Book review of Charlatan by Pope Brock
2008, Three Rivers Press, New York. Pages 1-325, incl index (pb)
reviewed by Dr Ian Freckelton SC
Brock’s biography of “Dr” John Brinkley is not the first account of arguably the most remarkable quack that the United States has produced but it is both absorbing and confronting. It tells the tale of a huckster who bought his way into a dubious medical school (the Bennett Eclectic Medical College), never finished the course and then achieved a remarkable level of fame and fortune by pioneering xenotransplantation for the recovery of virility.
Brock locates the career of Brinkley in what he calls the world’s most “quack-prone and quack-infested” country in the early 20th century, commenting (p 10):
“Of course, quacks have flourished in all ages and cultures, for nothing shows reason the door like cures for things. Unlike most scams, which target greed, quackery fires deeper into Jungian universals: our fear of death, our craving for miracles. When we see night approaching, nearly all of us are rubes.”
He describes the 19th century as a time when, perversely, charlatans and snake oil salesmen were almost joyously embraced in the United States. Patent medicines were hawked from town to town by charismatic purveyors who took liberal advantage of the difficulties of law enforcement across State boundaries.
Brock parallels “Dr” Brinkley’s career with that of the man who became his nemesis, the long-time editor of the Journal of the American Medical Association (JAMA) (between 1924 and 1950), Dr Morris Fishbein, himself an extraordinary and divisive character. Dr Fishbein graduated in 1912 and almost immediately (namely, without any significant time in clinical practice) made his way in an editorial capacity to JAMA and in due course embarked on an influential and high-profile career of exposing quackery.
Brinkley is best known for his transplantation of goat gonads into the testicles of males wanting to enhance or recover their sexual potency. He commenced the procedure in 1917, soon claiming that he could also cure dementia praecox (schizophrenia) and other conditions by the same technique. Brinkley’s greatest gift was in self-promotion, a skill that led his xenotransplantation to earn him up to a million dollars a year, a remarkable sum for the 1920s and 1930s. He became a household name throughout the United States with celebrities and ordinary people alike flocking to his clinics in search of potency. He managed this feat in spite of the deaths of a number of his patients and increasingly vehement attacks by Dr Fishbein, utilising articles in the JAMA, including the unsubtly titled, “John R Brinkley – Quack, The Commercial Possibilities of Goat-Gland Grafting”. Brinkley had happened upon men’s propensity to not just indulge their fantasies of avoiding ageing but their folly in preparedness to take extraordinary measures to try to counter sexual decline. He diversified into marketing potions said to enhance virility. In due course these were exposed as no more than coloured water. In 1930 his medical licence was revoked by the Kansas Board of Medical Examiners. His response was to run for Governor. He nearly succeeded.
Undeterred by his failure to assume high political office, Brinkley intensified his efforts to promote “rejuvenationism”, advertising his successes with impunity from Mexican radio stations which were outside the reach of the United States authorities but effectively broadcast across the border. He purchased a series of yachts, became friends with the Duke and Duchess of Windsor and indulged his passion for sports fishing.
In 1938 Dr Fishbein published a two-part article entitled “Modern Medical Charlatans” in the journal Hygeia. He denounced Brinkley as the apotheosis of charlatans. Brinkley’s response was his one great error – he sued for libel, seeking $250,000 in damages. Brock’s account of the trial is absorbing and dramatic. Judge McMillan declined to receive evidence from former patients prepared to extol the advantages they felt they had experienced from Brinkley’s treatment. However, he permitted expert evidence on behalf of Dr Fishbein to establish whether Brinkley had a reputation capable of being damaged. This resulted in three Texas urologists each denouncing Brinkley, his prostate treatments and his use of goat gonads. Then evidence was led about his coloured water scam.
A key phase in the trial was the testimony of Dr Fishbein who calmly told the jury that reversing the natural ageing process was no more possible than restoring the elastic in a pair of suspenders. Rejuvenation, he said, was a snare and a delusion from which he hoped the public was beginning to awaken. Cross-examination of him was brutal but the essence of what he contended was undamaged.
Brinkley himself took the stand to an assault from the orthodox pillars of scientifically based medicine. His performance was erratic at best with effective assaults upon his false and extravagant claims. Judge McMillan’s summation to the jury was damningly in favour of Dr Fishbein, directing jurors’ attention to a litany of anomalies in Brinkley’s evidence and the realities of his bogus credentials. The jury took only four hours to find in favour of Dr Fishbein “that plaintiff should be considered a charlatan and quack in the ordinary, well-understood meaning of those words” (p 264). Brinkley proclaimed that he would appeal but the Supreme Court denied review. A slew of lawsuits brought by former patients ensued and his empire fell to pieces. By 1941 he declared bankruptcy and a year later he passed away in his sleep.
Dr Fishbein, by contrast, lived until 1976 and has the “Morris Fishbein Center for the History of Science and Medicine” at the University of Chicago named after him. Brock comments of him (p 274):
“He won for the AMA the undisputed authority to set licensing standards for doctors nationwide. The case marked the boundary line between the unregulated melee that was American medicine going back two or three centuries, and the sober centralization that has defined it since.”
However, he laments that since Dr Fishbein’s death “new quacks with new quackeries have sprouted faster than ever” (p 275):
“[W]hatever ground he cleared the jungle soon reclaimed. Today bogus cancer and weight loss treatments, biological dentistry, ear candling, … Wild Yam cream, chelation therapy, Qiqong, and untold thousands of other get-well-quick schemes keep their inventors swimming in champagne.”
As the author suggests, much in Brock’s account of Brinkley’s life and exploits has a highly contemporary relevance with entrepreneurial charlatans continuing to prey upon the vulnerable with iconoclastic treatments and portraying themselves as pioneers and champions in the war against the medical establishment. When the lack of evidence-based justification for their treatments is raised against them, their usual response is to attack their critics personally and to attempt to distract by questioning the evidence base of conventional medicine, citing examples of the misdeeds of “Big Pharma” and the limitations of and deficiencies in conventional medicine. Modern quacks are found in many areas of the health professions but, typically, congregate in the vicinity of those with cancer, long-term ailments, progressive diseases and fertility issues. Quacks also all too often ply their treatments in the areas of cosmetic and anti-ageing medicine.
The extraordinary success of Brinkley attests to the propensity of the desperate and the hopeful to repose trust in those who make the promises that they would like to hear. Whether one views the phenomenon in terms of community gullibility or the potential for exploitation of the vulnerable perhaps does not matter. Commercial opportunities continue to abound for unscrupulous quacks. Arrayed against them are the regulatory frameworks of consumer protection and the disciplinary processes that apply to registered health practitioners. But the potential for lawsuits for defamation and for deceit, as well as for breaches of contract, and misleading and deceptive conduct, constitute important protections for persons who are taken advantage of by charlatans.
Brock’s tale of the rise and fall of “Dr” John Brinkley is a journalistic but riveting account of a remarkable phenomenon in American health care history. It is well researched and referenced. It is well written and hard to put down. Charlatan is one of those books that is truly memorable. It should be read by all who are tempted to invest in ready cures or extravagant promises made by persons offering novel treatments. It should galvanise regulators and plaintiff lawyers alike – bringing quacks to heel and exposing the cruelty and falsity of their promises is an important contribution to public health. Brock’s Charlatan is an account that is as relevant to today’s conditions as it was to those of the 1920s and 1930 when “America’s most dangerous huckster” thrived so outrageously. It has much to teach us.
The full citation for this book review is: (2012) 19 JLM 854