14 Quackery

The Quack Frog: Once a frog came out of the marshy land and croaked aloud, "I am an erudite physician. I have a divine gift. I possess many unique remedies. I can cure any type of disease that you have.” Many gullible animals succumbed to the sales-talk. But a fox with his critical faculty intact challenged the frog, "You, a healer! You can't even cure your own weak legs and wrinkled skin."

Nath was a glib tongued villager who used to "cure" all sorts of ailments. You can't fool all the people all the time and soon the villagers ceased to seek his advice. He decided to try his luck in the city. He ran an advertising blitz in the health magazines and gave interviews. A smart media person asked him, "If your system is as great as you claim, how is it that no villager consults you?"

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Like politics, health care has also become the last refuge for many scoundrels. Quacks like Nath, make hay while the society is ready to 'consume' with a great enthusiasm, any old dogma that is unearthed. Bernard Shaw had a lot to say on this: "The condition of the medical profession is so scandalous that unregistered medical practitioners obtain higher fees and are more popular with educated patients than registered ones. In short, private medical practice is governed not by science but by supply and demand; and however scientific a treatment may be, it cannot hold its place in the market if there is no demand for it; nor can grossest quackery be kept off the market if there is a demand for it."

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These words of 1933 remarkably reflect the current Indian scene. We continue to be a gullible and uncritical lot. A cynic may well say, "We crave for and therefore deserve all the quackery that is being unleashed upon us.” The activists should take a more proactive role in educating the gullible.

Suspecting Quackery or Fraud in health care

Young JH, a professor of history, has compiled the following points as sign-posts of probable quackery and fraud in health care.

 Exploitation of fear and phobias.  Claims of miraculous scientific breakthroughs.  Promise of painless safe treatment with excellent chances of "cure."  Reliance on anecdotes and testimonials. They don't separate facts from mere opinions and causal effect from a mere coincidence.  Heavy promotional advertising.  Large sums of money payable by clients for achieving a cure.  The use of 'simpleton science' (dogma) like 'diseases have one basic cause' and 'one way of treatment takes care of all diseases'. For example, water-imbalance is the basis of all diseases and hydrotherapy cures them.  The 'victim of scientific establishment' story-line: "The establishment is blind, I am far ahead of times and will be a hero to future generations."  Shifting theory to adjust to changing circumstances.  Distortion of "freedom of informed choice" as "freedom of choice" to coax the gullible to end with "freedom to be foolish."

How do quacks succeed?

To find out the secret of their success, one should appreciate the two factors that greatly help them.

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 Over 90% of illness are self-limiting and the body heals by itself. Even 90% of all the snake bites are non-poisonous and a quack can claim credit for its "cure" if he is smart enough to refer the minority with venomous bites to a hospital.  Of the various factors that contribute to healing of illnesses in a community, only 20% could be ascribed to rational treatment using medicines or surgery. The remaining 80% is divided among three faith based factors. (White KL, 1988) i) faith in a placebo (an inactive substance or a procedural ritual). ii) faith in a system, a facility or a professional (Hawthorne effect). iii) faith in oneself or in the supernatural (spiritual factor or factor-X).

If a quack learns to operate within these three faith-related areas, stay away from any rational therapy that may have harmful side effects and refer the serious cases to qualified physicians, he can be quite successful with a majority of his clients. Faith in a practitioner can be facilitated if the three arts of medicine, viz., the arts of Dialogue, Prediction and Remedy are well demonstrated by him/her. The artof remedy can even eclipse the scienceof remedy for a long time and a successful quack knows it (see Chapter22).

On the other hand, modern medical professionals tend to confine to the 20% rational (evidence-based) healing and ignore the faith related healing especially in ambulatory care and in managing chronic diseases. They need to be trained to include the placebo, Hawthorne and X-factors in their treatment options and not reject them as unwanted and unscientific trivia. The disenchantment with the doctors of modern medicine may be largely related to this deficiency in their training. Martin Fischer advised the doctors, "Don't cry out against the quack; find out wherein his success lies and be a better quack".

How to bring the faith based healing processes into the fold of scientific practice of modern medicine without usurping its rational base is a challenge for the medical educators and professional bodies.

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