The Strange and True History of Combating Health Fraud in America: Why and How the Boundaries of Orthodox and Unorthodox Medicine were Established with Guest Historian Dr. Eric Boyle

May 24, 2022 | Podcast

In this episode, I turn to history to find out why and how selective types of healthcare become mainstream.

Do you ever wonder how some medicines are acceptable and other medicines are alternative or fringe? Who made these decisions and how did we get here? What does this have to do with your access to good healthcare and your ability to care for yourself?

Everything.

What Makes Medicine Mainstream?

There’s plenty of health fraud to go around since humans first tried to heal other people. In fact, health fraud was hard to manage even before the internet. Now that we live with more information than anyone could ever digest in a lifetime, it’s much harder to know what is truly good for us.

Starting with the industrial revolution, healthcare converted to a commodity. Towns and cities grew larger and when the care of the sick changed from families (the home) to professionals and institutions. Several individuals and companies tried to sell “snake oil” remedies and cures. Medical care needed to be standardized to a large extent for public safety and to make sure a drug or a nondrug treatment worked. But, casting a wide net to fight health fraud potentially limited access to good medical care that was not labeled as mainstream medicine.

My guest and historian, Dr. Eric Boyle, shares his research on the history of trying to control health fraud, also known as quack medicine. The title of his book is Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America. He reviews the attempts to eliminate health fraud while exposing the strengths and weaknesses of managing healthcare in the medical marketplace.

I confess that I first judged this book by its cover. I grew up in a household with an integrative doctor who practiced both traditional and nontraditional medicine. I heard some doctors, who never studied Chinese medicine, judge this type of medicine as quackery. I also trained in two models of medicine to be a doctor, and one model was acupuncture.

But Dr. Boyle’s research opened my eyes to how we are influenced to judge medical models that are not mainstream like acupuncture, osteopathy, naturopathy, and chiropractic medicine. He said, “I’ve always thought of myself as a little bit of a medical agnostic…I’m always fascinated by the way that people’s world views unavoidably, in ways that people don’t really understand, end up shaping their approach to medicine and how they think about medicine.”

This episode focuses on the anti-quackery movement and the intended and unintended consequences of these efforts. A future episode will cover the history of medical education reform and medical licensing in more detail as ways for medical practitioners to assert their legitimacy in the competitive healthcare market.

 

The Impacts on Your Third Opinion

The anti-quackery movement is a source of information that gives a rich perspective on why we are the way we are today, especially coming out of the pandemic with polarizing opinions about the health of individuals, communities and the nation.

We might be feeling angry or anxious about people wearing masks or not wearing masks, about getting vaccinated or not getting vaccinated. Our nation has very deep roots here, and history often repeats itself. Two hundred years ago, there was a large backlash against mainstream “heroic” medicine. When we discover our history, we can understand people better.

Why can’t you just rely on consumer protection from oversight agencies, what healthcare organizations tell you, or what insurance companies approve for treatment since they have the knowledge and training to do this? Healthcare operates in a medical marketplace. None of these institutions have your best interests as their goals. Most doctors want to help you, but they are often bound by the system’s restrictions and bureaucracy.

We live in a society with an over-dependance on medical authority. Insurance companies dictate what is best for their bottom line. The family doctor is no longer your best advocate when you check into a hospital, and they no longer know you. Most of your healthcare is now under a stranger. How do you know whether a medicine is quackery or legitimate? It starts with being well-informed and being proactive.

A large part of your success with getting the best healthcare is to hone your ability to discern what is good and not good for you. Above all else is how you decide to live your life, which includes: proper food, consistent movement, good sleep, balanced emotions, loving relationships, and sustainable and enjoyable work.

Never stop asking questions if something doesn’t feel comfortable or best for you. Always seek a second or Third Opinion if you have doubts about the care you are receiving. That Third Opinion can be your intuition once you’ve cultivated it. Only you, and you alone, have the ability to be the best leader for your health.

In this episode, Dr Eric Boyle and I discuss:

  • definition of quack medicine, or health fraud
  • how boundaries between orthodox and unorthodox medicine were established
  • reasons for sectarian (nontraditional) medical groups forming in the 1820s as a response to “heroic” medicine
  • combative relationships between different medical groups like traditional physicians, osteopaths, chiropractors, naturopaths
  • anti-quackery operation launched by the American Medical Association and the reasons for their efforts (protect the public, political and economic gains)
  • self-reliance for one’s health and how it’s changed over time
  • the challenges in combating quackery in the twentieth century

 

Speaker Opportunities:

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Resources

For more information on the topic of quackery in 20th-century American healthcare, read: Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America by Eric Boyle

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James Reston (whom I mentioned in this episode) was a New York Times correspondent and executive editor who wrote a ground-breaking article in 1971 about the powerful effect of acupuncture after being hospitalized in China for acute appendicitis. The New York Times obituary on December 7, 1995 stated, “One exclusive dispatch came by accident. In 1971, as one of the first American reporters allowed into China, Mr. Reston developed appendicitis. His report, filed from his bed in the Anti-Imperialist Hospital in the capital, ran on the front page under the headline, “Now, About My Operation in Peking.”

  • After a successful operation through Western medical surgery, Mr. Reston developed abdominal pain, bloating and constipation coming from a post-surgical complication called ileus (the digestion stops moving) that worsened into the second night after his operation to remove the appendix.
  • He was treated with only three acupuncture needles, and the condition was resolved within one hour.
  • His article created the first major wave of interest in acupuncture in the United States.

