Americans Fell for a Theranos-Style Scam 100 Years Ago. Will We Ever Learn?
The huckster understands what people want – an easy route to good health -- and figures out just how to provide it as long as no one asks too many questions.
"Americans are very much prone to this sort of thinking: Give me a pill or give me a magical bean that can make me lose weight!"
The keys to success: Hoopla, fancy technology, and gullibility. And oh yes, one more thing: a blood sample. Well, lots and lots of blood samples. Every testing fee counts.
Sound familiar? It could be the story of the preternaturally persuasive Elizabeth Holmes, the disgraced founder of Theranos who stands accused of perpetrating a massive blood-testing fraud. But this is a different story from a different time, one that dates back 100 years but sounds almost like it could unfold on the front page of The Wall Street Journal today.
The main difference: Back then, watchdogs thought they'd be able to vanquish fake medicine and scam science. Fat chance, it turned out. It seems like we're more likely to lose-weight-quick than make much of a dent into quackery and health fraud.
Why? Have we learned anything at all over the past century? As we sweep into a new decade, experts says we're not as advanced as we'd like to think. But the fight against fraud and fakery continues.
Quackery: As American As America Itself
In the 17th century, British healers of questionable reputation got a new name -- "quack," from the Dutch word "quacksalver," which originally referred to someone who treats others with home remedies but developed a new meaning along the lines of "charlatan." And these quacks got a new place to sell their wares: the American colonies.
By 1692, a Boston newspaper advertised a patent medicine that promised to cure "the Griping of the Guts, and the Wind Cholick" and – for good measure – "preventeth that woeful Distemper of the Dry Belly Ach." A couple centuries later, the most famous woman in the United States wasn't a first lady or feminist but a hawker of nostrums named Lydia Estes Pinkham whose "vegetable compound" promised to banish "female complaints." One advertisement suggested that the "sure cure" would have saved the life of a Connecticut clergyman whose wife killed him after suffering from feminine maladies for 16 years.
By the early 20th century, Americans were fascinated by electricity and radiation, and both healers and hucksters embraced the new high-tech era. Men with flagging libidos, for example, could irradiate their private parts with the radioactive Radiendocrinator or buy battery-powered electric belts equipped with dangling bits to supercharge their, um, dangling bits.
The Rise of the Radio Wave 'Cure'
Enter radionics, the (supposed) science of better health via radio waves. The idea was that "healthy people radiate healthy energy," and sickness could be reversed through diagnosis and re-tuning, write Dr. Lydia Kang and Nate Pedersen in their 2017 book "Quackery: A Brief History of the Worst Ways to Cure Everything."
Detecting illness and fixing it required machinery -- Dynamizers, Radioclasts and Oscillocasts – that could cost hundreds of dollars each. Thousands of physicians bought them. Fortunately, they could work remotely, for a fee. The worried-and-potentially-unwell just needed to send a blood sample and, of course, a personal check.
Sting operations revealed radionics to be bogus. A skeptic sent a blood sample to one radionics practitioner in Albuquerque who reported back with news of an infected fallopian tube. In fact, the blood sample came from a male guinea pig. As an American Medical Association leader reported, the guinea pig "had shown no female characteristics up to that time, and a postmortem examination yielded no evidence of ladylike attributes."
When Quackery Refused to Yield
The rise of bogus medical technology in the early 20th century spawned a watchdog industry as organizations like the American Medical Association swept into action, said medical historian Eric Boyle, author of 2012's "Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America."
"When quackery was recognized as a major problem, the people who campaigned for its demise were confident that they could get rid of it," he said. "A lot of people believed that increased education, the truths of science, and laws designed to protect consumers would ultimately drive quackery from the marketplace. And then throughout the century, as modern medicine developed, and more effectively treated one disease after another, many observers remained confident in that prediction."
There's a bid to "flood the information highway with truth to turn the storm of fake promotional stuff into a trickle."
But fake medicine persisted as Americans continued their quest to get- healthy-quick… or get-rich-quick by promising to help others to get- healthy-quick. Even radionics refused to die. It's still around in various forms. And, as the Theranos scandal reveals, we're still hoping our blood can offer the keys to longevity and good health.
Why Do We Still Fall for Scams?
In our own era, the Theranos company rose to prominence when founder and CEO Elizabeth Holmes convinced journalists and investors that she'd found a way to cheaply test drops of blood for hundreds of conditions. Then it all fell apart, famously, when the world learned that the technology didn't work. The company has folded, and Holmes faces a federal trial on fraud charges this year.
"There were a lot of prominent, very smart people who bought into the myth of Elizabeth Holmes," a former employee told "60 Minutes," even though the blood tests never actually worked as advertised.
Shouldn't "prominent, very smart people" know better? "People are gullible," said Dr. Stephen Barrett, a psychiatrist and leading quack-buster who runs the QuackWatch website. But there's more to the story. According to him, we're uniquely vulnerable as individuals to bogus medicine.
Scam artists specifically pinpoint their target audiences, such as "smart people," desperate people and alienated people, he said.
