Books and Arts

Nature 451, 628-629 (7 February 2008) | doi:10.1038/451628a; Published online 6 February 2008

JAMA and the mountebank

Michael Shermer1

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A timely tale of one man's mission to stamp out medical fraudsters in 1920s America.

BOOK REVIEWEDCharlatan: America's Most Dangerous Huckster, the Man Who Pursued Him and the Age of Flimflam

by Pope Brock

Crown Publishers: 2008. 304 pp. $24.95

JAMA and the mountebank

KANSAS STATE HIST. SOC.

'Quack' John R. Brinkley and his wife at their Kansas clinic.

Human cognition has a problem — anecdotal thinking comes naturally whereas scientific thinking does not. The recent medical controversy over whether vaccinations cause autism illustrates this barrier. On the one side are scientists who have been unable to find any causal link between the symptoms of autism and the vaccine's ingredients. On the other are parents who noticed that shortly after having their children vaccinated autistic symptoms appeared.

Anecdotal associations are so powerful that they cause people to ignore contrary evidence. In the vaccination case, the imagined culprit for autism's cause is the preservative thimerosal. Yet it breaks down into ethylmercury, which is expelled from the body too quickly to have a damaging effect (plus autism continues to be diagnosed in children born after thimerosal was removed from vaccines). The story holds power despite the contrary facts.

The reason for our cognitive disconnect is that the brain evolved to be cautious. We favour anecdotes because false positives (believing there is a connection between A and B when there is not) are usually harmless, whereas false negatives (believing there is no connection between A and B when there is) may take you out of the gene pool. Our brains are 'belief engines' that seek connections.

This faith in anecdotes can make us easy to exploit. Any medical huckster promising that A will cure B has only to advertise a handful of successful testimonials. Enter John R. Brinkley, one of the most notorious medical quacks of the first half of the twentieth century, and his nemesis Morris Fishbein, the quackbusting editor of the Journal of the American Medical Association (JAMA). Their long struggle throughout the 1920s and 1930s, wonderfully retold in a gripping narrative by Pope Brock, brings to life this tension between folk and scientific medicine.

As Brock ably demonstrates, Brinkley came of age on the tail end of the freewheeling 'patent remedy' era in which con-men hawked their folk medicine out of the side of wagons:

"They usually performed at night. A platform was unfolded and torches placed at each corner as the audience gathered, drawn by handbills and word of mouth. First a fiddler or a dancer got the crowd warmed up. A short morality play followed, in which a noble head-of-house or ringleted female died pathetically for lack of a miracle tonic, identified by name. Finally the physician himself (Brinkley) shot onstage in a dinner-plate hat, cutaway coat and pious pants that buttoned up the sides, theeing and thousing, singing and selling, waving a bottle of Ayer's Cathartic Pills. Or maybe Burdock Blood Bitters or Aunt Fanny's Worm Candy. One thing was for sure, whatever it was cured whatever you had."

What many men had, Brinkley discovered as he honed his scam, was a lack of sexual vitality. He developed a surgical technique that offered the type of firm results that his male clientele so desperately sought: goat testis sewn into the patient's scrotum, which he likened to "embedding a marble in an apple". Come one, come all. And they did, to the tune of $750 per surgery, advertised widely in newspapers (more than half of all newspaper advertising at the time was for patent remedies) and on radio, the new-fangled technology that Brinkley took to like an evangelist to television.

It made him a rich man. But as his business grew he got careless, performing operations both before and after happy hour, and fobbing off work to assistants whose medical credentials were even shadier than his own (Brinkley graduated from the improbably named and then unaccredited Eclectic Medical University of Kansas City). "Dozens of patients died over the years, either in the operating room or shortly after their return home," Brock explains. "Many others were permanently maimed."

This attracted the attention of the ambitious medical writer Morris Fishbein, whose career coincided with an attempt by the American Medical Association (AMA) to stamp out charlatanism through accrediting medical colleges and licensing practitioners. Fishbein made his public mark in 1923 when the Chicago Daily News sent him to investigate the 'Hot Girl of Escanaba', a woman who suffered from a temperature of 46 °C for two weeks. Fishbein exposed her as a "hysterical malingerer" when he found a flesh-coloured hot-water bottle was used to elevate rectal thermometer readings.

"Along with making him famous as a fraudbuster extraordinaire," Brock notes, "the case fixed him in a role he would revel in for years to come: the face, the popularizer, the lord high priest of the AMA." For the next two decades Fishbein pursued the country's "most daring and dangerous" swindler, as he called Brinkley, until he finally brought him down in a decisive court room confrontation that reads like a Hollywood film script.

Stripped of his licence to practise medicine and embroiled in lawsuits, Brinkley moved to Mexico where he dispensed pseudo-medical twaddle over the airways through a 'border-blasting' radio station that could be heard all the way to Canada. When the Mexican government shut him down in 1941 — in part because of his public sympathies for the Nazis — he was a broken man. "My health is gone. I am ready for the bed and out," he wrote to his wife three days before a heart attack killed him, aged 56.

Fishbein's promotion of science-based medicine was heroic in his day. More than half a century later, medical flimflammery still flourishes on the Internet. Every medical association and journal needs a quackbusting Fishbein on its staff, for without such eternal vigilance, folk medicine will trump scientific medicine in the minds of patients.

  1. Michael Shermer is adjunct professor of economics at Claremont Graduate University, Claremont, California 91711, USA. He is publisher of Skeptic magazine (http://www.skeptic.com) and author of The Mind of the Market.