"Moon dust," promoted as a cure for arthritis and other afflictions, cost $100 for three ounces -- and turned out to be just plain sand.
The "miracle spike," a tube containing about a penny's worth of barium chloride, a chemical used in rat poison, was supposed to be worn around the neck as a cure for cancer and diabetes. It cost $300.
The "Congo Kit," billed as a cure for arthritis, was actually two hemp mittens.
These are just three of several hundred worthless, unproven and sometimes harmful products uncovered by a House subcommittee during a four-year investigation of quackery, completed last year. The subcommittee report, titled "Quackery: A $10 Billion Scandal," calls quackery the "single most prevalent and damaging of the frauds directed at the elderly."
"We found the inventiveness of the quacks to be as unlimited as their callousness and greed," said Rep. Claude Pepper, D-Fla., chairman of the House Aging Committee's subcommittee on health and long-term care. "We found promoters who advised arthritics to bury themselves in the earth, sit in an abandoned mine, or stand naked under a 1,000-watt bulb during the full moon.
"These suffering souls have been wrapped in manure, soaked in mud, injected with snake venom, sprayed with WD-40, bathed in kerosene and made to pay for the privilege of being afflicted that way."
Federal efforts to control quackery are "minimal" and "diminishing," the subcommitte charged, in the face of a quackery problem that is "growing at an alarming rate."
"In short," it concluded, "there is little risk and a tremendous amount of money to be made in selling hope to the desperate."
Quackery is hardly new. "The first snake oil salesman was the snake in the Garden of Eden," says Dr. Victor Herbert, professor of medicine at Hahnemann Medical Center in Philadelphia and an expert on nutrition and health fraud.
The term "quack" dates back to the 16th century as an abbreviation for "quacksalver," a charlatan who boasts or "quacks" noisily about the curative or "salving" powers of a product without knowing anything about medicine.
"We are certainly in a time when quackery is epidemic again," says William Jarvis, chairman of the department of Public Health Science at Loma Linda University in California and president of the National Council Against Health Fraud. "It's happened before and it's happening again."
Experts say quackery is flourishing for many reasons, including increasingly sophisticated marketing efforts, the aging of the population (the elderly are especially vulnerable targets), growing interest in health (which is easily exploited by fad-promoters and quack advertisers), and lessening attention from federal regulators.
Although the Food and Drug Administration (FDA) was established early in this century to crack down on fraudulent and unsafe food and drugs, its primary role shifted in the early 1960s after the thalidomide disaster. Congress amended the Food, Drug and Cosmetic Act to require that new drugs be proven not only safe but effective, and since then, FDA has been largely preoccupied with testing prescription and over-the-counter drugs.
FDA devoted only about one-half of 1 percent of its budget last year to fighting quackery. It obtained 24 seizures and three injunctions and referred three cases to the Justice Department for criminal prosecution in 1984, says spokesman Bruce Brown, but has completed less than one criminal prosecution a year for health fraud since 1970.
"Okay," said then-FDA Commissioner Arthur Hull Hayes Jr. in a speech to the Pharmaceutical Advertising Council three years ago, "if this [quackery] is such a big problem, what is FDA doing about it? The answer, I'm afraid, is not much.
"We are . . . simply overmatched. There are too many quacks, too skillful at the quick change of address and product name, for the cumbersome procedures of FDA regulation."
"In reality," admits an FDA pamphlet, "it's much easier for a swindler or quack to get his product on the market than it is for the government and others to take it off the market."
Under growing criticism from inside and outside, FDA set up a Fraud Branch last September to process enforcement actions through its 150 branches around the country. The agency also stepped up public education efforts to "vaccinate" buyers against health fraud, and has included "increased activity against quackery" among its 10 top priorities.
But critics such as Herbert aren't satisfied. He supports proposed legislation to set up a federal Strike Force on Health Quackery, with members from FDA, the Federal Trade Commission and the U.S. Postal Service.
"The answer is, they FDA ought to get a bigger budget for their enforcement arm," Herbert says. "Fraud is crime, and when the fraud is organized nationally, it's organized crime."
The most common quack products, according to FDA, promise to help relieve pain, cure arthritis and cancer, reduce weight, eliminate baldness, restore youth and improve sex life. Such products rip off up to $10 billion a year from the elderly, Pepper estimates, and as much as $25 billion from the entire population.
Quackery resists easy definition, prompting some officials to echo what Supreme Court Justice Potter Stewart once said of hard-core pornography: I may not be able to define it, but "I know it when I see it."
