In Praise of Quackery?

Twice in my life I was a Recognized Authority. These were periods when strangers would call, asking for interviews, to write articles, or to speak at conventions and seminars. Both times, I was in charge of the drug information service at a highly respected medical center.

The first time I achieved any sort of recognition was in 1980. The United States Postal Service asked me to review products suspected of mail fraud. The Postal Service took a proactive role in medical fraud. Postal Inspectors ordered advertised products that seemed too good to be true. They sent the products, along with a copy of the ad, to me to compare the ingredients with the advertised claims. If the product was as good as it claimed, that was the end. If the product wouldn't grow hair, improve sexual performance, or let you lose weight without exercising or dieting, then the Postal Service's Legal Department could charge the seller with using the mail to defraud.

I did the work well. There was a good feeling about doing something socially useful, and the pay was good, too. But even so, I found the work depressing. I read through the ads, the promises, wishing each time that there would be something new, something I couldn't explain, hadn't seen before. It never happened. The ads promised wonders for weight loss, for sex, for prostate enlargement. But the ingredients were nothing but herbs that had been supplanted by better treatments half a century before.

I became a crusader against medical fraud and quackery – not just through a feeling of outrage at the practice of cheating the sick and the poor but also from a feeling that I was being personally cheated. I wrote for whoever would publish and spoke to whoever would listen. It was my job to tell the world the Emperor had no clothes.

What to Do?

A year later, four of the physicians where I worked published a description of a new disease. Officially, it was called Epidemic Kaposi's Sarcoma, although among ourselves we called it Mystery Disease. It was only later that the disease became GRID, for Gay Related Immunodeficiency Disease, and, later still, it became AIDS for Acquired Immune Deficiency Syndrome. The hospital became one of the leading centers of AIDS treatment and research, and I became an expert on AIDS therapy – not from ability but through proximity.

In those first years, the worst part of AIDS was the blow to our egos. We knew we didn't have all the answers to human health, but we thought we knew all the questions. AIDS shattered that thought. It was a disease we had never seen before – one we couldn't understand. We gave drugs – antibiotics, antifungals, antineoplastics – uncertain of what they would do. What we learned, more than anything, was the limitation of our knowledge and the futility of our efforts.

At the peak of my professional career in pharmacy, I was a Recognized Authority in two areas. I knew a lot about drugs that didn't work, and I knew a lot about a disease that had no drug treatment.

When the Quacks Move In

Since we had nothing to offer our patients, the quacks and fakes moved in. A local shaman offered a cure of healing crystals, while another said the cause was "failure of self-love." A PhD from Missouri wrote a book explaining that AIDS was caused by air pollution and that he had developed the disease while working as an instructor at a General Motors factory. You could put a label Immune Booster on a bottle of aspirin and make a sale and, probably, someone did.

It was a good time to be an expert on medical fraud and quackery because there was so much of it so close to the surface. Blue-green algae, which has been sold as a memory booster and a way to increase psychic powers, was revived as an AIDS cure. Baths in chlorine bleach and injections of hydrogen peroxide were popular. Healers offered several kinds of massage therapy and lessons in self-hypnosis.

There was a certain logic to it. If you had AIDS, you had nothing to lose. What if, just perhaps, the treatment actually did some good? The doctors and hospitals had nothing to offer but took your money anyway – so why not give it to somebody who offered some hope?

The Case of W

More than anything, what I remember about W is his feet. Most of the hospital rooms had enough space for me to pull up a chair and see the patient's face. W's room had less space because of some respiratory equipment, so I had to sit at the foot of the bed, looking upwards. He was in a unit where patients were encouraged to dress in street clothes rather than hospital gowns. When I try to recall what he looked like, all that comes to mind are bare feet, faded jeans, denim shirt, and blond hair the color of corn silk. His face is lost to memory. There was a time when I took pride in knowing each patient by name and could recognize each one. That was at the start, before the numbers became overwhelming. By the time W was admitted, I had lost count and lost track. He was one of the patients I knew best, yet I'm not sure I could have recognized him if we met outside the hospital.

All of W's drugs were given by vein, so there wasn't much for me to do professionally. I could have dropped him from my consultation list, but I preferred to stop in as a break from seeing patients who were angry or severely depressed.

W was pleasant. He seemed to have made peace with himself and his disease, and talking to him for ten minutes was a relaxation break. We talked about events of the day and about ourselves. He had worked as a dispatcher at a commercial bakery and had played the trumpet in a marching band. When he could, he slipped out of the hospital to practice the trumpet in the courtyard behind the medical school.

He had a case of Pneumocystis carinii pneumonia that had resisted every known treatment. He asked me to bring a newspaper, hoping there would be a report of a new breakthrough or, at least, new funding for a government initiative to find a cure. The article he wanted was never there. He had been admitted for a trial of a drug that wasn't expected to work.

One day he said, "I got some oral interferon. But it hasn't been doing any good. I'll probably just stop. It's a waste of time."

It wasn't a quack drug in the traditional sense. The drug, sometimes called Kemron, had been developed in Kenya and was a small dose of interferon taken under the tongue. Kemron's inventors, Davy K. Koech, PhD and Arthur O. Obel, MD, both of the Kenya Medical Research Institute, claimed to have cured between seven and 32 AIDS patients using this method. Since these same patients were already receiving massive doses of interferon by injection to treat Kaposi's Sarcoma, there was no reason to believe that Kemron could be effective. But the discoverers, if that's the term, were adamant that their drug was an effective cure. They said that perhaps they had stumbled on a special type of interferon, or perhaps there were very special interferon receptors underneath the tongue.

Later studies indicated that oral interferon was worthless. And, yet, Koech and Obel were qualified researchers who appeared to believe their claims. Perhaps it was despair. I could imagine Koech and Obel working desperately. The AIDS infection rate was about 14% nationally, and in one district the prevalence rate was about 33%. AIDS causes the weight loss (cachexia) that led Africans to call it "slim disease." I imagine that, surrounded by the walking symbols of their failure to help, the researchers snapped.

When To Turn a Blind Eye

Other people in other times might have thought they had a divine revelation. Koech and Obel, being modern, rational, and scientific, didn't hear the voices of angels. Instead, they focused on the project they had at hand and began to believe it was the cure. It had to be the cure. These men weren't promoting a false cure for money – they were doing it because they needed hope as desperately as any of their patients did. And patients, also in need of hope, bought oral interferon. Or water that was labeled oral interferon. It didn't matter. They both did the same thing.

W was talking about his life with AIDS and his relationships with friends and family. There was a quiet sadness in his voice. He was a good person, in the old-fashioned sense of the word, and I wished there were something I could do besides delivering newspapers and talking about hospital food and band music.

"How long have you been taking the oral interferon?" I asked.

"About two weeks," he said.

"Give it a while longer," I suggested. "Two weeks is a short time. Give it a while longer."

In Praise of Quackery?

What to Do?

When the Quacks Move In

The Case of W

When To Turn a Blind Eye

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About the Author

Samuel D Uretsky, PharmD

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