More Ploys That Can Fool You
Stephen Barrett, M.D.
Victor Herbert, M.D., J.D.
"Alternative" promoters are reaching people emotionally. What sells is not the quality of their products, but the ability to influence their audience. Their basic strategies are to promise the moon and knock the "competition." To one and all, they promise better health and a longer life. They offer solutions for virtually every health problem, including some they have invented. To those in pain, they promise relief. To the incurable, they offer hope. To the nutrition-conscious, they say, "Make sure you have enough." To a public worried about pollution, they say, "Buy natural." For ailments amenable to scientific health care, they offer "safer nontoxic alternatives." And they have an arsenal of ploys for defending themselves against criticism. To gain your allegiance it is not necessary to persuade you that all of the statements below are true. Just one may be enough to hook you.
"We really care about you!"
Although being "cared about" may provide a powerful psychological lift, it will not make a worthless remedy effective. It may also encourage over-reliance on an inappropriate therapy.
"We treat the whole patient."
There is nothing wrong with giving due attention to a patient's lifestyle and social and emotional concerns in addition to physical problems. In fact, good physicians have always done this. Today, however, most practitioners who claim to offer "alternative," "complementary," "integrative," or "holistic" health methods are engaged in quackery and embrace such terms as marketing tools. Few actually "treat the whole patient."
"No side effects"
"Alternative" methods are often described as safer, gentler, and/or without side effects. If this were true—and often it is not—their "remedy" would be too weak to have any effect. Any medication potent enough to help people will be potent enough to cause side effects. FDA approval requires evidence that the likelihood of benefit far exceeds the probable harm.
"We attack the cause of disease."
Quacks claim that whatever they do will not only cure the ailment but will also prevent future trouble. This claim is false. Illness can result from many factors, both internal and external, some of which have been identified and some of which are unknown. Scientific medical care can prevent certain diseases and reduce the odds of getting various others.
"We treat medicine's failures."
It is often suggested that people seek "alternatives" because doctors are brusque, and that if doctors were more attentive, their patients would not turn to quacks. It is true that this sometimes happens, but most quackery does not involve medical care. Blaming doctors for quackery's persistence is like blaming astronomers for the popularity of astrology. Some people's needs exceed what ethical, scientific health care can provide. Some harbor deep-seated antagonism toward medical care and the concept of a scientific method. But the main reason for quackery's success is its ability to seduce people who are unsuspecting, gullible, or desperate. Several years ago, a survey done in New Zealand found that most cancer patients who used "alternative" therapies were satisfied with their medical care and regarded "alternative" care only as a supplement . A more recent study found that only 4.4% of those surveyed reported relying primarily on alternative therapies. The author concluded:
Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life .
Many quack promoters suggest that use of their method(s) will provide mental benefit that transcends the physical properties of their remedy. This is typically described with terms like "mind/body interaction," "mind over matter," or the power of positive thinking. A positive attitude may make people more apt to comply with an effective treatment regimen. Contrary to "popular wisdom," however, there is little scientific evidence that optimism or faith in a treatment causes people to live longer or to recover faster from an illness. Even if there were, it would not outweigh the dangers of misplaced trust.
"Jump on the bandwagon."
Quacks and vitamin pushers use several strategies to claim that their methods are popular (which may or may not be true), that popularity is a sign of effectiveness (which often is untrue), and that therefore you should try them. The popularity claim may involve endorsements or testimonials (which are inherently misleading) or statistics (which typically are inflated). The statistics can include the number of consumers supposedly using a method, how long the method has been in use, the number of practitioners administering it, and/or the length of time a practitioner or facility has been in business.
"Time-tested" or "Used for centuries!"
This ploy suggests that the length of time a remedy has been used is a measure of its effectiveness. Its promoters imply that if the remedy didn't work, it wouldn't remain available. Some promoters claim (sometimes truthfully, sometimes not) that their methods have been handed down from generation to generation, are steeped in folk wisdom, were derived from ancient writings, or the like. The falsity of this ploy is easily seen by noting that astrology has survived for thousands of years with no reliable evidence of any validity. Note, too, that many genuine methods survive briefly because they are replaced by more effective ones.
"Backed by scientific studies"
Since most people regard scientific evidence as a plus, unscientific promoters claim to have it when in fact they do not. Their writings may list dozens or even hundreds of publications that supposedly support what they say. But the references they cite may be untraceable, misinterpreted, outdated, irrelevant, nonexistent, and/or based on poorly designed research. The classic example is Adelle Davis's book Let's Get Well, which lists 2,402 references. Many did not support her viewpoints and some were not even related to the passage in which they were cited. What should count is not the number of references but their quality and relevance—which the average reader will find difficult or impossible to judge. When talking with experts, quacks may acknowledge that "some aspects of what we do are not well understood," thus implying that other aspects are solidly based and the rest will eventually be substantiated.
