Back to the future: When men were men, quacks were quacks, and the FDA was the FDA

Perusing the skeptical medical blogosphere, I came across some rather amusing, but nonetheless informative, videos from the 1950s about medical quackery. There are a number of aspects of these videos that are a bit unsettling to modern viewers, such as the “doctor knows best” paternalism, naïve faith in the AMA and other medical organizations, the utter seriousness, the cheesy reading of lines, and a rah-rah cheerleading for science and technology über alles. On the other hand, as Steve Novella points out, there was a refreshing directness about how the government viewed dubious medical practices. The FDA was not afraid to call a quack a quack, as demonstrated in this PSA from 1959 (hat tip: Quackometer):

Besides showing that some forms of quackery are at least decades old (Z-rays, “healing music” therapy), it also shows a willingness to be direct in saying that there area no such thing as Q-rays and this device doesn’t work. Today, the National Center for Complementary and Alternative Medicine (NCCAM) would probably fund several grants to determine whether or not there are in fact Z-rays (seemingly renamed to Q-rays these days) and whether or not tape-recorded music could in fact cure cancer.

The other video is also a snapshot of a simpler time:

And here’s part II:

Yes, the acting is pretty atrocious, as is the dialogue, but this educational short actually does explain several important principles of why unscientific remedies seem to be effective, including regression to the mean, the placebo effect, and confirmation bias. The social mores and attitudes in these videos may seem conservative and silly, and the paternalism of the physicians and unquestioning acquiescence to the experts of the characters is not a model that empowers patients or to which we should go back. However, the videos themselves suggest that, at least in terms of critical thinking about “alternative” medicine, we probably haven’t made much progress in the last 50 years. In fact, we’ve arguably gone backwards, with more tolerance than ever for unsupported, unscientific nostrums than at any time since the time when non-science-based remedies were conventional medicine.

Think I’m exaggerating? Well, let’s go back to NCCAM for a moment, shall we? Even in these tight budgetary times, we taxpayers are still funding it to the tune of $121.6 million in FY 2008. With that money, it’s funding multiple trials in acupuncture, naturopathy, reiki therapy, therapeutic touch, chiropractic, the Kelly/Gonzalez regimen, homeopathy, and even energy healing. Meanwhile, it funds and actively encourages programs at medical schools to teach non-evidence-based and nonscientific woo to the next generation of medical students and residents and infiltrating even the bastion of scientific medicine in the U.S. at the NIH, the NIH Clinical Center. Is it any wonder that there are now at least 40 academic medical centers with active “integrative” medicine programs that teach nonscientific modalities alongside scientific medicine? (It’s a list that I keep promising to update but haven’t gotten around to it because contemplating it depresses me so.)

I agree with Steve that I wouldn’t want to go back to the 1950s in terms of the doctor-patient relationship. The model then was too paternalistic and authoritarian in a way that was sometimes abused. The cooperative model of empowering patients to help their doctor forge a therapeutic plan as partners is in general a good thing. However, it should not necessitate acquiescing to pseudoscience to the point of “integrating” it into scientific medicine. In that aspect, despite all the good that’s come of shedding the paternalistic doctor-patient relationship, we need to find a way to keep the good from that from being overshadowed by the increasing willingness of medicine, apparently largely in response to “giving the patient what he wants,” to accept non-evidence-based and even extremely scientifically implausible therapies into our armamentarium as though they had passed the same gauntlet of basic scientific and clinical studies that the latest cancer treatments have. After all, as I have said so many times before, there is no such thing as “alternative” medicine. There is scientific and evidence-based medicine; there are scientifically plausible but as yet unproven medicine; and there is non-evidence-based and unproven medicine. We should be using the former; the middle should only be used in the context of clinical trials; and the latter should be relegated to museums of medical history.