Immortal quakery, part 1, April 12, 1985

Robert Hudson: ... my mother would've believed in me. So, Dr. Howard and Muriel. Dean Extein and Mrs. Extein. Dr. Martin and [inaudible 00:00:18] back to Iowa. As I mentioned to the noon group, I had to give a little thought to the fact that most of the people I knew here, closely, all left time simultaneously when they heard I was coming. Nevertheless, I was really impressed to look, again, at greater length at the Martin collection. The important thing about that, to me, as a medical historian, are not the books themselves. But what they mean for the future. He says that if you look at the history of medicine in the United States, the focus of teaching and research in almost every institution where it exists, had started out because one individual put together a good collection of history of medicine books. Once you hit the library, and once you hit the books themselves, other important things start to happen. You get a context of medicine. You get even, sometimes, a full-time profession in the history of medicine. And, before you know it, you may even have a department. But, the books are the focus. They're the thing that start things going. I have an idea that, perhaps, 25 years from now someone can get up and say this very thing about the Martin collection, and the history of medicine in Iowa. As I understand my assignment, it was to give you induction anesthesia at noon today and put you completely under this evening. I'm now prepared to do that on the subject of quackery. In 1828, an American physician by the name of Caleb Ticknor was amassing the prevalence of practicum in his day in the United States, and he did it with the following ornamental flourish. "Who would employ a blacksmith to repair a watch? A barber to shoe a horse? A ship carpenter to make buns? And, who would expect the human system repaired by someone who knows nothing of it?" But, the answer to the last of Dr. Ticknor's rhetorical question, both then and now, is quite a few people indeed. While it's impossible to get exact figures on the exact magnitude of quackery, the latest report by House of Representatives Bob Pepper's subcommittee indicate that it now is in the neighborhood of a $10-billon dollar a year industry. Now, if this were nothing more than a separation of fools from their money, we could all be a good deal more sanguine about it. But, as everyone recognizes, it's always been more [inaudible 00:03:02] quack the business of quackery, than the exchange of dollars for foolishness. Thomas [Rollas 00:03:07], in this cartoon from the 19th century, shows the quack doing a flourishing business out front. But, symbolically, you see, also, in the back the sign of death that sometimes goes with quackery. Film actor Steve McQueen, who was suffering from cancer in 1980, took himself out of the hands of the regular professional and hide off to Mexico where he placed himself in the care of a defrocked Texas dentist, who treated him with what was called metabolic therapy. Which meant [inaudible 00:03:41] coffee enemas, injection with animal cells, [inaudible 00:03:44], vitamins and other supplements. A month after the announcement that his tumor had shrunk, and that he was on the way to improving, McQueen was dead. Now, there's no way to be certain that McQueen would have lived longer or died easier if he remained under regular medical care. But, the fact is certain that a lot of individuals have suffered as a result of their pursuit of quackery. Voltaire, who we see here, informs us that quackery got its start when first fool met the first knave. This makes it clear that the problem is a difficult one, historically-inclined, to sort out the first episode of medical charlatanism. In fact, you really can't do it. There's no way to identify. It goes back as far as history itself, and it is has had an uninterrupted existence. It's a phenomenon, which strikes anybody who gets into it seriously, is how it has persisted in every society we have a good record of from the beginning of that society's history. Hence, the title of this evening's presentation, a quotation by Oliver Wendell Holmes to the effect that quackery and idolatry are all but immortal. Now, the variegation of this word quack is shrouded in obscurity. The OED has it as one way, and other dictionaries in another. I won't even attempt to sort it out. It isn't all that important. But, by the 17th and 18th centuries, we do know that the word quack had filtered into the language to include things other than just medical deception. It was used, for example, by Lady Mary Wortley Montagu, of smallpox fame, when she was writing a friend and said, "I know you equally condemn the quackery of all churches as much as you revere the sacred truth in which we both agree." So, she was talking about religious quackery, as far back the 18th century. But, they're difficulties not just in the origin of this word, but also in its definition. And this applies with my medical