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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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57. Testimonials & Quackery
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Any medical practitioner who advertises a positive cure for any disease, who issues nostrum testimonials, who sells their services to a secret remedy, or who diagnoses and treats by mail patients that they have never seen, is a quack.
~ Samuel Hopkins Adams
Testimonial Deception
The Dangers of Quackery and Unethical Use of Patient Testimonials in Medical Practice
Dr. Emily Miller was a well-respected physician in her community. She had a successful practice, a devoted staff, and a loyal patient base. However, Dr. Miller had a problem. She wanted to increase her patient base and had recently started using patient testimonials as part of her marketing strategy.
One of Dr. Miller’s new patients, Mr. John Smith, had been struggling with chronic pain for years. He was desperate for relief and had heard about Dr. Miller’s practice from a friend who had provided a glowing testimonial. Mr. Smith visited Dr. Miller, and she prescribed him a medication that provided significant pain relief. Delighted with the results, Mr. Smith wrote a testimonial for Dr. Miller’s website, praising her as a “miracle worker.”
However, Dr. Miller’s use of patient testimonials raised concerns among her colleagues. They recognized that testimonials could provide social proof of a practitioner’s skills and services, but they also knew that testimonials could be deceptive and unprofessional. They worried that Dr. Miller was engaging in quackery, the act of making exaggerated claims for financial gain.
One day, Mr. Smith was found dead in his home. Dr. Miller was devastated. She had grown close to Mr. Smith during his treatment, and his death hit her hard. However, things only got worse for Dr. Miller when the police found evidence that Mr. Smith had been taking medication that was not prescribed to him. The medication was traced back to Dr. Miller’s practice.
The investigation revealed that Dr. Miller had been using patient testimonials to attract new patients, many of whom were seeking relief from chronic pain. She had been prescribing medications that were not evidence-based and had been making exaggerated claims about their effectiveness. Dr. Miller had been engaging in quackery, and it had cost a patient his life.
The medical community was outraged. Dr. Miller’s license was revoked, and she faced criminal charges. Her colleagues used her case as an example of the dangers of quackery and the unethical use of patient testimonials. They emphasized the importance of maintaining a patient-centered approach and upholding the principles of autonomy, beneficence, and nonmaleficence.
Dr. Miller’s story served as a cautionary tale for medical students and healthcare providers on the dangers of quackery and the unethical use of patient testimonials. It reminded them that patient-centered care should always be the top priority, and that medical practitioners should never compromise the patient-practitioner relationship for financial gain.
Abstract
The use of patient testimonials in medical marketing can have both positive and negative effects. Testimonials can provide social proof of a practitioner’s skills and services, but they can also be deceptive and unprofessional. Quackery, the act of making exaggerated claims for financial gain, is a concern and patients are vulnerable to its seduction, especially in times of stress and pain. Requesting a testimonial from a vulnerable patient may not be a violation of HIPAA, but it is considered a form of coercion and violates the patient-centered nature of the patient-practitioner relationship. The medical practitioner’s obligation is to provide patient-centered care and never compromise the relationship for financial gain. Making exaggerated claims is unprofessional and illegal, and asking for a testimonial from a vulnerable patient is unethical. Medical practitioners must maintain focus on patient-centered care and not engage in deceptive practices.
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Think
[57:1] Testimonials can be an effective marketing tool for educating the public about available services, describing the patient’s level of satisfaction, and expressing the quality of the patient-practitioner relationship. This is especially true as social media expands in its influence and ability to help individuals connect with the right service provider for health concerns.
[57:2] Testimonials are what marketers call social proof. Academics, employment, and the medical professions use various testimonials, such as letters of recommendation and attestation of a colleague’s expertise, skills, and professionalism.
[57:3] However, testimonials by patients about a practitioner’s unique skills, treatments, and success can also be deceptive and unprofessional, especially if those unique skills and treatments are contraindicative of medical standards of care and the treatment successes have not been evidentially established and peered reviewed.
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal diseases, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
[57:5] Testimonials from patients have the risk of creating a conflict of interest with the patient-practitioner relationship that is supposed to be patient-centered, not practitioner-centered.
Assess
Patient: 1) Autonomy
[57:6] Autonomy, or self-rule, is typically understood to exist when a patient with decisional capacity decides after being informed of their diagnosis, prognosis, risks, and benefits of each legitimate treatment option, having all questions addressed, and not being under compulsion or manipulation. The patient-practitioner relationship is essential to trust that the practitioner will keep all the patient’s information confidential and private. Without that assurance, the patient might not provide the protected health information (PHI) necessary for the practitioner to assess the information necessary for informed consent, and is a violation of the Health Insurance Portability and Accountability Act (HIPAA), a federal statute with punishable fines of up to $250,000 and a jail term of up to 5 years.
