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It’s called black salve and accord-ing to dozens of websites, it willcure cancer (skin, prostate, colon

and breast), alleviate yeast infections,remove plaque and even eradicategum disease.Marketed under such monikers as

Grandma’s Black Salve, AmericanNative Black Salve, Balm of Gilead orCompound X, it has testimonialsgalore:“In the 1960’s (Howard McCreary)

was diagnosed as having stomach can-cer,” says one website. “He took anoral dose of Compound X the nightbefore his scheduled surgery. … On the5th day Howard said he passed a largequantity of black, vile smelling feces,apparently the growth itself. When thedoctors took x-rays … the cancerousgrowth was gone.”“About two years ago my Brother-

in-law had a cancerous mole on hisforehead,” says another. “My Brother-in-law … used Black Salve that I hadgiven him. He said that he experienceda lot of pain with it but he tolerated it ashe knew it was working.”Adam Zimmerman, competition law

officer with the Competition Bureau ofCanada, which regulates false and mis-leading advertising, says there’s a goodreason the user experienced a lot ofpain. “It actually burns the skin. So youend up with scars and burn tissue.Black salve is outright illegal in the US[United States] and hasn’t beenapproved for sale in Canada,” althoughsome websites claim otherwise.It’s also an excellent example of

what are commonly called quack medi-cines — salves and tonics, pills andpotions, gadgets and cures that promisewondrous benefits.“Quackery has always been with

us,” says Jim Connor, professor ofmedical humanities and history of med-icine at Memorial University in St.John’s, Newfoundland and Labrador.“Maybe the common factor is quacks

certainly directly respond to the mar-ketplace. They may take on differentcolours and hues and shapes and sizesover the years, but clearly they seem tobe able to exploit the public, or agullible public, or sometimes a verywilling public, with respect to a partic-ular in-vogue ailment or problem ormarket niche.”There’s probably less quackery than

in the past due to stronger governmentregulation and a medical establishmentthat quacks find harder to duck, Connorsays. “The quack has to use differentmedia and you have to pay for thatmedia and that means that they leave apaper trail or some kind of record. Ifyou go back to the 19th century, I couldjust get on my horse and wagon and goaround villages and set up my stall andsell my coloured water for everythingthat ails you and move on. So I wouldbe very mobile and it would be verydifficult for the long arm of the law orthe medical law to catch up with me.”But scammers can now tap a much

larger audience, he adds. “The charac-

teristic 19th-century quack or charlatanwould maybe go to a fair and try todrum up business with a crowd ofmaybe 10 or 20 people around you. Butif you put something on the Internet,who knows how many millions of peo-ple you could hit in a millisecond.”Hucksters may also be more adept at

“sensing where the gaps are” in themarket, Connor adds. “Obesity isclearly a market. It’s also perhaps afield where, I won’t say biomedicinehas failed, but there is a gap therebetween what organized medicinemight be able to do and the quack canslip through the cracks and appealdirectly to the customer.”Zimmerman says scammers often

seek to drive a wedge between patientsand doctors. “The scammers are con-stantly preying on the consumer’s senseof fear. The basic trick is to say, ‘I’mthe only guy with the cure for this.’When you’re at the point when you’resaying, ‘Look, medical science isn’tdoing anything for me,’ that’s whenyou take the bait.”

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Salves and silver bulletsPublished at www.cmaj.ca on Mar. 24

Potions and pills promising wondrous benefits have “always been with us,” says JimConnor, professor of medical humanities and history of medicine at Memorial Univer-sity in St. John’s, Newfoundland and Labrador.

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The silver bullets include weight-loss gimmicks and cures for life-threat-ening conditions or diseases, he adds.It was ever thus.The Museum of Health Care in

Kingston, Ontario, houses more than 30000 medical artifacts from the 18thcentury onward. That includes surgicaltools, laboratory instruments and med-ical potions, including a large collec-tion of bottles of the enduringly popu-lar, “Lydia Pinkham’s VegetableCompound,” a cure-all for “femalecomplaints.”“It’s difficult to judge the effective-

ness of these things because it’s all inthe eyes of the beholder,” says curatorPaul Robertson. “If it’s effective foryou, then it’s effective therapy. It’smedicine. For many people who reliedon them they often were effective inthat they felt better.”“For example, here at the museum,

we have cholera medication which, ifyou analyze it, it has nothing to do withbattling cholera but it probably tookyour mind off it,” he adds. “Oftentimes,you felt better because many of thesepatented medicines from the 19th andearly 20th centuries had a heavy alco-hol base and often had an opiate baseas well — morphine, cocaine, that kindof thing were all standard ingredientsfor the time. It wasn’t a cure, eventhough perhaps they purported to becures in the early days. As regulationschanged, of course they had to clawback on that, tone down the rhetoric.But I think it was more the fact thatpeople felt better.”Many of those therapies were more

affordable and accessible in an erawhen doctors didn’t necessarily have aslofty a status and weren’t as accessible.

