentation before this seminar, in which laetrile should constitute a principal ingredient of my remarks. Some of you have devoted weeks of your lives to concern over this unorthodox cancer treatment and have played major roles in helping the Commissioner prepare his decision on laetrile's status at the end of the rulemaking procedure called for by the 10th Circuit Court. This decision, published in the Federal Register on August 5, 1977 seems to me the most thorough, broad-gauged, and insightful analysis of a highly touted but ineffective product, the mode of its promotion, and the psychology of its acceptance that I have ever read.

What then, in the company of you experts, can I say that will not seem oppressively like res adjudicata or déja vu? So as to gain what I hope may be a fresh perspective, let me try to differentiate between what might be called endemic and epidemic quackery, essaying some historical epidemiology to point to factors present when epidemics occur. Endemic quackery has existed in the world, to quote Voltaire, since the first knave met the first fool. As long as some diseases remain unconquered and death marks the certain terminus of our earthly pilgrimage, and as long as an ethical medical profession abstains from promising the impossible, the unscrupulous will boldly cater to our often desperate hopes. Therefore, a certain basic level of quackery, I take for granted, has existed in all places and at all times and is destined to continue. Occasionally, as one scans the past, he can detect an outburst of quackish energy that I should like to designate as an epidemic. Sometimes a single promotion achieves such a status. At other times the epidemic level consists of a congeries of separate ventures. Before getting to laetrile, let me discuss briefly one epidemic promotion and one epidemic period from the American past.

In 1796, 180 years before the Medical Device Amendments of 1976, the federal government took perhaps its initial action regarding a medical device. In that year the government granted the first patent issued under the Consti­tution in the area of health to a Connecticut physician for "Improving Pain, Etc., by Metallic Points." Elisha Perkins' famous "tractors" furnished the new nation's first example of a health quackery epidemic.

Always in such single-promotion epidemics, it seems to me, an ingenious promoter, or group of promoters, shrewdly devises and/or luckily falls upon an approach that meshes with remarkable pertinence into key elements of the prevailing social climate. In Perkins' case these elements were fascination with electricity and cultural nationalism.

A small-town country doctor probably trained by apprenticeship to his father, Perkins discovered that he could ease pains in various parts of his patients' bodies by drawing the blade of his penknife across the skin above the hurting parts and that he could relieve headaches by the ministration of a lacquered iron comb. He also observed that sometimes muscles contracted suddenly when touched during surgery by his knife. Knowing about Franklin and Mesmer, reading an account of Galvani's experiments, Perkins did what many would-be innovators before and since have done, he compressed what he had heard and observed into a simple theory. Almost all painful conditions, he concluded, especially gout, pleurisy, rheumatism, violent insanity, "inflammatory tumors," and yellow fever, resulted from a surcharge of an electric fluid that accumulated in the bodily parts. This could be released by drawing a metal point across the afflicted surface, always moving from the center toward the extremities, thus ending pain and working a cure. Asserting in his letters the necessity and propriety of making money from his discovery- Perkins bad a family of ten children to support--, this Yankee from the Nutmeg state shifted his therapeutic instrument from simple knife and comb to specially fabricated devices, a pair of small pointed metal "tractors," called so because they pulled out pain. Made in a furnace in Perkins' home, the two tractors were composed of secret alloys, one gold in color, the other silver. In time, forgetting the knife and comb, Perkins insisted that only his patented points would work. Perhaps he became genuinely persuaded such was the case. In the history of quackery many schemers have become converts to the gospel of their own oratory. Perkins sold his tractors for $25 a pair, in his day a princely sum.

Electricity was much in the air in the 18th century, and to posit an electrical cause for most diseases and a sort of miniature lightning rod cure struck the popular mind as both exciting and plausible. At least one testimonial, from a leading figure in the American Philosophical Society, compared Perkins' achievement favorably with Franklin's famous experiment and disparaged critics of Perkinism as similar to the English philosophers who had attacked the Philadelphia sage.

