The Medical Messiahs:
A Social History of Health Quackery
in Twentieth-Century America

Chapter 20: The Perennial Proneness

James Harvey Young, PhD


"There is a class of minds, much more ready to believe that which is at first sight incredible, and because it is incredible, than what is generally thought reasonable."

 —Oliver Wendell Holmes, 1842 [1]


"Quackery . . . s the legitimate offspring of ignorance." So asserted an orator in the opening of a new medical school in Nashville in 1851. Certainly ignorance remains one of medical quackery's major props. "Many people . . . ," asserted a recent Food and Drug Commissioner, "know little more about the human body than if they had lived a hundred years ago." Much of what is "known" is what was known a century ago, traditional lore, handed down from generation to generation by precept and example, some of it going back centuries, even millennia, or at least resembling medical lore cherished in those remote days. One scholar bas done an intriguing job of tracing back the supposed aphrodisiac properties of the mandrake root, which was a popular article long before Machiavelli wrote his play centered on this theme. The same might be done with other aspects of medical and nutritional folk belief. False beliefs about health and therapy derive in part from outmoded theories of orthodox physicians, Such antiquated theories, for example, provide the base for a great deal of today's arthritis quackery. "The rag-bag of folk medicine," wrote the historian Edward Eggleston, "is filled with the cast-off clothes of science." [2]

Part of the untrue knowledge concerning health that handicaps laymen is the incorrect relationship among facts. Man's reasoning seems to flounder particularly, commented a 19th-century observer, when the issues relate to matters medical, the "most difficult, obscure, and complicated" of all branches of human learning [3]. It remains true that, in this vast morass, he who seeks to guide himself by the same commonsense cause-and-effect logic he applies to certain other aspects of life may well get stuck.

"Ailment plus medicine equals cure" is an equation widely cherished as true. But the algebra is not so simple. Countless times, of course, the true equation is "Ailment plus Nature equals cure, and if any drug is added its value is zero. Why, a physician once asked, was quackery more prevalent in medicine than in other areas of science? "Because," he answered himself, "the medical quack attributes to himself what is due to Nature. Nature can not build a railway, but she can very often cure disease." [4] Quacks have harvested countless testimonials from customers whose gratitude was thus misplaced.

Another version is this: "symptoms equal disease," hence, add medicine to produce cure. A vastly confusing aspect of medical science, to physician as well as to layman, is the way so many ailments, major and minor, are heralded by the same symptoms. An Atlanta chest specialist, checking medical textbooks, found 56 different causes for spitting blood, 76 different causes for pain in the chest, 137 different causes for coughing [5]. The quack has taken advantage of such confusion, claiming that his bottled remedy has cured a dread disease at the serious end of the cough spectrum—say, tuberculosis—when in fact a change in the weather has dried up postnasal drip. To the quack and his most susceptible victims, all coughs are consumption, all lumps cancer, all backache kidney disease.

Since "symptoms equal disease" in the mathematics of credulity, the quack can go a step further in tampering with the equation. He can, through his promotion, substitute false symptoms for real symptoms. He can convert normal physiological conditions, like low spirits, tiredness, mild insomnia, spots before the eyes, into dire harbingers of syphilis and insanity. Therefore, in the patent medicine algebra, "non-symptoms equal disease," ergo, add Helmbold's Extract of Buchu to produce cure.

It is not fair, to be sure, to characterize this artificially stimulated malaise as non-disease. For it is every bit as traumatic, although of emotional origin, as if caused by germ or virus and may indeed display marked physiological effects, like stiffness, pain, and rash. Half of current sickness, according to the widespread generalization, has a psychogenic component. Certainly the placebo effect has been a subject of recent earnest inquiry in reputable medicine. Henry K. Beecher, the Harvard anestbesiologist, has written that placebos appear to cause improvement in some 35 per cent of all cases, no matter what the affliction [6]. Obviously countless ailments throughout history have been relieved by nostrums or by the ministrations of quacks because the sufferers have had faith in the process. The assurances in printed advertising, or the comforting attentions of self-promoting healers, are sufficient to reverse, at least temporarily, the emotional tides.

In this province of ill health, then, a series of suggestions and counter-suggestions may, in the very susceptible, actually create an ailment where none existed and then remove the ailment, all for a price. Such was the mechanism of the New York "clinic" which frightened healthy young men into thinking they had syphilis or grievous ailments resulting from masturbation, then relieved their fear by electric therapy so vigorous as to persuade its chastened victims they certainly must have received a cure [7].

