Thread by @omlakhani

#Medtwitter #ClinicalPearl

This thread will tell you how Quackery works...

Step 1: Quacks understand the market needs. If patients find oncology treatment painful and expensive, they will 'create' a product for cancer. Quacks understand entrepreneurship

Step 2: Once the "area of need" is identified, quack delivers a product that is relatively cost-effective (and largely ineffective). It could be a mixture of "herbs", "natural product", some fancy-sounding "diet"

Step 3: They create a campaign around this product. They either create some pseudoscience trying to give it authenticity or try to rely on some ancient socio-religious tradition or ritual

Step 4: They communicate well. Quacks understand communication. A quack who is NOT a good communicator becomes irrelevant very quickly. They promise the moon to vulnerable patients.

Step 5: Now comes the interesting part. They administer the said treatment to a large group of patients. Sometimes they even give it for free like free samples of FMCG products. (As a matter of fact, it resembles a Ponzi scheme more than anything).

Step 6: Now comes the interesting part. Quacks understand probability very well.

Let's say 1000 people receive and take the product (paid or free). 999 of 1000 will have no benefit. But 1 in 1000 will see "improvement"

This improvement could be attributed to "chance" (patient has a milder disease, to begin with, which improved on its own) or some placebo benefit.

In some cases, the "improvement" is actually because of some modern medical treatment that the patient took and it is showing a delayed response. This is typically seen with Chemo or Radiotherapy in Oncology

Remember the old saying "Even the broken clock gives the right time twice in a day". This is exactly what happens here.

Step 7: They identify this 1 out of 1000 person who they say "benefited" from the treatment. They use him/her for marketing.

The 1 in 1000 is also positively reinforced and becomes a proponent of the said quackery.

This in psychological terms is called "Survivorship bias"

This 1 in 1000 becomes an evangelist for the said "miracle" and refers more patients to the quack. This cycle is hence repeated.

What about the 999 out of 1000 who did not benefit. Some of them openly criticize the quack and are label as cynics. The majority keep quiet.

Hence the business of the quack perpetuates

Remember quackery is very easy. In fact, you don't need a medical degree for that, all you need to do is to read up some books on marketing especially multi-level marketing or Ponzi scheme

You can literally use ANY product for this scheme with the same results. It could be fancy-sounding stuff like #coronil or BGR-34 or something completely bizarre like Cow urine or "Homeopathy".

This is a reason why modern medicines insist on Randomized controlled trials which eliminates this chance phenomenon.

QED