Quackery

Quackery is a derogatory term used to describe the promotion^[1] of unproven or fraudulent medical practices. Random House Dictionary describes a "quack" as a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan."^[2]

The word "quack" derives from the archaic word "quacksalver," of Dutch origin (spelled kwakzalver in contemporary Dutch), literally meaning "hawker of salve".^[3] In the Middle Ages the word quack meant "shouting". The quacksalvers sold their wares on the market shouting in a loud voice.^[4]

"Health fraud" is often used as a synonym for quackery, but quackery's salient characteristic is aggressive promotion ("quacks quack!") rather than fraud, greed or misinformation.^[1] "Pseudo-medicine" is a term for treatments known to be ineffective, regardless of whether their advocates themselves believe in their effectiveness.

Contents 1 Definition 2 The quacksalver 3 History of quackery in Europe and the United States 4 Quackery in contemporary culture 4.1 People's Republic of China 5 Presence and acceptance 6 Notable historical persons accused of quackery 7 See also 7.1 Regulatory organizations 7.2 Anti-quackery organizations 8 Footnotes 9 References 10 External links

Definition

Since there is no exact standard for what constitutes quackery, and how to differentiate it from experimental medicine, protoscience, religious and spiritual beliefs, etc., accusations of quackery are often part of polemics against one party or other, and sometimes in polemic exchanges.

In determining whether a person is committing quackery, the central question is what is acceptable evidence for the efficacy and safety of whatever treatments, cures, regimens, or procedures the alleged quack advocates. Because there is some level of uncertainty with all medical treatments, it is common ethical practice (and in some cases, a legal requirement) for pharmaceutical companies and many medical practitioners to explicitly state the promise, risks, and limitations of a medical choice.

Since it is difficult to distinguish between those who knowingly promote unproven medical therapies and those who are mistaken as to their effectiveness, U.S. courts have ruled in defamation cases that accusing someone of quackery or calling a practitioner a quack is not equivalent to accusing that person of committing medical fraud. To be both quackery and fraud, the quack must know they are misrepresenting the benefits and risks of the medical services offered (instead of, for example, promoting an ineffective product they honestly believe is effective).

In addition to the ethical problems of promising benefits that can not reasonably be expected to occur, quackery also includes the risk that patients may choose to forego treatments that are more likely to help them, in favor of ineffective treatments given by the "quack".

Stephen Barrett, who runs the alternative medicine watchdog website, Quackwatch, a consumer information organization with several websites dedicated to exposing quackery, defines the practice this way:

To avoid semantic problems, quackery could be broadly defined as "anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word "fraud" would be reserved only for situations in which deliberate deception is involved.^[1]

The quacksalver

Unproven, usually ineffective, and sometimes dangerous medicines and treatments have been peddled throughout human history. Theatrical performances were sometimes given to enhance the credibility of purported medicines. Grandiose claims were made for what could be humble materials indeed: for example, in the mid-19th century Revalenta Arabica was advertised as having extraordinary restorative virtues as an empirical diet for invalids; despite its impressive name and many glowing testimonials it was in truth only ordinary lentil flour, sold to the gullible at many times the true cost.

Even where no fraud was intended, quack remedies often contained no effective ingredients whatsoever. Some remedies contained substances such as opium, alcohol and honey, which would have given symptomatic relief but had no curative properties. The few effective remedies sold by quacks included emetics, laxatives and diuretics. Some ingredients did have medicinal effects: mercury, silver and arsenic compounds may have helped some infections and infestations; willow bark contained salicylic acid, chemically closely related to aspirin; and the quinine contained in Jesuit's bark was an effective treatment for malaria and other fevers. However, knowledge of appropriate uses and dosages was limited.

History of quackery in Europe and the United States

With little understanding of the causes and mechanisms of illnesses, widely marketed "cures" (as opposed to locally produced and locally used remedies), often referred to as patent medicines, first came to prominence during the 17th and 18th centuries in Britain and the British colonies, including those in North America. Daffy's Elixir and Turlington's Balsam were among the first products that used branding (e.g., using highly distinctive containers) and mass marketing to create and maintain markets.^[5] A similar process occurred in other countries of Europe around the same time, for example with the marketing of Eau de Cologne as a cure-all medicine by Johann Maria Farina and his imitators. Patent medicines often contained alcohol or opium.

