Paranoid mental state, paranormal and psychopathic tendencies and belief encroachment will also make a professional engage in quackery and health fraud.

 While it is true that some drugs like artemisinin and quinine were extracted from the barks of trees, the truth is that these have been properly analyzed, catalogued and synthesized from the labs. Nature provides the basic tools on which science builds upon. Most quacks put a label of natural product or supplement on their product and use this to claim superiority above modern science. This is untrue; it is the beginning of fraud for ‘natural’ does not equal safe and synthetic does not connote, for instance tetanospamin is natural but deadly while nitroglycerin is a life saving synthetic. To start with, most quack – read herbal - products have no names known to science either unknowingly because there are no proper classification facilities or the names are deliberately omitted to conceal fraud from science. Whenever there is any problem with any drug the culprit can easily be traced but this is not so with alternative preparations. One is sure that if the products coming from these alternative practitioners and bearing NAFDAC’s registration number are properly analyzed, they cannot stand the rigorous scientific analyses. Yet this is what is paraded as endorsement of these products. Most multilevel drugs don’t even bother to carry NAFDAC’s number. The use of double blind study, the gold standard in efficacy, effectiveness and safety is criminally waived. The pharmacokinetics and pharmacodynamics of their cherished elixirs are not even known. So the fact that a product is a natural supplement or carries NAFDAC’s registration number does not automatically confer the status it desires on it but unfortunately most members of the public do not know this.

 That a product or method has been used since the early man does not mean properly designed control studies have been done on it or that it is safe or effective or efficacious. Cow urine has been used by the Yorubas for aeons in concoctions for, amongst others, febrile convulsion but medicine says it is unsafe to the kidneys and liver and causes hypoglycaemia. For storage purpose shells, gourds, earthenware, horns, trunks, hides and leaves are replaced with ampoules, vials, sachets, dispensers, tins, jars and bottles; this is good marketing yet science says the repackaged mystery stuff needs proper scientific assessment. It is still the old untested wine in new bottle. It is not safe until proven otherwise. In alternative medicine, a therapy or product is safe and effective all the time even in the presence of compelling counter evidence. Dregs of palm wine are assumed to boost spermatogenesis.

 Chicanery, health fraud, mismanagement and malpractice or ‘medical quackery’ is a continuum of undesirable medical practice. Especially in the cities, we are blessed with more than a fair share of these rabid phenomena.

 The fertile soil of fraud and quackery is watered by a number of interrelated factors. Unfounded superstition and myths, poverty, medical illiteracy and wrong beliefs are at the root of patients’ vulnerability to health fraud and quackery. Even in this age of cloning, nanomedicine and organ transplant, Nigerians are a most backward vulnerable lot. Belief in witchcraft, faddism and esotericism is rampant; the Akwa Ibom experience, weight loss craze and Synagogueism being ready examples. Faced with the prospect of chronic suffering, deformity or death, many people, even the intelligent and well educated, out of desperation will try anything that offers the slightest hope of cure or amelioration. This has led to untold hardship for sufferers of chronic diseases like diabetes mellitus, hypertension, fibroids, infertility, arthritis, AIDS and cancer. The leeway given to today’s quacks by loose regulation of medical practice, advertisement on the mass media etc has opened a super highway to misinformation and disinformation; it is a strong incentive to the quack and his quarry.

 Modern promoters use scientific jargon and pseudomedical words, and often quote or misquote scientific references that can fool people not familiar with the concepts being discussed. For example which scientist ever heard of ‘the research done on aloe vera and staph at UCH’? Prof Ilesanmi, the revered gynecologist and CMD of UCH may assist us with this: Sir, what is that research done at UCH on aloe vera and staphylococcus? What is dislocated uterus, please?

 Quacks and health frauds also introduce phenomena that are strange and meaningless to science. These strange ideas and neologism, coming from empiricism, ancient folklores, old wives’ tales and practice without rigorous scientific analyses are enough suspicious reasons to the discerning mind. And talking about medical research in Nigeria, we have not even started.  

 Bogus therapies are promoted with glee and enthusiasm, testimonials from ‘satisfied’ customers who often turn out to be employees or relatives, endorsements from dubious sportsmen and the showbiz crowd, and ‘experts’ opinions. And these remedies do seem to work! But do they really work?

 Barry Beyerstein in his thesis ‘Why Bogus Therapies Often Seem to Work’ identified seven reasons why this is so. The disease may have run its natural course, [for] example the spontaneous remission in the common cold which has no cure; the cyclical nature of many diseases, [as] in rheumatoid arthritis; wrong diagnosis or prognosis ab initio, [for] example the use of unripe papaya in physiological jaundice; the placebo effect, [to] which about 10-20% of patients are responsive; temporary improvement being confused with cure, [for] instance the upturn in renal colic; people who hedge their bet crediting the wrong thing, [for] example concomitant use of garlic and ACE inhibitor in hypertension; and psychological needs distorting what people perceive and do, are some of the reasons why people credit worthless quack methods.  

 Other reasons will include but are not limited to post hoc fallacy, subjective or selective validation, self deception, wishful thinking, communal reinforcement, confirmation bias and operant conditioning.