To some, it includes any health product for which unsubstantiated claims are made. To others it is a useless treatment or product sold for profit by someone who knows it doesn't work.
"If you believe in chewing on old socks to cure your arthritis and you want to chew old socks in the privacy of your own home, that's fine," says Val Halamandaris, president of the National Association for Home Care. "If you get up on a soapbox and say chewing on old socks cures arthritis, I still don't have a problem.
"But when you start charging money to sell people old socks to chew on as a cure for arthritis, then I start to worry."
The Pepper subcommittee report focused on unproven remedies whose common elements are "conscious deceit," profit and disregard for scientific fact. But more than three-quarters of the unproven remedies reviewed by the subcommittee were also found to be potentially dangerous. And even "harmless" products can cause harm indirectly, by delaying or inhibiting effective treatment or simply wasting lots of money.
"This isn't a Mickey Mouse thing," Halamandaris says. "You add up millions of dollars and millions of dollars, and you get billions of dollars.
"It's easy to joke about some of these schemes because they're so ridiculous, but when you stop laughing, people are getting ripped off and injured and killed."
In an era of instantaneous mass-media communication, promoters can quickly turn out and hype a product that rides the wave of the latest fad and then -- if authorities crack down or the fad passes -- start searching for the next wave.
Recently, the Ventura County, Calif., District Attorney's office sued a company for alleged fraudulent marketing of a product called Dreamaway, which was supposed to promote weight loss during sleep. The company settled out of court, paid the county $162,500 in civil penalties and costs, and agreed not to market the product anymore in California. But Deputy District Attorney Richard Brungard acknowledges that the company may have cleared a million dollars or more before the settlement.
Increasingly, FDA uses the term "health fraud" instead of "quackery," because it is easier to define legally and not as emotionally charged.
"Quackery is not a legal term," says Clinton Ray Miller, lobbyist for the National Health Federation -- a diverse, 17,000-member association of health enthusiasts dedicated to freedom of choice in health matters. "It is a pejorative term by which health bigots categorize people who don't belong to their inside group."
Miller, who calls his federation "a Sherwood Forest for everybody who gets clobbered by the Nottingham of organized medicine," is sharply critical of the Pepper subcommittee for "closing its eyes" to what he calls "true medical fraud -- unnecessary surgery, unnecessary drugs and unnecessary hospitalization."
But health fraud, by anybody's definition, is profitable and widespread.
"It goes from the ridiculous and the almost-funny to the tragic," says Sorell Schwartz, professor of pharmacology at Georgetown University. "It runs the gamut from people who don't have enough intelligence to void in the morning to people with M.D. degrees."
"To me," Schwartz says, "over-the-counter diet pills are a fraud, but they are also an accepted form of health fraud. Or a cream that is supposed to make your skin look 20 years younger.
"Anybody 60 years old who believes something he takes is going to give him the skin of a 20 year old probably deserves what he gets."
In the 19th century, before passage of federal food and drug laws, cure-all patent medicines and secret-formula nostrums were promoted unabashedly in the press. As recently as the early 1900s, even Coca-Cola was sold as a tonic.
An early ad for Coke promised that it "will cure you if you feel generally miserable or suffer with a thousand and one indescribable bad feelings, both mental and physical" -- including weariness, lifelessness, weakness, dizziness, shortness of breath, cold feet, "languor in the morning and a constant feeling of dread, as if something awful was going to happen."
Federal law now prohibits such sweeping and unsubstantiated claims. But promoters of unproven remedies often get around the law by distributing books or brochures to stores that sell such products. Claims on the label are unnecessary because they are highly visible in the printed material displayed nearby.
Many quack products today are distributed or sold through the mail. Consumers Union recently set up its own health food store operating in two states and ordered more than 300 products from about 70 companies. But instead of selling the products, Consumers Union took them to a seven-member panel of nutritionists, doctors and lawyers.
The panel concluded that 42 of the companies market or distribute at least one product violating federal law -- either as an unapproved new drug or a misbranded product. The results were published in last month's Consumer Reports, along with a report highly critical of the FDA, which it said has "pretty much thrown in the towel" in the battle against health fraud.
FDA responded with a letter from Commissioner Frank E. Young and a two-page press release detailing recent enforcement actions and policy.
"FDA's policy against health fraud is to act immediately against life-threatening products, quickly against health-threatening ones and when resources permit against various forms of economic fraud," the release stated.
"If you buy that one," comments Halamandaris, "I've got a bridge in Brooklyn I can sell you real cheap. The FDA is a joke in terms of what they do in medical quackery."