The number of internationally marketed quack medicines increased in the later 18th century; the majority of them originated in Britain^[6] and were exported throughout the British Empire. These treatments were so popular that by 1830, British parliamentary records list over 1,300 different "proprietary medicines,"^[7] the majority of which were "quack" cures by modern standards.

In 1909, in an attempt to stop the sale of such medicines, the British Medical Association published Secret Remedies, What They Cost And What They Contain. The publication was composed of 20 chapters, organising the work by sections according to the ailments the medicines claimed to treat. Each remedy was tested thoroughly, the preface stated: “Of the accuracy of the analytical data there can be no question; the investigation has been carried out with great care by a skilled analytical chemist.” The book did lead to the end of some of the quack cures, but some survived the book by several decades. For example, Beecham's Pills (identified as containing only aloes, ginger and soap, but claiming to cure 31 medical conditions) were still on sale in 1997.^[8]

British patent medicines started to lose their dominance in the United States when they were denied access to the American market during the American Revolution, and lost further ground for the same reason during the War of 1812. From the early 19th century "home-grown" American brands started to fill the gap, reaching their peak in the years after the American Civil War.^[6][9] British medicines never regained their previous dominance in North America, and the subsequent era of mass marketing of American patent medicines is usually considered to have been a "golden age" of quackery in the United States. This was mirrored by similar growth in marketing of quack medicines elsewhere in the world.

The Dutch Society Against Quackery was established in 1880. Within a short time the Society grew to more than 1,100 members. Initially, quackery mainly consisted of the unauthorized practice of medicine and the peddling of "secret remedies". By the 1950s, their energy mostly shifted to magnetizers. Since the 1980s the society has fought against so-called alternative medicine. Their primary targets are Chinese acupuncture, homeopathy, manipulative therapy, anthroposophical medicine, and naturopathy.^[10]

In the United States, false medicines in this era were often denoted by the slang term snake oil, a reference to sales pitches for the false medicines that claimed exotic ingredients provided the supposed benefits. Those who sold them were called "snake oil salesmen," and usually sold their medicines with a fervent pitch similar to a fire and brimstone religious sermon. They often accompanied other theatrical and entertainment productions that traveled as a road show from town to town, leaving quickly before the falseness of their medicine was discovered. Not all quacks were restricted to such small-time businesses however, and a number, especially in the United States, became enormously wealthy through national and international sales of their products.

One among many examples is that of William Radam, a German immigrant to the USA who, in the 1880s, started to sell his "Microbe Killer" throughout the United States and, soon afterwards, in Britain and throughout the British colonies. His concoction was widely advertised as being able to "Cure All Diseases" (W. Radam, 1890) and this phrase was even embossed on the glass bottles the medicine was sold in. In fact, Radam's medicine was a therapeutically useless (and in large quantities actively poisonous) dilute solution of sulfuric acid, coloured with a little red wine.^[9] Radam's publicity material, particularly his books (see for example Radam, 1890), provide an insight into the role that pseudo-science played in the development and marketing of "quack" medicines towards the end of the 19th century.

Similar advertising claims^[11] to those of Radam can be found throughout the 18th, 19th, 20th and 21st centuries. "Dr." Sibley, an English patent medicine seller of the late 18th and early 19th centuries, even went so far as to claim that his Reanimating Solar Tincture would, as the name implies, "restore life in the event of sudden death". Another English quack, "Dr. Solomon" claimed that his Cordial Balm of Gilead cured almost anything, but was particularly effective against all venereal complaints, from gonorrhoea to onanism. Although it was basically just brandy flavoured with herbs, it retailed widely at 33 shillings a bottle in the period of the Napoleonic wars, the equivalent of over $100 per bottle today.

Not all patent medicines were without merit. Turlingtons Balsam of Life, first marketed in the mid-18th century, did have genuinely beneficial properties. This medicine continued to be sold under the original name into the early 20th century, and can still be found in the British and American Pharmacopoeias as "Compound tincture of benzoin". It can be argued that for some of these medicines this is an example of the infinite monkey theorem in action.