This linkage with Franklin underlined the proud fact that Perkins' pur­ported breakthrough was an American discovery. In the aftermath of a successful Revolution, cultural nationalism blazed brightly in the new nation. Dr. Benjamin Rush, a signer of the Declaration of Independence and now the most distinguished physician in the land, argued that there existed in the United States twenty times more intellect and a hundred times more knowledge than there had been in the American colonies before the war. Could it not be, Perkins' champions queried jubilantly, that a nation which had provided the perfect example of freedom to the world might not also, through the metallic tractors, provide the means to universal health?

Perkins' shrewd decision to get his tractors patented fit in neatly with this patriotic theme. In truth, patenting was still a very simple practice requiring no proof of an invention's utility, but a patent could easily appear to be a symbol of governmental backing, even the consummate testimonial to healing potency. Perkins took immediate steps to bolster this sentiment among potential customers. At the very time the state medical society in Connecticut was ousting him for having "gleaned up" his tractors "from the miserable remains of animal magnetism," Perkins labored to find distinguished buyers in Philadelphia, the nation's capital. And he succeeded. Several members of the Congress acquired a pair. So did the Chief Justice of the Supreme Court, who wrote a letter praising the tractors to future Chief Justice Marshall. And a pair of the metallic points seems to have been bought by President Washington himself. With the three branches of the government thus leading the way, Americans engaged in a frenzy of "galvanizing trumpery."

As these events demonstrate, Perkins had first-rank promotional talents. Prior to the tractors, he had added to his medical fees income secured from trading mules. His vigorous, magnetic personality certainly had much to do with both his therapeutic and his marketing successes. His series of testi­monial pamphlets shows that Perkins worked as effectively in print as in face-­to-face encounter. He gave tractors to some clergymen, along with a certificate saying they had bought them. And, despite their high cost, the metallic points sold well. An account suggests that people sold horses and carriages in order to buy them, and in one case a Southern plantation.

Perkins countered the opposition of his erstwhile fellows in the Connecticut medical society as the unorthodox almost always do. He accused them of blind­ness and greed. And he pointed out that some physicians supported his discovery, despite "menaces" from the stodgy establishment.

Besides electrical wonder and cultural nationalism, a third factor in the climate of the 1790s may have aided Perkinism to reach epidemic proportions. This was fear of yellow fever. That dread disease appeared again and again during the decade, including devastating attacks on Northern cities. In the Philadelphia epidemic of 1793 Perkins himself had lost a daughter, son-in-law, and two grandchildren. So a special poignancy marks his inclusion of yellow fever among the ailments amenable to tractor treatment. And the surest proof that Perkins placed great faith in the efficacy of his patented points comes from his going to New York in 1799 when that city lay prostrate in the grip of yellow fever to treat the ill by plying his device. He could not save himself. He contracted the fever end died of it.

Perkins' death ended the American boom. A British craze, perhaps even more frenetic, engineered by one of Perkins' sons, vanished when a provincial physician demonstrated that he could get just as enthusiastic patient response by using wooden tractors painted gold and silver as he could secure wielding the authentic patented points.

Some writers, admitting Perkins' desire for money and his convenient forgetfulness about penknife and comb while later stressing that only the twenty-five dollar tractors possessed therapeutic efficacy, nonetheless wonder if it is appropriate to term him a quack. As his way of death demonstrates, they argue, he believed in his product, and therefore could not be a fraud. Does quackery require fraudulency? Does one "knowingly" have to sin or err in these matters to run afoul of the moral or statutory laws? Yes, said Congress in the 1912 Sherley Amendment. But I prefer ~o stand with the 1938 law's negative, and even apply the principle retrospectively, granting some diffi­culties as one moves backward in time and acknowledging, under this definition, that some "quacks" are more reprehensible than others. To pin down the term , social result as well as personal motive must be taken into account. To the patient-victim it makes no difference whether his self-asserted savior lies brazenly or speaks what he himself ignorantly believes to be the truth.