The Nashville orator of 1851, after calling quackery "the legitimate offspring of ignorance,- went on to say that quackery could "only be abridged by elevating the standard of medicine and disseminating a correct public sentiment." In "an intelligent community," he added, reflecting an optimism often echoed since, quackery could not flourish. Medicine has certainly been elevated since this orator spoke, and education vastly augmented. Since, in view of this, quackery has not been vanquished, commentators have raised the question as to whether ignorance alone is a sufficient explanation for quackery's persistence, or at least whether ignorance must not be defined so as to include something more than mere lack of adequate facts plus fuzzy logic. respectable medical historian, Fielding H. Garrison, referred to a "fetichistic instinct," a "primitive craving for the supernatural which is ever latent in man." This craving he saw as a common aspect underlying primitive medicine and modern quackery. It is sometimes tempting to believe in an emotional vaulting toward the occult, something positive in itself and not merely an act of bad judgment made on the basis of wrong premises and incorrect information. Rabbits' feet afford a steady market in America, at prices ranging from a dime to five dollars. Charms, voodoo bags, and love potions have been said to bring in a million dollars a year from residents of Alabama, Mississippi, and Louisiana alone. And a Missouri root doctor found customers for three magical remedies, a cathartic, an emetic, and—as he called the third—a "rank pizen," all made from the very same root. Hibobalorum was prepared by peeling the bark downward, Lobobahirum by peeling it upward, and Hi-lo-bustem by peeling it around [8].

If not so deeply implanted as an instinct, the proneness to quackery may often be related to personality structure. Among the victims of medical charlatanry are many who make their decisions on grounds almost belligerently anti-intellectual. Before elaborating this point, it needs to be stressed that "intellectuals" are not immune to quackery. "I do not know," Erasmus wrote centuries ago, "whether out of the whole world of mortals it is possible to find one who is wise at all times of the day." The quack can erect a beautifully logical structure on the basis of one false but plausible premise. Countless intelligent and educated men have missed the premise, admired the logic, and been trapped. Indeed, it has been argued that the highly literate man, familiar with words and self-assured about their use, may be even more susceptible than his less literate fellow when approached outside his field of expertise with a well-structured and persuasive piece of prose. In his "fantasy life," a Temple University professor has written, the American business executive possesses the same craving for magical cures as does "the Zanzibar pygmy." And Dr. Walter Alvarez insists that "university towns are hot-beds of quackery [9].

Suffering, of course, may also sweep aside the intellectual defenses of the very bright. Jerry J. Walsh, executive director of the Illinois chapter of the Arthritis and Rheumatism Foundation, himself an arthritis victim, explained for some Senators how this might be [10].

"But I can guarantee any of you gentlemen . he said, "that if you are in this bed of pain with arthritis, you will try anything to stop the pain, at any cost. You say, 'What have you got to lose?

"I know that I went from copper bracelets to buckeyes trying to find a cure. I've tried vibrating machines and diets, and had a chiropractor break one of my legs with his special treatment. Yet, continually, I went back, maybe to the tune of $2,000 or $3,000 more. You don't keep track of the dollars, and in fact you like to forget them. You are always looking for relief. . . .

"If someone would approach me today offering me, with a glib tongue and all, the opportunity of getting better, even better than I am right now, I am sure that I would think it over maybe for a couple of days. If I could do it in the back room unbeknown to you gentlemen, and I wouldn't have much to lose in time or money—and I don't know where I would draw the line on time or money, $200 or $300—I am sure that I would sneak a treatment."

It is sad enough that men of high intelligence and great capability should, through such suffering or through a distortion in their perception, become merely the customers of pseudo-medicine. It is even sadder that the gifted but misguided have now and again used their great influence to champion the quack or even, like the engineer who devised the MicroDynameter, to enter upon dubious careers. As has been suggested, dedicated members of Congress, because of a sort of blindness in one sector of their awareness, have given specious drugs strong support and have thus created much belieif in the popular mind. Nor has this troublesome astigmatism been absent from the judicial bench."