The end of the road for the quack medicines now considered grossly fraudulent in the nations of North America and Europe came in the early 20th century. February 21, 1906 saw the passage into law of the Pure Food and Drug Act in the United States. This was the result of decades of campaigning by both government departments and the medical establishment, supported by a number of publishers and journalists (one of the most effective of whom was Samuel Hopkins Adams, whose series "The Great American Fraud" was published in Colliers Weekly starting in late 1905). This American Act was followed three years later by similar legislation in Britain, and in other European nations. Between them, these laws began to remove the more outrageously dangerous contents from patent and proprietary medicines, and to force quack medicine proprietors to stop making some of their more blatantly dishonest claims.

Medical quackery and promotion of nostrums and worthless drugs were among the most prominent abuses that led to formal self-regulation in business and, in turn, to the creation of the NBBB.^[12]

Quackery in contemporary culture

"Quackery is the promotion of false and unproven health schemes for a profit. It is rooted in the traditions of the marketplace", with "commercialism overwhelming professionalism in the marketing of alternative medicine".^[13] Considered by many an archaic term, quackery is most often used to denote the peddling of the "cure-alls" described above. Quackery continues even today; it can be found in any culture and in every medical tradition. Unlike other advertising mediums, rapid advancements in communication through the Internet have opened doors for an unregulated market of quack cures and marketing campaigns rivaling the early 1900s. Most people with an e-mail account have experienced the marketing tactics of spamming—in which modern forms of quackery are touted as miraculous remedies for "weight-loss" and "sexual enhancement," as well as outlets for unprescribed medicines of unknown quality.

While quackery is often aimed at the aged or chronically ill, it can be aimed at all age groups, including teens, and the FDA has mentioned^[14] some areas where potential quackery may be a problem: breast developers, weight loss, steroids and growth hormones, tanning and tanning pills, hair removal and growth, and look-alike drugs.

In a 1992 article in the journal Clinical Chemistry, then president of The National Council Against Health Fraud, William T. Jarvis, wrote:

"The U.S. Congress determined quackery to be the most harmful consumer fraud against elderly people. Americans waste $27 billion annually on questionable health care, exceeding the amount spent on biomedical research. Quackery is characterized by the promotion of false and unproven health schemes for profit and does not necessarily involve imposture, fraud, or greed. The real issues in the war against quackery are the principles, including scientific rationale, encoded into consumer protection laws, primarily the U.S. Food, Drug, and Cosmetic Act. More such laws are badly needed. Regulators are failing the public by enforcing laws inadequately, applying double standards, and accrediting pseudomedicine. Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist."^[15]

For those in the practice of any medicine, to allege quackery is to level a serious objection to a particular form of practice. Most developed countries have a governmental agency, such as the Food and Drug Administration (FDA) in the US, whose purpose is to monitor and regulate the safety of medications as well as the claims made by the manufacturers of new and existing products, including drugs and nutritional supplements or vitamins. The Federal Trade Commission (FTC) also participates in some of these efforts.^[16] To better address less regulated products, in 2000, US President Clinton signed Executive Order 13147 that created the White House Commission on Complementary and Alternative Medicine. In 2002, the commission's final report made several suggestions regarding education, research, implementation, and reimbursement as ways to evaluate the risks and benefits of each.^[17] As a direct result, more public dollars have been allocated for research into some of these methods.