"Studies are underway."
If no studies exist, quacks often claim that research is underway. If that is true, they imply that if their method were not effective, reputable researchers would not spend time and money to study it. If a genuine study fails, the quacks invariably claim that it was not properly designed. Moreover, in many cases, the research claim is a complete fabrication.
"Take charge of your health!"
This is probably the most powerful slogan in the quack's bag of tricks. People generally like to feel that they are in control of their life. Quacks take advantage of this fact by giving their clients things to do-such as taking vitamin pills, preparing special foods, meditating, and the like. The activity may provide a psychological lift, but believing in false things tends to carry a high price tag. The price may be financial, psychological (when disillusionment sets in), physical (when the method is harmful or the person abandons effective care), or social (diversion from more constructive activities) .
"Think for yourself."
Quacks urge people to disregard scientific evidence (which they cannot produce) in favor of personal experience (theirs or yours). But personal experience is not the best way to determine whether a method works. When someone feels better after having used a product or procedure, it is natural to give credit to whatever was done. Most ailments are self-limiting, and even incurable conditions can have sufficient day-to-day variation to enable quack methods to gain large followings. In addition, taking action often produces temporary relief of symptoms (a placebo effect). For these reasons, scientific experimentation is almost always necessary to establish whether health methods are really effective. Individual experience rarely provides a basis for separating cause-and-effect from coincidence. Nor can the odds of a treatment working be determined without following participants in a well-designed study and tabulating failures as well as successes—something quacks don't do.
"What have you got to lose?"
Quacks and vitamin pushers would like you to believe that their methods are harmless and therefore there is nothing to lose by trying them. With vitamins taken as "nutrition insurance," for example, many people feel as though they are making a bet with very little to lose and a great deal to gain. If a method doesn't work, do the odds of it causing physical harm really matter? Moreover, some quack methods are directly harmful; others harm by diverting people from proven methods. All waste people's time and/or money.
"If only you had come earlier."
This phrase is handy when the treatment fails. It encourages patients and their survivors not to face the fact that consulting the quack was a mistake.
"Science doesn't have all the answers."
Quacks use this ploy to suggest looking beyond what scientific medicine has to offer; they also imply that since medical care has limitations, they are entitled to have them too. Medical science doesn't claim to have all the answers, but its effectiveness keeps increasing because the scientific method offers ways to find more answers. The idea that people should turn to quack remedies when frustrated by science's inability to control a disease is irrational. Quackery lacks genuine answers and has no method for finding them.
"Don't be afraid to experiment."
This advice is typically based on the cliché that "what works for one person may not work for someone else with the same problem." Although this statement is literally true, scientific methods enable us to determine which methods are most likely to work and which ones are not worth trying. If a barrel is full of apples that are obviously rotten, does it make sense to sample all of them to see whether one tastes good?
"Let's work together."
This ploy is used to portray quacks as "nice guys" while suggesting that their critics are not. "Since science doesn't have the answers," they may say, "let's put our differences aside and work together for the common good." That would be fine if they had something to offer besides empty promises. Proponents of "complementary medicine" (also called "integrative medicine") claim to integrate scientific and "alternative" medicine, using the best of both. Is it helpful to add ineffective methods to effective ones? Does it make sense to go to someone who uses the "best" ineffective methods? Is someone whose reasoning process is faulty enough to believe in such things as homeopathy likely to deliver high-quality medical care? Do "complementary" practitioners use reliable methods as often as they should? From what we have seen, the answer to each of these questions is no.
"Keep an open mind."
Quacks portray themselves as innovators and suggest that their critics are rigid, elitist, biased, and closed to new ideas. Actually, they have things backwards. The real issue is whether a method works. Science provides ways to judge and discard unfounded ideas. Medical science progresses as new methods replace less effective ones. Quack methods persist as long as they remain marketable. Even after they are gone, they still may be glorified. Open-mindedness is the willingness to follow where the evidence leads and should include willingness to defer to impartial investigations rather than one's own predilections . It is not close-minded to reject ideas that are unsubstantiated and lack a scientifically plausible rationale. Nor is it close-minded to rely upon the vast body of accumulated scientific knowledge as a guide to giving advice or making practical decisions.
"Why don't you clean your own house!"
