A Historian's View of Quackery in 1974

James Harvey Young, Ph.D.
with Comments from Stephen Barrett, M.D.

Humbug and Fraud, two recent books, help clarify the intellectual climates in which health quackery began to flourish mightily in America and, a century and a half later, continues to prosper. Humbug: The Art of P.T. Barnum, by Neil Harris, scarcely alludes to deception with respect to health, but its brilliant analysis of how a more democratized people came to behave in Jacksonian America can be applied to the area of health so as to offer probing insights into quackery. Fraud: The United States Postal Inspection Service and Some of the Fools and Knaves It Has Known, by E. J. Kahn, Jr., mainly concerns the very recent past. Among its richly variegated cast of knaves, several health tricksters play most disturbing roles.

Dr. Young, who lived from 1915 to 2006, was the foremost authority on the history of quackery. This essay was written in 1974 and, as far as I know, has not been published elsewhere. It describes how quackery thrived during the previous 100 years and the gradually increasing but insufficient efforts of our government to curb it.—SB

Quackery began, so Voltaire asserted, when the first knave met the first fool. Such encounters may be presumed to have continued, in occurring in all times and in all places. Certainly colonial America played host to knaves who cheated the gullible, like Nicholas Knopp in seventeenth century Boston, who sold a water he called a cure for scurvy, and Francis Torres in eighteenth century Philadelphia, who vended pieces of' horn called "Chinese Stones" to cure the bites of mad dogs and rattlesnakes. The cultural nationalism of the Revolutionary generation spurred native American nostrums as it stimulated other prideful innovations.

An even greater surge forward in the promotion and use of patent medicines and other types of pseudomedical deception occurred during the second quarter of the nineteenth century. Linkages between burgeoning quackery and expanding democracy have long been recognized. Democracy brought an increase in newspapers, both in villages and in cities, written to appeal to the interests of a populace acquiring the rudiments of literacy as a result of tax-paid common schooling. Patent medicine promoters placed their advertisements in these papers. Mail service expanded as the nation's boundaries grew, and the cost for service fell. Nostrum vendors broadcast their circulars throughout the republic by means of the U.S. mails.

The increased passion for equality brought old inequalities into popular disrepute. Establishment culture seemed suspect to the great body of citizens. Members of the learned professions, with their special knowledge, their elevated status, their sometimes pompous manners, lost favor among egalitarians. "The priest, the doctor, and the lawyer," wrote one champion of the common man, all were guilty of "deceiving the people." Licensing laws, which had given the more learned physicians the right to control who practiced medicine, went into the ashcan as those of democratic persuasion gained control of state legislatures.

In such an atmosphere humbug flourishes. Neil Harris' discussion of these years—when P.T. Barnum was developing his career—adds new dimensions to our understanding. When the old leaders of opinion lose their accepted role in a period of untrammeled democracy, each man must make up his own mind for himself. ["Think for yourself" (rather than trusting experts) is still one of quackery's most powerful sales pitches.—SB]

The right to do so stimulates pride, fires ambition, but also provokes anxiety. Which of the countless voices appealing for his favor can he believe? Hard, sharp, unscrupulous bargaining reigns in the realm of trade and in the realm of thought as well. Life and thought become intensely competitive. A horde of tricksters appears, and victimization runs rampant. Everybody expects roguery, anticipates being cheated, himself cheats in turn. Nor, within limits, do men mind being hoodwinked. They have made their own decisions, taken their chances in a free environment. Sometimes they are bound to lose. Indeed, clever imposture amuses them. Humbuggery tickles the fancy.

Barnum's genius, Harris explains, lay in part in his keen perception of his fellow Americans during the age of Jacksonian democracy. A master of imposture, he could manipulate men and even win their gratitude because they had been gulled so cleverly. Barnum so fully exploited the possibilities of exaggeration, Harris declares, that the showman converted this art into a new aesthetic. When learned scientists disputed over the Fejee Mermaid that Barnum was displaying, he enticed even larger crowds of viewers by advertising, "Who is to decide when doctors disagree?" The answer was obviously each separate individual spectator who paid his fee, intrigued even while suspecting fakery.