He and other agency critics -- including some on the inside -- call for more prosecution of carefully chosen criminal cases as a deterrent to health fraud, much as the Internal Revenue Service tries to deter tax-cheating.
"Administrative remedies [such as seizures and injunctions] do not afford a sufficient punishment to fit the crime," says James Harvey Young, a leading historian of quackery in America. "Old-fashioned litigation, with the threat of major fines and of prison, even if sometimes cumbersome, is sorely needed."
But criminal prosecutions are the most expensive, labor-intensive and time-consuming way of cracking down on quackery, says FDA spokesman Brown. And with limited resources, the agency must go after dangerous products before nonlethal rip-offs.
"The economic frauds will always lose out to the life-threatening ones," Brown says. "A mix of enforcement and educational remedies is needed."
Both FDA and its critics agree that the most frequent victims of health fraud are the elderly and people with chronic, incurable illnesses, such as cancer, arthritis, heart disease, high blood pressure and diabetes.
Four out of five Americans 65 and older have at least one chronic health condition, and many have more than one. The vulnerability of older people to quackery is increased by their relative lack of mobility, their concern about health and their dependence on the mails.
One of the fastest-growing and most profitable types of unproven remedies includes products that claim to slow or reverse aging and restore youth. So far there is no scientific basis for these claims, says Dr. Edward L. Schneider, deputy director of the National Institute on Aging, who evaluated them recently in the New England Journal of Medicine.
Schneider's favorite book on the subject is "How to Live to be 100 or More," by 91-year-old comedian George Burns. "The reason I like it so much is the only thing it promotes is humor," says Schneider.
The most common form of quackery today, says the National Council Against Health Fraud's Jarvis, is in the field of nutrition. A 1976 amendment to the Food, Drug and Cosmetic Act, passed under pressure from the National Health Federation and other health-food groups, prohibits the FDA from regulating the potency of vitamins, minerals and other "food supplements."
That loophole allows health food marketers to sell "food supplements" -- such as "bio-flavonoids," super-vitamins and amino acids -- that actually are unapproved drugs for which unsubstantiated health claims are made, Jarvis says.
"If you take cocaine and call it jelly beans, that doesn't make it a food," Jarvis says. "It's still a drug."
Nutrition experts are also concerned about the ease with which individuals with no training can pass themselves off as nutritionists or dietary consultants.
Health fraud expert Victor Herbert has two pets: a French poodle named Sassafras and a cat named Charlie. Both are certified nutrition consultants.
Sassafras is a dues-paying member of the American Association of Nutrition and Dietary Consultants -- a fellow member is Bellman Jukes, a basset hound owned by University of California at Berkeley professor Thomas Jukes. Charlie is a member of the Academy of Nutrition Consultants. (The two associations have now joined forces to form the American Association of Nutritional Consultants in Las Vegas.)
Herbert and Jukes enrolled their pets in those organizations as a prank to show how easy it is to claim credentials as a nutritionist.
"It's not a question of orthodox medicine versus unorthodox medicine," Herbert says. "It's aquestion of responsible treatment versus irresponsible treatment."
Quackery's victims are by no means limited to the elderly, the uneducated and the desperate. A recent study at the University of Pennsylvania Cancer Center found that most cancer patients who seek unorthodox treatments such as Laetrile, megavitamins or faith-healing believe -- rightly or wrongly -- that they are responsibly taking control of their own health.
"Quackery does keep up with the times," says Kathleen Gardner, staff director of the House subcommittee on health and long-term care. "It's very sophisticated.
"A bright PhD could easily fall prey to claims for products that can't live up to their promotion."
And Rep. Pepper laments, "There are so many opportunities for quackery. The human heart yearns for health and happiness, and therefore is gullible." CAPTION: Picture 1, The Smithsonian's Michael R. Harris models an aluminum helmet sold as arthritic cure; Picture 2, The micro-dynameter, marketed as a way of diagnosing and treating virtually all diseases, consisted on a galvanometer attached to electrodes that could be applied to the patient's body. Thousands were sold in the 1950s and 1960s at prices up to $900; Picture 3, Several "patent medicines" and tonics sold over the past century as cures for what ails you. Photos by Lucian Perkins -- The Washington Post; Picture 4, Rep. ClaudePepper displays the "Oxydonor," a stainless steel tube which claims to reverse the death process into the life process and cure arthritis and rheumatism, for $30. Photo Courtesy the House Subcommittee on Health; Picture 5, FDA historian Wallace F. Jansen with the FDA's collection of quackery. Photo by Ray Lustig -- The Washington Post