Reference to bodily humors in ancient and medieval Western medicine: Based on the ancient Greek and Roman physicians and philosophers, accessed on 5/21/2022 from Wikipedia: https://en.wikipedia.org/wiki/Humorism

Here is an FDA article on the medicine, Elixir Sulfanilamide, disaster: https://www.fda.gov/files/about%20fda/published/The-Sulfanilamide-Disaster.pdf

Transcript

Barbara de la Torre: Welcome to Third Opinion MD. I’m your host, Barbara de la Torre. I’m an artist and integrated physician asking questions about why we live with the healthcare system the way it is. I teach you ways to navigate, and I want to empower you to adopt self-care measures to ease your dependence on the system so that we can change it together.

I’ll be digging deeper into the history of how the heck we inherited the healthcare system we have, and why some medicine is considered traditional and another medicine is considered alternative. Who gets to make that choice anyway on whether a type of medicine is mainstream or fringe?

We have an era, Watergate, systems that are exposed for corruption, and then there was an informant for Watergate. His name was Deep Throat, and that was a pornographic film in the 1970s. What I loved about your book is that the AMA, or American Medical Association, had a similar scandal with an informant from the AMA and what was his nickname?

Eric Boyle: He was known as Sore Throat.

Barbara: Nice.

Eric: Yes [laughs]. 

Barbara: [Laughs]. So, what did Sore Throat expose? This was a doctor who worked for the AMA, I think, for 10 years?

Eric: Yes. So, it was an anonymous, unidentified source who claimed to be a doctor who worked in the Chicago offices of the AMA for 10 years.

Barbara: I want to welcome a very special guest today. His name is Dr. Eric Boyle. He has earned his PhD in the history of science technology and medicine from the University of California at Santa Barbara. His first book is called, Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America. It won the Outstanding Academic Title award from Choice Publication of the Association of College and Research Libraries, and it was awarded Best Print Publication by the Archivists and Librarians in the History of the Health Sciences. His current work includes a book project, which I really want him to finish [laughs] as soon as possible. It’s titled, In the Belly of the Beast. It’s a history of complementary and alternative medicine at the National Institutes of Health. Welcome, Eric. 

Eric: Thank you so much for having me. 

Barbara: What’s your focus for the second book that you’re writing?

Eric: The second book is really just the early history of alternative medicine at the NIH. It looks primarily about how this office came to be and how it attempted to do the work that was mandated for it by Congress.

Barbara: I want to share with the audience how I found you, first –

Eric: OK.

Barbara: – [laughs] because I have to say living in Portland, Oregon, we have one of the most amazing independent book stores on the planet.

Eric: Yeah. Last time we were in Portland we bought a couple kids’ books for our daughter there. 

Barbara: Yeah. That’s where I found your book.

Eric: Oh, great. Almost every time I go into a book store, I check and see if it’s there and I never find it, so [laughs].

Barbara: That’s because I have your copy [laughs]. I walked by the history of medicine stacks and I saw your book. At first I didn’t want to read it. That’s my honest answer [laughs] – 

Eric: [Laughs]

Barbara: – and I’ll tell you why, because I saw the name “quack medicine,” and as a physician I was like, “Are you kidding? Somebody’s probably going to talk about acupuncture in a bad way.” That was my first reaction. I walked away, actually. Then I walked back because I was looking for something and your book caught my attention again. I decided I better give it a fair shot, and I started to read the dust cover and I was hooked from that point forward. Because what you’re actually writing about is not about what’s necessarily quack medicine and for people to take that as dogma, but you were actually examining the history of quackery and the anti-quackery movement. What is quack medicine?

Eric: Well, the way it was defined in the early 20th Century which is when the book really begins after a brief overview of 19th Century efforts to define what quackery was, the implied meaning in calling someone a quack or saying that something was quackery is to delegitimatize it, is to say that it’s fraudulent. It’s purposefully misleading, deceptive, conniving, and it’s intended to essentially dupe the person, to fool the person, into believing in something that is invalid or untruthful.

Quackery in the early 20th Century wasn’t a term that wasn’t necessarily limited to medicine or medical practice. You could be a quack preacher, for example. You could be a quack writer. So, it was somebody who intended to be deceptive purposefully, to swindle something.

Barbara: They knew what they were doing. The definition says, “You know what you’re doing is wrong.” For example, if you are prescribing snake oil, you know that it is not something that will help someone. You’re just trying to make money.

Eric: Yes, exactly.

Barbara: But quackery is not something that we really see now. We tend to see the terms “health fraud.”

Eric: Mm-hmm.

Barbara: When did that change? 

Eric: The term health fraud isn’t used widely until the late 1980s, I think, is when the terms first kicked around. I think partly because over time quackery kind of lost its cultural resonance, lost its power. When I started this research years ago I set up a Google alert for quackery, and I was kind of surprised that I didn’t get very many hits, because the term just wasn’t used very often. Most of the hits that I get today don’t come from the US. They come from India. But quackery, I think, loses its power in the ’60s and ’70s. But when health fraud is used in the 1980s, it’s used I think very purposefully and deliberately; a more modern expression of quackery. I think it’s a little more direct as well. 

Barbara: When we talk about quackery today, maybe exchanging those terms occasionally, you mentioned that when they tried to modernize the term to health fraud that creates confusion. Because when we think of health fraud, the first thing I think of is Medicare –

Eric: Right [laughs].

Barbara: – or pill mills or things like that. I don’t think about this very broad term, not only encompassing what is harmful for the public, but what is deemed not conventional or not traditional. 

Eric: Yes. 

Barbara: How did you even start down this whole road of wanting to explore quack medicine or quackery? 

Eric: Well, when I was back in grad school and was trying to think about what I was going to do for my dissertation topic, I was kicking around a variety of different subjects in the history of medicine field. I went back to my undergraduate thesis, which looked at the broad history of alternative medicine in the 20th Century. One of the things that I was most interested in was how and why the relationship between alternative medicine and mainstream conventional orthodox medicine, how that relationship had evolved over time. 

Barbara: What was your dissertation on? 