[57:7] Asking a patient to provide a testimonial on social media or any other venue may not be a HIPAA violation, but it is asking a patient, who may be vulnerable and dependent on the practitioner, to divulge their private information. Such a request from a vulnerable patient is, at the very minimum, a type of coercion invalidating the patient’s freely given informed consent.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[57:8] The medical practitioner’s professional obligation is to provide patient-centered health care that maximizes the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. To ask a patient to provide testimony as to the practitioner’s effectiveness in providing patient-centered health care for the practitioner’s financial gain is self-contradictory as it is practitioner-centered; rather than patient-centered. It is also never professionally permissible for a practitioner to ask “favors” from patients who are currently or who may in the future be dependent upon the practitioner for their health care needs. This dependent state makes the patient vulnerable and compelled to involuntarily comply with the practitioner’s requests violating the patient-practitioner relationship.
Public Policy: 4) Justice
[57:9] The Pure Food and Drug Act of 1906 required the labeling of certain ingredients and eliminated numerous quack cures for a variety of serious diseases. However, many of these quack drugs were then repackaged and sold as cures for the common cold and other generalizable ailments. The Federal Food, Drug, and Cosmetic Act of 1938 and the Wheeler-Lea Act established safety and purity standards and was amended in 1963 to include proof of the effectiveness of all drugs and gave the U.S. Food and Drug Administration control over medication advertising.
[57:10] These laws have curbed many quack remedies, but the public demand for needed remedies, the availability of a gullible population, and the enormous economic profit associated with the business of quackery has only increased its market demand.
Conclude
[57:11] Medical practitioners must stay focused on patient-centered care and never compromise the patient-practitioner relationship for pecuniary gains. Making exaggerated claims about one’s ability and claiming to have a medical cure that is not evidence-based-medicine is unprofessional, illegal, and unethical. Asking a patient to provide a testimonial from a patient who is already vulnerable and dependent on the practitioner violates the patient-practitioner relationship.
[57:11] In summary, medical practitioners must be vigilant in maintaining their focus on patient-centered care and ethical practices. Requesting testimonials from vulnerable patients can be coercive and unethical, and engaging in quackery for financial gain is both unprofessional and illegal. By upholding the principles of autonomy, beneficence, and nonmaleficence, practitioners can provide the highest quality care for their patients while preserving the integrity of the patient-practitioner relationship.
**
57. Review Questions
1. Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists.
2. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued.
3. Educating the public in the basic sciences has tremendously impacted dispelling public gullibility.
4. Asking a patient to provide a testimonial on social media or any other venue is asking a patient, who may be vulnerable and dependent on the practitioner, to divulge their private information.
5. It is also never professionally permissible for a practitioner to ask “favors” from patients who are currently or who may in the future be dependent upon the practitioner for their health care needs.
6. Public demand for needed remedies, the availability of a gullible population, and the enormous economic profit associated with the business of quackery has increased its market demand.
**
Wrong 😕
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
CORRECT! 🙂
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
CORRECT! 🙂
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
Wrong 😕
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
Wrong 😕
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
CORRECT! 🙂
[57:4] Quackery makes exaggerated claims about a practitioner’s ability to heal disease, generally for financial gain. The quack will often claim a formula, method, device, or product unknown to other practitioners or scientists. People are prone to the seduction of quacks, especially in times of stress, pain, and sorrow when any source of hope will be pursued. Educating the public in the basic sciences has had no impact on dispelling public gullibility.
CORRECT! 🙂
[57:7] Asking a patient to provide a testimonial on social media or any other venue may not be a HIPAA violation, but it is asking a patient, who may be vulnerable and dependent on the practitioner, to divulge their private information. Such a request from a vulnerable patient is, at the very minimum, a type of coercion invalidating the patient’s consent.
Wrong 😕
[57:7] Asking a patient to provide a testimonial on social media or any other venue may not be a HIPAA violation, but it is asking a patient, who may be vulnerable and dependent on the practitioner, to divulge their private information. Such a request from a vulnerable patient is, at the very minimum, a type of coercion invalidating the patient’s consent.
