It’s always about the grift

I’ve been writing about quacks for over 20 years now if you count my time on Usenet before I launched the first iteration of this blog in 2004. Indeed, my very first (substantive) post asked the question: How can intelligent people use alternative medicine? Soon after, I started deconstructing alternative cancer cure “testimonials” (with many variations over the years) and thus this blog was born. Over the years, I’ve occasionally contemplate another question: Do those pushing alternative medicine “miracle cures,” be they for cancer or other serious diseases, really believe in their quackery or are they just in it for the grift? In other words, are they true believers or scamming grifters? The answer is more complicated than I had initially thought, but when you come right down to it often they’re both. They believed, which led them to start selling their “cures,” and now they’re in it for the grift too.

Take Joe Mercola—please!—for instance. He originally started his empire of quackery and disinformation back in the late 1990s with a website and an email newsletter about “natural medicine” and supplements. As his popularity grew, he then started selling those supplements and products to support his bandwidth charges and other expenses involved in running a website with increasing traffic. His traffic grew, as did his sales, which were driven by the increasing popularity of his website, to the point where I now call him a quack tycoon because his net worth is north of $100 million. Unfortunately, he is now using that immense wealth to fund antivaccine causes and promote COVID-19 disinformation. In other words, in the case of Joe Mercola, it started with true belief, but then came the grift. Now it’s mainly about the grift.

I was thinking of this general question of belief versus grift as I came across an article last night by Micah Lee for The Intercept entitled Network of right-wing health care providers is making millions off hydroxychloroquine and ivermectin, hacked data reveals. As you might have guessed, it’s about a fairly frequent topic of this blog since the COVID-19 pandemic hit, namely repurposed drugs that have been promoted since very early in the pandemic as “miracle cures” for COVID-19, the two most prominent and common of which have been hydroxychloroquine, which was promoted more last year but failed to demonstrate efficacy in clinical trials, and ivermectin, which is the new hydroxychloroquine.

Hydroxychloroquine, as you might recall, is an antimalarial drug that also has mild immunosuppressive effects that make it useful to treat rheumatoid arthritis and other autoimmune conditions. I once called it the Black Knight of COVID-19 treatments, because no matter how many negative studies were published its promoters, like the proverbial Black Knight in Monty Python and the Holy Grail after Arthur had lopped off one of his limbs, responded, “‘Tis but a scratch.” Ivermectin is an antihelmintic drug used to treat diseases caused by parasitic roundworms in animals and humans that has supplanted hydroxychloroquine as the preferred “miracle cure” for COVID-19. One feature of the craze surrounding both drugs is the way that the promotion of them provoked runs on the drugs. Early in the pandemic, rheumatoid arthritis sufferers and others with autoimmune diseases were often unable to obtain hydroxychloroquine because it was sold out. More recently, runs on ivermectin have led to serious problems for ranchers, veterinarians, and farmers, who pay inflated can’t obtain the drug for animals or end up paying massively inflated prices for it because of shortages.

You can probably guess what Lee found out about the promotion of ivermectin (and, to a lesser extent, hydroxychloroquine. Basically, some of our favorite quacks have been engaging in some very profitable grift:

A network of health care providers pocketed millions of dollars selling hydroxychloroquine, ivermectin, and online consultations, according to hacked data provided to The Intercept. The data show that vast sums of money are being extracted from people concerned about or suffering from Covid-19 but resistant to vaccinations or other recommendations of public health authorities.

America’s Frontline Doctors, a right-wing group founded last year to promote pro-Trump doctors during the coronavirus pandemic, is working in tandem with a small network of health care companies to sow distrust in the Covid-19 vaccine, dupe tens of thousands of people into seeking ineffective treatments for the disease, and then sell consultations and millions of dollars’ worth of those medications. The data indicate patients spent at least $15 million — and potentially much more — on consultations and medications combined.

Of course America’s Frontline Doctors are at the heart of this grift! You might remember that the first time I ever wrote about this group was during the summer of 2020. That’s when they first hit the national news for holding a “press conference” in which, besides spewing a number of common COVID-19 conspiracy theories (such as the “plandemic” conspiracy theory, some very dubious doctors claiming to be at the “frontlines” taking care of COVID-19 patients also touted hydroxychloroquine as a miracle cure for coronavirus. You might recall that one of the “frontline” doctors involved, Dr. Stella Immanuel, provoked a veritable frenzy of “demon sperm” memes when it was learned that she believed that sex with demons was responsible for many gynecological complaints in women. More recently, the group has turned antivaccine, having sued over the supposed deaths of thousands due to COVID-19 vaccines. Naturally, they’ve also turned to hawking ivermectin and ivermectin conspiracy theories based on fraudulent studies. Worse, you’d think that such a bunch of quacks and grifters would be marginalized. You’d be wrong. One of them, Dr. Joseph Ladapo, was recently nominated to be Florida’s Surgeon General and Secretary of the Florida Department of Health.