Eric: On how boundaries were defined between orthodox and unorthodox medicines. How it was that different people who were involved in that process tried to distinguish between one and the other, and the techniques that they used, the people who were engaged in that effort. I was focused mainly on the early 20th Century, but I was focused on that early period in large part because it really became clear early on that that’s when these boundaries that lasted for much of the 20th Century were initially carved out.

Barbara: These boundaries and what we’re talking about is the difference between two terms – orthodox and unorthodox medicine. Frankly, Eric, there are so many terms to describe both sides.

Eric: Sure [laughs].

Barbara: That it’s almost like rules in football, because it’s all about name-calling, too, gain power and dominance. So, you have the traditional medical doctors or profession. They’re called by their opposition, allopathic medicine. That was coined by the homeopathic physicians in the 19th Century?

Eric: Mm-hmm.

Barbara: They were called conventional medicine, biomedicine –

Eric: Regulars [laughs]. 

Barbara: Regulars, oh [laughs]. I’m a regular physician. Well, I’m guess I’m not a regular physician. Were there any other names?

Eric: Regular was the term that was used to identify one in the 19th Century was referred to as the mainstream “sect” of medicine.

Barbara: Let’s look at the other side, unconventional, sectarian, which you referred to the term sect, which has a religious connotation – I find that really interesting – irregulars, and the alternative, which would be a later term. 

Eric: Yes.

Barbara: When was alternative term coined?

Eric: ’60s and ’70s. But in the early 20th Century the most widely used term from a critical perspective was to refer to these groups as cults; so they were medical cults.

Barbara: This is probably why I looked at your book at first with this distrust, I think, initially because that word was such a loaded term. I grew up in a family that introduced me to that term, because my mother was a family physician and an acupuncturist; so, I think she was getting some of that from some of the mainstream establishments at the time. I think that’s why I knew more about it. With my history, I had to get over and read the dust cover.

Eric: [Laughs] 

Barbara: I didn’t see a lot in the book, at least I think because Chinese medicine didn’t really make a big splash at that time in our history of medicine in the United States. Were you coming across anything about Chinese medicine at that time period that you were writing about?

Eric: No. I really don’t think it registers until the 1970s, maybe the 1960s when you look at the list of what’s referred to in the teens and twenties and thirties as sectarian medicine. I don’t know if Chinese medicine is listed as a medical sect or not.

Barbara: It wasn’t. I wanted to ask you a question about sectarian medicines. The word “sect” refers to a separate group from a religious group. So, it has a religious connotation. I found that really interesting and a lot of terminology that I saw by these orthodox practitioners was that it was doctrine. That if you were going against doctrine, therefore, you were a sect or a cult.

Eric: Mm-hmm.

Barbara: Isn’t that interesting? When they’re really trying to tout science as the reason for them being right, and yet it seems religious? That’s another thing that comes up. I hear this from colleagues, the provider will actually ask the question, “You really believe in acupuncture?”

Eric: Mm-hmm. 

Barbara: So, there is that religious connotation comes back. I’m really confused by that. Why do you think they called it sectarian?

Eric: I think there was an effort to define what was legitimate and what was illegitimate. Using those terms likely resonated with people in a way that transcended medicine, that didn’t sound like something that was created or fabricated by the medical profession, but instead was something that they could really understand. I think it also, in a lot of ways, was borrowing on language that conveyed to the practitioners of mainstream medicine what was really at stake for them beyond professional competition or professionalization. Using the term “medical cults” was inherently a way to delegitimize something on its face. There was no room for dialogue or conversation or understanding. It was a way of labelling something like labelling as quackery that delegitimized it before that conversation could even start.

Barbara: Even just in Medscape, it’s for doctors, but there’s an author writing from Yale saying, “Is acupuncture a sham?” This is in 2022. It keeps coming back over and over and over again. I don’t understand how the boundaries with these medical models, why aren’t our future doctors, for example, studying other kinds of medicine? How can we penetrate those boundaries and blur them a bit so that we can extrapolate the good from all of these models?

Eric: That was really the intent ultimately of the work that was done and continues to be done at NIH. You can see that intent just in looking at the change in the language over time. The first office that was created at NIH to study unconventional, non-mainstream medical practices was referred to as the Office for the Study of Unconventional Medical Practices. 

Barbara: What year was that [laughs]?

Eric: That was 1991, I think –

Barbara: Oh my God. 

Eric: – was created. So –

Barbara: I’m still in shock, because they called it that in the early ’90s, and that was 20 years after James Reston wrote about acupuncture.

Eric: In their defense, that name didn’t last long. I think within a year they changed it to the Office of Alternative Medicine. But when they changed the name of the Office of Alternative Medicine, it became the National Center for Complementary and Alternative Medicine. I think that was evidence of effort to push beyond this idea that all of these things had to be alternatives, that they were complementary. I think the more recent incarnation to make it – 

Barbara: The NCCIH, the National Center for Complementary and Integrative Health.

Eric: Health, yes. In that name change you have, again, a third iteration there. So we’re going from unconventional to alternative to complementary to integrative. I think even the shift in dropping medicine and making it about health in some ways is also an opening-up of sorts. But if you look at what is being studied now versus what was being studied then, in some ways fewer modalities are being studied now than were being studied back in the 1990s. Because the NIH has made a conscious decision to narrow its mission in a way that is less controversial [laughs], is more operating within the bounds of acceptability. 

Barbara: Well, for example, Qigong is something that I’ve given talks on the research that has been conducted. Even acupuncture – the concept of sham acupuncture – it’s ridiculous?

