Quackery and cures

With the amount of medical misinformation that has hounded us since 2020, scientists and health professionals continue to look for evidence and support advocacies for a better COVID-19 response. Unfortunately, most of what we have to say does not penetrate the convictions of those who have already made up their minds about vaccines or unproven drugs. I have tried to discuss the process of evidence-based medicine in previous columns (“Learning to look at the evidence,” 4/5/21, 4/12/21), to unknown effect, as I continue to be barraged with e-mails about anecdotal evidence on ivermectin and vaccines. I believe we may be able to explain the need for evidence-based medicine better if we consider the history of medical fraud and barbarism.

It’s an interesting subgenre of history, where snake oil peddlers and doctor posers of the past swindled patients on the strength of their charms and useless, even harmful, wonder drugs. To single out one charlatan in a rich history of frauds is difficult. The reader might find it interesting to Google-search “quackery” and look through its most famous examples. Consider the original quacks of the bubonic plague, practitioners who “quacked” on street corners to peddle their unregulated goods.

There’s also a long line of licensed quacks in history. John Harvey Kellogg, of corn flake cereal fame, in the 1900s advocated such treatments as applying carbolic acid to women’s genitals to curb sexual desires. In the 1940s, neurologist Walter Freeman popularized a procedure called “lobotomy” where a sharp instrument, like an ice-pick, was inserted through the skull and into the frontal bone to treat mental and other disorders. While the procedure, now deemed barbaric, resulted in a few improvements at the time, the scientific basis was woolly at best and there were frequent and severe, sometimes fatal, effects, often disregarded by its practitioners. Whatever the intentions of these historical figures — whether well-meaning or mercenary — they are united by promotion of unsubstantiated methods to cure patients. The process of substantiating those claims is what is now advocated by evidence-based medicine.

The history of quacks — unregulated practitioners and peddlers of unproven nostrums — continues today. Nostrums were unregulated medications of the past, available without a doctor’s prescription and taken at one’s own risk; with recent stories of incomplete prescriptions of a certain anti-parasitic, does this sound familiar to the reader?

Unfortunately we contend both with those seeking to profit and with those who do mean well, but who are either unqualified to prescribe medication, or who advocate for medications with insufficient evidence. The distribution of some unproven Drug A to the general population may eventually be proven to have one of few effects: To cause harm; to cause benefit; to cause both, with one more important than the other; or to have no effect at all. It is fortunate if there is benefit, but the risk of harm is real enough that caution and legitimate trial must precede distribution. I ask the public to consider that doctors, who are themselves at risk of infection and who have lost colleagues and family members to the plague, will gladly welcome an inexpensive, effective, proven therapy as long as there is evidence of benefit, obtained through a well-designed, sufficiently powerful and critically analyzed trial.

Years from now, we will look back on COVID-19 and cast judgment on the treatments and safety measures the world has advocated in the last year. As evidence evolves, some drugs will fall out of favor, and some will fall in; some practices will be less encouraged, like the overzealous cleaning and disinfectant craze of the past year, and some will meet with more support, like better air ventilation for airborne-

transmitted COVID-19. As illustrated by the long road scientists took to convince the world that COVID-19 is an airborne disease, science evolves daily, not unaffected by political currents or the biases held even by our highest authorities.

But regardless of where science will lead us next, what should safeguard patients and the world at large from quackery and barbarism should be a respect for the scientific process: For transparent, humanely, and systematically obtained, critically analyzed evidence. This process is what safeguards us from nostrum peddlers. All of history is a cautionary tale, and science as it is practiced today exists because of those lessons. Let’s not disregard them.

kchuarivera@gmail.com