MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

A recent comment by Richard Rawlins stated: “In healthcare, people who act as wannabe doctors and make false claims are quacks. If they make money at it, they are frauds. But fools they are not.”

I hope you agree that this is a notion well-worth exploring a bit closer. Specifically, I want to try and differentiate the ‘fools’ from the ‘frauds’.

But how?

Perhaps by listing some of the qualities that characterise the two categories.

FRAUDS

The hallmarks of a fraud in medicine are, I think, that a) he is lying and b) he is trying to get at your money (as much of it as possible). By ‘lying’ I mean presenting untruths as facts, despite knowing they are not correct. Essentially, this means that a fraud is dishonest and might even be guilty of a criminal offence (in turn, this means that we ought to be able to take legal action against him).

Frauds are egoistic and do not care much about their clients or the fact that they might cause harm.

FOOLS

By contrast, fools in medicine are naïve and deluded. They are not necessarily dishonest because, even though they tell untruths, they believe them to be true (in a way, fools have fallen for their own lies). Like frauds, fools might also try to get at your money (some of it), but they would claim that they simply need to be paid for their services in order to make a living.

Fools often live under the impression of being altruistic and they are convinced they do a lot of good.

WHO IS WHO?

The distinction between fools and frauds in the realm of alternative medicine is often less than obvious; there is plenty of overlap between the two. I have met hundreds of alternative practitioners and, if I try to retrospectively allocate them into either of the two categories, I run into considerable difficulties. Many belong to neither of them; and most have qualities that are reminiscent of both. But if I was forced to make a binary choice, I would probably put most of them in the camp of fools. Perhaps I was fortunate, but I have not many outright frauds amongst alternative practitioners.

WHO IS MORE DANGEROUS?

Did I say I was ‘fortunate’? Yes, fortunate for not having to deal all that often with dishonest crooks. But in terms of potential for harm, there is nothing fortunate about the fools. For the consumer, frauds are usually easier to recognise than fools, and once identified, they become far less harmful. Fools are often so convinced of their ‘truths’ that desperate patients easily fall for their falsehoods. And this is precisely what constitutes the main danger of fools in (alternative) medicine: they tend to be so convincing and so sure of doing something positive that people tend to find them credible. Consequently, many consumers, patients, politicians, journalists etc. follow their foolish and often harmful advice.

CONCLUSION

We tend to find frauds immoral and despicable and are often perceive fools as ethically and socially more acceptable. However, considering their potential for doing harm, the fools are frequently far worse than the frauds. I therefore conclude we must be vigilant about frauds but, at the same time, become more weary about fools.

 

 

19 Responses to Fools or frauds?

  • That reminds me of people like Peter Fisher, Deepak Chopra and Dr. Oz. I find it hard to believe that these people are mere fools. They have studied medicine, and succeeded. To think they are merely deluded, stretches the limits of my imagination (which may say, of course, more about my imagination than about reality). Dr. Oz even all but admitted that during a hearing in the American senate, and Peter Fisher seemed to hint at it during an interview with Richard Dawkins. In any case, given that they are professionals, they are presumed to be in the know. Whether they are or not, they should be defrocked by any organisation that takes medical ethics seriously.

  • Of course there is no black and white dichotomy, and clarifying where on the spectrum any practitioner lies is nigh impossible, but I share Bart’s cynicism.
    Surely the default position must be that these folk are not fools and do know what they are doing.

    There are some caring folk who want to ‘heal and care’ (as did I), and we may hope they will enter one of the regulated conventional healthcare professions. There they will meet many fools whose thinking is awry, and also some frauds who hide behind the white coats of respectability and make claims they know to be false.

    I am concerned about practitioners, medically qualified or not, who claim to have professional standards of ethics, scientific understanding, critical thinking and practices as do doctors – yet promote alternatives to regularly organised medicine.
    Like Bart, I find it hard to believe that they are deluded about ‘potencies’, ‘meridians’, ‘innate intelligence’, ‘vital energy’, ‘subluxations’ etc. – they will have studied the same evidence on these matters as the rest of us.
    But they persist, and are therefore quacks.
    If they try to gain financial advantage by promoting their ‘beliefs’ – they are frauds and should indeed be charged as such. In the NHS, writing a prescription and expecting the NHS to pay for a homeopathic pillule should be investigated as fraud. What else is it?

    The GMC will only act if a patient complains, and patients are disinclined to complain for fear of appearing foolish, or because they have experienced a beneficial placebo response – so no matter what we may think, there the matter rests.

    I would like to see this issue properly explored by psychologists and social scientists: ‘The extent to which practitioners of complementary and alternative medicine (camists) are deluded in their professed beliefs, or are knowing practitioners.’
    Worth a PhD?

    • …and what about my point that fools tend to be more harmful than fools?

      • …and what about my point that fools tend to be more harmful than fools?

        That point does have a priori plausibility. It seems logical that someone who is convinced her/his claims are correct, is not hindered by doubts or actual knowledge. I think the only defence against them is the defence we are not likely to see in our lifetimes: the teaching of critical (evidence-based) thinking in schools. Religionists will oppose it, and as long as religion is given a free ride, the alternologists/quacks will ride along, I think, since there is no essential difference between them.