Individuals and non-governmental agencies are active in attempts to expose quackery. According to Norcross et al. (2006) several authors have attempted to identify quack psychotherapies; (e.g., Carroll, 2003; Della Sala, 1999; Eisner, 2000; Lilienfeld, Lynn, & Rohr 2003; Singer and Lalich 1996). The evidence based practice (EBP) movement in mental health emphasizes the consensus in psychology that psychological practice should rely on empirical research. There are also "anti-quackery" web sites, such as Quackwatch,^[18] which help consumers evaluate particular claims.^[19] Quackwatch's information is relevant to both consumers and medical professionals.^[20]

People's Republic of China

Zhang Wuben, a quack who posed as skilled in traditional Chinese medicine in the People's Republic of China, based his operation on representations that raw eggplant and mung beans were a general cure-all. Zhang, who has escaped legal liability as he portrayed himself as a nutritionist, not a doctor, appeared on television in China and authored a best-selling book, Eat Away the Diseases You Get from Eating. Zhang, who charged the equivalent of $450 for a 10 minute examination, had a two-year waiting list when he was exposed. Investigations, launched after the popularity of his theories resulted in a run on mung beans, revealed that, contrary to his representations, he did not come from a family of accomplished traditional practitioners (中医世家) and never had the medical degree from Beijing Medical University he claimed to have. His only education was a brief correspondence course completed, or night school course, after he was laid off from a textile factory. Zhang, despite negative publicity on the national level, continues to practice, but has committed himself to finding a cheaper cure-all than mung beans. His clinic, Wuben Hall, adjacent to Beijing National Stadium, was torn down as an illegal structure. Much of Zhang Wuben's success was due to the efforts of Chinese entrepreneurs, including one government-owned company, who promoted him.^[21][22][23]

Hu Wanlin, who did hold himself out as a doctor, was exposed in 2000 and sentenced to 15 years in prison. He adulterated his concoctions with sodium sulphate, Glauber's salt, a poison in large doses. That case resulted in creating a system of licensing medical doctors in China.^[23]

Presence and acceptance

Opponents of quackery have suggested several reasons why quackery is accepted by patients in spite of its lack of effectiveness:

• Ignorance: Those who perpetuate quackery may do so to take advantage of ignorance about conventional medical treatments versus alternative treatments, or may themselves be ignorant regarding their own claims. Mainstream medicine has produced many remarkable advances, so people may tend to also believe groundless claims.
• The placebo effect: Medicines or treatments known to have no pharmacological effect on a disease can still affect a person's perception of their illness, and this belief in its turn does indeed sometimes have a therapeutic effect, causing the patient's condition to improve. This is not to say that no real cure of biological illness is effected—though we might describe a placebo effect as being "all in the mind"", we now know that there is a genuine neurobiological basis to this phenomenon.^[24] People report reduced pain, increased well-being, improvement, or even total alleviation of symptoms. For some, the presence of a caring practitioner and the dispensation of medicine is curative in itself.
• The regression fallacy: Certain "self-limiting conditions", such as warts and the common cold, almost always improve, in the latter case in a rather predictable amount of time. A patient may associate the usage of alternative treatments with recovering, when recovery was inevitable.
• Distrust of conventional medicine: Many people, for various reasons including the risk of side effects, have a distrust of conventional medicines (or of the regulating organizations themselves such as the Food and Drug Administration (FDA) or the major drug corporations).
• Conspiracy theories: Anti-quackery activists ("quackbusters") are accused of being part of a huge "conspiracy" to suppress "unconventional" and/or "natural" therapies, as well as those who promote them. It is alleged that this conspiracy is backed and funded by the pharmaceutical industry and the established medical care system – represented by the AMA, FDA, ADA, CDC, WHO, etc. – for the purpose of preserving their power and increasing their profits. In the case of chiropractic, the case for a conspiracy was supported by a court decision, ruling that the AMA had engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession."^[25][26][27]
• Fear of side effects: A great variety of pharmaceutical medications can have very distressing side effects, and many people fear surgery and its consequences, so they may opt to shy away from these mainstream treatments.
• Cost: There are some people who simply cannot afford conventional treatment, and seek out a cheaper alternative. Nonconventional practitioners can often dispense treatment at a much lower cost.
• Desperation: People with a serious or terminal disease, or who have been told by their practitioner that their condition is "untreatable," may react by seeking out treatment, disregarding the lack of scientific proof for its effectiveness, or even the existence of evidence that the method is ineffective or even dangerous.
• Pride: Once a person has endorsed or defended a cure, or invested time and money in it, they may be reluctant to admit its ineffectiveness, and therefore recommend the cure that did not work for them to others.
• Fraud: Some practitioners, fully aware of the ineffectiveness of their medicine, may intentionally produce fraudulent scientific studies and medical test results, thereby confusing any potential consumers as to the effectiveness of the medical treatment.