CORRECT! 🙂
[57:8] The practitioner’s professional obligation is to provide patient-centered health care that maximizes the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. The asking of a patient to provide testimony as to the practitioner’s effectiveness in providing patient-centered health care for the practitioner’s financial gain is self-contradictory as it is practitioner-centered; rather than patient-centered. It is also never professionally permissible for a practitioner to ask “favors” from patients who are currently or who may in the future be dependent upon the practitioner for their health care needs. This dependent state makes the patient vulnerable and compelled to involuntarily comply with the practitioner’s requests violating the patient-practitioner relationship.
Wrong 😕
[57:8] The practitioner’s professional obligation is to provide patient-centered health care that maximizes the patient’s best interests in accordance with the patient’s reasonable goals, values, and priorities. The asking of a patient to provide testimony as to the practitioner’s effectiveness in providing patient-centered health care for the practitioner’s financial gain is self-contradictory as it is practitioner-centered; rather than patient-centered. It is also never professionally permissible for a practitioner to ask “favors” from patients who are currently or who may in the future be dependent upon the practitioner for their health care needs. This dependent state makes the patient vulnerable and compelled to involuntarily comply with the practitioner’s requests violating the patient-practitioner relationship.
CORRECT! 🙂
[57:10] These laws have curbed many quack remedies, but the public demand for needed remedies, the availability of a gullible population, and the enormous economic profit associated with the business of quackery has increased its market demand.
Wrong 😕
[57:10] These laws have curbed many quack remedies, but the public demand for needed remedies, the availability of a gullible population, and the enormous economic profit associated with the business of quackery has increased its market demand.
57. Clinical Vignettes
1. Ms. Samantha Rodriguez is a 50-year-old accountant who presented to her primary care practitioner with complaints of fatigue, weight gain, and hair loss. She reports feeling depressed and anxious and has noticed that her skin is dry and itchy. Her practitioner orders blood tests, which reveal an elevated level of thyroid-stimulating hormone (TSH) and a decreased level of free thyroxine (FT4). The differential diagnosis for Ms. Rodriguez includes hypothyroidism, depression, and anxiety.
2. Mr. Jacob Smith is a 35-year-old computer programmer who has been experiencing chronic low back pain for several months. He has tried over-the-counter pain relievers and stretching exercises, but nothing has provided long-term relief. He searches online for alternative treatments and finds a website advertising a "revolutionary" new treatment for back pain called "spinal manipulation therapy" that uses a special device to manipulate the spine. The website claims that this treatment is more effective than traditional medical treatments and has no side effects. Mr. Smith decides to make an appointment with the practitioner offering this treatment.What is an example of quackery in the context of treating chronic low back pain?
3. Mr. John Smith is a 60-year-old retiree who has been experiencing severe back pain for several months. He decides to visit a practitioner who claims to have a unique method of treating back pain. During the consultation, the practitioner tells Mr. Smith that his back pain is caused by "energy blockages" and that the practitioner's treatment can unblock the energy and provide relief. Which of the following is true about this quack practitioner?
4. Ms. Maria Rodriguez is a 40-year-old woman who has been diagnosed with breast cancer. She is receiving standard medical treatment, but she is also interested in alternative therapies that might help with her symptoms and overall well-being. She comes across an advertisement for a practitioner who claims to have a treatment that can cure cancer. The practitioner claims that chemotherapy and radiation therapy are ineffective and even harmful. Ms. Rodriguez is tempted to try the treatment but is unsure if it is legitimate. Which of the following is true about the quack practitioner's claims?
5. Ms. Rachel Lee is a 30-year-old woman who has been seeing a chiropractor for several months for chronic back pain. The chiropractor has helped alleviate her symptoms, and Ms. Lee is very happy with the treatment she has received. The chiropractor asks Ms. Lee if she would be willing to provide a testimonial for their website and social media accounts, describing the treatment she has received and how it has helped her. Ms. Lee is initially hesitant but eventually agrees. Which of the following is true about the chiropractor's request for a testimonial from Ms. Lee?
CORRECT! 🙂
Explanation: Asking a patient to provide a testimonial on social media about their medical treatment is unethical and violates the patient-practitioner relationship [57:5]. Offering a discount on medical bills in exchange for a positive review on a medical review site is similarly unprofessional and puts the practitioner's financial gain ahead of patient-centered care [57:8]. Recommending an unproven treatment and offering a discount in exchange for a testimonial is illegal and dangerous, as it puts the patient's health at risk and is considered quackery [57:4]. Providing Ms. Rodriguez with information about hypothyroidism, including treatment options and potential risks and benefits, and encouraging her to make an informed decision about her care is the most ethical option, as it respects Ms. Rodriguez's autonomy and supports patient-centered care [57:6][57:8].
