MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Having just finished reading an ‘satirical esothriller’ entitled ‘VIER FRAUEN UND EIN SCHARLATAN’ (it’s a good book but it’s in German, I’m afraid), I have been thinking more than usual about charlatans. A charlatan is defined as a person who falsely pretends to know or be something in order to deceive people. In the book, the charlatan character is deliberately exaggerated as a dishonest, immoral crook. I have met such people; in fact, I have met plenty of such people in alternative medicine. But I have to admit that, in my experience, there are other charlatans too; in particular, I am talking of ‘honest’ quacks who pretend to know while also being utterly convinced to know.

Come to think of the categories of charlatans, I think the matter is really quite simple: as far as I can see, in alternative medicine, there are essentially just two types.

THE CROOK

This type of charlatan is the one we think of first when we mention the term. He (usually it’s a male) has a range of remarkable features:

  • he is dishonest;
  • he is entirely rational;
  • he knows about evidence and has prepared all the necessary pseudo-arguments to belittle science vis a vis his followers;
  • he is only interested in himself;
  • he is immoral;
  • he wants to make money;
  • he employs all the means available to achieve his aims, including PR, advertising, branding, merchandising etc.
  • he does not believe in his ‘message’;
  • he systematically studies and exploits his target group;
  • he does not live by his own rules;
  • when he is implicated in harming a patient, he consults his lawyers;
  • he is cynical;
  • his ‘charisma’, if he has any, is well-studied and extensively rehearsed;
  • when challenged, he sues.

THE FANATCIST

This type is very different from the crook and would be deeply shocked by the crook’s behaviour and attitude. She (often it is a female) can be described as follows:

  • she is convinced to be profoundly honest;
  • she is deluded, often to the point of madness;
  • she ignores the evidence totally and argues that science is just one of several ways of knowing;
  • she feels altruistic;
  • she thinks she is on the moral high ground;
  • she is not primarily out to make money and might even offer her services for free;
  • she does not seek fame;
  • she is religiously convinced of the correctness of her message and wants to save mankind through it;
  • her message is for everyone;
  • she strictly adheres to her own gospel and thinks that those who don’t are traitors;
  • when she is implicated in causing harm, she consults her ueber-guru;
  • she abhors cynicism;
  • her charisma, if she has any, is real and a powerful tool for convincing followers;
  • when challenged, she feels hurt and misunderstood.

As I indicated already, this is a SIMPLE classification. Between the two extremes, there are all shades of grey. In fact, it is a continuous spectrum.

Why should any of this be important?

Charlatans of both types cause immeasurable harm, and it is impossible to decide which type is more dangerous. Our aim must be to prevent or minimise the harm they do. I think, this aim can best be pursued, if we know who we are dealing with. Identifying where precisely on the above scale a particular charlatan or quack is situated, might help in the prevention of harm.

4 Responses to Minimising the risks of quackery: A simple classification of charlatans

  • My mental model of quackery too is divided into these two broad categories. Although I think Type 1 quacks can be subdivided into two distinct groups. Type 1a are your rational crooks, but I think there are large numbers of Type 1b quacks who me might call ‘Bullshitters’. I follow the Harry G. Frankfurt approach here to understandig Bullshit.

    Type 1b Bullshitters can be differentiated from Type 1a by the following

    – Has no care for truth or falsity.
    – Is supremely narcisistic.
    – Cares for evidence only when it can be used to advance their aims.
    – He wants to have dominance over his enemies rather than mere financial gain.

    The crook, the fanatasist and the sceptic all care about the truth. The crook will subvert it, the fanatisits has an unshakable belief they have found it, the sceptic wants to find it. The Bullshitter does not care about the truth, only what furthers their aims.

    I suspect quack bullshitters and not so much to found in practice but at the periphery – in academia, training courses for quacks, book sellers and pill sellers. As such, they prey just as much on Type 2 quacks as they do on the gullible.

  • I’ve always divided them into the categories of ‘Charlatan’ and ‘Quack’, but with the same general features you’ve described.

  • US regulations I have studied imply that not all quacks are frauds.
    Even the most egregious con-artist type quack cannot be charged with fraud unless they actually charge for their services and intend gaining pecuniary advantage.

    Personally I find this to be semantic sophistry.
    Why would any practitioner make claims that homeopathically prepared (HP) pillules, skin puncturing, musculo-skeletal pummelling and pushing, unrefined phyto-chemicals or preternatural powers have any effect on pathological processess unless the practitioner intends to dishonestly deceive (a quack); defraud (a quack and a fraud) – or sincerely does not intend fraud but is deluded beyond rational analysis (a quack who lacks insight and is deranged).

    In the US, disquiet about false claims, quack remedies and dangerous ingredients led to eleven articles about ‘The Great American Fraud’ in Collier’s Weekly during 1905. Written by investigative journalist and one of the first ‘muckrakers’, Samuel Hopkins Adams, these were a significant stimulus to better regulations. Following the American Medical Association’s criticisms of patent medicines, the US Pure Food and Drugs Act was introduced in 1906.

    Press on!

  • For me the Fantacist is more difficult to deal with since it is impossible to talk rationally to them. If you present evidence (and I mean evidence that pretty much any person on the planet would regard as 100% conclusive) they will not address it or recognise it. If anybody has found a way to tackle this mindset I would be very interested.

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