field. If you consult Webster's Unabridged, you'd find it defined as, "An ignorant pretending of medical or surgical skill." Well, certainly, ignorance by itself is not enough to classify one as a quack. And, to certify that, all you have to do is look at the history of 19th century American medicine, at which time most practitioners were engaged in the use of theories and practices that we now recognize as not only erroneous but, at times, positively harmful to their patients. And they were charging their patients for all these. This problem of trying to sort out quack practices from regular medical practice was perceived with typical servitude by George Bernard Shaw in the preface to his doctored dilemma, where he wrote, "The distinction between a quack doctor and a qualified one is mainly that only the qualified one is authorized to sign death certificates." "As you would expect," he went on to say, "for which both sorts seem to have about equal occasion." So, simply why a system of medicine cannot be equated with quackery, the fact that 50 years from now, most of the theories and many of the practices that you and I have engaged in, in medicine, with have been abandoned by no means implies that, historically, we should be labeled as quacks, but, what we're doing nowadays. The key to defining this word lies in the other half of the dictionary definition which, I just cited as pretending, the true quack does not believe the claims he makes for his products or procedures. In other words, he's engaging in a measure of conscious deception. It is immoral, this trickery. Rather than any other. Now, if you accept this definition, then a modern chiropractor who truly believes in his theories of disease causation, and the fact that it can all be remedied by manipulating the back and other joints, then he would not, by my definition, be labeled a quack. You might choose to call him an ignorant pretender, but, not a quack. But before examining the common denominators that I'm going to try to identify, that have conspired to give quackery it's long, uninterrupted history, I need, first, to give you a case study that demonstrates the appeal that the really successful quack can generate. For this I don't need to engage in any sort of geographic chauvinism, because my home state of Kansas produced one of the most successful and sophisticated quacks in the annals of medical history. This individual was Dr. John Orr, or, John Richard Brink, better known as JR Brinkley. The JR you have on Dallas, would have liked this one. Brinkley moved off to Kansas for the first time in 1917 in a small town called Milford, which you see above Junction City, where Fort Riley's located in the central part of the state. When he came to Milford, there was no electricity, no central water supply, no sidewalk, and a third-class post office. Before he left Milford, they had their sidewalk, their power plant, their electricity, paved streets, and they had a first-class post office, which was overworked. All because of Brinkley. He also provided Milford with its first hospital, but from the historical standpoint, this turned out not to be an ordinary hospital. Because it was here in this operating room in 1918 that Brinkley undertook his first operation for goat gland transplant on a 46-year-old impotent farmer. Within a year, the farmer had a son, presumably his own. Now, the Brinkley compound operation, as it came to be known, was literally just what I said it was. He prepared a nest above the human testicle and transplanted into it, literally, the testicles of a goat, and claimed that he was also doing microsurgery to connect the nerves and blood vessels. We doubt the latter, now, because both techniques were just in their interest. He would not have been that good a surgeon. But, nevertheless, this is what he claimed to be doing, and what he was literally doing. He then began a tremendous publicity program, pulling out tons of advertising literature. Here you see him at the radio station he had built, KFKB, Kansas First Kansas Best, in one of his twice daily appearances on the radio program. Here is a typical day's program and the parts went in on the morning and afternoon Medical Practice Box. Because it was at this time that he did his diagnosing and treatment by radio. You simply sent in a postcard with your symptoms, and he would tell you what was wrong with you. He was not overwhelming modest, as these individuals never are. He had something to promise for everyone. For the younger men, there was greater virility. For older men, there was rejuvenation. And, for women, there was more joy and satisfaction. That's all you had to say back in the day to Lydia Pinker. [crosstalk 00:11:58] Well, this operation was a tremendous success. By the mid-1920's he was shipping 50 goats a month from his Arkansas goat farm out in the [crosstalk 00:12:06]. Now, these were not ordinary goats. These were young, [inaudible 00:12:13] billys, and known among rural folks to be the