Webster's Dictionary defines quackery as "the actions or pretensions of a quack," and a quack as "a pretender to medical skills he does not possess." Quack is short for "quacksalver"  meaning literally to quack "like a duck about his 'salves' and remedies."  The duck symbolizes quackery because it makes a lot of noise about nothing. A congressional study defined a quack as "Anyone who promote medical schemes or remedies known to be false, or which are unproven, for a profit." Quackery is as quackery does, and the defining behavior of quackery is promotionalism. To promote is "to contribute to the growth and prosperity of; to present for public acceptance through advertising and publicity." Advertising is less pernicious than publicity because it is recognizable as a sales vehicle. Publicity generally passes as being noncommercial information, but publicity about quackery is a form of hidden advertising. Publicity abuse has been dubbed flackery  the actions of a flack: one who provides publicity; a press agent. Flack is thought to have come from anti-aircraft barrages that resemble the persistence of press agents who barrage the press with publicity schemes.
Quacks may be placed in three different categories: charlatans, cranks, or health hucksters based upon whether they are immoral, misguided, or amoral.
Charlatans are deliberate fakers. They can exploit people without feeling guilty because they are Cleckley psychopaths who, according to psychologist Dr. Robert Hare, are "social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and in feelings for others, they selfishly take what they want and do what they please, violating social norms and expectations without the slightest sense of guilt or regret."  Hare says that "psychopaths are the shyster lawyers, doctors always on the verge of losing their licenses, and businessmen with a string of deals where his partners always lose out." 
Cranks are delusional individuals who sincerely believe in themselves and their nostrums. They are likely to be as honest as anyone, and often exhibit selflessness and generosity. Science historian George Sarton had cranks in mind when he observed that "it is not true that all quacks are crooks, and some expert physicians are as greedy as quacks; the difference between them lies not so much in greediness as in a lack of criticism." Crankism may sometimes be difficult to recognize because it involves new ideas--in fact, most claim to be misunderstood modern day "Galileos."  However, anyone advocating a health-related idea who seeks scientific acceptance must expect to undergo a great deal of scrutiny, criticism, and testing before it can be accepted. The persistence a pioneering scientist needs to continue pursuing a good idea requires a level of self-confidence and drive that may be indistinguishable from crankism. True scientists differ from cranks in that they are more committed to the justice of their methods than any result they may obtain. True scientists are willing to admit that an idea may be wrong; and, that even if correct, has reasonable limitations. Cranks are willing to accept any support for their results, no matter how faulty, persist in the face of reasonable controverting evidence, and are often more grandiose in their expectations about the value of their theories. Medical scientists focus upon clinical evidence of safety and effectiveness with less attention to the mechanisms of action until something has proved worthwhile. Cranks often focus upon elaborations about theorized mechanisms of action rather than demonstrating that their methods significantly alter the natural variations that can be expected in the course of a disease, are better than a placebo, or improve upon the standard methods currently in use. Cranks are often paranoid, interpreting normal scientific criticism as "opposition" or even "persecution."  Cranks may be more dangerous than charlatans because while the latter may limit their claims in order to avoid bringing the law down upon themselves, cranks generally refuse to acknowledge limitations to their beloved methods.
Health hucksters are business people who idealize entrepreneurialism and who are merely exploiting opportunities offered by the public's interest in health. To them the marketplace is the best testing ground for ideas. If it sells, they reason, it must be good. Health hucksters are little concerned about the scientific validity of their wares. Customer "satisfaction," "closing the sale," and "the bottom line" are their primary concerns. Hucksters believe in the rule of caveat emptor (let the buyer beware), and social Darwinism (if people aren't smart enough to spot worthless health remedies, they are too foolish to survive in a modern economic society). Victor Herbert, MD, JD, has dubbed this philosophy buccaneer entrepreneurialism. Buccaneer entrepreneurs reject consumer protection law and science when it is bad for business. Hucksters work at the psychology of selling. Showmanship is a hallmark of the health huckster, and celebrities are often used as accomplices. Some of Hollywood's leading stars have allowed themselves to be used to promote quackery's agenda. Health hucksters pay lip service to American capitalism and the benefits of free enterprise. However, as quacks they pervert responsible enterpreneurialism by engaging in unfair competition. They use marketing techniques that no responsible business person or health professional would do when they claim to have secret remedies, or to be able to treat conditions without scientific evidence of safety and efficacy.