But back to the grift.

I do rather love how grifters gonna grift, but generally aren’t nearly as careful about it as they should be if they wish to avoid incriminating evidence coming to light. For example:

The Intercept has obtained hundreds of thousands of records from two companies, CadenceHealth.us and Ravkoo, revealing just how the lucrative operation works. America’s Frontline Doctors, or AFLDS, has been spreading highly politicized misinformation about Covid-19 since the summer of 2020 and refers its many followers to its telemedicine partner SpeakWithAnMD.com, which uses Cadence Health as a platform. People who sign up then pay $90 for a phone consultation with “AFLDS-trained physicians” who prescribe treatments such as hydroxychloroquine and ivermectin to prevent and treat Covid-19. The drugs are delivered by Ravkoo, a service that works with local pharmacies to ship drugs to patients’ doors. Of course, that’s if patients ever get the consultation; many customers told Time they never received the call after paying.

The data from the Cadence Health and Ravkoo sites was provided to The Intercept by an anonymous hacker who said the sites were “hilariously easy” to hack, despite promises of patient privacy. It was corroborated by comparing it to publicly available information. The Intercept is not publishing any individual patient data and has taken steps to secure the data.

There’s so much to unpack here. The first point is obvious. You’d think that grifters would be more careful about cybersecurity, given that failure to protect their information stored on computers tends to be how many of them end up being taken down by law enforcement. In this case, the failure is hilariously epic. One can’t help but feel a healthy measure of schadenfreude.

Next, it’s obvious that this whole operation was always a pill mill. Instead of selling, for example, opioid prescriptions, America’s Frontline Quacks (a far better name for them) are selling prescriptions for ivermectin and hydroxychloroquine. The telehealth visits are just a sham that allows the grift to proceed. Patients who ever thought that this was about anything other than the grift and that they were going to get a real medical consultation via telehealth soon learned the error of their ways. It’s even worse than that, though. So thorough is the grift that patients paid their money and didn’t get anything:

Mike says he was struggling with COVID-19 when he felt his breathing getting worse. He did not want to go to the Veterans Affairs hospital near his home, where he believed doctors might put him on a ventilator. And he knew they would not prescribe the treatment he really wanted: a drug called ivermectin.

So in late July, Mike, who says he is a 48-year-old teacher and disabled veteran from New York state, contacted America’s Frontline Doctors (AFLD), a group he had been following on social media. AFLD has been a leading promoter of ivermectin, a medication typically used to treat parasitic worms in livestock, as a “safe and effective treatment” for COVID-19. Through its website, Mike says, he paid the group $90 for a telemedicine appointment with a doctor willing to prescribe the drug.

A week later, he was still anxiously waiting for the consultation. Calls and emails to AFLD went unreturned, he says. Finally, he called his bank to report a fraudulent charge. “Not even an apology,” Mike, whom TIME is referring to using a pseudonym because of his concerns about his job, told TIME in an interview. “This is absolutely nuts. This organization is not helping anyone but their pocketbooks.”

Well, yes. That is what this is about now. I rather suspect that many, if not most, of America’s Frontline Quacks started out believing in these COVID-19 treatments, but now it’s all about that sweet, sweet grift, as a previous TIME investigation showed:

Its followers aren’t the only ones with questions about AFLD. It’s hard to pin down how many people the group employs, how much money it’s taking in, or how that money has been spent, in part because the non-profit has failed to file required disclosures. After it failed to submit its annual report in Arizona, where the group is registered under the name “Free Speech Foundation,” the state recently downgraded the organization’s charitable status to “pending inactive.”

Over the past three months, a TIME investigation found, hundreds of AFLD customers and donors have accused the group of touting a service promising prescriptions for ivermectin, which medical authorities say should not be taken to treat or prevent COVID-19, and failing to deliver after a fee had been paid. Some customers described being charged for consultations that did not happen. Others said they were connected to digital pharmacies that quoted excessive prices of up to $700 for the cheap medication. In more than 3,000 messages reviewed by TIME, dozens of people described their or their family members’ COVID-19 symptoms worsening while they waited for an unproven “wonder drug” that didn’t arrive.