The period I wish to point to in which no single promotion dominated but which saw the overall level of quackery reach epidemic proportions covers roughly the middle third of the 19th century. In many ways during these years the social fabric of the nation underwent fundamental change. Quacks and sectarians attuned to the new currents and maneuvering cleverly within their imperatives managed to flourish mightily.

In its political dimension, the period began with Jacksonian democracy, which discredited an older elite leadership and broadened political power among the populace. In an intellectual sense during these years all branches of the educated establishment suffered widespread popular suspicion and scorn. "The priest, the doctor, and the lawyer," wrote an untutored New Englander, all stood convicted of "deceiving the people." Orthodox physicians learned nothing about the nature of medicine, he added, except "how much poison . . . could be given without causing death." This jab at the heroic practice of the regulars had some pertinence~ and quacks were frequently to make it even while they themselves ladled out huge doses of opium and mercury. But it was the lofty status and established power of the educated which came espe­cially under attack. The so-called state "Bla.ck Laws" by rich orthodoxy sought to monopolize medical practice irked a growing breed of irregulars. "We go for free trade in doctoring," a Cincinnatian wrote in 1849; "medicine, like theology, should be divorced from the State, and . . . . as in the dif­ferent sects of religionists, the various medical systems . . . [should] be treated alike." Licensing laws were swept away, and Thomsonians, homeopaths, hydropaths, and almost anyone who wanted to could practice. The patent medicine side of quackery profited from other facets of burgeoning democracy, which expanded the newspaper press at the same time that it schooled more people to a level of literacy capable of reading the nostrum advertising which the new journals contained.

In this atmosphere of freedom, as the common man increasingly made up his own mind about his health, he bought more patent medicines. The right of choice stimulates pride, fires ambition, but also provokes anxiety. Which of the many voices appealing for favor could best be believed? Hard, sharp, unscrupulous bargaining reigned in the realm of both thought and trade. Life became intensely competitive. Tricksters proliferated, and victimization was rampant. Everyone expected roguery, anticipated being cheated, himself sought to cheat in turn. Nor, within limits, did people mind being hoodwinked.

They had made their own decisions, taken their chances in a free environment. Sometimes they were bound to lose. Indeed, clever imposture tended to amuse them. Such was the state of the popular mind as the sales of nostrums soared. This picture of the period emerges from Neil Harris' brilliant book on "the art of P. T. Barnum," titled Humbug.

Coinciding with these complex aspects of freedom's ferment, the arrival of the romantic movement also helped quackery along. A romantic climate, Grete de Francesco has written, favors "all sorts of nature cures" and "the development of a new kind of imposture: a falsification of Nature through overemphasis on the natural." All over America, as vell as in Europe, lay healers in rustic settings employed a variety of "natural" remedies, water being especially prominent. Among those bemoaning the increasing artificiality of life, a preoccupation began with the "natural" diet. Not that critique of the normal diet was not deserved. But some sages went much further. Sylvester Graham plotted a dietary regimen that he hoped might restore the pristine conditions and the purity of life in the Garden of Eden. Graham's ideas influenced the doctrines of new religions, the prescriptions of unorthodox physicians, and the promotions of patent medicine vendors.

Please do not get the idea that I am decrying democracy, freedom, and romanticism because they provided an environment in which clever promoters could manipulate such currents so as to produce an epidemic of quackery. It is Just my hope, of course, to use history to help reveal the dynamism of a perennial threat.

So far I have spoken of pre-germ theory days when the yardstick of orthodoxy could not by the nature of things measure quackery with the precision of our own times. Therefore, it is a paradoxical phenomenon deserving our earnest scrutiny that probably the single quackery promotion receiving the largest amount of public attention in all our nation's history should be one of our own day. What mesh of elements from the social climate and maneuvers by its promoters explain the sensational epidemic of laetrile?

Basic, of course, are both the facts and the image of cancer in our society. With the decline of contagious diseases as a cause of death, due to sanitation, vaccines, and chemotherapy, cancer has risen to second place in the mortality lists. The 1900 death rate from malignant neoplasms was 64 per 100,000 deaths, the 1969 rate 160. On the disease and death front then, cancer and its mortality, have moved more to the center of public attention. In light of chemo­therapeutic miracles, the public wonders uneasily, why can't there be such a miracle involving cancer? This sense of urgency transmits itself to the Congress which allocates more money which, in turn, increases preoccupation with the disease.