        The media could possibly help a little by adding a statement about any alternologist/quack they present to the public: ‘this person is stating a peronal opinion, not based in fact or on evidence and is unqualified to have such an opinion’. Or something along those lines.

      • I am not sure about fools tending to be more harmful in general. The fraud has to be considered as completely amoral with no concern for the patient other than their bank balance where the fool, hopefully hopes to do some good and “may” not persist with a deadly treatment.

        I would think that both frauds and fools have roughly equal capacity to do harm, albeit for different rationales.

  • I’ve thought about a lot in my life (for personal reasons that have nothing to do with quack medicine). I have trouble forgiving the fools.
    They claim to know something, when they manifestly do not.
    A little logical thinking and research could dissuade them, but they don’t do it.
    Sometimes reality is shoved in their faces, but they still don’t accept it.
    They hurt people. Sometimes they really hurt people. And they always justify it; it’s never their fault. They were sincere, they did their very best. The Britt Hermes of the world are few.
    When confronted with their crimes, they cry persecution, and surround themselves with supporters.
    They have lots of supporters because they are friendly and supportive, but it’s not clear to what extent they are really friendly, are being friendly to fool people, or have conditioned themselves to be friendly because they require all those friends to reinforce the delusions.

    Somewhere there’s a serious philosopher who has covered all this, but I’m out of my depth.

  • Funny how i was thinking along the same lines as Edzard. Are sceptics either fools or frauds? Now where do you enlightened smart guys place yourselves on the fool-fraud spectrum?

    • Fools and frauds have in common that they regularly tell untruths. This is not regularly the case with sceptics.

      • Fools and frauds have in common that they regularly tell untruths. This is not regularly the case with sceptics.

        I think I would add that the untruths of skeptics tend to be mistakes, those of fools delusions and those of frauds lies.

    • Skepticism is not making a claim. It is analyzing a claim critically.

  • Interesting post. I think many start out as fools but then become frauds. When you are a young bright eyed student who wants to help other people it is quite easy to fall for those flashy brochures filled with big promises regarding quack courses that some unis and many colleges dish out to students. If you don’t conclude within the first couple of months that this is rubbish then you are stuck in the system (you loose time and become indebted) and with time you become a fraud. Unfortunately they have to, because there is no easy way out. Depending on the amount of time that they’ve spend in the system the more difficult it becomes.

    Someone told me once that everyone has a choice to do the right thing, and yes I agree, but very few have the courage to jump from a financial cliff, because that is in effect what they have to do. So my opinion is that most are frauds because they don’t have the courage (or resources) to get out.

  • Frank, this is the classic ‘cost loss fallacy’.

    But young folks know that marketing gurus, magicians and politicians will be trying to fool them.
    Penn and Teller even have a TV show “Fool Us”.

    Surely, intending students for courses in higher education must have at least a minimal understanding of critical thinking, so just why do they choose to study CAM – camistry?
    Because they wish to learn how to be frauds?
    They must explain their motives, particularly if they wish to claim on the public purse for their courses.

    • Not so sure, I think many students don’t really know what they want to study, sure they have a general idea e.g. something in healthcare, but many (including myself- I started with geology/geography) just enrol to get the ball rolling (social pressure & expectation etc). Only in year 2 or 3 do you decide you want to specialise in this or that (and many never decide and drop out altogether). So if you happen to have enrolled in one of the many quack courses you might unfortunately get stuck there – it is not always that easy to change your degree.

      But when you look at the curriculum of many Homeopathy degrees (I had the course content of the Univ of Johannesburg, but can’t find it anymore), you’ll notice that in year 1 there is almost no homeopathy (chemistry, physics, biology etc), it only starts in year 2/3. So on face value the degree looks legitimate and as we all know many fall for it. But what is so amazing is that you as a student will attend a chemistry lecture, which presumably will include analytical chemistry, and then later on walk into a homeopathy lecture where all the chemistry is simply thrown out the window.

      I don’t think one should blame the student, all the blame should be on the University management, and the regulators allowing these universities to mislead people – we can also include the politicians, and why not pharmacists selling the stuff, and who else can I blame?

      • for me, the question is not about blame. it is about how we might make progress. for that we all obviously need to do more to inform ‘the man in the street’ better than we did so far.

        • Providing the public with better information is of course important, but to fight those who continue to create and spread misinformation is equally important – in my view. And for this we need to know which people (they are usually in a position of power) are behind it all and if they are fools or frauds. If we take Gwyneth Paltrow and HRH Prince Charles – in which category do they fall? And what can be done about it?

  • Unfortunately, things are a bit more complicated.
    When people start feeling enthusiastic about, let’s say, Traditional Chinese Medicine (TCM), they usually start as believers. Believing in things like a “triple flow of energy in the 12 regular meridians” makes them fools. But once they start talking nonsense to their patients, or start teaching for money, or founding TCM societies and writing a curriculum which even might become obligatory nation-wide – then fools become frauds.
    Some of those frauds still believe in what they are teaching. Others do not. But again, their pupils usually start as believers, becoming fools when believing in ridiculous things, and themselves becoming frauds when earning money with it. Believers, fools and frauds are constantly changing their roles. And when someone proves a fraud being a fraud (which I did when I proved that the “father of Western acupuncture” George Soulié de Morant was a fraud), like in religion the fools and believers do not thank them, but hate them.
    That’s the tragic we have to live with.

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