Imagine that. America’s Frontline quacks never filed any required disclosures and then rebranded itself under a different name after failing to submit an annual report. Meanwhile, the grift continues, and the marks keep coming, even as the grifters make excuses, such as blaming the victims for user error, citing “overwhelming demand” for ivermectin, and promising refunds for customers who never received the consultations with doctors and prescriptions that they paid for. The simplest retort to this is: If that’s the case, then why did you keep taking orders for telehealth visits and charging the customers before any such visits occurred? A reputable and honest business might continue taking orders, but would not charge patients until after the telehealth visits had occurred.

But how much grift are we talking about here? Back to The Intercept, where accomplices of America’s Frontline Quacks are scattering in the light after the rock has been lifted off of them:

After The Intercept reached out, Cadence Health’s Roque Espinal-Valdez said he shut the platform down, not wanting any part in profiting off of Covid-19 “quackery.”

What are the odds that Mr. Espinal-Valdez knew what was going on? How could he not have known? Did he not consider it rather…odd…that his company was suddenly receiving so much business from one rather notorious group? That’s the excuse he’s making:

Roque Espinal, Cadence Health’s CEO, told The Intercept that he was unaware of the scheme and that Cadence Health simply provided a telehealth platform for SpeakWithAnMD.com, its patients, and physicians. “I’m totally flabbergasted. I had to look up exactly who these people were,” he said. “I’m fully vaccinated. My children are fully vaccinated. I’m trying to make heads and tails of this right now.” After talking with The Intercept on Monday, Espinal said he terminated service with SpeakWithAnMD. He added, “I don’t want to be associated with any crap like that. None of that quackery that’s going on.” SpeakWithAnMD’s telemedicine platform, which relies on Cadence Health, is currently down.

I can’t escape the sneaking suspicion that Espinal turned a blind eye to what was going on because he liked how this website was fattening his company’s bottom line. I also rather suspect that Espinal would never have shut down the website used by America’s Frontline Quacks if it hadn’t been for a reporter sniffing around working on a story about the grift going on. Let’s look at it this way. I see two options. Either Espinal was in on the grift, which he denies, or he honestly never figured out what was going on, in which case he really shouldn’t be running a company like Cadence because he really failed here. Big time. Take your pick regarding which option is more likely to be the correct one.

It’s hard not to conclude exactly the same thing about Ravkoo’s CEO:

The hacker also provided records of 340,000 prescriptions that Ravkoo has filled between November 3, 2020, and September 11, 2021 — amounting to an estimated $8.5 million in drug costs. Forty-six percent of the prescriptions are for hydroxychloroquine or ivermectin, and another 30 percent are for zinc or azithromycin, two other ineffective medications that the SpeakWithAnMD physicians, who America’s Frontline Doctors claims it trains, prescribe in their Covid-19 consultations.

“We take data breaches very seriously,” Ravkoo CEO Alpesh Patel told The Intercept. Patel claims that Ravkoo stopped doing business with SpeakWithAnMD and AFLDS at the end of August because “the volume over there went up crazy, and we didn’t feel comfortable. And we don’t have that much capacity to fill that many prescriptions.” The hacked data shows that they filled hundreds more prescriptions for AFLDS in the first weeks of September. “That might be refills or prescriptions that got stuck and we had to fill it,” Patel claimed.

As is the case for Cadence, I rather suspect that Mr. Patel didn’t shut down the profit train until after a reporter had started sniffing around and showed him the data that had been acquired that showed just how many prescriptions Ravkoo had been filling. I could be wrong about this but rather suspect that I probably am not.

Similarly amusing is the way that at least one of the doctors who did bother to provide some actual telehealth visits and prescriptions invoked what skeptics like to call the Quack Miranda warning:

At least one of the prescribers is aware that medical experts recommend against using these drugs to prevent or treat Covid-19 but prescribed them anyway, according to patient records. One physician included this disclaimer in their consultation notes with several patients: “I, [physician’s name], have a complete understanding of the recent release from the WHO, FDA, CDC, and NIH on March 5th, 2021 as it pertains to the use and prescribing of Hydroxychloroquine and Ivermectin. I understand that these two medications have been deemed ‘Highly Not Recommended’ by the for-mentioned [sic] medical governing bodies but are not illegal to prescribe. … I have explained that I will not be held legally or medically responsible for an adverse reaction by this patient should they choose to take them and have explained they will not be able to hold me medically neglectful, pursue any form of malpractice, nor any criminal and civilly [sic] suits.”