Yet the image of cancer may be an even more important force for quackery than its factual circumstances. Heart deaths exceed cancer deaths, but no waves of unorthodox cardiovascular cure-alls have surfaced similar to those in the cancer field, although perhaps obesity remedies may contain an element of this. All diseases possess a popular image. A sports columnist wrote recently that, as a boy, O J. Simpson suffered from rickets, which made him bow-legged and pigeon-toed and forced him to wear his shoes on the wrong feet. In college O.J. told his friends that he had been attacked by polio, because he considered polio a much classier disease than rickets.

Through most of history the big killers have been pneumonias and gastro­intestinal disorders, taken for granted by the populace because so common and familiar. What brought panic were diseases that caused less loss of life overall, but killed swiftly and painfully when they did come in epidemics, diseases possessing horrible external lesions, like smallpox, cholera, and the yellow fever which Elisha Perkins sought to cure. The fear of leprosy also greatly exceeded its morbidity. Syphilis, in English Restoration drama, was a subject of stock humor: the saddle nose, the falling hair, the aching bones brought gales of laughter from the audience as characteristics of the combatant who had lost in Venus' wars. In the romantic 19th century, syphilis ceased to be a hilarious disease and became a moral cataclysm. Under the romantic impact, tuberculosis gained the distinction of being the ennobling way to die. Lesions were hidden inside the body. As the consumptive wasted away, his mind was said to become more ethereal and spiritual as he gradually ascended toward his heavenly reward. Nor was this vision a male prerogative: recall the heroines of all these tragic operas.Indeed, for both men and women, a sort of tubercular standard of beauty came to prevail. If one could not achieve the proper paleness, frailness, and slenderness by contracting the disease, diet might lead to the desired result. Published beauty counsel suggested banning butter, cream, milk, cheese, fish, and vegetables. Sometimes small doses of arsenic were prescribed.

These examples illustrate how the image of a disease can have a powerful influence on conduct. [After drafting this paper I was intrugued to find a more elaborate discussion of the disease theme in the current (January 26) issue of the New York Review of Books. I direct your attention to Susan Siontag's most perceptive analysis called Illness as Metaphor] That centuries ago cancer began to acquire a hostile and terrifying image may be deduced from the fact that the word "cancer" itself derives from the Greek word for crab. The crawling spread of cancer, gradual but relentless, whether exteroal and observable or internal and secretive, through the centuries appeared to be, and indeed a.mounted to, a sentence of death. This image hangs on, a powerful force in men's minds, a force not adequately updated by the victories orthodoxy increasingly has won. No doubt orthodoxy's message, ever more encouraging but never completely reassuring, cannot hope to compete with the frenzied fear, deeply embedded in the folk tradition and constantly revivified by the camp meeting oratory of orthodoxy's opponents. Here is Harry Hoxsey writing two decades ago on page 1 of his book entitled You Don't Have to Die:"Suppose you suddenly discovered that you have cancer. A horrible crab-like disease has invaded your body, is gnawing your flesh, has pushed greedy tentacles into your vital organs. A loathsome scavenger slowly and inexorably is consuming you alive, cell by cell." And, of course, the unorthodox make orthodox weapons against the disease seem as terrifying as the disease itself. It was a laetrile champion who recently spoke scornfully of regular medicine's "cutting, burning, and poisoning."

The assertiveness of the cancer theme among the varieties of quackery available preceded the laetrile epidemic. In recent years, as Wallace Janssen has so vividly pointed out in FDA Consumer, the names of Koch and Hoxsey and the brand name Krebiozen have achieved high public recognition.