Eric: [Laughs] 

Barbara: The idea of sham is where they are pretending to place needles, but it’s not needles. Instead, I think it’s the wrong points or – It’s ridiculous, because part of healing is also about placebo effect and also if the intention is there, something is happening. The Qigong research is quite interesting. We still have a ways to go. For example, there are some studies I found here in the States where it’s either too small of a study, too much heterogeneity, their control is not appropriate, so they’re not conducting really good quality studies here. But they’re happening. You’re saying now going back to the NCCIH that they’re trying to cover themselves by focusing on what’s less controversial?

Eric: Well, in limiting yourself to only studying modalities that are amenable to a double-blind clinical experiment, there are certain things that just aren’t amendable to that. There is no good blind in those studies. If you’re fabricating it, coming up for the purpose of testing the efficacy of a modality, you’re doomed before you even begin.

Barbara: Are we even in the early stages of having conversations about offering more than one way of studying something? With evidence-based medicine, we’re pretty restricted and also with the scientific studies in the Western world, we have ways of studying things, honing in rather than this broad circular inter-dependent understanding of things that’s problematic with Eastern medical model. I agree, that’s why people scratch their heads and – I’ll just say this, you give me hope with just even discussing [laughs] –

Eric: [Laughs] 

Barbara: – the fact that they’ve changed the name from something quite frightening to something that’s much more resonant with what’s happening now and what’s possible. What got you so interested in alternative medicine? Why did you keep going back to that topic? 

Eric: That’s a good question. The funny thing is like I tell people I’ve always thought of myself as a little bit of a medical agnostic. I believe in something, but I don’t really believe in anything. So [laughs] I think I’ve always been fascinated by how it is that there are such diverse approaches to such a fundamental thing as health and medicine and how you approach that on kind of a broad level. Also, I’m always fascinated by the way that people’s world views unavoidably, in ways that people don’t really understand, end up shaping their approach to medicine and how they think about medicine.

On a personal level, one of the things that was really at the root of my interest in the subject as a whole is my mother had cancer when I was a child. I think she was first diagnosed when I was six or seven, had breast cancer and had a mastectomy and was in remission for a while. Then the cancer came back and metastasized and she ended up passing away when I was 11. So, I have a lot of memories of what it was like to go through that for her and for me as a child. I have these crazy memories, like this memory of us going down to Mexico with my aunt, because they were going to try to get her some drugs that she couldn’t get in the US, and that was the only way she could get them. 

Barbara: That must’ve been really hard. Cancer is one of the big illnesses that really brings up a lot of, I would say, desperation in a lot of people because of what we have that’s offered and mainstream.

Eric: I remember very vividly the suffering she went through and how awful that experience was with her, for her. When I started learning about the fact that there were all these different approaches to diseases like cancer that weren’t so biomedically inclined, I was really interested in that. But I was also interested in how it was possible that there could’ve been all of these different ideas and approaches to health and medicine, and yet a lot of those options just aren’t available to people, especially through the mainstream medical system that most people are a part of. When I first interested in this subject, it was almost impossible to see anybody outside of an MD or a DO if you wanted medical treatment. Probably the exception was if you went to see a chiropractor. That experience is at the root of my fascination with the subject as a whole. 

Barbara: Where did you grow up? 

Eric: In California. 

Barbara: California was actually a place where you would have more access than some states – 

Eric: Sure. 

Barbara: – at that time, and even then was limited. When was your mom sick? Do you remember the years?

Eric: In the late ’70s and early ’80s.

Barbara: So even at that time there were only three things that you could – Well, four. One was either radiation, surgery, medication, or nothing.

Eric: Right. [Laughs] 

Barbara: Right, but that left a huge field for people to explore in cancer and arthritis and some other chronic devastating or terminal conditions were really forcing people to look elsewhere. That’s why I’m wondering about the system how they’ve come to define these boundaries between orthodox and unorthodox medicine.

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Why do you think it’s been so difficult to create a system where it can be and and both rather than either or? 

Eric: I think it’s in large part because there is this very long history of contentious relationships between different medical groups. In my research back to the early 19th Century has always been around to some extent, and that’s partly because beliefs that define medical systems are inherently tied to deeper or broader ideological positions or ideologies. In the early part of the 19th Century the group of people who would think of themselves as medical professionals had used a variety of tools to sort of carve out the medical profession in opposition to what medical offerings were out there that weren’t part of that group. They used medical licensing as a big part of it and educational requirements and things like that.

But in the 1820s there was this huge backlash against those restrictions. The medical field really opened up in a way that it hadn’t been open previously for a number of decades. The result was that a number of new medical groups came to the fore and they defined themselves in opposition to the existing medical profession. They were very critical of medical doctors and the way that they approached their medical practice. That relationship was inherently contentious from the beginning. 

Barbara: What was it that they were fighting against? What was the doctrine in the 1820s and ’30s that caused such a movement to take shape? 

Eric: Well, the main prevailing approach to medicine at the time was referred to as the heroic approach. Heroic medicine was medicine that was designed to elicit a strong, measurable physiological response. That physiological response was evidence of the effectiveness of that therapy. If you were a medical doctor, in order to treat somebody you had elicit a response in your treatment that was designed to counter the symptoms that the patient was experiencing. That was the whole idea, for example, behind bloodletting, which had been around for centuries. When you open up someone’s vein and the blood starts pumping out or leaking out, there’s a physiological response, and that was evidence that it was having an effect on the disease or the condition that the person was experiencing.

There were a whole wide range of very dramatic treatments at the time. Bloodletting was just one of them. There were various pills or substances or concoctions that were designed to make you vomit profusely or sweat profusely or evacuate your body of whatever it was that was causing your illness in other ways [laughs]. I won’t get into that. 

Barbara: Every humor known to man.

Eric: Yes, exactly. So, that response was seen as inherently problematic by these new groups, and so they developed new approaches that had much milder therapies and really reconceived what illness was in some ways. So, as a result, these new groups who were referred to predominantly as medical sects at the time, defined themselves in opposition to the mainstream regulars. The regulars were also then extremely antagonistic of what they saw as inherently their opposition. 