“You didn’t run to the doctor or ahospital the way we would now,”Robertson says. “Hospitals were gener-ally places people went to die. Drugswere also aimed at a lower income pop-ulation because they didn’t have accessto some of the other treatments thatwealthy people did. You had to befairly wealthy to go to the spas.”Holistic medicine claims some ben-

efits that are not clinically verified but

that doesn’t mean some of those thera-pies aren’t helpful, he adds. “Echinaceafor colds, for example. The clinicalstudies indicate that maybe it isn’t aseffective as you think. But who knows?I know I take it, for what it’s worth.” Connor notes that acupuncture,

homeopathy and various spa treatmentswere deemed quackery for decades butare now often considered “complimen-tary and alternative medicine. I think asignificant portion of mainstream medi-cine would now view that as being auseful adjunct to regular care. So that’snot a question of tightening up laws. Ithink it’s a question of redefining howa therapy or a medical system is inter-preted.”It’s easy to “demonize” therapies,

says Jackie Duffin, professor of medi-cine at Queen’s University in Kingston.“One man’s quackery is another man’smainstream medicine. It’s a term thatgets bandied around all the time, butit’s the unlicensed and unregulatedpractise of health care.”That distinction was meaningless in

an era in which everyone was prescrib-ing alcohol, opium and other “drugs weconsider poison,” she adds. “The wholetilting towards improving medicinemeans that we should be prepared toview our current medicine as wrong,someday. So the word quack is a pejo-rative. … Things that get labelledquackery are not only fraudulentmoney-making. There are wise women,herbalists who get called quacks whoreally believe in their remedies anddon’t make lots of money out of it.”Such remedies only became “quack-

ery” when doctors were given regula-tory authority to essentially oversee themedical profession, Duffin says. “Onceone kind of medicine triumphed andbecame the main medicine, then allothers became alternative. Once doc-tors developed their own colleges, theybecame self-governing. Doctors deter-mine who gets a licence. Doctors deter-mine who should be disciplined. It’s anamazing privilege that is accorded tothem in modern societies.”Duffin argues, though, that it’s

important for physicians to keep

apprised of what alternative therapiestheir patients are utilizing and to thatend, notes that medical students atQueen’s are now being taught toapproach patients with “very neutral,nonjudgmental questions. … If wereveal our hostility towards it, in theway we question them, they’re notgoing to tell us.”History also shows that some legiti-

mate therapies are appropriated byquacks just to hustle a buck, Robertsonsays. “Some electrotherapy was, Ibelieve, legitimate but at one point itgot a bad rep in the early to mid-20thcentury. One of the things that gave itthat bad rep were these electrical beltswhich men and women could use toelectrically stimulate digestion. But itwas largely marketed to men as theViagra of today. There were specialloops that would attach around the gen-itals to give a little bit of an electricalstimulation. That was supposed to helpwith so-called men’s weaknesses.”Erectile dysfunction has now gone

mainstream, Connor notes. “I don’tknow about you, but I certainly getplenty of email suggesting all the thingsthat are wrong with me and all of thethings that will fix me up. Is that quack-ery? What about Viagra and Cialis? Thelargest pharmaceutical corporation onthe planet is selling a drug for erectiledysfunction. At one time that mighthave been considered quackery.”The line between mainstream medi-

cine and quackery can be blurry,Robertson says, citing energy drinks asan example. “This is really a modernversion of the patent drugs of yearsago. It’s partly the language. It cloaks itin a quasi-medical way and it’s build-ing energy, it’s revitalizing. This iskind of a neat, modern retread of an oldidea.” Quackery is forever, Zimmerman

muses. “If there is one thing quackeryneeds to proliferate, it would be some-one who is willing to part with theirmoney for a miracle cure. And there isnever any shortage of that.” — BeckyRynor, Ottawa, Ont.

DOI:10.1503/cmaj.109-3215

CMAJ • APRIL 20, 2010 • 182(7)E286