Notable historical persons accused of quackery

• Franz Anton Mesmer (1734–1815), born Friedrich Anton Mesmer, was a German physician and astrologist, who invented what he called magnétisme animal.

• Thomas Allinson (1858–1918), founder of naturopathy. His views often brought him into conflict with the Royal College of Physicians of Edinburgh and the General Medical Council, particularly his opposition to doctors' frequent use of drugs, his opposition to vaccination and his self promotion in the press.^[28] His views and publication of them led to him being labeled a quack and being struck off by the General Medical Council for infamous conduct in a professional respect.^[29][30]

• Lovisa Åhrberg (1803–1866), the first Swedish female doctor. Åhrberg was met with strong resistance from male doctors and was accused of quackery. During the formal examination she was acquitted of all charges and allowed to practice medicine in Stockholm even though it was forbidden for women in the 1820s. She later received a medal for her work.

• Johanna Brandt (1876–1964), a South African naturopath who advocated the "Grape Cure" as a cure for cancer.^[31]

• Hulda Regehr Clark (1928–2009), was a controversial naturopath, author, and practitioner of alternative medicine who claimed to be able to cure all diseases and advocated methods that have no scientific validity.^[32]

• Samuel Hahnemann (1755–1843), founder of homeopathy. Hahnemann believed that all diseases were caused by "miasms," which he defined as irregularities in the patient's vital force.^[33] He also said that illnesses could be treated by substances that in a healthy person produced similar symptoms to the illness, in extremely low concentrations, with the therapeutic effect increasing with dilution and repeated shaking.^[34][35][36]

• Lawrence B. Hamlin (in 1916), was fined under the 1906 Pure Food and Drug Act for advertising that his Wizard Oil could kill cancer.^[37]

• L. Ron Hubbard (1911–1986), was the founder of the Church of Scientology. He was an American science fiction writer, former United States Navy officer, and creator of Dianetics.^[38][39][40]

• John Harvey Kellogg (1852–1943), was a medical doctor in Battle Creek, Michigan, USA who ran a sanitarium using holistic methods, with a particular focus on nutrition, enemas and exercise. Kellogg was an advocate of vegetarianism, and is best known for the invention of the corn flake breakfast cereal with his brother, Will Keith Kellogg.^[41]

• D.D. Palmer (1845–1913), was a grocery store owner that claimed to have healed a janitor of deafness after adjusting the alignment of his back. He founded the field of chiropractic based on the principle that all disease and ailments could be fixed by adjusting the alignment of someone's back. His hypothesis was disregarded by medical professionals at the time and despite a considerable following has yet to be scientifically proven.^[42] D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."^[43]

• Ignac Semmelweis (1818–1865), was a Hungarian physician described as the "savior of mothers".^[44] Despite discovering the importance of what later became hand disinfection thus reducing the incidence of puerperal fever, his theory was regarded with suspicion by many fellow scientists, including his supervisor in the Vienna General Hospital and later his peers in Budapest as well. Since it happened several decades before the explanation of the germ theory of disease, many of Semmelweis' contemporaries viewed his theories as unscientific, baseless speculation not unlike of those of earlier decades.^[45] He did not gain recognition in his life (for which he became rather bitter) nor his death: hardly any medical periodicals took note of his death, only a few people attended his funeral and the Hungarian Association of Physicians and Natural Scientist has failed to even mention his death.^[46] He was vindicated only after the confirmation of the germ theory of disease by Pasteur and others.