Barnum's question, "Who is to decide when doctors disagree?," applied not only to mermaids, but also to medicines. Each citizen decided for himself with whom to entrust his health. A multitude of voices crying from the advertising columns of the press sought to persuade him. Amidst this fierce competition, the citizen, no doubt amused by the ingenuity of the appeals, perhaps as suspicious of therapeutic claims as of the mermaid's authenticity, nonetheless made his own choice and bought his pill or potion. The sale of patent medicines escalated enormously.

Barnum passed a brief and futile period trying to market bear's grease as a hair restorer, even though he thought a great deal of patent medicine promotion went beyond the limits of benign humbuggery into harmful deception. When he first came from Connecticut to New York City, the career of nostrum vendor was one opportunity Barnum deliberately eschewed. In his book, The Humbugs of the World, published in 1865, Barnum included vignettes of famous European charlatans. He analyzed scathingly the pamphlet of an American self-styled "Good Samaritan and Domestic Physician" who boasted that his Hasheesh Candy would cure seventy-one diseases including "bleeding at the nose and abortions," these bold claims bolstered by purported testimonials from two generals, Ulysses S. Grant and Robert E. Lee.

Yet, not all patent medicine men deserved the harsh designation of quack, in Barnum's opinion. Take, for example, Benjamin Brandreth. This English irmnigrant began to promote his Universal Vegetable Pills with perhaps the largest advertising sign yet seen in New York City. Brandreth blamed all disease upon the impure state of the blood, a condition which, he boasted, his pills would both prevent and cure. Reiterated in a thousand clever ways, this message lured countless customers, Barnum—so he himself said—among them. Indeed, the showman remembered, the multiple symptoms listed in Brandreth's advertising so coincided with "every symptom that I experienced, either in imagination or in reality," that "extensive consumption" of the pills seemed to Barnum "absolutely necessary to preserve my life." Touring the South at the time, Barnum bought a box of Brandreth's pills in Columbus, Mississippi, following this purchase with larger ones in Vicksburg, Natchez, and New Orleans.

"I took them morning, noon, and night," wrote Barnum. When he returned to New York he hurried to Brandreth's office so as "to congratulate him on being the greatest public benefactor of the age." The "doctor" seemed highly gratified until he learned that Barnum had made his purchases in the South. The pills were not yet distributed there! The showman must have been swallowing a counterfeit article!

Barnum expressed amazement. "Was it possible then, that my imagination had done all this business, and that I had been cured by poisons which I supposed were Brandreth's Pill? I . . . told the doctor that, after all, it seemed the counterfeits were as good as the real pills provided the patient had sufficient faith." Brandreth quickly decided that the pills Barnum had taken must have been genuine, secured somehow illegally by druggists in the South.

Long after this episode was over, Barnum asserted that he cherished a favorable opinion of Brandreth, whom he evidently continued to know and considered "an edifying companion." When Barnum introduced Jenny Lind to the American public, he besought Brandreth to bid high for a ticket at the auction preceding the Swedish nightingale's first concert. But the reader of a book on The Humbugs of the World written by the master of humbuggery may question the literal truth of each of Barnum's tales. His Brandreth story sounds very like a fable intended to enlighten the reader as to the key healing ingredient in widely advertised proprietary medicines, to wit, the self-doser's own faith. Moreover, it is hard to imagine Barnum keeping up a busy touring schedule on the Southern circuit if he swallowed as many of Brandreth's pills as he insisted he did. For the pills were a powerful purgative. Like scores of other pill men of the period, Brandreth had learned a valuable secret, how, as a pharmacist put it, "to open men's purses by opening their bowels." Faith might work the cure, but faith received a strong boost from the indisputable fact that the pills clearly did something.

Many of the same ruses, regarding health and otherwise, which P.T. Barnum catalogued in The Humbugs of the World, show up again without significant change in the pages of E. J. Kahn's Fraud. Sharp operators continue to fleece the gullible by methods well tested by time. In contrast with the caveat emptor climate of Barnum's day, however, in these latter times the federal government seeks to protect the consumer from such chicanery.