 By the way, legitimate products do not need endorsements and testimonials, and very few uncompromised scientists and doctors are willing to provide them especially for marketing purposes. Genuine products need no sponsored programmes, and no advertisement. Little wonder mainstream medicine frowns at even subtle forms of advertisement or self adulation. This distinguishes orthodox medical practitioners from the alternative practice crowd who also use reverse labeling to condemn mainstream medicine.  

 Quacks and charlatans are super salesmen and master psychologists marketing their wares under different guises and cynically manipulating people’s psyche. They appeal to human foibles, emotions and vanities, turn customers into salesmen, use money back guarantees, and shift blames. To those in pains, they promise relief. To the incurable, they offer hope. To the weak, they instill fear. Quackery attracts customers by inventing disease. Virtually everyone, said Stephen Barrett, has symptoms of one sort or another- minor aches or pains, reactions to stress or hormone variations, effects of aging etc. Labeling these ups and downs of life as symptoms of diseases enables the quack to provide ‘treatment’. Some practitioners claim to detect ‘deficiencies’ before any symptoms appear or before they can be detected by conventional means. Then they can sell supplements. And when the terrible consequences they warn about don’t develop, they can claim success.

Robot  # 1 | 08.01.2009 00:37

Quacks and charlatans are super salesmen and master psychologists marketing their wares under different guises and cynically manipulating people’s psyche. They appeal to human foibles, emotions and vanities, turn customers into salesmen, use money back guarantees, and shift blames. To those in pains, they promise relief. To the incurable, they offer hope. To the weak, they instill fear. Quackery attracts customers by inventing disease. ...Read the full article.

Lapalapa  # 2 | 08.01.2009 05:49

Thank you very much for bringing this important issue to the village square again. Not quite a week ago, I was telling my children about the "molue pharmacists" in Lagos and how my mother was always falling for them every time she took those buses! I was using it to illustrate the persuasive power of Nigerian indigenous languages, including our version of the English language. Anyone who could make another human being with a good sense of smell drink a stinking cow urine as medicine deserves his price! I dream of the day when the government will be able to use this special persuasive talent as a strategy for health promotion in the country. Imagine employing those "pharmacists" to educate our people on what democracy actually means. As for drug efficacy, well, that is another story. It is amazing to know that the number of drugs that are known to work is a multiple of the number of drugs whose exact mechanisms of action are known. Drug efficacy results from a combination of Psychology, Physiology, Chemistry, Genetics, etc, among others. And when one looks at how the efficacy trials of some of the "newer" Western drugs are done you would sometimes wonder about whether someone is fooling us. Imagine that a cancer drug could be licensed because there is a "statistical" evidence that it adds 3-6 months to the life of a patient. By the time you try to unravel the Statistics behind the story, you will realize that there is always an element of "good faith" somewhere! Remember that the white man (as we like to call non-Africans) is sometimes the master conman. So, to cut the long story short, my take on this is: if NAFDAC can ensure that all these "cure all" herbal products are safe, it is the prerogative of the user to determine efficacy. The approach is the same in many countries, Chinese traditional doctors are making more money than allopathic physicians in some cities in the United States and Canada. Even highly educated people here have been made to believe that those "doctors" could make a diagnosis of liver disease by simply touching your hands and picking up "vibrations"! They would displace physicians if only they had the talents of the Nigerian "molue pharmacists". One of my greatest regrets in life is that I never tried to ask or understand why my father would pull certain plants for certain diseases. He died with that knowledge because he couldn't read or write, and he had educated children who thought if the drug was not made by a pharmaceutical company it was not worth taking. I now know that the world has missed on a lot of potentially excellent natural pharmaceutical products that could have eventually become synthetic because of this attitude. As for medical research, I can assure you Nigerian natural product chemists are doing a lot of good work. We only need to figure out how they can be better organized and funded. However, this is not to say that Nigeria should still allow well-tested prescription products like antibiotics and antimalarials to be sold in Nigeria of 2009 without a physician's prescription. That should not be an area for itinerant pharmacists!

Danmeka  # 3 | 08.01.2009 09:49

Abayomi, thanks for your article. When a country cannot provide health facilities and equipments for doctors to use, even our President goes abroad for treatment not trusting our own doctors what do you expect.A nation that cannot provide basic infrastructures to aid socio-economic development that would provide employment and better the lives of every average Nigerians is bound to fall. No wonder you have all sort of people selling all kinds of drugs some of which are even banned in EU countries and even some so called drug manufacturers are even producing drugs using deadly chemicals. Do our leaders relly care about the average Nigerian. NO

maikanodahiru  # 4 | 08.01.2009 11:34

Thanks for bringing the attention of these forum to these type of quackery that has been causing mortality and morbidity in our towns and cities. The situation has deteriorated to a level where "herbal fairs" are now held on daily basis where guillible patients are cajoled to buy these concoctions. Often patients present to hospital with life threatening complications from ingestion of these concoctions. We should enlighten our people more of the dangers of taking these medications. Regulatory authorities should enforce strict penalties on these quarcks. people should demand compensation when their relative is harmed by the activities of thes people. Abdullahi Dahiru Kano

Bunch17  # 5 | 08.01.2009 13:02

I have read part one and part two and to say that I don't know how to adequately respond to both articles is a gross understatement. All I can come up with at present is this; May you and all yours prospers. May the almighty continue to give you the strenght and resources to continue educating our people!