Besides cancer's image as an element of popular culture helping explain the laetrile boom, other facets of the broad climate are involved. The whole trend of 20th century thought, for example, has brought us to new and gloomy versions of romanticism. As our century opened, the prevailing mood was cheerful and so hopeful about the future that progress seemed inevitable. Science had much to do with this, having revealed a comfortable, homey universe working by natural laws. The methods of science seemed transferable to the study of social situations, offering the prospect of resolving society's strains. Morality was palpable; people discussed all questions in moral terms with nary a blush. Americans as openly esteemed patriotism as morality, antici­pating a great future destiny for the nation. Leaders were generally esteemed. Goodness marked basic human nature, and man's transgressions resulted not from evil but from error. Education would eliminate error, as technology would banish poverty. One seer welcomed the new century by taking material progress for granted, then adding: "Laws are becoming more just, rulers humane; music is becoming sweeter and books wiser; homes are happier, and the individual heart becoming at once more just and more gentle."

Things did not continue quite along this line. Relativity and indeter­minacy replaced certainty in science, and the fixity of other 19th century solids also dissolved, including morality. Inevitable progress fell under the impact of a series of terrible wars. The inherent goodness of human nature, battered by new schools of philosophy, crumbled under the revelations from the German concentration camps. The belief in education as a social panacea withered. Science-technology inventiveness did continue to produce wondrous products for mankind's benefit, but also devised nuclear weapons and polluted the atmosphere. A kind of confident, reasonable, cheerful 19th century syn­thesis gradually came apart, as the 13th century Thomistic synthesis broke up in the 14th century. At this juncture we cannot detect a new Renaissance that might re-establish a common confidence and faith. Rather the omens are disheartening.

A whole host of new religions have sprung up seeking to win the adherence of distraught humankind. As in the 14th century, some of them seem diabolical. Since modern urban industrial civilization strikes many people as part of the problem, some disturbed souls strive to return to nature. Pressing upon this long developing major crisis of belief came Vietnam,. an unpopular, unsuccessful var that put generations at each other's throats, and Watergate, a seeming indisputable proof of what some voices had long been crying, that blame for discontents could be laid upon leadership.

In my bones, I feel sure that such a setting as I have quickly sketched provides an atmosphere for the flourishing of quackery. Those questing for new faith are terribly vulnerable to false prophets. The widespread distrust of established authorities encompasses those who traditionally have sought to protect the public from charlatanry. The medical profession su1'fers sus­picion, including the specialists within it concerned with cancer. In the behavioral survey of health practices and opinions sponsored by the FDA and six other federal agencies and released five years ago, it was concluded that 42% of American adults would not be persuaded by almost unanimous expert opinion that a purported "cancer cure" held out false hope. And, of course, distrust of authority also encompasses regulatory agencies.

The major explanation for the epidemic proportions achieved by laetrile, it seems to me, lies in the shrewdness with which its proponents have recog­nized these factors I have been discussing in the cultural environment and the skill with which they have exploited them. Misused authority constitutes oppression, and the opposite of oppression is freedom. If, in these parlous times, you can sell a panicked cancer sufferer and his family on the concept, not only that you have a treatment that will do some good, but also, that in accepting the treatment they are taking, in a confused immoral world, a nobly moral stand for an ancient and patriotic virtue, are joining a crusade for freedom itself, If you can do this, I say you are in business. The pitch may even seem persuasive to state legislators and federal judges.

A radical right-wing reaction to our time of troubles, a movement opposing the initiatives of modern government, seems to be. a growing phenomenon. The adherence of such true believers to the ranks of laetrile promoters has unquestionably helped the movement grow. Some leaders of the Committee for Freedom of Choice in Cancer Therapy may have profited from the marketing of laetrile as part of their motivation, but there exists unquestionably a massive component of the zeal of the doctrinaire. Frank Salaman, one of the founders of the group, sees "at stake" a "strong principle of human freedom from uncon­stitutional interference." And the pro-laetrile film strip "World without Cancer" opened with the deceptively disarming words, "We are not prescribing any course of treatment. We endorse nothing but freedom of choice."