Barnum published his book on Humbugs in 1865, the last year of the Civil War, at the beginning of a post-bellum era of swindling that achieved great magnificence. According to a member of the Congress at the time, "All through the country thousands of innocent and unsophisticated people, knowing nothing about the ways of these city thieves and robbers, are continually fleeced and robbed, and the mails are made use of for the purpose of aiding them in their nefarious designs." To inhibit such fearful circumstances, the Congress enacted in 1872 a statute, only slightly revised since then, making mail fraud a crime.

For more then two decades, the Post Office Department used its new authority to restrain fraud involving finance but not fraud threatening health. At the turn of the century, however, postal authorities began to concern themselves with various nostrums, including those promising to restore "lost manhood," one of them named Mormon Bishop Pills, which came in three colors, red, white, and blue. Having no chemical or medical experts in the Department, postal officials turned for help to the Bureau of Chemistry of the Department of Agriculture, headed by Harvey Washington Wiley. Both a chemist and a physician, Wiley found that some male rejuvenators depended on red pepper for their presumed potency. Aided by the Bureau's analyses and advice, the Post Office Department began to bring criminal cases against the most outrageous quacks plying their trade through the mails. For lesser deceptions, the issuance of fraud orders prevented mail from their would-be customers from reaching quackish promoters: letters were intercepted by postmasters, stamped "Fraudulent," and returned to the senders.

This system, still maintained, has saved countless citizens from being cheated. The Postal Inspection Service ferrets out fraud with great ingenuity and dedication, securing the evidence to warrant fraud orders and criminal convictions. Liaison between the United States Postal Service and the Bureau of Chemistry's successor, the Food and Drug Administration, remains close. In Fraud, Kahn tells the story of National Scientific Laboratories of Des Moines: whose operators during the 1950s and 1960s advertised in osteopathic and chiropractic journals that they would analyze the urine of patients and make diagnoses. Reports were invariably gloomy—"hormonal imbalance" or "impaired body chemistry"—and recommended the use of a certain brand of' vitamins made by an interlocking company, Professional Foods. The practitioners shared both the fees for the urinalyses and the charge for the vitamins. Eventually Walter Cronkite exposed the scheme on the CBS television news. A postal inspector—in the process submitting his own urine for analysis—gathered evidence in the case, and three promoters were eventually convicted of mail fraud. Before this termination, deceived citizens had spent three million dollars on phony urinalyses and eight million dollars on needless vitamins.

Despite such victories, mail fraud perseveres. Cheaters are many, postal inspectors few. Quick killings permit the charlatans, operating behind company names, to grab money sent in the first response to advertising, then dissolve their companies and disappear before they can be caught—to try new variants of the same scheme tomorrow. Many such operators deal in such modest sums of money for each promotion and in such grey zones of health deception that federal prosecutors give such cases a low priority. In the aggregate, the sum for such deceptions bulks high. To cite a story appearing in the New York Times on May 6, 1974: "This city [of Newark] has become a center for mail frauds in which the unwary are being bilked of millions of dollars a year through advertisements promoting work-at-home schemes, weight-reduction gimmicks, substances promising prolonged 'bridegroom' strength and sexual stamina, and 'miracle' cures for illnesses." [The Mail Order Amendments Act of 1983 gave the Postal Service much more power, but, in early 1990s, without public notice or explanation, it abandoned its afforts against quack products sold through the mail.—SB]

At the start of the century, while Dr. Wiley aided the Post Office Department in directing its statutes at frauds in the health field, the chief of the Bureau of Chemistry strove diligently to secure the passage of a federal law that would provide him with a more direct means of combatting quackery. Attempts to secure a comprehensive federal food and drug act dated back to the late 1870s. During the final years of struggle leading to success, Wiley served as generalissimo of forces favoring such a measure. In 1906 the Pure Food and Drugs Act emerged from the Congress and received President Theodore Roosevelt's signature.