lustiest mammals alive. This was not lost upon him. In fact, he picked goats as donor animals particularly because of the fact that, deprived of their normal sexual outlet, they've been known to do some very strange things. The normal charge for this operation was $750 dollars, but on occasion it could go to $1,500 if you wanted the bilateral procedure. Simply put, Brinkley was very soon a millionaire. He loved his diamonds, and there you see him sporting a few of them. Look at that high-class, for instance, if you want to see a nice one. Here is one ... Sorry, if you wanted to see the high-class, I could go back. I had trouble doing that. This one. I was surprised when I saw it. This is one of his three yachts, Dr. Brinkley one, two and three, which were supposed to have cost him about $1,000 a day to operate. And, very soon, he was in trouble with organized medicine. In the words of the biographer that he hired ... This is not his biographer, as some of you would recognize. "Dimly, Brinkley had begun to recognize that he was gifted beyond a lot of doctors and he could not be bound by the rigid, artificial ethics of the American Medical Association." Soon the battle was joined. In 1928, Morris Fishbein, whom you see here, wrote a four-page expose in the Journal of the American Medical Association that concluded with this quote, "John R. Brinkley is a blatant quack of unsavory professional antecedents." Now, don't you wish you could get away with telling it like it is nowadays? You ever made a statement like that against any quack, you'd be in court for the rest of your life now. The Pratt County Medical Society resolved to revoke his license, the Kansas Medical Society condemned him, and then they petitioned the Federal Radio Commission to not let him renew his application for license for his radio before he could be called before the Kansas Board of, what we now call Healing Arts. He was called on Washington, D.C., to show cause why KFKB should not have its license revoked. He took with him, of course, the solid backing of the citizens of Milford, 1,200 affidavits of cure, and also the testimony of a number of pharmacists who sold his prescription. I failed to mention that, over the radio, the prescriptions were number coded. He did not send them a prescription, which could be filled anywhere, they were sent a code, say, 69, 72 and 43. And the only place they could get these filled were in pharmacies that Brinkley controlled. Well, the FCC was apparently more impressed by the testimony of such individuals as the urologist, Dr. Hugh Young, from Johns Hopkins who testified that the operation was simply fraudulent and impossible. On June 13th, the FCC denied his application for renewal of a license for KFKB. Brinkley was down, but he was not out. He returned to face a hearing with the Kansas Board of Medical Examiners Registration, which must have been the liveliest one that that ordinarily sedate body has ever held. Against the testimony of some of the best experts in the United States, Brinkley paraded one satisfied patient after another to the stand. Finally, he, himself, took the stand, as you see here. And, he was absolutely cool, he ended up inviting his [inaudible 00:16:08] on out to Milford to watch him perform this procedure. And, they went. And, there's no doubt that on that day, on two patients, John Brinkley transferred testicles from two goats into these human recipients. Two days later, the board found him guilty of gross immorality and unprofessional conduct. But, before this decision could have any impact, Brinkley announced himself as a write-in candidate for governor of Kansas. At first no one took him seriously. And, indeed, the editorial cartoonist actually [crosstalk 00:16:43]. Well, in retrospect, where Brinkley's campaign was seen as a distinct, important historical event. He revived, even though temporarily, the populist movement, which had been so important in Kansas back in the 1890's. But, more importantly, by most agreement nowadays, by social historians, he ran the first modern political campaign in the United States in terms of using the media and transportation as it had never been used before. Here is his sayer, Lloyd Faulkner, with whom he had each program introduced to, sort of, warm the crowd up. He would swoop down onto a pasture full of a crowd of people in his Ford Trimotor. Now, you have to remember, most people in Kansas had never even seen an airplane at the time we're talking about. And, this was not an ordinary airplane. This was romancing. The very plane Charles Lindbergh had used to fly to Mexico City to move Anne Mora, that's his wife. This, of course, was publicized, too. He toured Kansas in one of his gaudily painted 16-cylinder Cadillacs. Can you image a 16-cylinder Cadillac? You wouldn't even know if the engine was running. Or, took a long one of, what he called, his ammunition trains. This is ammunition train number one, which had a microphone and a speakers platform so that in