Wrong 😕
Explanation: Asking a patient to provide a testimonial on social media about their medical treatment is unethical and violates the patient-practitioner relationship [57:5]. Offering a discount on medical bills in exchange for a positive review on a medical review site is similarly unprofessional and puts the practitioner's financial gain ahead of patient-centered care [57:8]. Recommending an unproven treatment and offering a discount in exchange for a testimonial is illegal and dangerous, as it puts the patient's health at risk and is considered quackery [57:4]. Providing Ms. Rodriguez with information about hypothyroidism, including treatment options and potential risks and benefits, and encouraging her to make an informed decision about her care is the most ethical option, as it respects Ms. Rodriguez's autonomy and supports patient-centered care [57:6][57:8].
CORRECT! 🙂
Explanation: Using a device that has not been approved by the FDA to manipulate the spine and claiming that it is more effective than traditional medical treatments is an example of quackery. The use of unapproved medical devices is illegal and can be dangerous [57:10], and making exaggerated claims about the effectiveness of a treatment that has not been supported by scientific evidence is quackery [57:4]. The key characteristic of quackery is making exaggerated claims about the effectiveness of a treatment that is unsupported by scientific evidence. If the practitioner uses evidence-based treatment methods, those methods must have undergone peer-review and been published in medical literature in order to be considered a medical standard of care. If the practitioner's unique method has not undergone the same level of scrutiny and evaluation, then claiming that it is effective without scientific evidence is a hallmark of quackery [57:3][57:4]. The other options are incorrect because, evidenced-based treatment methods must be peered review and published in order to a medical standard of care [57:3], because the concept of "subluxations" is not recognized by mainstream medicine and is not supported by scientific evidence [57:4], and because encouraging the use of over-the-counter pain relievers without evaluating potential drug interactions is unprofessional and potentially dangerous [57:8].
Wrong 😕
Explanation: Using a device that has not been approved by the FDA to manipulate the spine and claiming that it is more effective than traditional medical treatments is an example of quackery. The use of unapproved medical devices is illegal and can be dangerous [57:10], and making exaggerated claims about the effectiveness of a treatment that has not been supported by scientific evidence is quackery [57:4]. The key characteristic of quackery is making exaggerated claims about the effectiveness of a treatment that is unsupported by scientific evidence. If the practitioner uses evidence-based treatment methods, those methods must have undergone peer-review and been published in medical literature in order to be considered a medical standard of care. If the practitioner's unique method has not undergone the same level of scrutiny and evaluation, then claiming that it is effective without scientific evidence is a hallmark of quackery [57:3][57:4]. The other options are incorrect because, evidenced-based treatment methods must be peered review and published in order to a medical standard of care [57:3], because the concept of "subluxations" is not recognized by mainstream medicine and is not supported by scientific evidence [57:4], and because encouraging the use of over-the-counter pain relievers without evaluating potential drug interactions is unprofessional and potentially dangerous [57:8].
Wrong 😕
Explanation: The practitioner's diagnosis of Mr. Smith's back pain as being caused by energy blockages is not recognized by mainstream medicine and is not supported by scientific evidence [57:4]. Making exaggerated claims about the effectiveness of a treatment that is unsupported by scientific evidence is the definition of quackery [57:4]. The other options are incorrect because, the practitioner's method has not undergone scientific scrutiny and is not supported by the information provided in the vignette [57:4], because the practitioner is not using an FDA-approved device to manipulate energy fields and is not supported by scientific evidence [57:4], and because although encouraging the use of over-the-counter pain relievers without evaluating potential drug interactions is unprofessional and potentially dangerous, we have no information in this scenario that indicates that this is happening [57:8].
CORRECT! 🙂
Explanation: The practitioner's diagnosis of Mr. Smith's back pain as being caused by energy blockages is not recognized by mainstream medicine and is not supported by scientific evidence [57:4]. Making exaggerated claims about the effectiveness of a treatment that is unsupported by scientific evidence is the definition of quackery [57:4]. The other options are incorrect because, the practitioner's method has not undergone scientific scrutiny and is not supported by the information provided in the vignette [57:4], because the practitioner is not using an FDA-approved device to manipulate energy fields and is not supported by scientific evidence [57:4], and because although encouraging the use of over-the-counter pain relievers without evaluating potential drug interactions is unprofessional and potentially dangerous, we have no information in this scenario that indicates that this is happening [57:8].