With regard to patent medicines, the new law instituted modest controls over labeling, The presence and amount of a short list of drugs deemed dangerous—including alcohol, the opiates, and acetanilide—must always be indicated on the label. Nor could the proprietor place upon his label "any statement, design, or device" regarding the medicine or its ingredients which was "false or misleading in any particular," unless he wanted to stand trial for misbranding.

Wiley's Bureau was charged by the law with initiating enforcement actions, which could be of two types: seizures aimed at driving offending medicines from the marketplace, and criminal actions against proprietors, which could result in fines and imprisonments. The first court trial under the 1906 law involved a proprietary with the improbable name of Cuforhedake Brane-Fude, a headache mixture containing acetanilide. Its proprietor, a pharmacist who swung some political weight around Washington, had served as president of the District of Columbia Chamber of Commerce, and hence might be presumed to know what made good sense in medications. Much about the labeling Wiley deemed false and misleading, the implication, for example, that the medicine could "cure" a headache, and the suggestion that it was food for the brain. Twelve jurors agreed, convicting the proprietor of misbranding his product. Wiley hoped for a severe sentence after this first conviction that would deter would-be violators, and so did Roosevelt. The President talked with the district attorney, urging him to request that the judge put the offender in jail. The judge listened but did not accede, thus setting a precedent almost invariably followed under the 1906 law: convictions for engaging in quackery did not result in imprisonment. The judge fined Cuforhedake Brane-Fude's proprietor $700, a sum much greater than levied upon many subsequent violators.

Besides the no-jail, low-fine policy that generally prevailed, another obstacle to the Bureau of Chemistry's efforts at curtailing quackery arose with an adverse Supreme Court decision. In seeking to squelch a purported cancer remedy, Wiley and his aides discovered that the 1906 law's prohibition of false and misleading labeling statements did not apply to therapeutic claims. Congress plugged this loophole in 1912 with the Sherley Amendment, but, paying heed to what the justices had said, banned only those labeling claims that were "false and fraudulent." As Wiley's successors discovered, demonstrating that a nostrum maker harbored fraudulent intent proved to be a difficult, sometimes an impossible, burden to sustain in court. In 1922, for example, the government lost such a case lodged against a cherubic former court reporter and still active Sunday School teacher who sold a liniment made essentially of turpentine, ammonia, and raw eggs as a cure for cancer and tuberculosis. Such a defeat emboldened all quacks who could assume a guise of injured innocence and to political morality. To reverse this thwarting of true justice, governmental regulators consumed a decade—the name of their agency changing midstream from the Bureau of Chemistry to the Food and Drug Administration—painstakingly developing evidence that might prove to another jury that the ex-court reporter had fraud in mind. In 1932 victory in court vindicated their years of toil.

Many other successes against quackery marked the first quarter century's enforcement of the 1906 law, and the general state of the self-medication market improved. But the comfortable assumption people often get that the enactment of a law automatically solves a problem was no more warranted then than on later occasions. Besides legal difficulties encountered enforcing the law's provisions, food and drug officials faced the frustrating fact that wide gaps existed in the law's coverage. No clause restrained fake medical devices, for example, and as the radio came to fascinate popular attention, quacks marketed weird gadgetry promising cures, even long distance cures by radio waves.

Nor did the 1906 law ban false claims made in advertising. Therefore, many wily promoters cleaned up their labels, transferring the same futile therapeutic promises to pamphlet, poster, and paid space in newspaper and magazine. They could do so secure in the knowledge that such advertising would persuade many readers to buy a nostrum, paying no heed to what the label said at either the moment of purchase or the time of taking the first dose. The priority of advertising impact over labeling impact upon consumer behavior, it needs be said, continues to be a significant factor in health deception.

