JREF Swift Blog

The Quack Clinic Checklist

I am asked almost daily about one kind of medical pseudoscience or another. The free market has produced a seemingly endless variation of medical quackery and nonsense for sale. I could never address all of them, because by the time I worked by way through the catalogue of chicanery there would be a fresh crop waiting for me.

There are, however, a couple of strategies for dealing with the thousands of claims and products. The first is to lump them into categories - many dubious claims are just variations on a pseudoscientific theme, and if you understand the themes you can quickly size up a particular manifestation of the theme. For this reason defenders of science-based medicine will often deconstruct these pseudoscientific themes, such as energy medicine, detox treatments, homonculus-based diagnostic schemes, and nutritional fallacies.

Another strategy is to build a list of features or red flags that should alert a savvy health consumer to the questionable nature of a practitioner, claim, or product. That is what I am going to cover in this article, exploring some of the most common features of medical quackery.

The Lone Maverick

Modern science is a transparent community effort, and that included medical science. Treatments that are science-based, therefore, have a trail leading up to them, a trail of research, evidence, and basic science. New treatments rarely come out of nowhere, and if they did they would still need to be validated by research. This requires a community of scientists working together, evaluating each-others research and claims, and hammering out a consensus. In medicine we call this consensus the standard of care.

Dubious treatments, however, are often offered by a single practitioner or clinic working by themselves, isolated from the broader medical community. Their ideas do not flow from solid science and they have not met the burden of plausibility and evidence necessary to be taken seriously by the mainstream, let alone accepted.

These practitioners and their proponents, therefore, reframe the fact of their isolation as stemming from their visionary genius. The established is therefore portrayed as corrupt, greedy, or just blind and narrow-minded. The dubious practitioner is cast in the role of lone maverick, fighting against the establishment to bring light and healing to the world. Sometimes the lone maverick is even portrayed as somewhat of a messiah.

Conspiracy Theories

From the lone maverick complex it is a short trip to conspiracy mongering. How else can we explain the lack of mainstream acceptance - there must be a conspiracy against the medical genius whose ideas are just too far ahead of our times.

Conspiracy theories are convenient rhetorical tools because they can be used to explain away all criticisms of the lone maverick and their quack clinic. Any scientist or doctor that bothers to explain why the claims are implausible or against current evidence is just part of the establishment trying to keep down anything too innovative.

Such practitioners often come under regulatory scrutiny, and when this happens it just become more evidence for the conspiracy.

"I'm too busy treating patients..."

Even for the lone genius fighting against "the man" it's hard to get away from the fact that they do not have evidence to back up their claims. Sometimes they point to basic research that doesn't really support their claims, but it may superficially seem related, and most people won't follow the links to all those references which make the treat seem science-based. Other times practitioners publish small case series, which is really nothing more than their own incredibly biased and carefully selected anecdotes.

What they can never produce, however, is rigorous replicable science that specifically supports their clinical claims. If such research existed showing the treatments were safe and effective (and better than other options), then everyone would use them. They would become part of the standard of care.

Dubious practitioners therefore have a couple of ready-made excuses for this lack of such evidence. One of the most common is that they are simply too busy treating patients to jump through hoops (do responsible research) for the establishment. What is amazing are those charlatans who make this claim even after years or decades of practice netting them millions of dollars. It simply becomes implausible that they could not have managed to carry out some decent controlled studies.

Often the "I'm too busy" claim is used as a delaying tactic, while simultaneously claiming that research is coming. That treatments are "being researched" is used to lend a false sense of legitimacy to the treatments, fend off the criticisms of lack of evidence, while never actually producing the results of the research.

It should also be pointed out that research proving safety and efficacy should come before marketing a treatment to patients, not years after.

Too Good to be True

This is an old bit of generic wisdom, but still holds. Any claims that sound too good to be true probably are. Everyone wants a pleasant, non-scary, non-invasive treatment for their illness that is entirely safe and incredibly effective. We also all want a single simple explanation for all our ills. Quack clinics often offer exactly that - a simple cause of all disease, and equally simple cure for all ailments.

The ultimate manifestation of this is faith healing, but really blatant faith healing is just at one end of the spectrum that includes many dubious claims and treatments. Many so-called alternative treatments are really just faith healing with a bit of medical theater.

Some claims are inherently implausible in the "too good to be true" direction, like losing weight without diet or exercise, reversing aging, and curing serious illness (like cancer) with simple interventions, like diet.

Indication Creep

Part of the "too good to be true" feature of dubious treatments is that they are also "good for what ails ya." They may have started out as a treatment for one specific condition, but over time the indication for the treatment creeps over to more and more problems until it seems it can treat everything.

There are a couple of reasons for this general trend. The first is that the claims for these dubious treatments are disconnected from evidence and reality. Practitioners therefore have no reason to limit the claims they are making, and any one indication claim is just as evidence-free as any other. Even when the practitioner is self-deluded and believes in their own treatment, they are mainly relying upon anecdotes and confirmation bias to assess their treatments, and so it will seem to work for everything.

Of course a treatment that seems to work for everything probably works for nothing - the "works for everything" feature just indicates that the claims are not science-based.

We also have to consider the plausibility of a single treatment working for a long list of diseases that have very different pathophysiologies. It is a rare treatment indeed that can fight infections, treat cancer, cure nutritional deficiency, reverse trauma, prevent or reverse degenerative changes, correct genetic disorders, and cure toxicity.

Of course you have to understand some basic biology and the true causes of known diseases for this problem to become apparent. This also leads back to the "one true cause of all disease" claim that some practitioners make, to help explain how their one treatment can cure so many seemingly distinct illnesses.

The other reason for indication creep is simple marketing - why limit your potential market to one illness. Indication creep, therefore, is often simply expanding the market.

"Do you suffer from any of these common ailments?"

Some quack clinics seek to create demand for their product or service by manufacturing a fake illness that only they can treat. Such fake illnesses are often nothing but a list of common everyday ailments. They often include fatigue, headache, difficulty losing weight, joint aches, depression, and difficulty concentrating or focusing (so called "symptoms of life"). Sometimes real and common medical conditions are included, like hypertension and diabetes.

With this list of symptoms anyone can be made to believe they have the mysterious syndrome X, that only doctor quack can diagnose and treat.

Just Over the Border

Many dubious clinics are strategically located just over the border, in a neighboring country that has conveniently lax regulations. For this reason Tijuana, for example, is a favorite destination for dubious medical treatments.

Globalization, however, has spread such clinics around the world. There are now many countries (China and India, for example) with a cottage industry of dubious medical clinics trying to lure wealthy Westerners with their amazing claims.

Of course, existing in the US or Europe is no guarantee of legitimacy, but the worst offenders do seek refuge away from annoying regulations that attempt to maintain a standard of care.

Conclusion

The features outlined above are very consistent among dubious clinics and practitioners. Not every such clinic will have every feature, of course, but having any of them should raise serious red flags about the legitimacy of the clinic and the claims they make.

Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.



Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.