No one, therefore, can afford complacency, thinking himself forever immune from the quack's ingenious appeals. Yet there are not enough errant intellectuals among us to keep quackery flourishing. The poorly educated do after all pay most of the bills. Among them is a group motivated, it would seem, by something more than sheer lack of knowledge. Some sort of alienation, some sort of perversity, drives these people to follow the most extreme pathways. Often they share with others not so far out as themselves a deep resentment against orthodox authority. Physicians have always been highly vulnerable to attack. They have an impossible job to do: keeping mankind out of the grave and well. Yet they often make pronouncements with an ex cathedra air, and by no means always in the field of their own expertness. They earn more and live better than most of their patients, engendering envy. The high pressure under which they live often leads to a manner resembling brusque busyness, so that intruding upon their time is done uneasily. The therapy they prescribe may be unpleasant and protracted. Some patients are easily frustrated and cannot muster "the patience, discouragement, and degree of cooperation" necessary "in the course of receiving scientific medical care." Much medication, any doctor knows, is prescribed but never taken. Through the centuries physicians have had a hard time with their public image, and motivational research reveals the same today. Through the centuries the quack has played on this widespread latent suspicion of the regular doctor [12].

Besides criticizing reputable medicine, the quack also lauds his own alleged miraculous cures. Here too he finds an eager hearing with a segment of the people. "There is a class of minds," wrote Dr. Oliver Wendell Holmes over a century ago, "much more ready to believe that which is at first sight incredible, and because it is incredible, than what is generally thought reasonable. Credo quia impossibile est." [13] That class of minds is still extant. Although, through the years, Holmes and other commentators have reflected fruitfully on this phenomenon, not until recently have the insights learned through the modem study of personality been turned toward understanding the quackery-prone mind.

Delegates attending the Second National Congress on Medical Quackery, held in Washington two years after the first Congress, and likewise sponsored by FDA and AMA, listened to one such significant effort at explanation. Dr. Viola Bernard, professor of psychiatry at the Columbia University College of Physicians and Surgeons, recognized that "economic, ethical, socio-cultural and educational factors," all intertwined and reinforcing each other, are deeply involved in the quack victim's motivation, She sought to probe, however, in her address, "the psychological component of this broad issue." [14]

Some emotionally immature people, Dr. Bernard suggested, carry over into adulthood the magical thinking common in childhood, "along with an excessive inner sense of their own vulnerability and a corresponding exaggeration of the power of others to harm or protect them." When trouble comes—sickness or stress of some other kind—their fear of death or bodily harm may be exaggerated to an excruciating degree. So too may their trust be exaggerated in him who offers a "get well quick" solution. Reliance on a quack seems to provide a hopeful alternate course to the "effort, frustration and risks of failure which are essential to realistic success in overcoming or improving the stressful situation." The "Medicine Man" is endowed in the believer's mind with the childhood image of "parental omnipotence" over life and death.

The sense of hopelessness making some people prone to quackery, Dr. Bernard asserted, may rest in various emotional problems, much of the mechanism unconscious. Some persons are frustrated because their fantasies of achievement far transcend their capabilities to perform. Their goals, indeed, may be impossibly idealistic, involving "cravings for 'perfect beauty' or other forms of inordinate excelling." Other people "have come to feel it futile to compete in ordinary ways for the rewards of a hostile rejecting society." Among the various categories of the hopeless, with nothing to lose and everything to gain, are to be found the most committed of quackery's converts. People of this personality type can seldom be weaned away from their loyalty by rational appeals; a challenge to their delusion only strengthens its hold. Such converts—as we have seen with Hoxsey's army of dedicated disciples—often treasure a wide assortment of irrational health biases. "There is a close resemblance—and often actual identity—between those who are fervently for some medically unauthorized health 'causes' and those who are as fervently against certain health programs under medical auspices."

Discussing the same problem in its broader dimensions, the historian Richard Hofstadter has commented that the "most malign forms" of anti-intellectualism are found in a small but "vociferous" segment of the American people, possessing what he calls "the one-hundred percent mentality—a mind totally committed to the full range of dominant popular fatuities.".For this group, imbued "with obscure and ill-directed grievances and frustrations," hatred becomes a kind of creed. A whole host of enemies threaten and evoke their ire. Their leaders, sharing these fears and hates, play on them, provoking letter-writing campaigns and worse. Case histories have been well told in Ralph Lord Roys Apostles of Discord and the techniques of such agitation lucidly analyzed in Leo Lowenthal and Norbert Guterman's Prophets of Deceit. Their gospel is perversely irrational. As Hofstadter says, using a Latin phrase very like that cited a century earlier by Oliver Wendell Holmes, "Credo quia absurdum est ." [15]

The modes of thought, feeling, and action of those committed to the most extreme pathways are often reflected not only in the pursuit of health but also across the whole range of life's concerns. The implications are significant not merely for those who would seek to counter quackery by education, but also for those dedicated to preserving a healthy democracy.