The more reputable proprietors, those who had gone farthest in eliminating the most outrageous claims from labeling and advertising, felt aggrieved at competition from uninhibited rascals. In 1914, when the Federal Trade Commission was created and given wide powers to investigate, publicize, and prohibit "unfair methods of competition," medicine makers, along with businessmen from other fields, appeared before that new body. Believing that unscrupulous advertising by competitors hurt them, they asked the FTC to take a hand. The Commission did so, and through the 1920s now and then in a modest way confronted deceptive advertising in the health field, sometimes ordering an advertiser to cease and desist. However, as had the Bureau of Chemistry earlier, the Federal Trade Commission in 1931 lost a major case in the Supreme Court. The Commission had sought to ban advertising that promoted a desiccated thyroid preparation called Marmola as a scientific and harmless way of losing weight. Danger accompanied Marmola's use, the high court readily agreed, but hazard to the public did not give the FTC authority to restrain Marmola advertising. The Commission had not undertaken to prove, as its basic law required, that Marmola advertising had injured Marmola's competitors in the weight-reducing business.

During the New Deal, in 1938, the Federal Trade Commission received from Congress the Wheeler-Lea Act increasing the Commission's power to control advertising of health products. Besides the "unfair methods of competition" of the 1914 law, now commercial practices "unfair or deceptive" to the consumer also were taboo. What was not said in an advertisement as well as what was, said could be taken into account in determining if the ad be false or misleading. The law gave the FTC increased enforcement powers as well.

The Wheeler-Lea Act represented a victory in Congress for the Federal Trade Commission, won only after a protracted and bitter battle with the Food and Drug Administration. When the New Deal began, food and drug officials recognized the new reform period as an opportunity to secure legislation strengthening many features of the 1906 law which experience had revealed as inadequate for proper consumer protection. Quack devices should be covered, for example. And realizing the indispensable role of advertising in the success of quackery, Commissioner Walter G. Campbell and his aides thought it a natural next step to expand the FDA's authority over health products to include their advertising. So much frustration since 1906 had resulted from this lack of control. The Supreme Court had ruled recently that the FTC's jurisdiction over advertising did not extend to sheer protection of the public. So in the draft bill sent to the Congress in 1933, the FDA sought to assume control of advertising in the drug, device, cosmetic, and food fields. The Federal Trade Commission considered this proposal a transgression upon its traditional sphere of responsibility. In the end Congress sided with the FTC.

This internecine struggle within the New Deal helped postpone revision of the 1906 law. Finally, two months after the Wheeler-Lea Act had given the FTC new authority, the Food, Drug and Cosmetic Act expanded the Food and Drug Administration's powers. As a quackery-fighting weapon, the 1938 law far exceeded the 1906 law in impact. The fraud joker had been discarded: now a medicine could be banned as misbranded for any false or misleading assertion in its labeling. Falsity included the omission of needed warnings. Drugs—like Marmola—dangerous to health when used according to directions on the label were now deemed illegal. More information than before about ingredients had to be placed upon the label. No newly discovered drug could enter the marketplace until its sponsor had persuaded FDA officials of the drug's safety. The new law covered medical devices. And it increased penalties and let the FDA seek an injunction if public safety required fast action.

Employing these new powers, food and drug officials began a vigorous effort to make self-medication safe. As after 1906, the main wing of more reputable proprietary manufacturers sought to conform to the new statute's requirements. Fringe operators dragged their heels. The FDA went after obesity products containing dangerously potent drugs, Marmola among them, and seized powerful painkillers not adequately labeled with directions for use and warnings against misuse. Worrisome devices—pessaries, electric insoles, pile pipes, breast developers—furnished another regulatory target. With the outbreak of World War II, an ancient hazard saw widespread revival, the sale of corrosive abortifacient pastes, and the FDA unleashed all three of its weapons: seizures, injunctions, and criminal actions. Thus many of the most flagrant and dangerous deceptive schemes which had flourished earlier now were considerably reduced.

