A review of Pope Brock’s Charlatan. America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam.

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 that 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 favor 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.

Even in the age of modern science, our 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. 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 wares 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, and he developed a surgical technique that offered the type of firm results that his male clientele so desperately sought: goat testis sewn right 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 (a study revealed that over half of all newspaper advertising at the time was for patent medicines) and the new fangled technology, radio, which 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 unaccredited and improbably named Eclectic Medical University of Kansas City). “As a result 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 Morris Fishbein, whose career coincided with the rise of the American Medical Association’s attempt to reign in flimflamery 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” (Michigan), a woman who suffered from a temperature of 115 degrees for two weeks. Fishbein exposed her as a “hysterical malingerer” when he discovered that a flesh colored hot water bottle was employed to elevate rectal thermometer readings. “Along with making him famous as a fraud buster 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 courtroom confrontation that reads like a Hollywood film script.

Stripped of his license to practice medicine and embroiled in lawsuits, Brinkley eventually 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 his wife three days before a heart attack terminated his tenure of 56 years.

Fishbein’s promotion of science-based medicine was heroic in his day, but medical flapdoodle flourishes today on the internet so 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.

(New York, 2008, ISBN 978-0307339881)
This review was originally published in Nature.

The latest fad in cold remedies is full of hot air

I violated Feynman’s first principle during a recent book tour. I traveled daily through congested airports, crowded jets and crammed bookstores amid sneezing, coughing, germ-infested multitudes. One day, while squeezed into the sardine section of coach, with the guy behind me obeying the command of the germs in his lungs to go forth and multiply, I cursed myself for having forgotten my Airborne tablets, an orange-flavored effervescent concoction of herbs, antioxidants, electrolytes and amino acids that fizzles into action in a glass of water.

In the logic-tight compartments of my brain, my magic module had trumped my skeptic module. I had not given this product any thought until, much to my chagrin, the host for one of my book tour stops, a Menlo Park, Calif., Internet venture capitalist and science blogger named David Cowan,
mentioned that recently he had debunked Airborne in on his blog. A science-savvy investor, Cowan was quick to spot the clever marketing technique of suggesting that Airborne prevents or cures colds without actually saying so. “Take at the FIRST sign of a cold symptom or before entering crowded environments,” the instructions say. Then “repeat every three hours as necessary.” In the (really) fine print, however, is this: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Even more perfidious is how the company turned a liability into an asset. Most drugs are developed by Big Pharma — Brobdingnagian corporations with vast teams of scientists who have, to date, failed to cure the common cold. Airborne’s creator is “Knight-McDowell Labs” — Victoria Knight-McDowell is a schoolteacher and her husband, Rider McDowell, is a scriptwriter. Instead of hiding their lack of credentials, they boast about them on their Web page (www.airbornehealth. com): CREATED BY A SECOND-GRADE SCHOOL TEACHER! “As any confidence artist knows,” Cowan explains in his blog, “disclosing unflattering facts up front wins the target’s trust.” And $100 million in annual sales is all the data the lab needs.

As for real scientific evidence on Airborne, the Web page used to provide a link to “clinical results” (no longer there). When Cowan wrote to the company for the information, h received this reply: “The 2003 trial was a small study conducted for what was then a small company. While it yielded very strong results, we feel that the methodology (protocol) employed is not consistent with our current product usage recommendations. Therefore, we no longer make it available to the public.” Why? The company CEO, Elise Donahue, told ABC News: “We found that it confused consumers. Consumers are really not scientifically minded enough to be able to understand a clinical study.”

ABC News looked into the clinical trial and discovered that it was conducted by GNG Pharmaceutical Services, “a two-man operation started up just to do the Airborne study. There was no clinic, no scientists and no doctors. The man who ran things said he had lots of clinical trial experience. He added that he had a degree from Indiana University, but the school says he never graduated.”

In one final lunge at product verisimilitude (dang it, that zesty taste feels like it works), I consulted Harriet Hall, a retired U.S. Air Force flight surgeon and family physician who studies alternative medicine. Hall looked up Airborne’s ingredients in the Natural Medicines Comprehensive Database and found no evidence that any of the ingredients prevents colds. Worse, vitamin A is unsafe in doses greater than 10,000 units a day, and Airborne contains 5,000 units per tablet and recommends five pills a day or more. The only positive finding was for vitamin C, for which some evidence indicates that taking high doses may shorten the duration of cold symptoms by one to one and a half days in some patients. But the large amounts needed may cause side effects. “There’s more evidence for chicken soup than for Airborne,” Hall told me. “In the absence of any credible double-blind studies to support the claims for Airborne, I’ll stick to hand washing.”

Chicken soup for the traveler’s soul.

Hold on just a moment. When was all of this decided? Was I abducted by aliens and missed the public debate? Smallpox was eradicated by 1980. What’s going on here? Terrorism, that’s what; or, more precisely, the fear of terrorism. That fear, in fact, has been in the driver’s seat since 9/11. A single shoe-bomb incident now means we all get to disrobe our feet in front of airport strangers.

Smallpox, it seems, would make a horrific weapon of mass destruction for terrorists. Between 1880 and 1980 it killed about half a billion people — more than all the deaths in the two world wars combined. So, yes, smallpox could be effectively employed as a deadly weapon by Iraqi or Al Qaeda operatives against Americans.

Then again, they could also use anthrax, or half a dozen other biological weapons. They could go with chemical weapons, even nuclear weapons. Heck, fertilizer in a cargo truck is pretty damn effective at razing a building to the ground. When did “we” the American public — presumably in charge of our own governance — decide which of the literally dozens of potential terrorist weapons should be targeted for protection? Given limited time and resources, are we really sure this is the most likely weapon to be used against us?

And we must bear in mind that the vaccination process is not without some risk. The smallpox vaccine is made from its weak biological cousin cowpox. When you are vaccinated with the weaker virus, your body develops an immunity to the stronger smallpox virus. So, in essence, you are purposefully making yourself slightly sick so that you do not later become deadly sick. Unfortunately, the system is not full proof. The Centers for Disease Control estimate that 74 people will suffer serious complications and one will die for every one million vaccinations given. Of the 130 million Americans never vaccinated about 2,000 would face life-threatening complications and somewhere between 125 and 250 would die. For the other 158 million Americans that may need revaccination, about 800 would be threatened with death, with about 40 succumbing.

These are not trivial casualty statistics. Although when compared to the roughly 30 percent death rate of an actual smallpox epidemic it may seem well worth the risk, what we do not know — or, at least, we have not been given the data from our government — is the likelihood that terrorists would or could use smallpox as a terrorist weapon. When told by experts and authorities that we are supposed to fear something, the natural human reaction is to believe them. But what worries me is what we are not being told to fear, or that we are being told to fear the wrong thing.

This is not a new problem. In the 5th century B.C. the citizens of the Sicilian city of Camarina were told by their leaders that they were being threatened by a disease pestilence festering in a nearby marsh. The city officials drew up plans to drain the marsh and rid the public of their newly discovered fear. The plague epidemic never hit and the citizens were grateful … until their enemies, the Syracusans who lived on the other side of the protective marsh, could now waltz across the drained land and conquer the Camarinas, which they promptly did.

Until we think through more carefully which threats are real and which are not, skepticism of the government’s program is a healthy response. Don’t drain the marsh until we know that is the best course of action.

This opinion editorial was originally published in the Los Angeles Times.