Quackery in medicine


Good jab, bad jab

Modern medicine has grown by leaps and bounds since the mid-20th century. From basic physical examinations, we have progressed to delving into the molecular aspects of the human body.

Nowadays, to be an expert in a specialty, you must have finished training and passed the specialty board certifying examinations. Further subspecialization requires undergoing a fellowship in the particular field of interest. In cardiology, for example, there is the subspecialty of electrophysiology, which is the study of the conduction system of the heart which malfunction leads to rhythm abnormalities that may be fatal. My orthopedic-surgeon classmate specialized in hand surgery. Neurosurgery now has neuro-oncology, neurovascular surgery, neurotraumatology (brain trauma), etc. 

Yet, quackery persists, much like the proverbial snake-oil salesman of the 19th century. Unlike the quacks of old who did harm mainly to the patients they treated, modern quacks have the ability to reach hundreds of thousands to millions just by the click of a computer, a news article, radio or television broadcast. Thus, the harm is exponentially much greater.
There are several categories of quackery. One is the person who is not trained at all but claims to be an expert. He can be seen online marketing herbs, supplements, or drugs like hydroxychloroquine during the Covid pandemic, which caused many deaths due not only to the drug’s lack of efficacy but also to delays in seeking the proper treatments. Similarly, a medical graduate with not a single day of training in any specialty performed “autopsies” and claimed, without basis, that the children died from the effects of the Dengvaxia vaccine.
Another is the person in a specialty who claims to be an expert in a field he/she has not trained in. They are called epistemic trespassers (experts who pass judgment on questions in fields where they lack expertise). We’ve seen this as well in the Dengvaxia controversy when many “experts” weighed in on vaccinology when they were not experts in that field, causing mass hysteria and the demonization of a vaccine that is now licensed in over 20 countries and considered by WHO as an essential medicine. 

The ill effects are the continuing high rates of dengue infections and deaths, and the spillover of vaccine hesitancy to other childhood vaccines, leading to outbreaks of measles, pertussis, and polio, among others. Vaccine coverage dropped from over 90 percent to 32 percent in the aftermath of the controversy.

The worst is probably the ultracrepidarian, a person who criticizes, judges, and gives advice outside their area of expertise. We have the example of a doctor who claims to be an expert in all things medical, and proceeds to criticize the real experts in their fields. But unfortunately for this person, he has been shown to be not an expert in the area of public health, nor in forensic pathology. Heck, he’s not even board certified in his specialty. When pressed to confirm his lack of credentials, he  resorted to playing victim. He even quotes a fictional character, Albus Dumbledore of the Harry Potter movies, of all things fantastical, to justify his being “far more than our abilities.” If that’s not a confession that he has overreached his competency,  I don’t know what is.

A word of advice to media practitioners: Be more discerning of whom you interview, write about and feature in your newspapers, radio shows, social media posts, and telecasts. Do research on their education, training, experience, and capacity about the issue at hand. Not all doctors are the same. Seek out the real public health experts if it’s about public health. Don’t believe someone on autopsies and causes of death if he’s not a pathologist. Being a doctor who’s also a lawyer doesn’t automatically qualify him to be a forensic expert. Beware the noisy ones who hog the limelight without investigating their credentials. 

If you amplify their false messages, you will be complicit in their effects on the health of our people. The deaths they cause will also be on your conscience. If you find that they are false prophets, epistemic trespassers, or ultracrepidarians, expose them to the public for the pied pipers they are, for causing great public harm. You have a responsibility to the people you seek to enlighten and entertain, to tell them the truth, no matter who gets hurt. That is the nobility of your profession, and some of you have made the ultimate sacrifice. Let their deaths not be in vain.