Barbara: So, who were the new kids on the block in the 19th Century, in the early 19th Century?

Eric: In the early 19th Century you have Thompsonianism, Eclectics, Osteopaths. Homeopaths come around a little bit later. They’re part of that same continuum of new medical sects in the 1800s..

Barbara: What’s Thompsonianism?

Eric: Thompsonianism was essentially what we would think of as herbalism today, using natural substances, predominantly herbs, to treat people, and again in a way that was designed to respond to the symptoms that there were experiencing.

Barbara: When did we see this shift of it’s OK to take care of yourself to you don’t know how to take care of yourself? It seems like that’s been more and more established as a boundary in the 20th Century. Was that so in the 19th Century?

Eric: There has never been a time in which there was any sort of unanimous position from the mainstream medical profession that self-care was a bad thing, or it was something that should be avoided at all costs, or that you could only be treated for a medical condition by a doctor. It’s never been that rigid, but I think there have been trends over time that reflected in many ways the place of the profession more broadly. So in times in which the profession as a whole felt more threatened, I think often times the response was to promote increased reliance on the doctor as the authority, in part because that included an implicit message that you should not necessarily just not be treating yourself or diagnosing yourself or making those decisions as an individual, but also you shouldn’t be seeking them from other people or other places outside the profession.

Barbara: That brings us to the formation of a medical association called the AMA.

Eric: Mm-hmm.

Barbara: The American Medical Association. That was established in – Was it 1847?

Eric: Yes. Late 1840s, yes.

Barbara: That was around the time that other sectarian –

Eric: Yes.

Barbara: – medical groups emerged. Was that to protect their authority and their prominence?

Eric: It was very much an effort to sort of recapture professional identity, and also create an organization that could work on behalf of mainstream medical doctors. So, it could do things for the group as a whole for the profession that individual doctors just weren’t capable of doing.

The AMA saw its role as being an advocate, not just for the profession, but creating clear standards, creating a code of ethics, creating clearly-defined educational requirements that doctors should meet, standards of practice that would benefit not just members of the profession, but people as a whole.

Barbara: To be fair, at the time there were also these diploma mills that people could pay a certain amount of money and get a diploma for absolutely no training.

Eric: In a number of the other medical sects at the time followed that model themselves. Homeopaths, eclectics, osteopaths, much later all followed that same model that was established by the American Medical Profession and they created their own organizations, their own publications, their own standards, their own code of ethics, for example. It was followed by others, too. 

Barbara: There’s certainly nothing wrong with standardizing things that creates safety for the public. At the same time it can also cast a wide net on what’s acceptable and what’s not acceptable. What would you say was AMA’s, or American Medical Association’s, role in controlling healthcare fraud or quackery?

Eric: Well, really, they began that effort in the early 1900s, coming on the heels of what was a broader effort advertising the banner of what they called “therapeutic reform” at the time. One of the ways in which the medical profession had kind of failed to deliver the most really was in the development of new innovative, effective medical therapies. While, at the time, there had been some pretty major advances in the medical sciences in the late 1800s and early 1900s in particular, not a lot had been done in terms of delivering new medical therapies. But, at the same time, a lot of other medical therapies that existed and were developed outside of the mainstream medical profession were proliferating. So, there was an effort to try to figure out how to set standards for medical treatments.

One of the offshoot efforts related to that was creating an organization that would tell people through a variety of different channels, educational channels, using a variety of different techniques, which medicines were effective and which weren’t. 

Barbara: There were a lot of medicines out there. I think it was before the Pure Food and Drugs Act of 1906, a lot of these medicines could be acquired by the public without a prescription. 

Eric: Yes.

Barbara: Then there was another act in 1938 that made it more difficult? 

Eric: Yeah. The Federal Food, Drug and Cosmetic Act in 1938, went a little bit further than what the Pure Food and Drug Act of 1906 did.

Barbara: How did those acts change the way medicines were vetted?

Eric: Well, the idea behind the Pure Food and Drugs Act of 1906 was to make drugs that were advertised directly to consumers safer. It was designed to protect consumers from deceptive practices and secrecy used in that advertising by prohibiting false and misleading labelling and packaging. The act included two main provisions. The first was that the presence or the amount of 11 drugs that were determined by the medical professionals at the time to be habit-forming drugs, had to be listed on the label of the bottle or the package.

Then secondly, most importantly, the Pure Food and Drugs Act made it illegal to include a false or misleading statement anywhere on the labelling or the packaging for a drug.

As you can imagine, there were limits to the effectiveness of that approach. It was limited in reach, the interpretation of what was deceptive and what was misleading was also up for interpretation. It was very difficult to enforce. While it did result in the successful prosecution of a lot of drug manufacturers or drug purveyors that violated the law, it did very little to address the issue of whether drugs were safe and whether they did what they claimed to do.

So it wasn’t until the Food, Drug and Cosmetic Act of 1938 that drug labels had to list all of their active ingredients, that they had to provide directions of use, for example, and they also to include warnings against dangerous uses. But it’s not until the 1960s that the safety and effectiveness of a drug had to be demonstrated before it was sold to the public. Until that time, there was no way to know whether a drug was safe or effective, because there wasn’t an official approval mechanism.

Barbara: In 1906 they passed this act, and it’s not until 1938 that it gets teeth for enforcing or regulating. In that time, you mentioned there were some habit-forming drugs in 1906. What were some examples? Just because I don’t know if people realize how far back some of these drugs go. Was it heroin, cocaine?

Eric: Yeah. What we would think of now predominantly as controlled substances [laughs].

Barbara: Now it would be illegal, right?

Eric: Yes.