every hamlet he immediately had audio contact, no matter how large his audience. He could handle his hecklers, as well. He really was a very bright man. When William Allen White, the great publisher from Emporia, referred to all Brinkley-ites as riff-raff and morons, on the next occasion he gave a talk he said, "Fellow riff-raffs and morons." You can imagine the populist appeal that this would have in a little state like Kansas. When one man kept interrupting Brinkley's speech by going, "Baa-baa," Brinkley said, "A little louder, please. I might be able to use you." Well, the estimates by the political pundits were that Brinkley would get anywhere from a few to 50,000 votes. When the dust cleared, he had 183,278. Which is only 30,000 more than the winner, Harry Woodring, whom you see here. And, by general agreement, by historians later and even by Woodring, in his lifetime, at least 50,000 Brinkley write-in votes were thrown own for every possible technicality. Omitting a myriad, between his jade paw, whatever. So, what I'm saying, in effect, is that, by popular vote that year, the people of Kansas elected John R. Brinkley as their governor. He even got 20,000 write-in votes as governor of Oklahoma, where he wasn't a citizen. Where he shouldn't have run for anything. Well, from there is, life ran what we would refer to as a downhill course, and it climbed back up [inaudible 00:20:14]. He was forced to leave Kansas, went down to Del Rio, Texas, where he built his home. Nothing shabby about it, at all. Across the river, across the Rio Grande in Mexico, he directed a new radio station, XER. And whereas KFKB had operated on 50,000 watts, XER now had 500,000 watts. Where once he could only reach those plains of the central part of the United States, he could now reach the entire North American continent. He could really peel the varnish off the old at-wire ken. Some claimed you could get XER without even turning the radio on. Others maintained it was when it was operating at full wattage, it would light the street lights in Calvary, Canada. If you are driving late at night, turn on your radio into that general area, you'll still hear it. XER, or what it's new call number are, I don't know. But, it still drowns out everything on both side of the band there for a long ways. But, he then entered the downhill course that I was talking about. In 1941 he suffered an embolism in his leg, had an amputation. He died in San Antonio is 1942, was buried in Memphis, Tennessee. This is the statue arrangement that he had to identify his Del Rio home, which was then moved to Memphis to serve as a gravestone. For so much, then, for the appeal that a charismatic quack can generate, the question of why remains. And, while I think certain aspects of the psychology of quackery can be identified, and I hope to do that for ya, I'm still left with an unsettling feeling that there's something about their success that we don't fully understand. Some sort of appeal to deceive and be deceived on the part of human beings. The main physiological factor that quacks succeed, of course, is well-known to all physicians. And, that is, that the majority of diseases are self-remedying. The patient's going to get well no matter what you do them as long as you don't hurt them or kill them. This helps the quack immensely, as you guessed. But, it's the psychological aspects that I'm most interested in here this evening. Among the psychological areas in which the successful quack must operate, of course, are areas of intense emotional appeal. The longest, and perhaps most powerful, of course, of these is humanity's age-old quest for immortality. Most recently manifested by the jogging phenomenon. Thomas Parr, of Shropshire, or Old Parr, as he came to be known, died in 1635 at the reputed age of 152. Having lived through the reins of 10 princes. His autopsy, incidentally, was performed by none other than William Harvey, of circulation of the blood fame. Now, Parr's life was uneventful, until his first marriage at the age of 82. And, his visibility increased greatly in the public's mind when, at the age of 105, he was forced to do public penance for adultery. Married again at the age of 112 to the state of complete satisfaction of his second wife, and was buried in Westminster Abbey. Whether honored for his remarkable longevity, or his centenarian adultery has never been made quite clear. But, in 1635, John Taylor publicized Parr's life in a poem. "The old, old, very old man, Thomas Parr." And, of course, years later, we had Parr's life pills. Now, the length between immortality and Parr's pills, and Parr's life, of course, is not very structured. And, yet, it gives a fair indication of the level of intelligence that the quack believes the American public has, and succeeds in believing. Another area of intense emotional appeal resides in those regions of social taboo. In our period of increased permissiveness, it's getting more and more difficulty to identify an [inaudible 