Smart people, for example, might be overconfident about their ability to detect fraud and fall for bogus medicine. Alienated people may distrust the establishment, whether it's the medical field or government watchdogs, and be more receptive to alternative sources of information.
Dr. Barrett also points a finger at magical thinking, which comes in different forms. It could mean a New Age-style belief that our minds can control the world around us. Or, as professional quack-buster Alex Berezow said, it could refer to "our cultural obsession with quick fixes."
"Americans are very much prone to this sort of thinking: Give me a pill or give me a magical bean that can make me lose weight! But complex problems need complex solutions," said Berezow, a microbiologist who debunks junk science in his job as a spokesman for the American Council on Science & Health.
American mistrust of expertise makes matters worse, he said. "When I tell people they need to get vaccinated, I'm called a shill for the pharmaceutical industry," he said. "If I say dietary supplements generally don't work, I'm a shill for doctors who want to keep people sick."
What can ordinary citizens do to protect themselves from fake medicine? "You have to have a healthy skepticism of everything," Berezow said. "When you come across something new, is someone trying to take advantage of you? It's a horrible way to think about the world, but there's some truth to it."
"Like any chronic disease, we will have to live with it while we do our best to fight it."
The government and experts have their own roles to play via regulation and education, respectively. For all the criticism it gets, the Food & Drug Administration does serve as a bulwark against fakery in prescription medicine. And while celebrities like Gwyneth "Goop" Paltrow hawk countless questionable medical products on the Internet, scientists and physicians are fighting back by using social media as a tool to promote the truth. There's a bid to "flood the information highway with truth to turn the storm of fake promotional stuff into a trickle," said Dr. Randi Hutter Epstein, a writer in residence at Yale School of Medicine and author of 2018's "Aroused: The History of Hormones and How They Control Just About Everything."
What's next? Like death, taxes and Cher, charlatans are likely to always be with us. Boyle quoted the late William Jarvis, a pioneering quack-buster in the late 20th century who believed health fraud would never be eradicated: "Like any chronic disease, we will have to live with it while we do our best to fight it."
Why You Can’t Blame Your Behavior On Your Gut Microbiome
See a hot pizza sitting on a table. Count the missing pieces: three. They tasted delicious and yes, you've eaten enough—but you're still eyeing a fourth piece. Do you reach out and take it, or not?
"The difficulty comes in translating the animal data into the human situation."
Your behavior in that next moment is anything but simple: as far as scientists can tell, it comes down to a complex confluence of circumstances, genes, and personality characteristics. And the latest proposed addition to this list is the gut microbiome—the community of microorganisms, including bacteria, archaea, fungi, and viruses—that are full-time residents of your digestive tract.
It is entirely plausible that your gut microbiome might influence your behavior, scientists say: a well-known communication channel, called the gut-brain axis, runs both ways between your brain and your digestive tract. Gut bugs, which are close to the action, could amplify or dampen the messages, thereby shaping how you act. Messages about food-related behaviors could be particularly susceptible to interception by these microorganisms.
Perhaps it's convenient to imagine your resident microbes sitting greedily in your gut, crying for more pizza and tricking your brain into getting them what they want. The problem is, there's a distinct lack of scientific support for this actually happening in humans.
John Bienenstock, professor of pathology and molecular medicine at McMaster University (Canada), has worked on the gut microbiome-behavior connection for several decades. "There's a lot of evidence now in animals—particularly in mice," he says.
Indeed, his group and others have shown that, by eliminating or altering gut bugs, they can make mice exhibit different social behaviors or respond more coolly to stress; they can even make a shy mouse turn brave. But Bienenstock cautions: "The difficulty comes in translating the animal data into the human situation."
Animal behaviors are worlds apart from what we do on a daily basis—from brushing our teeth to navigating complex social situations.
Not that it's an easy task to figure out which aspects of animal research are relevant to people in everyday life. Animal behaviors are worlds apart from what we do on a daily basis—from brushing our teeth to navigating complex social situations.
Elaine Hsiao, assistant professor of integrative biology and physiology at UCLA, has also looked closely at the microbiome-gut-brain axis in mice and pondered how to translate the results into humans. She says, "Both the microbiome and behavior vary substantially [from person to person] and can be strongly influenced by environmental factors—which makes it difficult to run a well-controlled study on effects of the microbiome on human behavior."
She adds, "Human behaviors are very complex and the metrics used to quantify behavior are often not precise enough to derive clear interpretations." So the challenge is not only to figure out what people actually do, but also to give those actions numerical codes that allow them to be compared against other actions.
Hsiao and colleagues are nevertheless attempting to make connections: building on some animal research, their recent study found a three-way association in humans between molecules produced by their gut bacteria (that is, indole metabolites), the connectedness of different brain regions as measured through functional magnetic resonance imaging, and measures of behavior: questionnaires assessing food addiction and anxiety.
Meanwhile, other studies have found it may be possible to change a person's behavior through either probiotics or gut-localized antibiotics. Several probiotics even show promise for altering behavior in clinical conditions like depression. Yet how these phenomena occur is still unknown and, overall, scientists lack solid evidence on how bugs control behavior.