Freedom of access to worthless cancer treatments, as I wrote in my affi­davit submitted to the rulemaking proceeding, "leads only [backward] toward the license of those ancient days, when 'the toadstool millionaires,' preaching religion and spouting patriotism, operating without restraint, fleeced and often killed their gullible victims. That is a fate from which seven decades of constructive legislation, beginning . . . [in] 1906, has somewhat rescued the nation. Complex, modern, industrial, urbanized society, with standards of medical judgment far more precise than those existing in the 19th century, cannot afford to let the nation's health be governed by a distorted definition of that great symbol, 'freedom,' which would return piratical anarchy to the realm of health." Legalizing laetrile, I fear, would breach the dike of the new drug efficacy provisions of the 1962 law in a most ominous way.

An additional major force lofting laetrile to epidemic proportions, it seems to me, is another kind of alliance formed by its promoters. I don't know how firm structural links may be, but in developing political action procedures laetrile's champions have sat at the feet of the health food lobby. And, of course, whatever its earlier purported modes of biochemical functioning, laetrile finally became· transmuted into a vitamin. In testifying last July before Senator Kennedy's Subcommittee on Health, Ernst Krebs, Jr. called laetrile "a scientific revolution as profound as the germ theory of disease . . . [and] the Copernican theory." What Vitamin C is to scurvy, niacin to pellagra, and Vitamin D to rickets, he suggested, Vitamin B-17 is to cancer. If every American took laetrile regularly, Dr. John Richardson told the same hearing," in 20 years cancer would be relegated to the dusty pages of history."

Converting laetrile into a vitamin must have seemed like a master stroke. Not only would it put the product under the food rather than the drug provisions of the national law, it would also broaden the market by giving a more plausible explanation for preventive therapy. Moreover, in light of folk attitudes, it would wrap the product in a glamorous cloak. For the word "vitamin," for reasons both sound and illegitimate, holds high esteem. The survey of health practices and opinions, already referred to, revealed that three out of four .Americans cherish the magical belief that, no matter how sufficient their diets, taking extra vitamins automatically provides more energy and pep. This myth of superhealth from vitamins stands ready to piggyback other health claims.

The survey revealed another telling point. Whereas in most aspects of self-treatment, no coherent body of theory underlies consumer action, which is motivated by what the study called "rampant empiricism," in the vitamin and health food area a different set of circumstances prevails. Here alone something like an organized rationale underlies conduct, one based on the premise that the normal food supply, because of inadequacies and introduced poisons, threatens health rather than promoting it, requiring supplements to save the day. This myth has been the deliberate and successful creation of the health food industry, especially since enactment of the 1938 law, fabri­cated out of food folklore running back to the dawn age of man, of clever leger­demain involving complex scientific nutrition, and of some true and scary episodes relating to standard foods. Linking in to the power of this myth could only aid in laetrile's popular acceptance.

The health food leaders have excelled at employing the modern mass media to disseminate their nutritional fairy tales. "In effect," as Stephen Barrett has put it, "the media have become the label," but a label so detached from the packaging as seldom to be actionable. Promoters of dubious nutritional wares have also proved to be amazingly skillful at mobilizing those whom they had converted into a powerful political force. The Vitamin Amendments of 1976 attest to this skill. In their efforts to thwart the FDA's regulatory goals, even to reduce the agency's statutory power, the health food industry pioneered in waving the flag of freedom against bureaucratic oppression. Their literature appealed to Washington and Lincoln, asserting "They Too Fought for Freedom Against Great Odds. "Surely these vitamin freedom shouters furnished an example in doctrine for those proclaiming the riskier freedom of treating cancer with the specious vitamin B-17. Pseudo-nutritionists have also shown laetrile leaders how to turn converts to their therapeutic doctrines into political shock troops.

Evidences exist of cooperative interaction between the National Health Federation, one of the health food industry's major pressure groups, and laetrile's supporters. At NHF conventions, pro-laetrile movies have been shown. An NHF governor has edited pamphlets espousing laetrile, and the president of one of the laetrile sponsoring organizations, the Cancer Control Council, has served on the NHF governing board. The NHF Bulletin has boosted laetrile. So it is not surprising that their respective patterns of drum beating, in­cluding political lobbying, should resemble each other.