Barbara: But at that time there were in products. They were even in commercial products even before then. So that was a landmark act for that to occur. Sometimes these acts pass more easily when there’s some kind of great tragedy that’s brought to the surface. There were many children that died from the use, I think it was the elixir sulphanilamide, that it was actually lethal. They were being dispensed by physicians. They were also, I think, accessible to the public without a prescription.

According to Dr. Boyle’s research, the Massengill Company of Bristol, Tennessee, they started selling this drug in the summer of 1937. That was the sulphanilamide. That’s an antibiotic that at the time was used to treat strep throat, for example, or other types of infections. It was only available in tablet or powder form and doctors and patients were expressing an interest to have something that was easier to tolerate. So, the company decided that it needed to repackage this in liquid form in order to corner the market. You need something that’s called a solvent or diluent. That’s what makes it possible to help it dissolve into a liquid without it settling down at the bottom of the bottle.

This company, their chief chemist used a solvent called diethylene glycol. That’s one of the main ingredients in antifreeze. It’s sweet-tasting and it’s extremely toxic. This is why over 100 people died when it was first packaged and distributed to the public and to doctors. There was no law that was requiring a listing of the solvent on the label. Over 100 people dying from just drinking even a teaspoon of this solvent, because one milliliter per kilogram weight of a person could kill them. Mostly children died in this case, and that’s what helped pass the law in 1938.

In this combating quackery what I found interesting is that as the AMA and all these other agencies are trying to fight against it, meanwhile the drug industries are growing.

Eric: Yeah.

Barbara: Who’s doing the testing of the drugs at this point?

Eric: The FDA is testing drugs and there’s a process that drugs have to go through before they come to the market. But it’s not until 1962 that you have to demonstrate both the safety and effectiveness of a drug through studies that are done that you submit as part of the approval process with drugs that are sold directly to the public.

Barbara: The AMA had a clinical laboratory department that could test things, but it was very limited on what they could do because they didn’t have the equipment to do that, nor did they have probably the staffing to accomplish meeting the goals of addressing all the drugs that came through.

Eric: Or really the methods to establish whether a drug was effective or not. We don’t really get those standards established by the medical profession until decades after the Council of Pharmacy was created by the AMA in the early 1900s. For drugs that doctors dispense, you had to have a prescription for prior to that. Most of those drugs were sort of grandfathered in by long-term use, and so they didn’t undergo an approval process. In many cases, they were just standardized treatments that all doctors use and have used for decades.

Barbara: The doctors, they go through training, and I’m talking about the mainstream doctors. They go through training, but we have a lot of drugs right now [laughs].

Eric: [Laughs]

Barbara: So, there are pharmacists who go to school to understand the drugs. There are drug companies that, of course, have their agenda to sell the drugs. The doctors have to look these up constantly for interactions. How on earth are we supposed to expect them to keep up with that? 

Eric: I don’t know, that’s a –

Barbara: I don’t either. The AMA formed their own department called – I think it was initially called the Propaganda Department in 1907. So, it was just a year after that act. They grew in influence until the 1970s. They were aligning with other agencies like the FDA, the Food and Drug Administration, the Federal Trade Commission, and the Post Office, medical boards. Why did they make so much of an effort to try to combat health fraud?

Eric: Well, from the AMA’s perspective, all the regulatory mechanisms that were used to keep quackery at bay were ineffective. They didn’t do what they intended to do, and that’s largely because they were limited in scope or they were limited in their effectiveness in terms of enforcement. What they saw as their duty was to be more specific in their advocacy or in their work to educate the public. They saw their role as establishing a clearing house of information on not just quack therapies, but quack practitioners and quack institutions. This benefited the profession in a number of different ways as well.

It eliminated some of the competition in the medical marketplace, because it exposed the dangers of so-called medicine peddlers and other advocates of what the AMA referred to as either quackery or pseudo medicine. But it also inherently, from the perspective of the AMA, legitimized them as a professional organization. The work that they did was purely on behalf of the public. They were doing it to protect people. They didn’t have to do this. This took a lot of time and effort. They sold the work that they were doing as altruistic. As a result that paid its own dividends.

Then as you referred to in the question, this effort also was an opportunity for the AMA to create a lot of working relationships with like-minded organizations and groups in and outside of the government. This group of actors that were involved facilitated the work that the AMA did throughout that time period.

Barbara: The idea that they went to such great lengths with the Propaganda Department, the AMA to educate the public. What I think they may have inadvertently done is created a passive culture. You can’t rely on your own senses to make good decisions. You have to take what we say.

Eric: That was at the heart of the whole approach to the Propaganda Department or Bureau of Investigation, was the idea that the ordinary person was not capable of making that determination and distinction. Because people had been doing that for so long, it was really their goal to communicate to people that they could not make that decision. That the decision was to be made by their doctor and it was to be made by the medical profession. There was no room for making decisions on your own, like you said. The decision was made by an organization that claimed the authority to make that decision and there wasn’t any room for negotiation. There wasn’t room for dialogue. That’s clear in the techniques that they used and the approaches that they used and all the materials that were disseminated to the public. You can see some of the posters that they toured around the country, for example. Everything was framed as education; was arguably indoctrination that they were [laughs] after. 

Barbara: And manipulation.

Eric: Yes.

Barbara: Quite biased. Why were they so – and I say “they” meaning the medical profession, those who wanted to hold on to power. Do you think there was a time where it was accepted by social and political spheres that people could take care of themselves? If so, when did that change? 

Eric: I think that sense has always been there on some level. I think what has changed is where the boundaries of decision-making are possible from the perspective of the medical profession. There’s always been this idea that freedom of choice is an inherently good part of the so-called medical marketplace. Where the line was crossed, I think, increasingly in the 20th Century was at these points in which an argument was being made that having access to this drug or this patent medicine or this alternative medical approach was inherently dangerous. It was increasingly framed as an issue of safety.