00:24:49], but in the past they used to include such things as women's sexuality. So, that the quacks reached many, many dollars, dealing with the secret remedies for gonorrhea and other venereal diseases and other worries and concerns that other people had about declining potency in men, and fragility and painful intercourse in women. Finally, in their emotional appeal, they go for vanity. What do you suppose this is? Anyone? Speaker #2: Make himself taller? Robert Hudson: Yeah. This is a device to make you taller. And you have to hope that the instructions are very explicit about [crosstalk 00:25:32] removing the neck portion [crosstalk 00:25:35] with your hand. They have exploitive devices to make us taller, increase our muscles, to augment busts, decrease busts, decrease body odors, sweeten breath, increase and decrease bodily hair. In fact, to change just about every human characteristic there is, except the uvula, which I've not yet found, but probably will. [crosstalk 00:25:57] Now the major area in vanity, of course, is now obesity. Now, after emotional appeal, a major second load mind-body charlatan is that of medical failures or neglect. There are a whole host of human conditions in which we, as regular physicians, don't do a very good job. These include arthritis, acne, varicose veins, backne, fatigue, headaches, and that great American fixation, constipation. The 1984 edition of Physicians' Desk Reference, there's 69 drugs or combinations of drugs designed to enhance fecal transit. 69 drugs. Now, the failure here, of course, is largely one of education. The medical profession, at one time, believed that the daily bowel movement of the proper consistency was symptom of normal health. We'd given that up. But, the public still continues to believe it, and the quack turns that belief into a fiscal virtue. Our third characteristic of quackery is paradoxical at first glance. And, that is, they do tend and have tended to flourish in places and times when regular science is a dominant force. This is, as I say, seems difficult to understand. But, it's true, historically. One of the reasons, of course, is that even well-educated people don't usually understand what's necessary to constitute rigid, rigorous, proof in clinical experimentation. They all suffer the post hoc, proctor hoc fallacy; after which, therefore because of which. You give something, you get better, it did something to make you better. Not only do the quacks play on that, of course, but many physicians fall into that same sort of fallacy-type of reasoning. In fact, it is so widespread that I have labeled an inborn-error in human intellectual vocabulary. Brinkley's success was directly related to the new science of his time, because he came along just as embryology was emerging as a new discipline. He came along just at the time that the media were announcing that the scientists could now make chicken, neuter them, and then turn them into roosters or hens by simply injecting the proper amount of the right hormones. Now, that's dramatic stuff. And that came, as I say, just at the time the Brinkley was convincing individuals that he could provide them with greater masculine characteristics by giving them, not just an injection that would change them, but a machine that would keep producing the chemical necessary to support this change. When electricity was tested around the beginning of this century for medical benefits by legitimate scientists, the quacks, very soon, were involved and had many electrical quack devices. Around the beginning of the 20th century. After X-rays were proved effective, both in diagnoses and treatment, in regular medicine, it wasn't long before patients with arthritis were sitting for long periods of time in abandoned uranium mines in order to absorb the radon gas, which was going to cure their arthritis for them. Did this pass? By no means. One such operation in 1967, 2,500 persons sat in such a mine in Montana for an average of 15 sessions each at $3 per session. This operation was still flourishing in 1983, when I read about it in the newspaper. And, at this point, it had gone so far, some had, as to suggest that Billings, Montana, should refer to itself at the Louvre of Montana. The most recent I could find was the leisure lift. You can now get a facelift without plastic surgery. Now, these are the unintended benefits that legitimate science confers upon quackery. They prey upon the newspaper items that have to do with strictly valid scientific medicine. Indeed, many more of than health quacks wrapped themselves in mantle of science. Most people think a modern health quack's easy to spot. But, he or she isn't. They talk in scientific terms, they write with scientific references. They're introduced on talk shows. Always a scientist ahead of their time, being fought by organized medicine. When one of our local radio stations, not long ago, with one of these introduced as a nutritionist, and had the title of doctor, seemed to be unaware ...