Quackery, fraud, and irresponsible practice

There is no clear definition of "quackery". Stephen Barrett, founder of Quackwatch, discusses the slippery nature of the definition and the issues of intent and competence. Defining quackery of necessity involves some subjective judgment, but there are objective parameters we can apply. If someone is hyping a medical practice without adequate scientific evidence and is profiting from it, they are a quack.

Quackery differs from "fraud", which is a legal concept. In my state health care fraud is defined as:

Intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

Additionally, "abuse" is defined as:

Provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program

What's harder to nail down is exactly what practices short of fraud and abuse can lead to disciplinary action. As Brother Orac has pointed out, state medical boards, which are responsible for physician discipline, are problematic institutions, usually willing to give doctors the "benefit of the doubt" when it comes to defining "professionally recognized standards."

So what to make of doctors who promote, for whatever reason, patently false health information and practices?

Commonly, doctors who promote unscientific health practices and ideas inhabit an ambiguous universe. Most health professionals see them as quacks, but their own patients/victims often see them as saviors. The fact that they may be revered does not, of course, make them right, but it is important. Anecdotes from satisfied marks are very powerful, often more powerful than expert knowledge. This can lead to a "credibility feedback loop", where satisfied customers give anecdotes, which are confirmed by pseudo-experts, who are further lauded by laypeople, adding to their pseudo-credibility.

This is the quality of expert seen at the Medical Voices Vaccine Information Center. This new organization, with its slick website and massive appeal to authority is a collection of the nations most famous anti-vaccine cranks. Their qualifications come not from their work in infectious disease, immunology, or epidemiology, but in fear-mongering and paranoia. Each of the claims on the front page of their site is either patently false or gravely deceptive.

For example, their first bullet point claims:

Real doctors: Medical doctors speak the truth about vaccines. Medical doctors convey the results of thousands of hours of study

This implies that all other doctors convey untruth about vaccines. And this "thousands of hours of study" is meaningless. What kind of study? Does a few hours of reading by a small group of cranks trump centuries of bench and clinical research? The answer is clear in the next bullet point:

Real scoop: Vaccines have eradicated nothing, ever. Learn the truth about the decline of "vaccine preventable" disease.

The absurdity of this claim is overwhelmed only by its audacity. Vaccines have never eradicated a disease? Smallpox is the best example of complete eradication, but local control or eradication of infectious diseases has been accomplished over and over, with diseases such as polio, measles, mumps, Haemophilus influenzae type b (Hib), and many others. How do they counter such well-grounded facts? It's not by science:

Vaccination does not equal immunization. Lifetime immunity is only conferred by natural exposure.

This is either a horrible misunderstanding or a lie. Different vaccines confer immunity for different amounts of time. The pertussis vaccine, for example, protects small children, those most vulnerable to the effects of the disease. Boosters can protect adults. The alternative, as they imply, is to become vaccinated naturally by contracting the disease. If the disease were the common cold, great, no problem. For pertussis or Hib, this can mean severe debility or death, just to satisfy some cranks ungrounded beliefs.

Independent of whether this new organization should be labeled "quackery" or "fraud", it's a danger to public health. It's a self-serving, quasi-religious front for disease promotion, akin to Scientology, or to Nemenhah, the cult behind the death of a young diabetic girl in Wisconsin. The tell is their claim that "natural infection" is required for "real" immunity. These people want your children to become ill and possibly die. That is unforgivable.