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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).[citation needed] 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".[5][6][7] Stephen Barrett of Quackwatch defines quackery "as the promotion of unsubstantiated methods that lack a scientifically plausible rationale" and more broadly as: Pietro Longhi's The Charlatan (1757) "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] Paul Offit has proposed four ways in which alternative medicine "becomes quackery":[8][page needed] "..recommending against conventional therapies that are helpful."[page needed] "..promoting potentially harmful therapies without adequate warning."[page needed] "..draining patients' bank accounts,..."[page needed] "..promoting magical thinking,..."[page needed] Quacksalver[edit] Unproven, usually ineffective, and sometimes dangerous medicines and treatments have been peddled throughout human history.

Criticism of quackery in academia[edit] The science-based medicine community has criticized the infiltration of alternative medicine into mainstream academic medicine, education, and publications, accusing institutions of "diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology."[9][10] R. Donnell coined the phrase "quackademic medicine" to describe this attention given to alternative medicine by academia.

Referring to the Flexner Report, he said that medical education "needs a good Flexnerian housecleaning."[11] For example, David Gorski criticized Brian M.

British patent medicines lost their dominance in the United States when they were denied access to the Thirteen Colonies markets 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.[14][23] 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.

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Daffy's Elixir and Turlington's Balsam were among the first products that used branding (e.g.

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.

Each brand retained the same basic appearance for more than 100 years.

In 1909, in an attempt to stop the sale of quack medicines, the British Medical Association published Secret Remedies, What They Cost And What They Contain.[20][a] This publication was originally a series of articles published in the British Medical Journal between 19.[22] The publication was composed of 20 chapters, organising the work by sections according to the ailments the medicines claimed to treat.

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