On the one hand, there was this idea that certain things like chiropractic adjustments were a threat to people’s lives because a chiropractor would snap your neck and you would die. There were those very real immediate threats. Or you would take a patent medicine and it would be laced with something and because no one really knew what was in them and you would die.

Barbara: Just to explain to the audience, patent medicine is something that is like a proprietary medicine. Ingredients are secret. The patent medicine to distinguish between proprietary was medicine that was sold to the public, not through the doctor.

Eric: Right, exactly. In the early 20th Century, there was really this popular idea that medicine should not be sold directly to the public. All medicine should be provided through doctors. That was part of the political push behind the Pure Food and Drugs Act of 1906. But in the aftermath of that, it became increasingly clear, I think, to people that trying to eliminate the market for consumer products was a fool’s errand. It wasn’t going to happen.

The decision was made instead to focus on issues of safety. As long as things were proven to be safe, then they had a path to legitimacy. As long as you were transparent with the contents, there was a path to legitimacy. Even with those permissive approaches, there was also under the banner of the promotion of this idea of scientific medicine, increasingly an effort to establish the efficacy of drugs as well. It wasn’t enough just to be safe. It wasn’t enough just to be transparent. You also had to show that the drug had its intended effect. In a lot of cases that was – because the rules were made by the medical profession, there wasn’t really a way in many cases to meet the standards that they set unless you were a drug manufacturer. 

Barbara: I just have to put a shout-out to the first leader of the Propaganda Department of the AMA, Arthur J. Cramp; is that correct?

Eric: Yes. [Laughs]

Barbara: I love that name [laughs].

Eric: Great name.

Barbara: But he really worked hard. He believed in what he did.

Eric: Yes.

Barbara: He sincerely believed he was doing good. So, one of the things that was interesting is that he was answering somebody to say why would we not consider naturopathic medicine, for example. Then he said the content would not be complementary. That really stuck out with me because this is, of course, said in the 1920s or or 1930s. There is this culture in our medicine, like you said, we infuse other parts of our life into medicine without knowing it. The idea that we live in this either-or culture. That you can either have traditional medicine, or you can have chiropractic or you can have naturopathic, and so forth. Why can’t we have both? It’s just a very different philosophy. It’s almost like, well, I’m in competition with you.

That’s what I’m hoping that we can change that mind-set that we should all have access to these things, but from a more integrated sphere. There were some vicious attacks against chiropractic and naturopathic schools, and osteopathic interestingly enough. I wasn’t aware of that. If you fast forward decades later, by the time we’re in the early 1970s, then we start to see some push-back and a backlash against institutions in general. We have Vietnam, Watergate, systems that are exposed for corruption, and then there was an informant for Watergate. His name was Deep Throat and that was after a pornographic film in the 1970s?

Eric: Mm-hmm.

Barbara: What I loved about [laughs] your book is that the AMA had a similar scandal with an informant from the AMA, and what was his nickname?

Eric: He was known as Sore Throat.

Barbara: Nice. 

Eric: Yes [laughs].

Barbara: [Laughs] So, what did Sore Throat expose? This was a doctor who worked for the AMA, I think, for 10 years?

Eric: Yes. So, it was anonymous, unidentified source who claimed to be a doctor who worked in the Chicago offices of the AMA for 10 years and initially began to release a number of documents to the media. These documents collectively exposed a lot of the dirty laundry of the AMA at the time, and were designed to show that the AMA was hoodwinking people.

Barbara: Eric Boyle in his book writes about an informant who claimed to be a doctor who disclosed or leaked all this information to expose the antitrust behavior of the American Medical Association. But it gets even more interesting because there are articles now that are pointing to possibly that informant being more than one informant. In AMA’s quest to squash quacks over the 20th Century, one of the groups that they targeted in the early ’40s, ’50s, ’60s, was Scientology.

That’s right. I’m not just saying the word “pornography” in this episode. We’re talking about Scientology as well, and there are allegations that Sore Throat was actually a scientologist or a group of scientologists who may have infiltrated the AMA in order to undermine AMA’s efforts to discredit scientologists. I wonder, do you think it was one doctor who worked there for 10 years who leaked all the documents? Or do you think it was much more organized? That’s all I’m going to say about it. What this does is this leaves now more mystery and more discussion in the future. But wow! I had no idea. When I approached Eric with this after our interview, he also is very intrigued by this. I wonder if it’s going to show up in another book.

Eric: One of the documents, for example, revealed how the AMA, which had asserted very vocally its independence from the pharmaceutical industry, in fact, had representatives of drug companies in its private policy-making discussions. They were working very closely with pharmaceutical companies and despite asserting their independence.

In a series of articles that came out that cited Sore Throat as the source, a lot of this work that the AMA was doing that was part of this propaganda for reform dating back to the early 1900s was also exposed. In particular, that included a number of documents that outlined how the AMA had conducted a decades-long campaign against the chiropractic profession in particular. The documents that came out showed that the AMA really was trying to eliminate the chiropractic profession using a variety of different techniques that constituted harassment. They tried to delicense chiropractors. They tried to organize boycotts of chiropractic services. This all culminated in the 1980s with what was referred to at the time by chiropractors as the “case of the century.” Again, all originated out of these documents that came from Sore Throat.

In 1987 after a protracted court battle, the AMA was essentially found guilty of a conspiracy against chiropractors. District court found them to be in violation of federal antitrust laws, a huge source of embarrassment –

Barbara: Wow!

Eric: – as you can imagine.

Barbara: That is an enormous source of embarrassment. That would explain why the AMA suddenly lost its influence.

Eric: That wasn’t the only scandal that the AMA faced [laughs] in the 1970s as well.

Barbara: Oh, please tell me more [laughs]. What else happened?