While Dr. Bernard was addressing the delegates attending the Second National Congress on Medical Quackery, down the avenue at another Washington hotel speakers of contrary view were talking before a competing Congress on Health Monopoly, sponsored by the National Health Federation. "Freedom of choice is the American heritage," a former Federal Trade Commissioner was saying, and that freedom should extend to use of Krebiozen. "Personally," the ex-commissioner remarked, "if I like to take two yeast tablets I want no damned bureaucrat breathing his fluoridated breath down my neck." [16]

Dr. Bernard, in seeking to provide insight into why people fall prey to quackery, employed psychoanalytical theory. The use of modern behavioral science research techniques might also furnish enlightening facets of an answer to this disturbing question. In the summer of 1966 such a research project got under way. Instigator of the project was Senator Harrison A. Williams, Jr. As a member of the Senate's Special Committee on Aging, he had listened to expert witnesses describe how the elderly were being victimized by medical fraud. As chairman of a Subcommittee on Frauds and Misrepresentations Affecting the Elderly, he had explored the matter further. Senator Williams' subcommittee report, issued in January 1965, recommended "a broad research study on consumer attitudes" as fundamental to the proposition that "educational efforts should receive at least as much attention at the Federal level as enforcement efforts." The next month Senator Williams requested the National Institute of Mental Health to help launch such a survey of consumer attitudes relating to medical quackery. During the following year seven federal agencies pooled their planning talents and their funds, the Food and Drug Administration serving as coordinator. In June 1966 a contract was signed with a private research agency to conduct the study. A broad-scale survey of 3,000 citizens selected at random so as to represent a cross-section of the population, the study ambitiously sought to probe many aspects of "Susceptibility to Health Fallacies and Misrepresentations." What role did family and educational background, previous health experiences, age, and psychological orientation have to play in determining susceptibility? How did a person develop the particular pattern of beliefs he had come to hold about sickness and the actions he should take, the practitioners he should consult, to overcome it? It was the hope of the agencies sponsoring the project that profiles of proneness might emerge from the research, a more sophisticated understanding that might permit the fashioning of educational antidotes for quackery more perceptively—and hence successfully—than had yet been possible [17].

The letting of the contract for this study happened to coincide with the 60th anniversary of the enactment of the first Pure Food and Drugs Act. To commemorate this pioneering statute, Food and Drug Administration officials hung in the lobby of their new building a portrait of their first chief under this first law, Dr. Harvey Washington Wiley. The ma who in 1966 occupied the post of authority which Wiley first had held was another physician, Dr. James L. Goddard, the first physician in more than four decades to head the FDA. Like Dr. Wiley, Dr. Goddard spoke out forthrightly, creating national headlines, and took brisk regulatory action. Prescription medication continued to be the most pressing area of the agency's drug concern, but not the only one. Long dormant, proposed regulations with respect to special dietary products sold direct to consumers were updated and announced: their enforcement, even in the modified form that might result after hearings and court action, would no doubt put a heavy brake on nutritional nonsense. Dr. Goddard raised doubts about therapeutic claims suggested or implied in some proprietary advertising, and he and FTC chairman Paul Rand Dixon got their heads together about how better to cooperate in confronting this problem. Increasingly rigorous enforcement of the laws could be anticipated." [18]

The millennium, of course, will never come. Knaves there will always be, and fools—whatever the justification for their folly—and, therefore, pseudo-medical deception. Yet there is room for guarded optimism that the high tide of medical quackery at the middle of the 20th century might be at least pushed back. Ever stronger federal regulation, more rigorous state laws better enforced, education more appropriately aimed than in the past, an increasing adequacy of sound medical care for a larger portion of the population, these forces might be expected eventually to reduce in some measure quackery's enormous toll in wasted dollars and frustrated hopes for health.