Beginning last week, the intake form began showing a similar disclaimer to all patients. “As a potential patient, I acknowledge and understand that the Hydroxychloroquine (HCQ) and Ivermectin have been deemed ‘Highly Not Recommended’ by the WHO, FDA, CDC, and NIH,” the disclaimer says. “Should a patient choose to not disclose their proper medical history, the clinician cannot be held liable nor can any medical license in any state be reviewed or held accountable.” Patients must check a box that says “I understand” to continue.

Usually, quack Miranda warnings (which nearly all quacks use) say something like, “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.” The above is merely a variant of a quack Miranda warning that seeks to shift the burden for the decision to use quackery over to the patient instead of the doctor. Here’s the thing. Disclaimers with a promise not to sue for malpractice or to complain to the doctor’s state medical board are generally not enforceable. Patients don’t know that, though, and doctors who require patients to sign such forms know that most patients don’t know that.

Even more amusing is the reaction of a representative of SpeakWithAnMD.com, who vehemently denies that his company is antivaccine:

“[SpeakWithAnMD] is not part of the anti-vax movement and we do not oppose vaccinations,” Jim Flinn, a public relations agent working for the site’s parent company, Encore Telemedicine, told The Intercept.

“We do not oppose vaccinations” gives away the game. Notice how, instead of replying in the affirmative (as in, “We strongly support vaccination”), Flinn responded with a negative (“We do not oppose vaccinations”). My guess is that Flinn’s company might not actually be antivaccine, but is more than willing to cater to antivaxxers like those in America’s Frontline Quacks and take their business because money is money and grift is grift.

So is politics, because—surprise! surprise!—right-wing political groups are in on the grift as well! That should have been obvious from the involvement of Dr. Simone Gold, who founded American’s Frontline Quacks last year and is also known for appearing at QAnon rallies. Indeed, her Arizona nonprofit, Free Speech Foundation, was started last year with a million-dollar annual budget and fiscal sponsorship from the Tea Party Patriots Foundation. Dr. Gold was even arrested and charged after the insurrection at the US Capitol on January 6.

All of this brings us back to the question about belief versus grift. I’ve been writing about quacks for nearly 20 years now, and my experience has led me to believe that most, if not all, quacks at least start out believing in their quackery. Sure, there are exceptions, such as Kevin Trudeau, who wrote Natural Cures “They” Don’t Want You To Know About and almost certainly was in it for the grift all along. However, most quacks at least start out believing. Look at Stanislaw Burzynski, for instance. In the early 1970s he started out doing research that led him (falsely) to believe that he had discovered peptides that were part of the body’s natural anticancer defense system and that he had discovered a highly effective cancer treatment. In 1976 left his university and started practicing, using his “antineoplastons” to treat cancer patients because he was rash, impatient, and disgusted with the slowness of the process of clinical research necessary to determine whether his antineoplastons were effective and safe or not. Over the 45 years since then, he charged more and more for his “cure,” becoming wealthy in the process. He still believed (after all, he kept trying to do clinical trials—badly—to show that his treatment worked) but he also profited. Like America’s Frontline Quacks, too, Burzynski made his money off of “management fees.” (He didn’t charge for the drug, antineoplastons, itself, although he did own a pharmacy that he required his patients to use for all their other treatment-related medications.) Belief and grift can go hand-in-hand.

So it appears to be with America’s Frontline Doctors. I have little doubt that they started out believing that hydroxychloroquine, ivermectin, and all the other “miracle cures” for COVID-19 that they were pushing worked. Even better from their perspective, if miracle cures for COVID-19 existed, that would help them argue that neither lockdowns nor mask and vaccine mandates are necessary, a position that fits very well with their right wing, Trump-loving political views. So when did belief turn into grift? Who knows? I suspect that it didn’t take long after that infamous press conference in July 2020, though. Now, they give every appearance of being all about the grift, with belief being secondary. I’ll conclude, though, as I started by noting this: For snake oil salesmen, it usually is about the belief (or at least starts out that way), but it’s also always about the grift.