The term ‘quack’ is often employed as a disrespectful description for clinicians, particularly those who are unskilled, ignorant, dishonest and employ bogus therapies for a profit. Quacks are everywhere, I am afraid, but alternative medicine seems like a promised land to them. Quackery endangers our wealth and, more importantly, our health.
To protect yourself from quackery, it is essential to be able to recognise the quacks’ ‘tricks of the trade’ and to take appropriate action against them. In this two-part article, I will disclose some of the most popular ploys used by quacks operating in the realm of alternative medicine, and I will offer some advice on quackery prevention.
Treating non-existent conditions
There is nothing better for enhancing a quack’s cash flow than allowing him to treat a condition that does not exist. Many alternative practitioners have made a true cult of this handy option. Go to a chiropractor and you will, in all likelihood, receive a diagnosis of ‘subluxation’; consult a practitioner of traditional Chinese medicine and you might be diagnosed as suffering from ‘chi deficiency’; see a homeopath and he might tell you that your ‘vital force’ needs boosting.
The beauty of a non-existing diagnosis is that the practitioner can treat it, and treat it, and treat it… until the client has run out of money or patience. Just before this point, however, the practitioner would proudly inform you that ‘you are completely healthy now’. This happens to be true, of course, because you have been healthy all along.
My advice for avoiding such exploitation: make sure that the diagnosis given by someone you suspect of quackery is correct; if necessary consult a real healthcare professional.
It must get worse before it gets better
When, after receiving regular treatments, patients feel not better but worse, quacks tend to tell them that this is entirely normal — because things have to get worse before they get better. They call this a ‘healing crisis’. But the healing crisis is a phenomenon for which no compelling evidence has ever been produced.
Imagine a patient with moderately severe symptoms consulting a clinician and receiving treatment. There are only three things that can happen to her:
— she can get better,
— she might experience no change at all
— or she might get worse.
In the first scenario, the practitioner would obviously claim that his therapy caused the improvement. In the second scenario, he might say that, without his therapy, symptoms would have deteriorated. In the third scenario, a quack would tell his patient that she is experiencing a healing crisis. In other words, the myth of the healing crisis is little more than a trick of the trade to make patients continue supporting the quack’s livelihood.
My advice: when you hear the term ‘healing crisis’, go and find a real doctor to help you with your condition.
A cure takes a long time
But there are other ploys to deal with patients who fail to improve after long-term therapy. Let’s assume your problem is back pain, and that the pain has not eased despite numerous treatments and large amounts of money spent. Surely in such a situation you would call it a day. You will have had enough. And this would, of course, be a serious threat to the quack’s cash flow.
To avert the shortfall, the practitioner merely has to explain that your condition has been going on for a very long time (if this happens not to be true, the practitioner would explain that the pain might be relatively recent but the underlying condition is chronic). Naturally, this means that a cure will also have to take a very long time — after all, Rome was not built in one day!
The continuation of ineffective treatments despite the absence of any improvement is usually not justifiable on medical grounds. It is, however, entirely justifiable on the basis of financial considerations: quacks rely on their patients’ regular payments and will therefore think of all sorts of means to achieve this aim.
My advice is to see a clinician who can help you within a reasonable and predictable amount of time. Insist on a proper treatment plan from the outset and stop if it is not fulfilled.
The notion that alternative medicine takes care of the whole person attracts many consumers. Never mind that nothing could be further from being holistic than, for instance, diagnosing conditions by looking at a patient’s iris (iridology), or focussing on her spine (chiropractic, osteopathy), or massaging the soles of her feet (reflexology). And never mind that any type of good conventional medicine is by definition holistic. What counts is the label, and ‘holistic’ is a most desirable one indeed. Nothing sells quackery better than holism.
Most quacks rub their false holism into the minds of their patients whenever and however they can. It has the added advantage that they have seemingly plausible excuses for their therapeutic failures. Imagine a patient consulting a practitioner with depression and, even after prolonged treatment, her condition is unchanged.
In such a situation, quacks do not need to despair: they will point out that they never treat diagnostic labels but always the whole person. Therefore, the patient’s depression might not have changed, but surely other issues have improved… and, if the patient introspects hard enough, she might find that her appetite has improved, that her indigestion is better, or that her tennis elbow is less painful (given enough time, things do change). The holism of quacks may be a false pretence, but its benefits for a quack’s income are undeniable.
My advice: take holism from quacks with more than a pinch of salt.
Many quacks surprise their patients by informing them that they are being poisoned. Subsequently, they insist that they need to ‘detox’ and, as it happens, their type of treatment is ideally suited to achieve this aim. Detox is short for detoxification which, in real medicine, is the term used for weaning addicts off their drugs. In alternative medicine, however, the term has become a marketing tool devoid of any medical sense.
The poisons in question are never accurately defined. Instead, you will hear vague terminologies such as metabolic waste products or environmental toxins. The reason for that lack of precision is simple: once the poison is named, we would be able to measure it and test the efficacy of the treatment in question in eliminating it from the body. But this is the last thing quacks want — because it would soon establish how bogus their claims really are.
None of the alternative therapies claimed to detox your body do, in fact, eliminate any toxin; all they do take from us is our cash.
Your body has organs (skin, lungs, kidneys, liver) which take care of most of the toxins you are exposed to. If any of these organs fail, you do not need homeopathic globuli, detoxifying diets, nor electric foot baths, nor any other charlatanry; in this case, you are more likely to need intensive care in an A&E department.
My advice is, as soon as you hear the word ‘detox’ from an alternative practitioner, ask for your money back and go home.
The test of time
Many alternative therapies have been around for hundreds if not thousands of years. To the quacks, this fact means that these interventions have ‘stood the test of time’. They argue that acupuncture, for instance, would not be in use any more, if it were not effective. For them, the age of their therapy is like a badge of approval from millions of people before us, a badge that surely weighs more than any amount of scientific studies.
But let’s get real: we are talking of technologies, of course, health technologies, in fact. Would we argue that a hot air balloon is an older technology than an aeroplane and therefore better suited for transporting people from A to B?
The fact that acupuncture or any other alternative therapy was developed many centuries ago might just indicate that it was invented by people who understood too little about the human body to come up with a truly effective intervention. And the fact that blood-letting was used for centuries (and thus killed millions), should teach us a lesson about the true value of ‘the test of time’ in medicine.
My advice is to offer leeches, blood-letting and mercury cures to the quacks who try to persuade you that the ‘test of time’ proves anything about the value of their quackery.
Edzard Ernst, emeritus professor at the University of Exeter, is the author of A Scientist in Wonderland and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.