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BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7021.1712 (Published 23 December 1995) Cite this as: BMJ 1995;311:1712

Re: Re: Quacks - more and more

Editor

Dr. Worth (Dunedin), along with Dr. Haslam the author and, I suspect
Dr. Thiagarajan, also of Dunedin (though quoting the 'quackbuster' site
www.quackwatch.com may be an attempt to remind us that the New Zealand
Government - from what I read recently - has officially labelled
information from it's author Barrett as "propaganda and of no evidentiary
value") appear to suggest that 'complementary therapy' is synonymous with
'quackery'.

The Concise Oxford Dictionary defines QUACK as "an unqualified
practiser of medicine"; as "slang for any doctor or medical officer"; or
"a charlatan".

MEDICINE is defined as "the science or practice of the diagnosis,
treatment and prevention of disease; any drug or preparation used for the
treatment or prevention of disease; a spell, charm or fetish which is
thought to cure afflictions"

CHARLATAN is defined as "a person falsely claiming a special
knowledge or skill".

Clearly, the definition of 'Quack' bears no relationship to those
therapists, from all areas of medicine, be it allopathic, complementary,
or alternative who are properly qualified in their field and who do not
falsely claim to have a special knowledge or skill which they have not
acquired. One could only identify as a quack one whose drug, spell, charm
or fetish thought to cure afflictions can be proven not to do so. ie. the
burden of proof appears to be on the accuser to prove a claim is false.

Unless Drs Haslam, Worth and Thiagarajan wish to submit updated
definitions acceptable to the Oxford Dictionary I suggest they adopt a
more accurate, scientific position when referring to 'Quack'.

Perhaps I could remind them of a few typical 'quacks',
identified by their peers, in excerpts from The World's Worst Medical
Mistakes by Martin and Karen Fido (ISBN No. 1 86200 001
8):-

Surgeon Isaac Baker Brown who in 1866 published a book called "the
Curability of Certain forms of Insanity, Epilepsy, Catalepsy and Hysteria
in Women" - he
cut their clitorises and noted with satisfaction that they all proved
docile and returned to their husbands after the operation.

2. He was closely followed by another surgeon Battey, who's "Battey's
Operation' became famous; other surgeons latched onto his technique of
ovarectomy and began to diagnose insanity "ovarimania", a popular non-
existent disease, remediable by ovariectomy; it's symptoms were that
women were 'unhappy' or 'hysterical'. By 1906 150,000 women had been
subjected to this useless sterilisation, their average age was 30.

3. How about Dieffenbach who's hemiglossectomy entailed cutting off
half the tongue as a rather radical late 19th century attempt to cure
stuttering. This was seriously proposed for other purposes by Dr. John
Scoffern in 1876 in The London Surgical Home and Modern Surgical
Psychiatry. Scoffern advocated glossodectomy for "ladies that talk too
much, tend to appropriate what does not belong to them or are over keen on
dancing".

4. Then there was Freud! CS Lewis jeered at Freud calling him
"Sigismund Enlightenment" and suggested that he so dirtied up all human
experience that he would have called a boiled egg 'the menstruum of a
verminous fowl'"; Freud supported Wilhelm Fliess, an ambitious young
Viennese nerve doctor who began to specialise in treating neurasthenia and
hysteria under the thoroughly Victorian conviction that these disorders
were usually caused by masturbation or coitus interruptus. Fliess wrote in
1902 "Women who masturbate are generally dysmennorheal,
they can only be cured through an operation on the nose if they give up
this bad practice". He began enthusiastically cauterising parts of his
patients' nasal passages, or numbing them with cocaine. Soon this was not
enough, he began to extract pieces of bone despite having no
training in surgery.

5. Son of a doctor Oscar Wilde, after suffering a brief period of
imprisonment, wrote a public letter of complaint on his release after
seeing police surgeons dealing with mentally defective inmates:-

"Prison doctors have no knowledge of mental disease of any kind. They
are as a class ignorant men. The pathology of the mind is unknown to them.
When a man grows insane they treat him as shamming. They then have him
punished again and again. Naturally the man becomes worse".

6. Dr.James Bailey was a student of Dr.Sargent of Guys, London.
Sargent pioneered 'deep sleep' treatment for serious mental conditions.
Bailey worked in Chelmsford Hospital, Australia. He developed his own
modified
Sargent method and used massive overdoses of sedatives to assist 'deep
sleep'. Patients began dying, and Bailey certified their deaths as caused
by heart attacks, his errors were later identified and his licence was
suspended, he committed suicide, the case was not closed till 1992.

