We puny humans simply cannot cope with the idea of a disease for which there is no cure. We will always find something to believe in, no matter how small. Since the Sars-Cov-2 virus was discovered, people have been circulating “cures” ranging from avoiding ice-cold drinks (no) to using special red soap (the soap is good, its color is bad). does not matter).
Certain speculative treatments have been pushed by politicians. Former UK Brexit supremo David Davis urged use of high doses Vitamin D supplements, while Donald Trump advocated hydroxychloroquine. Unfortunately, a high-quality randomized trial has shown that hydroxychloroquine is not a effective treatment. Low-dose vitamin D is a useful supplement to take in winter, but there are no good proof that high doses can treat Covid-19.
Then there is pure quackery: inhaling hydrogen peroxide, using a USB stick as a “bioshield”, or drinking a suspension of silver particles in water. There is a lot of money to be made by selling snake oil to the fearful or desperate.
False treatment is nothing new. Indeed, their enduring popularity is a headache. In 2010, economist Werner Troesken published a study of the American market for unproven concoctions – “patent medicines” – in the 19th and early 20th centuries. He concluded that, even after adjusting for inflation, people were spending over a hundred times as much on these drugs in 1939 as they were in 1810. This growth exceeded the overall spending by twenty times, and the market for patented drugs. eventually competed with the major industries. like fertilizers or paints.
So why the demand? Steven Johnson, in his new book Extra life, highlights two powerful forces that help make unnecessary treatments look good: the immune system and the placebo effect. The human immune system is a wonder: most people who are ill recover.
Now incorporate the placebo effect, the well-known but poorly understood tendency of people to simply profit from the belief that they are being treated. Troesken notes that many quack drugs included ingredients such as chili, alcohol, and opium, producing plausible highs, lows and tingling.
If you happen to recover from pain in your knees after applying petroleum oil seasoned with chilli, turpentine and camphor – Clark Stanley’s Snake Oil Liniment – then you might just give Stanley the benefit of the doubt.
The chronically ill rarely expected miracles, but were ready to try these treatments. What did they have to lose? The emergence of a few truly effective medical treatments has done nothing to curb demand: it has increased the plausibility of real and fake drugs. So people were jumping from potion to potion, more in hope than in expectation.
If these treatments had worked, writes Troesken, “people would have been healed. . . and expenses would have been reduced ”. The fact that they didn’t heal much was, ironically, part of the reason they were in demand.
And where were the regulators? Johnson describes an irony: They eventually became interested in a product that was not a quack drug but a real antibiotic, sulfanilamide. Because it was not soluble in water or alcohol, it came in pill form in large pieces that are difficult for children to swallow.
In 1937, a child-friendly version was marketed by a new pharmaceutical company, SE Massengill. It was a raspberry flavored syrup with sulfanilamide dissolved in diethylene glycol. Too few people knew then that glycol was toxic and there was no legal obligation to verify. More than 100 people, including 34 children, have died of kidney failure before the United States Food and Drug Administration understood the problem and tracked down the last poisoned bottle. Harold Watkins, who originally produced the deadly syrup, committed suicide.
The main role of the FDA had been to ensure that the syrup tasted like raspberries as advertised. In 1938, President Franklin D Roosevelt signed a new law requiring the FDA to also be able to test for toxicity. And Frances Oldham Kelsey, the young chemist who identified the toxin in Massengill’s “Elixir,” held a leadership position at the FDA, where she later refused to approve the use of the deadly drug thalidomide.
We the consumers need help. We cannot distinguish tricks from treatments without high quality information. This information can come from public, for-profit or not-for-profit sources, and regulators are well placed to demand the costly controls needed.
However, it is not easy to determine what to regulate and how. The FDA, of course, wants to avoid approving future drugs that kill children, but there is a price to be paid for caution. The FDA was slow to approve Covid testing in early 2020. It appeared skeptical of the Oxford / AstraZeneca vaccine approved by UK and EU regulators and used in more than 160 countries around the world. There is a risk of hasty approval but also a risk of delay.
I cannot help but draw a broader political lesson from the long history of the demand for quackery. When we feel that things are not going well and the experts could not help us, we seek more speculative remedies, even if we do not expect much. When these remedies fail, we become more desperate and we keep looking. There is always another charlatan around the corner.
Troesken points out the puzzle, writing “one would not normally expect high consumer demand for products that regularly fail to deliver”. Not a strong demand from voters either. And yet we are there.
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