Quackery, however, did not vanish, and for a host of reasons. For one thing, the Food and Drug Administration operated on a starvation budget with numerous tasks to perform, the combatting of quackery not necessarily the most important. A little later, a single dubious promotion in the health field assembled an army of salesmen that outnumbered all the employees of the FDA by a ratio of forty to one. There were just not enough policemen to patrol the busy beat. Moreover, as shrewd promoters analyzed the law, they found ways to deceive the public that were not so transparently illegal. Since the law applied to products in interstate commerce, why not label a nostrum in conformity with the law, ship it across state lines to its final destination for sale, then ship separately posters making excessive claims to be displayed where the medicine was vended? Such a scheme worked until FDA lawyers, pursuing the issue slowly through the courts, persuaded the Supreme Court to treat the law elastically and consider the posters part of the labeling. Other similar ruses required their protracted day in court, but, in the main, the Supreme Court ruled so as to strengthen consumer protection.

Some charlatans sought to avoid state lines altogether, and thus remove themselves from the interstate commerce imperative which controlled the federal law, finding state laws less rigorous and state enforcement officials less vigilant. Other schemers launched promotions within the grey zones where medical science had not yet found cures—as with arthritis and the common cold—or where great complexity reigned, permitting clever doubletalk, as in the relation of diet to health. Nutrition quackery boomed. Since a high proportion was of such wares was peddled by salesmen in health-food stores and door-to-door, making their misleading claims orally face-to-face with customers about packaged products whose printed labeling did not violate the law, this regulatory task proved difficult indeed.

The Food and Drug Administration's small staff of ingenious inspectors and imaginative lawyers curtailed quackery's worst excesses with remarkable diligence and skill. They won major pitched battles in a wide variety of fields against:

Despite such victories, FDA officials were the first to acknowledge that, in their continuing contest with quackery, the battle lagged. In the 1960s the Food and Drug Administration collaborated with the American Medical Association in sponsoring National Congresses on Medical Quackery in order to alert the public to the amazing magnitude of pseudomedicine. In terms of money wasted, health quackery had never before in American history amounted to such a gigantic enterprise. The FDA's court victories, Commissioner George Larrick said, had made only a "very small" dent in the total extent of nutrition quackery. And while the FDA had secured many injunctions against shippers of falsely labeled devices, up to 5,000 practitioners, especially chiropractors, continued to use bogus electrical machines.

Amidst these Congresses on quackery, the U.S. Congress enacted in 1962 an amendment to the 1938 Food, Drug and Cosmetic Act. Quackery provided none of the motivation for this law, which arose rather from Senator Estes Kefauver's investigations of the prescription drug industry. Nonetheless, the law's provisions furnished new means for controlling quackery. The Kefauver law placed an expanded burden of proof upon him who would market a new drug. Not only must the FDA be persuaded that the new drug is safe, as the 1938 law required, but now also the agency must receive convincing proof that the drug is effective in treating the ailments for which it is intended. No promoter could expect to evade this provision, selling a new drug direct to laypersons, without quickly facing a legal action he could not possibly win. Such an instance soon occurred, the FDA stopping the distribution of an unproved cancer remedy, Mucorhicin, extracted from a mold grown on a mixture of wheat, salt, yeast, and water fermented in a pan. Nor would the 1962 law permit a promotion—like the cancer treatment Krebiozen—to masquerade under the guise of pre-marketing clinical trials, distributing "medicine" in exchange for a "contribution" to help out with the promoter's expenses. The new law increased considerably the rigor of the FDA's surveillance of the pre-marketing testing of drugs.

The Kefauver law applied some of its provisions retroactively. The effectiveness standard governed not only new drugs appearing in 1962 and after, but also all new drugs that had been marketed since 1938. This vast task of reconsideration, involving mainly prescription medications, occupied the remainder of the 1960 decade. The comparatively few non-prescription drugs examined during this massive reappraisal persuaded FDA officials that tightened effectiveness requirements for all self-dosage drugs were imperative. Accomplishing this goal may occupy most of the 1970s. The FDA created seventeen expert panels, each charged with making decisions in one field wherein self-treatment is deemed legitimate. Panels were set up, for example, to evaluate analgesics, antacids, antiperspirants, hemorrhoidal products, laxatives, sleep aids, and vitamins. At the end of a long review process, with all interested parties having ample opportunity for input, a regulation will result from each panel's study. The regulation will govern all products in that field, specifying which ingredients are safe and effective and in what dosages; which ingredients are unsafe or ineffective; which claims can properly be made on labels and which, among those currently being used, no longer may be tolerated. When this set of regulations becomes complete, standards of legitimacy—changeable, of course, as medical knowledge develops—will bracket the proprietary medicine field. Deviations from the standard will be ipso facto illegal. The system will furnish another major restraint upon quacks. In addition to this broad approach to self-dosage drugs, a stronger law governing devices may come from the Congress. [Dr. Young's predictions were accurate but incomplete. The over-the-counter drug review process drove most of the ineffective ingredients out of these drug products. However, virtually all pharmacies carry irrationally formulated dietary supplements, and many stock dubious herbal and homeopathic products as well.—SB]