This type of statement comes up most often in debates between scientific and "alternative" practitioners, usually when the latter is not a medical doctor. Its aim is to portray the critic as a meddler or as someone with a grudge. The simple answer is that the shortcomings of medical care do not justify any form of quackery. Unnecessary surgery, for example, is an abuse of something that works and is entirely different from quackery, which is the use of things that do not work. Another big difference is that quackery is organized. There is no national organization of "Surgeons Dedicated to Unnecessary Surgery," but there are national organizations dedicated to quackery. Moreover, unlike members of the scientific community, quacks rarely criticize their own methodology or that of their colleagues.
"Prove me wrong!"
Quacks try to stand science on its head by demanding that their critics prove them wrong. Or they may say, "How do you know it doesn't work if you haven't tried it?" But there are not enough resources to test every idea that is proposed; for this reason, scientists tend to pursue those that seem most promising. Under the rules of science, the burden of proof is on the person who makes the claim. Unproven methods that lack a plausible rationale should be considered worthless until proven otherwise. Personal experience is not a substitute for scientific testing.
"We have no money for research."
When challenged about the lack of scientific evidence supporting what they espouse, promoters of quackery often claim that they lack the money to carry out research. However, preliminary research does not require funding or even much effort. The principal ingredients are careful clinical observations, detailed record-keeping, and long-term follow-up "to keep score." Advocates of "alternative" methods almost never do any of these things. Most who clamor for research do so as a ploy to arouse public sympathy. The last thing they want is a scientific test that could prove them wrong. If a scientific study is performed and comes out negative, proponents invariably claim that it was conducted improperly or that the evaluators were biased. Proponents of so-called "natural" products (dietary supplements and herbs) often complain that funding is difficult or impossible to obtain because the products can't be patented and therefore drug companies have little incentive to study them. That may be true for some products, but it is certainly not true for all. Think, for a moment, about plain, ordinary aspirin. Although not patentable, it has been subjected to thousands of published studies.
"I'm too busy getting sick people well."
Quacks use this response when asked why they have not tabulated their supposedly good results and submitted them for publication in a scientific journal. The key question, of course, is how can you know whether a method works without keeping careful score. The correct answer is that you can't. Even simple scorekeeping may provide significant information. In 1983, a naturopath named Steve Austin visited the Gerson Clinic and asked about thirty cancer patients to permit him to follow their progress. He was able to track 21 of them through annual letters or phone calls. At the five-year mark, only one was still alive (but not cancer-free); the rest had succumbed to their cancer.
"They persecuted Galileo!"
The history of science is laced with instances where great pioneers and their discoveries were met with resistance. William Harvey (nature of blood circulation), Joseph Lister (antiseptic technique) and Louis Pasteur (germ theory) are notable examples. Today's quacks boldly claim that they, too, are scientists ahead of their time. Close examination, however, will show how unlikely this is. The ideas of Galileo, Harvey, Lister, and Pasteur's overcame their opposition because they were demonstrated to be sound.
Quacks use the slogan "health freedom" to divert attention away from themselves and toward victims of disease with whom we are naturally sympathetic. Quacks who insist that "people should have the freedom to choose whatever treatments they want" would like us to overlook two things. First, no one wants to be cheated, especially in matters of life and health. Victims of disease do not demand quack treatments because they want to exercise their "rights," but because they have been persuaded that they offer hope. Second, the laws that outlaw worthless nostrums are not directed against the victims of disease but at the promoters who attempt to exploit them. These laws simply require that products offered in the health marketplace be both safe and effective. If only safety were required, any substance that would not kill you on the spot could be hawked to the gullible.
"We offer alternatives."
Quackery promoters are adept at using slogans and buzzwords. During the 1970s, they popularized the word "natural" as a magic sales word. During the 1980s, the word "holistic" gained similar use. Today's leading buzzword is "alternative." Correctly used, "alternative" refers to methods that have equal value for a particular purpose. (An example would be two antibiotics capable of killing a particular organism.) When applied to questionable methods, however, the term is misleading because methods that are unsafe or ineffective are not reasonable alternatives to proven treatment. For this reason, we place the word "alternative" in quotation marks when it refers to methods not generally accepted by the scientific community and which have no plausible rationale .
- Clinical Oncology Group. New Zealand cancer patients and alternative medicine. New Zealand Medical Journal 100:110-113, Feb 25, 1987.
- Astin JA. Why patients use alternative medicine: Results of a national study. Journal of the American Medical Association 279:1548-1553, 1998.
- Jarvis WT. How quackery harms cancer patients. Quackwatch, Oct 11, 2006.
- Adler JE. Open minds and the argument from ignorance. Skeptical Inquirer 22(1):41-44, 1998.
- Barrett S. Be wary of "alternative" health methods. Quackwatch, Feb 10, 2004.
This article is partially based on information in The Vitamin Pushers: How the Health Food Industry Is Selling Americans a Bill of Goods.
This article was revised on September 18, 2007.