• Louis Pasteur (1822–1895), was a French chemist best known for his remarkable breakthroughs in microbiology. His experiments confirmed the germ theory of disease, also reducing mortality from puerperal fever (childbed), and he created the first vaccine for rabies. He is best known to the general public for showing how to stop milk and wine from going sour – this process came to be called pasteurization. His hypotheses initially met with much hostility, and he was accused of quackery on multiple occasions. However, he is now regarded as one of the three main founders of microbiology, together with Ferdinand Cohn and Robert Koch.^[47]

• Linus Pauling (1901–1994), a Nobel Prize winner in chemistry, Pauling spent much of his later career arguing for the treatment of somatic and psychological diseases with orthomolecular medicine. One of his most famous claims was that the common cold could be cured with massive doses of vitamin C. Together with Ewan Cameron he wrote the 1979 book "Cancer and Vitamin C", which was again more popular with the public than the medical profession, which continued to regard claims about the effectiveness of vitamin C in treating or preventing cancer as quackery."^[48] A biographer has discussed how controversial his views on megadoses of Vitamin C have been and that he was "still being called a 'fraud' and a 'quack' by opponents of his 'orthomolecular medicine'".^[49]

• Wilhelm Reich (1897-1957), Austrian-American Psychoanalyst. Claimed that he had discovered a primordial cosmic energy called Orgone. He developed several devices, including the Cloudbuster and the Orgone Accumulator, that he believed could use orgone to manipulate the weather, battle space aliens and cure diseases, including cancer. After an investigation, the FDA concluded that they were dealing with a "fraud of the first magnitude". On February 10, 1954, the U.S. Attorney for Maine filed a complaint seeking a permanent injunction under Sections 301 and 302 of the Federal Food, Drug, and Cosmetic Act, to prevent interstate shipment of orgone accumulators and to ban some of Reich's writing promoting and advertising the devices. Reich refused to appear in court, arguing that no court was in a position to evaluate his work. Reich was arrested for contempt of court, and convicted to 2 years in jail, a $10,000 fine, and his Orgone Accumulators and work on Orgone were ordered destroyed. On August 23, 1956, six tons of his books, journals, and papers were burned in the 25th Street public incinerator in New York. On March 12, 1957 he was sent to Danbury Federal Prison, where Richard C. Hubbard, a psychiatrist who admired Reich, examined him, recording paranoia manifested by delusions of grandiosity, persecution, and ideas of reference. On November 18, 1957 Reich died of a heart attack 9 months later while he was in the federal penitentiary in Lewisburg, Pennsylvania.

• William Herbert Sheldon who created the theory of somatotypes corresponding to intelligence.^[50][51]

See also

• Charlatan
• Chelation therapy
• Homeopathy
• Consumer protection
• Dental amalgam controversy
• False advertising in health care
• Fraud
• Liquid Oxygen
• Medical ethics
• Mountebank
• Patent medicine
• Poseur
• Pseudoscience
• Radioactive quackery
• Snake oil
• Health care fraud

Regulatory organizations

• Federal Trade Commission
• Food and Drug Administration
• Medicines and Healthcare products Regulatory Agency
• AP Paramedical board.Andhra Pradesh.India

Anti-quackery organizations

• National Council Against Health Fraud
• Quackwatch
• Quackdown

Footnotes

References

• Carroll, 2003. The Skeptics Dictionary. New York: Wiley.
• Della Sala, 1999. Mind Myths: Exploring Popular Assumptions about the Mind and Brain. New York: Wiley.
• Eisner, 2000. The Death of Psychotherapy; From Freud to Alien Abductions. Westport; CT: Praegner.
• Lilienfeld, SO., Lynn, SJ., Lohr, JM. 2003; Science and Pseudoscience in Clinical Psychology. New York. Guildford
• Norcross, JC, Garofalo.A, Koocher.G. (2006) Discredited Psychological Treatments and Tests; A Delphi Poll. Professional Psychology; Research and Practice. vol37. No 5. 515-522
• Radam, W. (1890) Microbes and the microbe killer. New York: The Knickerbocker Press. 369pp.

External links

 Chisholm, Hugh, ed (1911). "Quack". Encyclopædia Britannica (11th ed.). Cambridge University Press. 

• Quackery at the Open Directory Project
• Medline Plus – entry on Health Fraud
• How to Spot Health Fraud Article from the Food and Drug Administration
• 'Miracle' Health Claims: Add a Dose of Skepticism Article at the Federal Trade Comiision
• Museum of Questionable Medical Devices – Science Museum of Minnesota
• "Quackery." Handbook of Texas.

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