Eric: This is all, again, early 1970s. There was a lawsuit filed by both the US Postal Service and the Internal Revenue Service for underpaying its bills. The Federal Trade Commission filed its own complaint against the AMA alleging that it had restrained competition among medical doctors by preventing members of the AMA to advertise the types of services that they provided to the public. There were a whole series of scandals and problems that they faced at the time.

Barbara: Why is it that I have to find your book in the stacks of piles to discover these things [laughs]? This is why I’m sharing this with all of you right now, to the audience, because this is important. Your book should be required reading for every medical student.

Eric: Thank you [laughs].

Barbara: Yes. I’m going to actually make that a mission of mine. If we don’t look back at history, we’re doomed to repeat it over and over again, and to understand why we use certain language. Physicians use the word “allopath” without even understanding that it’s a derogatory term.

Eric: Sure.

Barbara: Alternative medicine is thrown around without a really clear understanding. These boundaries, people switch sides all the time. Some modalities that are fringe becomemainstream. Did you come across in the ’90s how that was different, because AMA stopped, but who took over?

Eric: It was essentially privatized. There was a group that was created call Quack Watch that made a website and –

Barbara: I’ve seen that website.

Eric: I think it closed down a while ago, which maybe also is a reason to have hope, I don’t know [laughs].

Barbara: I hope so, too [laughs].

Eric: But, yes, essentially the work that was being done by the AMA was continued by private doctors who took up the mantle and made it a cause of their own. In many ways it represented a sort of modernization of approaches that had been used before, but essentially the same basic techniques. It was rooted in the same ideas. What was the strongest piece of evidence for the failure of the approach was that what was happening in the 1990s was the same thing that was happening in the early 1900s, and that was this idea that if only people knew better, if only we could educate them, only they had the evidence they would be convinced. I think in some ways it was evidence of an inability to understand that the reason that people have been using a lot of these approaches for not just centuries, but in many cases millennia, is because they work for them [laughs] you know?

Barbara: Exactly.

Eric: So, there was this inherent idea in Quack Watch and the work done by Cramp that there was no question about whether or not these things worked. They did not work and people just needed to understand that they didn’t work. Once that they understood that they didn’t work, they would just go away.

Barbara: Well, gosh, it’s no wonder that people don’t listen to doctors now –

Eric: Right [laughs].

Barbara: – right? They say, “Oh, you need to get vaccinated.” “Oh, no. I’m not listening to you. Look at what you did to my mom,” or “Look at what happened to me when I got healthcare.”

Eric: Yes. “You told me this would not work for me, and it does.”

Barbara: Or the opposite, “I went to get the care, I listened to the doctor, I did everything they told me. I got radiation treatment.” I’m not speaking for myself, I’m giving an example.

Eric: Right.

Barbara: “Surgery, radiation treatment and still didn’t get better or got worse.”

Eric: Sure.

Barbara: That’s not every case, but when people go and they dogmatically believe in something and you crush their spirit, they’re going to look for other things.

Eric: Sure. Yeah.

Barbara: That’s one of the reasons why as much as I love clinical medicine and I love practicing clinical medicine, my heart really goes out to teaching people, not just educating them on what’s good for them/not good for them, but how to make the decision of what is good for them. How to determine if something is valid or not. Not to say this is valid, take it from my word. There are people that are very motivated and they will look for things even if the doctor says not to.

Eric: That was the big shock to everybody in the early 1990s when the first nationwide studies of the use of what was, I think, predominantly called alternative medicine at the time came out. It showed that people were spending as much out of pocket for alternative medicine as they were paying for out of pocket for hospitalizations. They were going to visit alternative practitioners, I think, in 1991 it was something like 450 million visits that year. There was ample evidence that people were using these approaches in incredibly high numbers. The thing that was also, I think, really significant about those early studies was it showed that the majority of the people who were using those alternative modalities were not even talking to their doctors about them. So, they were using them in tandem with going to see their regular doctor. They’d go to their doctor’s visits, they’d get the prescribed treatments or drugs. But on the side they were also [laughs] doing other things, and their doctor in many cases was never the wiser for it.

Barbara: That’s hopefully changing, but even now someone told me last week that they don’t tell their doctor a lot about the acupuncture that they receive, because they get ridiculed or they get asked the question, “Do you really believe in that stuff?”

Eric: Mm-hmm, yes. 

Barbara: They will be silent about it. It’s better, though.

Eric, Thank you so much for being on the show. I want to encourage people to read your book, and if not, to read more about this history. It’s so fascinating. There’s more room for conversation on what’s happening today and explaining why we have the system we have now in order to make changes in the future. Thanks for being on the show today.

Eric: Well, thank you so much for having me. It’s been great talking to you. It’s a great pleasure to be here talking about my research.

Barbara: History is really interesting and the more you know about it, the better. What does this have to do with your health? Everything. This whole discovery of the anti-quackery movement really lends a rich perspective on why we are where we are today, especially coming out of the pandemic with such polarity, and many people feeling angry about either wearing masks or not wearing masks, getting vaccines or not getting vaccines. If you understand the cultural context of our country and our nation, it makes sense and we can have more conversations rather than blame, shame, get angry. It’s really time to sit down at the table and have a conversation so we can understand where we’re coming from. We have very deep roots here. When you understand history, you’re able to understand people better.

I’d love to hear from you. Please send me your comments, questions, or suggestions for future topics and guests you’d like to have on the show. You can find the contact form under the podcast tab at the website, ThirdOpinionMD.org. Third Opinion MD podcast is produced by me, Barbara de la Torre. Music is licensed through AudioJungle. Any comments made by the host or guest on Third Opinion MD reflect opinions about healthcare and self-care. Please consult with your own physician for any medical issues that you may be having.

Thank you for listening.

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