“No disorders have employed so many quacks, as those that have no cure; and no sciences have exercised so many quills, as those that have no certainty”.
– Charles Caleb Colton
The placebo effect is a powerful thing. The belief that a substance can alleviate an ill has the power to do just that in about 30% of the population. The more benign the ailment e.g. aches and pains, cold, the easier is this effect. Things get a little tougher when an ailment is more complex in nature. Throughout the years, there have been men and women who have exploited the placebo effect to sell “snake oil” to unsuspecting patients. Sometimes, they have been able to sell their worthless products sans even a placebo effect – all they needed was the force of their nature and the glibness of their tongue.
The original snake-oil salesman was Charles Stanley. In the 1900s, Clark Stanley was known for his snake-oil. He claimed his concoction was a blend of snake-oils and that the recipe was from an old Indian medicine man. He would draw crowds to his rattlesnakes-killing sessions, where he would then sell his snake oil for 50 cents a bottle (about $10 today). He claimed it could cure toothaches, ankle sprains, neuralgias and most other ailments. In 1917, the Feds seized a shipment of the snake oil and analyzed it. Well, they found it contained 99 percent mineral oil and 1 percent beef fat, with traces of red pepper and some turpentine to give it a medicinal smell. His business was shut down.
My favorite quack of all time was John R. Brinkley – a man who never went to medical school but somehow managed to buy a medical degree. One day, he observed two goats mating and marveled at the sexual prowess of the ram. He then came up with a theory – if one transplanted the testes of the ram into the human scrotum, the patient will acquire the sexual prowess of the ram. What? Well, he opened his first goat-testes-transplant clinic in 1918. Forget that he wasn’t a doctor, knew no good surgical or sterile techniques. Forget that the idea was stupid and ridiculous. Well, he was inundated with patients, opened more clinics all over the country and made millions. Later he touted the transplant as a cure for almost every ailment. His first patient even got his wife pregnant. He advertised on the radio. He entered politics. Finally in 1938, he was sued for malpractice, lost and later died in 1942 a pauper.
These days, with FDA oversight being the way it is, such concoctions and ridiculous procedures are tough to sell without approval. There are still lots of quacks in the world of alternative medical treatments, supplements and diagnostic devices. One of them is Elizabeth Holmes.
In 2003, at the age of 19, she dropped out of Stanford’s chemical engineering program. She had the nugget of an idea and she planned to use this idea to change the world. The idea was to build a machine that could use tiny drops of blood from pricking a finger to run blood test instead off the ‘gallons’ that those ‘draculic’ phlebotomist draw. She founded a company initially named “Real-Time Cures”. In February 2005, she bagged $5.8 million from a venture capitalist and another $9.9 million year later. She changed the company’s name to “Theranos”, an amalgam of “therapeutics” and “diagnostics”.
By the summer of 2014, she had raised $400 million and the company Theranos was valued at $9 billion. Since she owed 50% of the company, as of the of summer 2015, at the age of 31, she had a net worth of $4.5 billion! She also had her machine named “Edison”.
There was only a small problem with this Ms Holmes’ idea – it was not scientifically viable but her investors did not seem to know or care. Since she founded the company, she had refused to either discuss her ideas with anyone in the medical community or publish any papers on work done based on this idea or tests with the Edison device. In the medical community, there were great doubts about her work.
Outside this community though, Ms Holmes was being feted as the next big thing. She received one honor after the next. Her speaking engagements ranged form TED Talks to lectures at Harvard. She adorned the covers of Fortune, Forbes, and Inc. and others. She was profiled in The New Yorker. The Board of Theranos had people like Henry Kissinger, George Schultz and Bill Frist as directors. She was going to revamp how testing was done. She was going to build devices that could test for hundreds of diseases from a same sample of blood. The sky was the limit.
When she was asked about the technology and science behind her Edison blood-testing machine for the 2014 New Yorker article, this is what she said:
“A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.”
This got the attention of the veteran Wall Street Journal reporter, John Carreyrou. He started investigating the company. On October 16, 2015, the Journal published the article:
“HOT STARTUP THERANOS HAS STRUGGLED WITH ITS BLOOD-TEST TECHNOLOGY.”
It was the first in a series of articles that blew the lid off the scam. He found the Edison did not work so Theranos used the blood-testing machines made by Siemens and other medical device companies for it’s tests. The tests that were done with the Theranos machines in clinics that they had opened in Arizona had results that were way off. Incidentally, the FDA and
Centers for Medicare and Medicaid Service (CMS) were investigating Theranos around the same time. Earlier this year, the hammer fell. Ms Holmes was been banned by the CMS from operating any lab services for 2 years. The Edison machine was been banned by the FDA. Walgreen pulled out of an agreement with Theranos to open blood testing centers. Ms Holmes is being investigated by the SEC and some lawsuits are in the wings. That $9 billion valuation now looks like a pipe dream.
The practice of all branches of medicine lends to it’s practitioners a certain aura of authority that is the envy of many. Some also erroneously see the profession as a way to fame and fortune. Thus, the profession attracts not only the best and the brightest but also charlatans. These quacks also bleed into the pharmaceutical and medical device industries and can cause as much harm there. We in the profession can only hope and pray that the mechanisms in place can weed out these snake-oil salesmen pitching bad medicine.