It was once believed that medical progress would gradually eliminate quackery, yet, at a time when life expectancy has reached an all-time high, quackery is booming. Some of quackery's success is due to the availability of mass communication and modern marketing techniques, but it is also related to the human condition. Science has cured the easy diseases, and has nearly closed the gap between statistical life expectancy and the potential for the human life span. Most people alive today have not experienced dramatic advances such as the polio vaccine that were obvious to the public. Science and technology are seen more as sources of environmental problems than beneficial to humanity. Studies reveal that when humans are unable to control events with science and technology, they revert to magical thinking and behavior. Modern medicine routinely achieves what would have been considered miracles a short time ago, but is unable to fulfill the wishful thinking, and deep emotional needs of humanity. Due to its specialization and impersonalization, modern medicine may drive more people toward quackery than the quacks would be able to draw to themselves, but the success of quackery still is no more a failing of medical science than the success of astrology is due to the failures of astronomy. Quackery exploits a dimension that science and responsible medicine cannot. As Maple observed: "In the face of the great leveler, death, we are all children listening fearfully for the footsteps of doom--relieved only by the whisperings of hope--the quack is the peddler of hope." Quackery deals with more than deliverance from death, but as Maple's observation suggests, quackery fills the void between what is possible and what people wish were possible. Selling false hope in health promotion keeps people from achieving their goals. Effective health promotion means making tough lifestyle changes that require discipline and some self-denial in a land of plenty. Quackery's easy methods of swallowing special pills and potions to build up the body, improve performance, prevent disease, slow aging, and so forth, do not work. They waste time, steal money, and may undermine the accomplishment of what is needed to succeed. As appealing as selling hope to a dying person may sound, in reality, false hope merely keeps dying people from making the difficult psychological adjustment from denial, anger, bargaining and depression to acceptance. Once they accept the reality of their situations people have shown remarkable abilities to make constructive use of the limited time they have left. False hope can rob people of this invaluable use of time.
Estimates of the total cost of quackery to Americans run from $25 to $100 billion depending upon the criteria used to define the problem. Soft core quackery (that which involves only wasted money) is huge if cosmetic items are included. Hard core quackery (that which costs lives and health) is far less in dollar volume, but exacts a terrible toll in terms of human suffering. Health care consists of three levels: therapeutics (getting well), health maintenance (staying well), and health promotion (improving overall health or performance). In dollar volume, health promotion is the most lucrative. Included are vitamins for health insurance and energy, weight loss schemes, nutrition counseling, health/natural/organic foods, ergogenic aids, and so forth. Therapeutics is probably second in dollar volume, with cancer quackery leading the list at an estimated $3-4 billion annually. Other diseases widely exploited by quacks include AIDS, arthritis, back pain, chronic fatigue syndrome, diabetes, heart disease, impotence, multiple sclerosis, and psychoneurosis.
An old saying is: "A robber demands your money or your life; but, a quack demands your money and your life!" NCAHF divides the harm done by quackery into six categories: economic harm (to individuals and society), direct harm (injury, permanent injury, death), indirect harm (injury, permanent injury, death), psychological harm, harm to society, and harm to professionalism
The number of attributes that can help someone to spot a quack before becoming a victim (its much easier after the fact!) run from the basic three to more than forty that are widely employed. The basic three practices that signal quackery are:
NCAHF holds that promoters who refuse to participate in the drug approval process established by Congress in the Food, Drug and Cosmetic Act, eschew clinical research requirements to show that their methods are of value, and try to avoid accountability by lobbying for "health freedom" legislation that strip consumers of their rights to redress, are unworthy of people's trust. Politicians who pander to quackery by passing so-called "medical freedom" laws, strip consumers of protection by allowing questionable health claims, exempt dietary supplements from having to prove safety and/or efficacy, or allow nonscientific health care practitioners to treat human ailments under the guise of "any willing provider" laws, are rewarding outlaw elements in society. This is both irrational and self-destructive to both the concept of responsible medicine and an orderly government. NCAHF believes that everyone has a stake in having and maintaining a health marketplace that is rooted in science and social responsibility. Quackery is the antithesis of both.
© 1996, National Council Against Health
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