7.The words of pioneer Egas Moriz "Prefrontal leucotomy is a simple
operation, always safe, which may prove to be effective surgical treatment
in certain cases of mental disorder". He had developed technique of boring
three small holes in the skull and extracting small cylinders of brain
tissue. In 1936 he reported his first 20 cases. In 1939 a disgruntled
patient shot and injured him.

8. William Jackson Freeman pioneered frontal lobotomy, not himself a
surgeon he joined with James Winston Watts to carry out Moriz's
operations. Lewis J. Pollocok wrote for Archives of Neurosurgery in 1937
"This is not an operation it is a mutilation". Watt's began to excise more
tissue than Moriz suggested. Stanley Cobb wrote in 1940 'A review
of neuropsychiatry'......"is the surgeon justified in depriving a patient
of the most important part of his intellect in order to relieve him of
emotional troubles?". ...many were 'cured' of some anxiety as
they settled down to vegetative lives in asylums along with those now
suffering 'the China Doll Syndrome', many simply lay like wax dummies in
trance-like catatonic states.... all 'cured' of their anxieties!!

9. In 1949 The Nobel Prize committee decided the award of the prize
for medicine should go to this contribution to brain surgery by Freeman
and his prefrontal leucotomy. Between 1935 and 1949 10,000 such operations
had been carried out, a further 12,000 over the next two years. "Is
quieting of the patient a cure"? Nolan Lewis, Director of the New York
State Psychiatric Institute asked in 1949. In 1951 a study of over 100
cases was published and the authors, Moore and Winkelman, concluded that
'lobotomy causes most and perhaps all patients to suffer some
personality defect'. The same year Dr. Chevtenko of Moscow carried out
autopsies on lobotomised brains and discovered damage far more extensive
than enthusiastic surgeons were reporting. Freeman answered critics
saying "Society can accommodate itself to the most humble labourer, but
justifiably distrust the thinker...Lobotiomised patients make rather good
citizens". Dr. Kringle was Director of the El Camino Hospital Psychiatric
Service in New Mexico, he wrote in the house magazine "A fellow named
Freeman said, I've a sharp little knife that I drive; If you want to be
dead I'll bore holes in your head and then you won't know
you're alive"

10. America was shocked with figures in 1977; a full analysis of
surgical practice in 1973 showed that 18 million operations had been
carried out and one in every 72 patients had died following surgery. eg.
Tonsillectomy, 724,000 sets of tonsils had been removed in 1975, 150
patents died and 70% of the operations should not have been recommended.
eg. 2,700 patients died of prostatectomies, and 29% should not have been
removed, 783 old men had died prematurely for nothing. eg. Hysterectomies
were the biggest killer; of 787,000 women who lost their wombs in 1975,
1700 died and 22% had been wrongly or unnecessarily
referred for hysterectomies. 574 women died needlessly.
eg. Gall bladder removals, 472,000 operations and 6700 patients died, 938
should not have, 14% were wrongly referred.

"All professions, preface to the doctor's dilemma, are conspiracies
against the laity" wrote George Bernard Shaw. By profession he means "a
group of practitioners who band together and approve each other's practice
to the exclusion of the laity". As such a doctor may be accused of
quackery, but only for those specific actions not approved by their
profession. A genuine doctor may offer you utterly useless treatment, he
may give you quite unnecessary prescription selected almost at random from
the vast and growing pharmacopoeia pressed on him by drug companies. In
the days when doctors believed in bleeding and blistering, a
competent healer - a village midwife or bone setter for example - who was
not recognised by the approved Company of Physicians was a quack, and
liable to persecution or prosecution if the approved doctors were
sufficiently powerful or the law sufficiently clear.

Had the doctors been organised into a profession under the Roman
Empire, Jesus Christ might have been hauled before Pilate as a quack no
matter how many lame leapt, or blind testified to seeing again, where all
other physic failed.

Thank you Martin and Karen Fido for these revellations.

Of course allopathy has taken these lessons on board and is now
totally evidence-based!

Regards

John H.

Competing interests: No competing interests

13 January 2001
John P Heptonstall
Director of the Morley Acupuncture Clinic and Complementary Therapy Centre
West Yorkshire