In a democracy, of course, representative bodies chosen by the electorate make the rules, including those relating to highly complex scientific matters. I am an admirer of William Lowrance's book entitled Of Acceptable Risk, Science and the Determination of Safety, the result of an inquiry by the Committee on Science and Public Policy of the National Academy of Sciences. In essence, he concludes that in making public policy regarding matters of potential danger to society, the assessment of hazard is a scientific decision made by the experts, whereas the determination of risk is a political decision made by elected officials. Public opinion supported the enactment of food and drug laws, and those laws sought to remove from day-in, day-out legislative deter­mination highly complex particular questions, giving such decisions to expert agencies with rules of procedure defined in the laws. For legislatures to abandon this established tradition and rule on issues ad hoc seems to me highly unwise social policy, although of course legislatures possess the inherent power to do so. It is an indication of the epidemic levels of nutritional and cancer quackery that, in the federal and state areas respectively, enough pressure has been generated to cut back on the established pattern as well as on the rigor of regulation.

Sometimes, in short, when shrewdly propagandized, a major segment of public opinion can be led to support a stand contrary to the conclusions of reputable scientists. And the issue may become emotional enough to make an impact on legislative bodies. "Congress will rely on science when it can," the counsel for the House Health Subcommittee said recently, but in order for scientists to persuade legislators, they must convince the American people.

This means a battle for minds, and for wills too, the will to let legis­lators know convictions held. Champions of the unorthodox, for reasons I have sought to explain, bubble over with aggressive zeal. Opponents of the unorthodox on scientific grounds often act with greater diffidence. And when they do act, to many people they only confirm the distrust in which they already are held. Medical societies have not waged such effective battles against quackery recently as earlier in the century; indeed, the American Medical Association disbanded its anti-quackery machinery. Few local groups have demonstrated the vigor and imagination of Stephen Barrett's Lehigh Valley Committee Against Health Fraud, among whose anti-quackery ventures the preparation of an excellent book, The Health Robbers, aimed at a broad readership, ranks high in public service. The American Cancer Society has striven to alert the public to the dangers of unproven methods.

With respect to laetrile, the Food and Drug Administration has assumed the role of primary educator to the nation, in connection with the agency's legal actions and in a more general sense as well. In testimony before legislative committees, press releases, the pages of FDA Consumer, legal briefs, and a widely distributed poster, the FDA has striven to alert the public to laetrile's dangers. In the perspective of history, I trust the agency will receive for this service the credit it deserves. In light of what I have said earlier about our intellectual environment, I believe all foes of quackery have reason to remain alert.

A recent student of Elisha Perkins' career, Jacques Quen, points to the fact that Perkins' physician critics, in condemning him, did not pose for themselves a further question. Why did the metallic tractors evoke such a satisfied, indeed ecstatic response from those who used them for their pains? Now, 180 years later, a much better understanding prevails of the placebo effect. And the Commissioner's report contains some intriguing efforts to explain the motivation of laetrile's users and proselytizers. Yet do we know enough? Is this not a field requiring more research? Would there not be value in seeking to balance Dr. Richardson's Laetrile Case Histories with another set, revealing not only the physiological circumstances, but as fully as might be, the psychological parameters of laetrile users, not only including the disillusioned, but the most buoyant of champions? Difficult as this task might be, I believe the results might prove to be useful on both the educational and the regulatory fronts against threats from other quackery epidemics in the years ahead.


James Harvey Young (1915-2006), a professor of history at Emory University, was a social historian whose special interest was the development of food and drug regulation in America. He was a member of the FDA National Advisory Food and Drug Council. His books, The Toadstool Millionaires, The Medical Messiahs, and American Health Quackery, trace the history of quackery in America and efforts to control it. This paper was presented at an FDA Bureau of Drugs seminar in Rockville, Maryland.

This article was posted on July 17, 2018.

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