The Food and Drug Administration anticipates that the rules governing therapeutic claims on labels which will eventuate from the activity of the seventeen panels may also provide appropriate guidelines for the Federal Trade Commission to apply in regulating advertising. Almost certainly this would be a more rigorous standard than the FTC has hitherto sought to enforce. The Wheeler-Lea Act served the FTC well at restraining flagrantly false claims and transparently false suggestions, but as a deterrent against less tangible, although no less persuasive, types of appeal the law did not work so successfully. In any case, if a promoter ceased his improper advertising when, after a tedious decision-making process, the Commission ordered him to, he suffered no further penalty. His advertising campaign had usually long since run its course before the FTC's procedures could bring the Commission to the point of crying "Halt!" Thus, with weak law, cumbersome procedures, inadequate resources, and a shifting membership, the FTC has not maintained consistency of policy. The early 1970s saw the Commission at a summit of rigor, striving to fashion new procedures that might speed up and intensify controls. Past experience left room for concern as to the relentless sustaining of such effort. Perhaps when the Food and Drug Administration develops its lexicon of legitimate therapeutic claims for labeling, that agency and the Federal Trade Commission, applying them to advertising, may move in harness, aided by the Postal Inspection Service, to restrain health frauds and deceptions more thoroughly than hitherto has been possible. Since knavery and gullibility may be expected to abound, regulation will never snuff quackery out. Indeed, our own times share some elements with Barnum's day that tend to promote a state of mind susceptible to quackery's impositions: a wide-ranging questioning of all varieties of established authority, including that of science. Nor will educational efforts succeed in vaccinating all citizens against the quack's virus. Nonetheless, despite the gloomy odds, opponents of quackery, besides supporting rigorous regulation, need to continue to warn the broad public against the quack's lures. "It takes two to make a fraud," notes E.J. Kahn, Jr., in the final chapter title of his intriguing book, and he proceeds to lay out some sound advice on how to avoid being cheated and what recourses are open to you if you find you have been taken.

Over a century ago the master of humbug, P.T. Barnum, hazarded the belief that "if we could have a full exposure of 'the tricks of trade' of all sorts, of humbugs and deceivers of past times, . . . quackish and so forth, we might perhaps look for a somewhat wiser generation to follow us." Barnum wrote such an exposure without achieving, in the next generation, the results he hoped for. Such hopes continue to be slender. But in the interests of human welfare educational efforts to warn against fraud and humbug and quackery must continue.

Note about Sources

This essay was based on the following sources: P.T. Barnum, The Humbugs of the World (New York: Carleton, 1865); Neil Harris, Humbug: The Art of P.T. Barnum (Boston: Little, Brown and Company, 1973); E. J. Kahn, Jr., Fraud: The United States Postal Inspection Service and Some of the Fools and Knaves It Has Known (New York: Harper & Row, 1973); and three books of my own, The Toadstool Millionaires: Social History of Patent Medicines in America before Federal Regulation (Princeton: Princeton University Press, 1961); The Medical Messiahs, A Social History of Health Quackery in Twentieth-Century America (Princeton: Princeton University Press, 1967), and American Self-Dosage Medicines, An Historical Perspective (Lawrence, Kansas: Coronado Press, 1974).

This article was posted on November 14, 2016.

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