Quackery

Unfortunately, human nature being what it is, deception and fraud have plagued medicine since its earliest history.  People with medical problems make a willing market and there has never been a shortage of those who will supply remedies to ‘help’ them. 

 A quack, by definition, is someone who offers an ineffective or sham treatment.  Shame to say, there are still plenty of these inside medicine today as well as outside - in so called complementary and alternative therapies.

There are two different types of quack: those who deceive themselves and those who are well aware of the deception that they are committing. 

The former are perhaps less culpable: they may be well intentioned, kind, caring individuals who really want to help people and have convinced themselves that their treatment is effective.  This is the more usual type you might meet among qualified doctors. Their patients may speak very highly of them.  Being treated by a therapist,  who is kind, empathic and spends time with you can be a positive experience – so long as whatever it is they are treating you with doesn’t do too much harm. Concerns are sometimes raised if these therapists convince people to accept an ineffective therapy when an effective one could be given instead.

True frauds can be found in medicine too; including medical researchers who falsify their results and doctors who simply inflate their private practice for financial reward (click here for details of a recent case of fraud). 

Both types of quack can be found in complementary and alternative medicine, too. However, just as the presence of quacks in orthodox medicine does not invalidate all of the highly effective treatments offered in our hospitals today, neither does the presence of quacks in complementary and alternative medicine mean that this whole field is worthless.

Doctors are very sensitive to the charge of quackery.  Quacks are our embarrassing forebears.  Our status in society today largely rests on the efforts that we have made to distance ourselves from these ignominious origins.  Our professionalism is based upon principles of scientific scepticism and the absolute primacy of our patient’s benefit – even to the point of self-sacrifice.  As a result doctors are usually the most vocal in vilifying those whom they see as quacks, although this is usually aimed at those outside the profession.

The discipline of providing “evidence based medicine” is central to our conception of modern medical ethical practice.  Essentially, the idea is that such treatments have been proven effective by scientifically rigorous clinical trials – usually randomised controlled trials.  Treatments tested in this way form the “yellow-brick road” on which doctors are safe from the accusation of quackery and patients can be confident they are receiving effective treatment.

On either side of the yellow-brick road there is the forest in which lurk the temptations of treatments that have not been tested and the practitioners who offer them.  Into this forest, physician and patient should venture with caution.

The problem is that the temptations in the forest are almost irresistible.  Not all untested treatments are ineffective.  Every treatment that is eventually tried, tested and accepted into the canon of evidence based medicine has to start life in the forest as an untested treatment.  Other treatments will never be subjected to this rigorous (but very expensive) process.  In addition, the idea of an undiscovered cure which doctors have missed is tempting in its own right.  And finally, sometimes the yellow-brick road just runs out and then where do you go?

In PlanBe, we are trying to provide patients with some tools, some skills and some information to help them navigate their journey with cancer.  We discuss some of the warning flags that can help you spot a quack.  We explain how you can try to weigh up the pros and cons of treatments.  We discuss the evidence, such as it is and where we can find it for each of the possible therapies, diets, and lifestyle changes.

There will be times when the road appears clearly made up of reassuring blocks of yellow-brick, sometimes not (then the traveller must be on their guard!).  In the end we acknowledge that our patients have every right to choose for themselves, we do not have a monopoly of the right course of action, and everyone is responsible for their own well-being.   

Dr Michael Leahy
Consultant Medical Oncologist
The Christie NHS Foundation Trust

Have you ever had experience of quackery? What do you think about the reflections above? Please comment below, or alternatively contact us at planbe@christie.nhs.uk. 

Follow the project team on Twitter:

Dr Michael Leahy

Ben Heyworth