The publisher recently sent me a review copy of Quackery: The 20 Million Dollar Duck, by Tony Robertson. My first thought was “Do we really need another book on this subject? Don’t I know all this stuff already?” I was very pleasantly surprised. Robertson has ferreted out an impressive array of facts and details that I wasn’t aware of; and yes, we need as many good books on the subject as we can get. Each author has a somewhat different approach that may appeal to a different audience. Robertson’s book is a worthy addition to the canon. He is a retired gynecologist who practiced, taught, and still lives in Zimbabwe. He is a critical thinker who understands and promotes science-based medicine, and he brings a unique perspective, especially on subjects related to his specialty. The book is not just about charlatans, it’s about non-science-based practices wherever they are found, including in mainstream medicine and in Robertson’s own field of obstetrics and gynecology.
I expected to like the book after I read the Dedication “To those who appreciate the truth fairy rather than the toothed one” and the Acknowledgements: “To my teachers and mentors who encouraged me to think, always to question and only to accept where there is good evidence.” That could serve as a motto for all skeptics, scientists, and critical thinkers to live by: Think, question, and only accept where there is good evidence.
And I knew I was going to like it when I saw that he had written a whole section on “Tooth Fairy Science,” credited me with coining the term, and quoted me – even though he carelessly gave me credit for quotations that weren’t actually mine but were the words of Robert Carroll in his article on Tooth Fairy Science in The Skeptic’s Dictionary.
He begins with a general introduction to quackery, distinguishing the quack from the physician by their predominant motivation. Quacks are primarily motivated by profit; physicians are not devoid of profit motives but are primarily motivated by patient welfare. He also uses the term quackery to describe non-science-based treatments provided by those who mistakenly think they are doing what’s best for the patient but who ought to know better. He devotes chapters to various alternative medicine topics such as homeopathy, traditional Chinese medicine (TCM), food supplements and vitamins, and miracle cures. Other chapters address mainstream medicine quackery, research misconduct, pharmaceutical companies, evidence-based medicine, change, and management. He touches on a multitude of topics that we have addressed on Science-Based Medicine, including the infiltration of quackery into universities, problems with the publishing of scientific studies, bogus lab tests and electrodiagnostic machines, licensing and government regulation, the reasons people believe in bogus treatments, Edzard Ernst’s career and accomplishments, the questionable terms “alternative” and “integrative,” the waste of research funds by the National Center for Complementary and Integrative Health (NCCIH), and many, many others.
Mark Crislip has said that “In my experience” are the 3 most dangerous words in medicine. Robertson would agree; he says, “Experience is another term I have difficulty with. When a doctor tells me that he has been doing something the same way for the last twenty years I do become slightly anxious.” He might have been doing the same wrong thing for twenty years, or he might have developed a fault over time, or he might not have adopted newer, better methods as they became available.
To give you a taste of what’s in the book, here are just a few things I picked because they happened to present information that was new to me or ideas that gave me new food for thought:
He is particularly good at critiquing non-science-based practices in his own specialty. He deplores the increase in elective C-sections. A WHO consensus conference examined maternal and perinatal mortality rates and determined that a C-section rate of 10-15% was probably safest for mother and baby. I was surprised to learn that the C-section rate in China is the highest in the world at 46%, and that there are hospitals in Brazil where 100% of births are by C-section. There are doctors who schedule elective C-sections for reasons of their own profit and convenience; Robertson thinks they deserve to be called quacks.
He has an entire chapter on hormones. His analysis of the Women’s Health Initiative study on hormone replacement after menopause echoes mine but provides more details and arguments that I had not thought of. He covers “natural progesterone” and “bioidentical” hormones in depth, reaching the same conclusions I did.
In 1974, after a year with no pertussis cases, Japan discontinued pertussis immunization in response to unfounded public concerns about vaccine safety; 5 years later they had a pertussis epidemic with 13,000 cases and 41 deaths.
He covers the MMR vaccine controversy and the impact of Wakefield’s fraudulent research, and thinks Peter Medawar’s critique of an anti-evolution book is applicable: “Its author can be excused of dishonesty only on the grounds that before deceiving others he has taken great pains to deceive himself.”
He describes a published case report of a live birth after intrauterine relocation of an ectopic pregnancy; an investigation showed that the patient didn’t exist. The paper was retracted, the author was fired and lost his medical license, and the editor resigned.
A respected Norwegian oral cancer researcher admitted that he had fabricated data for 900 patients in a study published in The Lancet.
The Journal of the American Medical Association retracted the report of a “randomized, controlled trial” from China that was neither randomized nor controlled. What’s more, the research design was poor and had not been approved by an ethics committee.
Robertson repeats a joke about the three F’s in research integrity: Fabrication, Falsification, and Honesty. (There’s no “F-in” honesty.)
Supplements as quackery
His assessment of the evidence for glucosamine and chondroitin agrees with mine and adds to my concerns. When Consumer Lab tested 20 chondroitin products, 8 failed to correspond to the label and half of those contained between zero and eight percent of the amount stated on the label. And glucosamine showed a similar trend. Asda’s Healthy wholegrain bread claimed that 4 slices contained 31.3 grams of Omega 3, but tests showed it actually contained so little that you would have to eat over 11 loaves a day to get the recommended daily amount of EPA/DHA.
He points out that it is illegal to sell washing machines or television sets that do not work but it is perfectly legal to sell dietary supplements that don’t work.
Conclusion: well worth reading
I have a few nitpicks. He repeatedly mentions the American College of Obstetricians and Gynecologists. It’s actually the American Congress of Obstetricians and Gynecologists. I picked that up because I have been guilty of the same error myself. There are some typos: “lava for anxiety” instead of “kava.” (I would think lava would create anxiety rather than treat it!) And it could be better organized: there are several repetitions of the same information. But the flaws are few and the virtues are many.
You might not agree that all the subjects he covers deserve to be labeled quackery, but you can’t deny that they are problems that need to be addressed. This is an incisive, thought-provoking, well-written, thoroughly referenced book that is an important contribution to science-based medicine information and reasoning.
This article was originally published in the Science-Based Medicine Blog.