References

  1. Holmes, Medical Essays, 33.
  2. Addresses Delivered by Professors [Charles K.] Winston and [Paul F.]Eve at the Opening of the Medical Department of the University of Nashville (Nashville, 1851), 9-10; George P. Larrick, "Quackery as a Public Health Problem," mimeographed text of Oct. 23, 1957, address; C.J.S. Thompson, The Mystic Mandrake (London, 1934); F. William Saul, Pink Pills for Pale People (Philadelphia, 1949), 100-104; Ronald W. Lamont-Havers, "Quackery in Arthritis," Proceedings, National Congress on Medical Quackery (1961), 51; Edward Eggleston, The Transit of Civilization from England to America in the Seventeenth Century (N.Y., 1900), 60.
  3. Paul F. Eve, The Present Position of the Medical Profession in Society (Augusta, Ga., 1849), 22.
  4. Francis J. Shepherd, "Medical Quacks and Quackeries," Popular Science Monthly, 23 (June 1883), 162.
  5. Andrew Sparks, "How Good Are Physical Checkups?," Atlanta journal and Constitution Magazine, Apr. 15, 1956, 26.
  6. Atlanta Journal, Feb. 22, 1962; Medical Tribune, Feb. 15, 1963; Drug Trade News, 30 (June 20, 1955), 50; Henry K. Beecher, "Quantitative Effects of Drugs on the Mind," in Talalay, ed., Drugs in Our Society, 84.
  7. See ch. 11.
  8. Addresses Delivered . . . at the Opening of the Medical Department of the University of Nashville, 9-10; Garrison, "On Quackery as a Reversion to Primitive Medicine," Bull., N.Y. Academy of Medicine, 2s, 9 (Nov. 1933), 601-12; Atlanta Journal, Feb. 1, 1948; Willis F. King, Quacks and Quackery in Missouri (St. Louis, 1882), 23-24. See also Paul G . Brewster, "'Witchdoctor Advertising: Folklore in the Modem Advertisement," N.Y. Folklore Quarterly, 14 (1958), 140-44.
  9. Erasmus, The Praise of Folly, in Introduction to Contemporary Civilization in the West, i (N.Y., 1946), 424; "Ex-osteopath," Quacks and Grafters (Cincinnati, 1908), 38-40; Alvarez, "The Appeal of Quackery to the Nervous Invalid," Minnesota Medicine, 16 (Feb. 1933), 87.
  10. Frauds and Quackery Affecting the Older Citizen, Hearings before the Special Committee on Aging, United States Senate (88 Cong., I ses., 1963), Part 1, 9-10.
  11. See ch. 11; William W. Goodrich, "Searching for Medical Truths in the Courtroom," FDC Law Journal, 11 (Sep. 1956), 481-85, 492.
  12. Viola W. Bernard, "Why People Become the Victims of Medical Quackery," Proceedings, Second National Congress on Medical Quackery (1963), 53-56; Ernest Dichter, "The Doctor's Human Relationships," Medical Annals of the District of Columbia, 27 (Sep. 1958), 493-94.
  13. Holmes, Medical Essays, 33.
  14. Bernard, "Why People Become the Victims of Medical Quackery." See also: "Why Do People Detour to Quacks?," Psychiatric Bull., 4 (Summer 1954), 66-69.
  15. Hofstadter, Anti-Intellectualim in American Life (N.Y., 1963), 20, 37, 42, 118-19, 136; Roy, Apostles of Discord (Boston, 1953); Lowenthal and Guterman, Prophets of Deceit (N.Y., 1949).
  16. Wash. Evening Star, Oct. 25, 1963; Wash. Post and Baltimore Sun, Oct. 26, 1963.
  17. Frauds and Deceptions Affecting the Elderly, 89 Cong., 1 (1965), 17; Memorandum of Meeting, Health Fads and Fallacies Survey, Dec. 7, 1965; Dept. of HEW release, May 10, 1966; FDC Reports, July 11, 1966, T&G 2. Besides FDA, other agencies supporting the survey were the Administration on Aging, National Institute of Child Health and Human Development, National Institute of Mental Health, Vocational Rehabilitation Administration—all within the Department of Health, Education, and Welfare—the Agricultural Research Service of the Department of Agriculture, and the Veterans Administration.
  18. N.Y. Times Magazine, May 15, 1966, 23, 80-102; Advertising Age, 37 (May 30, 1966), 1, 64; (June 20, 1966), 50; FDC Reports, May 2, 1966, 22; June 20, 1966, 3-9; July 4, 1966, T&G 6.

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This page was posted on January 8, 2002.

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