CORRECT! 🙂
Explanation: The practitioner's claims that their treatment can cure cancer, and that chemotherapy and radiation therapy are ineffective and even harmful, are unsupported by scientific evidence and are potentially dangerous [57:4]. This is an example of quackery, which makes exaggerated claims about a practitioner's ability to heal diseases, generally for financial gain [57:4]. The other options are incorrect, because the practitioner's claims are not supported by scientific evidence, because the practitioner's claims pose a significant risk to Ms. Rodriguez's health by discouraging her from receiving effective standard medical treatment for her cancer [57:4], because there is no evidence to support the effectiveness of the practitioner's treatment, and it is potentially dangerous to forgo standard medical treatment for cancer [57:4].
Wrong 😕
Explanation: The practitioner's claims that their treatment can cure cancer, and that chemotherapy and radiation therapy are ineffective and even harmful, are unsupported by scientific evidence and are potentially dangerous [57:4]. This is an example of quackery, which makes exaggerated claims about a practitioner's ability to heal diseases, generally for financial gain [57:4]. The other options are incorrect, because the practitioner's claims are not supported by scientific evidence, because the practitioner's claims pose a significant risk to Ms. Rodriguez's health by discouraging her from receiving effective standard medical treatment for her cancer [57:4], because there is no evidence to support the effectiveness of the practitioner's treatment, and it is potentially dangerous to forgo standard medical treatment for cancer [57:4].
CORRECT! 🙂
Explanation: Asking a patient to provide a testimonial is a form of coercion and violates the patient-centered nature of the patient-practitioner relationship [57:5]. Patients may feel obligated to comply with the request due to their dependence on the practitioner for their health care needs. Therefore, the request is not acceptable, even if the patient agrees to provide the testimonial [57:5]. The other options are incorrect because, asking for a testimonial from a vulnerable patients is never acceptable, because asking for a testimonial does not necessarily involve the disclosure of private health information and is not a violation of HIPAA unless the testimonial includes PHI, and because financial compensation does not make the request for a testimonial acceptable if it is still a violation of the patient-practitioner relationship [57:5].
Wrong 😕
Explanation: Asking a patient to provide a testimonial is a form of coercion and violates the patient-centered nature of the patient-practitioner relationship [57:5]. Patients may feel obligated to comply with the request due to their dependence on the practitioner for their health care needs. Therefore, the request is not acceptable, even if the patient agrees to provide the testimonial [57:5]. The other options are incorrect because, asking for a testimonial from a vulnerable patients is never acceptable, because asking for a testimonial does not necessarily involve the disclosure of private health information and is not a violation of HIPAA unless the testimonial includes PHI, and because financial compensation does not make the request for a testimonial acceptable if it is still a violation of the patient-practitioner relationship [57:5].
**
57. Reflection Vignettes
57a
1. Dr. Lauren Smith, a 35-year-old family practitioner, communicates with one of her patients on social media and asks if they would not mind providing a good review about the success of the cures and the personableness of her care. However, this request from a vulnerable patient is a form of coercion that violates the patient-centered nature of the patient-practitioner relationship. While patient testimonials can be an effective marketing tool for medical practitioners, asking a patient to provide testimony for the practitioner's financial gain is self-contradictory and practitioner-centered. It is the medical practitioner's obligation to provide patient-centered care and never compromise the relationship for financial gain. Making exaggerated claims and asking for a testimonial from a vulnerable patient is unethical and unprofessional. Medical practitioners must maintain focus on patient-centered care and not engage in deceptive practices.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Dr. Emily Johnson, a 40-year-old naturopathic practitioner and owner of an online business, has been marketing a unique blend of vitamins as a cure for various ailments and improved sports performance. One of her products, with undisclosed proprietary ingredients, claims to reduce respiratory excretions and improve the body's cardiovascular system's overall efficiency in absorbing and transferring oxygen. The online site claims: This breakthrough new product, not yet recognized by the medical profession, can be used for respiratory ailments and increase aerobic sports performance.
The online promotion of Dr. Johnson's product meets the criteria of quackery. Quackery is the promotion of false or unproven medical treatments, usually for financial gain. Dr. Johnson's promotion of her product as a cure for respiratory ailments and improved sports performance, without proper scientific research, is a clear indication of quackery. Furthermore, claiming that the product is not yet recognized by the medical profession is a ploy to suggest that the product is unique, groundbreaking, and not readily available, further deceiving customers. The marketing of such a product without proper scientific backing is dangerous as it puts patients' health at risk, violates ethical principles, and is illegal. Therefore, Dr. Johnson's online business is defined as quackery.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