Bienenstock, however, is one of many continuing to investigate. He says, "Some of these observations are very striking. They're so striking that clearly something's up."
He says that after identifying a behavior-changing bug, or set of bugs, in mice: "The obvious next thing is: How [is it] occurring? Why is it occurring? What are the molecules involved?" Bienenstock favors the approach of nailing down a mechanism in animal models before starting to investigate its relevance to humans.
He explains, "[This preclinical work] should allow us to identify either target molecules or target pathways, which then can be translated."
Bienenstock also acknowledges the 'hype' that appears to surround this particular field of study. Despite the decidedly slow emergence of data linking the microbiome to human behavior, scientific reviews have appeared in brain-related scientific journals—for instance, Trends in Cognitive Sciences; CNS Drugs—with remarkable frequency. Not only this, but popular books and media articles have given the idea wings.
It might be compelling to blame our microbiomes for behaviors we don't prefer or can't explain—like reaching for another slice of pizza. But until the scientific observations yield stronger results, we still lack proof that we're doing what we do—or eating what we eat—exclusively at the behest of our resident microorganisms.
Who’s Responsible If a Scientist’s Work Is Used for Harm?
Are scientists morally responsible for the uses of their work? To some extent, yes. Scientists are responsible for both the uses that they intend with their work and for some of the uses they don't intend. This is because scientists bear the same moral responsibilities that we all bear, and we are all responsible for the ends we intend to help bring about and for some (but not all) of those we don't.
To not think about plausible unintended effects is to be negligent -- and to recognize, but do nothing about, such effects is to be reckless.
It should be obvious that the intended outcomes of our work are within our sphere of moral responsibility. If a scientist intends to help alleviate hunger (by, for example, breeding new drought-resistant crop strains), and they succeed in that goal, they are morally responsible for that success, and we would praise them accordingly. If a scientist intends to produce a new weapon of mass destruction (by, for example, developing a lethal strain of a virus), and they are unfortunately successful, they are morally responsible for that as well, and we would blame them accordingly. Intention matters a great deal, and we are most praised or blamed for what we intend to accomplish with our work.
But we are responsible for more than just the intended outcomes of our choices. We are also responsible for unintended but readily foreseeable uses of our work. This is in part because we are all responsible for thinking not just about what we intend, but also what else might follow from our chosen course of action. In cases where severe and egregious harms are plausible, we should act in ways that strive to prevent such outcomes. To not think about plausible unintended effects is to be negligent -- and to recognize, but do nothing about, such effects is to be reckless. To be negligent or reckless is to be morally irresponsible, and thus blameworthy. Each of us should think beyond what we intend to do, reflecting carefully on what our course of action could entail, and adjusting our choices accordingly.
It is this area, of unintended but readily foreseeable (and plausible) impacts, that often creates the most difficulty for scientists. Many scientists can become so focused on their work (which is often demanding) and so focused on achieving their intended goals, that they fail to stop and think about other possible implications.
Debates over "dual-use" research exemplify these concerns, where harmful potential uses of research might mean the work should not be pursued, or the full publication of results should be curtailed. When researchers perform gain-of-function research, pushing viruses to become more transmissible or more deadly, it is clear how dangerous such work could be in the wrong hands. In these cases, it is not enough to simply claim that such uses were not intended and that it is someone else's job to ensure that the materials remain secure. We know securing infectious materials can be error-prone (recall events at the CDC and the FDA).
In some areas of research, scientists are already worrying about the unintended possible downsides of their work.
Further, securing viral strains does nothing to secure the knowledge that could allow for reproducing the viral strain (particularly when the methodologies and/or genetic sequences are published after the fact, as was the case for H5N1 and horsepox). It is, in fact, the researcher's moral responsibility to be concerned not just about the biosafety controls in their own labs, but also which projects should be pursued (Will the gain in knowledge be worth the possible downsides?) and which results should be published (Will a result make it easier for a malicious actor to deploy a new bioweapon?).
We have not yet had (to my knowledge) a use of gain-of-function research to harm people. If that does happen, those who actually released the virus on the public will be most blameworthy–-intentions do matter. But the scientists who developed the knowledge deployed by the malicious actors may also be held blameworthy, especially if the malicious use was easy to foresee, even if it was not pleasant to think about.
In some areas of research, scientists are already worrying about the unintended possible downsides of their work. Scientists investigating gene drives have thought beyond the immediate desired benefits of their work (e.g. reducing invasive species populations) and considered the possible spread of gene drives to untargeted populations. Modeling the impacts of such possibilities has led some researchers to pull back from particular deployment possibilities. It is precisely such thinking through both the intended and unintended possible outcomes that is needed for responsible work.
The world has gotten too small, too vulnerable for scientists to act as though they are not responsible for the uses of their work, intended or not. They must seek to ensure that, as the recent AAAS Statement on Scientific Freedom and Responsibility demands, their work is done "in the interest of humanity." This requires thinking beyond one's intentions, potentially drawing on the expertise of others, sometimes from other disciplines, to help explore implications. The need for such thinking does not guarantee good outcomes, but it will ensure that we are doing the best we can, and that is what being morally responsible is all about.