Discontentment with the massive violations of the influential Dutch prime minister's (Johan Rudolf Thorbecke) health laws led to the foundation in 1880 of the Dutch Society against Quackery. Within a few years the Society had over 1100 members. Initially quackery mostly consisted of the unauthorized practice of medicine and the peddling of industrially manufactured 'secret remedies.' After World War II, however, the energy of the Society focused mainly on magnetizers, especially after they gained support from the field of parapsychology, lay-manipulators of the back and herb doctors. The most important object of the Society since 1980 has been the fight against so-called 'alternative medicine,' of which Chinese acupuncture, homeopathy, manipulative therapy, antroposophical medicine and naturopathy are prominent targets. Despite numerous costly lawsuits the Society still survives and is probably the oldest as well as the largest of its kind in the world.
In the Interest of All Who Value Their Purse and Their Health
In the first half of the 19th century, the Netherlands had a large number of medical practitioners who differed considerably in their level of training. A small proportion had received formal university-based education, whereas most of them had only been trained in the army or in 'clinical schools.' Training in these clinical schools, of which there were seven, took four years, and being able to read and write were the only admission requirements. Medical schools in the country even offered a two-year training, while making no requirements as to literacy.
In 1842 and 1849 respectively, enlightened and academically trained pharmacists and physicians founded the Dutch Pharmaceutical Society and the Dutch Medical Association. These new, professional organizations advocated improvements of legislation and took the fight against quackery in hand. In 1865, new legislation on health care was introduced under Prime Minister Thorbecke. The new laws gave academically trained doctors the exclusive monopoly on the exercise of medicine. As Thorbecke stated in his memorandum, these laws had indeed been designed explicitly to put a stop to quackery, which was defined as the exercise of treatments of questionable use, thus also indicating its unlawfulness.
After 1865, however, the medical inspection and the judicial system were either unable or unwilling to effectively prosecute and punish unauthorized healers, a situation that annoyed many doctors and pharmacists. In 1880 a private initiative of the Bruinsma brothers, one a practicing physician, the other a chemistry teacher, led to the founding of the Society against Quackery (VtdK). The Bruinsma brothers, perceiving much fraud and deceit in the flourishing business of quackery, considered it a dangerous evil in the society. The society was to act 'in the interest of all who value their purse and their health'.
By 1880 the two founders had already published a book: De hedendaagsche kwakzalver: Een waarschuwing voor allen die hun gezondheid en hun beurs op prijs stellen. (The Contemporary Quack: A Warning for All Who Value Their Purse and Their Health), in which they described 'modern quacks' and called upon adherents to join the fight against them. January 15, 1881, marked the publication of the first periodical of the Society called the Maandblad tegen de Kwakzalverij ('Monthly against Quackery'). In the Monthly, the quacks were described with their full names and addresses, because, as the Bruinsmas stated: 'It's no use accusing the cards, while not mentioning the cardsharps.' Within a year, the Society had more than a thousand members. Members of the Society were – and still are today – not only recruited from circles of physicians and pharmacists, but from many other walks of life as well.
The Early Period
Initially, quackery was characterized by stereotypical loudmouth market-vendors, peddling treatments and drugs for all kinds of ailments. During the nineteenth century – at the time of the foundation of the Society – and the beginning of the twentieth century, this type of quack increasingly receded into the background, making way for the prototype of their modern successors, the manufacturer and pusher of patent drugs.
The government was loath to prohibit the trade in patent drugs since many MPs considered a ban an unacceptable violation of individual freedom, thus these modern quacks could easily and shamelessly exploit credulous people for considerable personal profit. They also spent considerable sums on advertisements and bogus scientific articles that were to give their trade an aura of credibility. The Society consequently decided to intercept these patent drugs and have them analyzed. The outcomes were published in the monthly magazine, starting with the first issues in 1881. Almost without exception the nostrums turned out to be completely useless, but all too often they also contained dangerous ingredients. All this was highlighted in the Monthly in a pleasantly readable and highly sarcastic style.
From the start, the Society took an active part in the public debate on unauthorized practice of medicine, in which not infrequently Members of Parliament, journalists and lawyers were found opposing the Society's views. In addition, the Society brought a number of unauthorized healers to court. Both the oculist Goolam Kadar and the cancer-quack Windelinx were convicted and later fled the country. Even national celebrities such as Bijsterveld, de Haas and the very famous 'Staphorster Boertje' (1840-1922) - a farmer who had South African president Kruger amongst his clientele - could be seen in court at regular intervals. After customarily mild penalties the quack usually returned to his practice quickly, where more than once he found the judge's wife awaiting his advice! In 1931, the Society published De kwakzalversmiddelen. Hunne gevaren en de gevaren die bij het gebruik dreigen. ('The Quackery-Drugs: Their dangers and the dangers of their use.' It was an expanded version of a similar booklet published in 1916), a booklet 'in which all 813 drugs analyzed by the Society' were described. Amongst these 813 nostrums, Pink's pills could be found, as well as others with euphonic names, like 'Pilules Orientales, Novavita, Sequah oil, Alaska mouthwater, Sarsaparilian, Liqueur Antiépileptique de Fiévez and Orvietanose'. The booklet can still be found in antiquarian bookshops and makes for very entertaining reading, especially because of the inventive names given to the products and the moralistic and sarcastic tone of the Society's comments. In 1942 a supplement to this booklet was published, in which another 120 quack drugs were discussed. Trading in 'secret drugs' would be permitted until 1958, when legislation came into effect requiring the listing of ingredients for all medications.
In the 50s and 60s of the twentieth century the Society fought against the growing belief in paranormal forces. Parapsychology, magnetizers, sellers of boxes protecting against 'earth rays,' faith-healers, as well as selected quack doctors. The 70s, however, turned out to be an especially comfortable era for quacks because the old health law had virtually become a non-issue and increasingly went unenforced. The quacks were generally successful in presenting themselves as benefactors of mankind, who either worked on the basis of alternative views or claimed having special (even supernatural) gifts. Not infrequently, judges could be persuaded to believe that by applying the law they would unduly deprive the population of valuable, additional treatment methods. When Cornelis Moerman, for example, who alleged that his diet could prevent and cure cancer filed suit against the Society to forbid his diet from being called a form of quackery, the judge ruled against then Society-president De Groot.
In 1997 the Netherlands adopted a new health law, the 'Wet op de Beroepen in de Individuele Gezondheidszorg', (Wet BIG, Law on the Practice of Individual Healthcare). According to this law, essentially anyone could treat patients because no specific training of any sort was required. As a consequence, alternative healers can now only be prosecuted if they have demonstrably harmed a person's health. Their organizations have been trying to enhance the 'quality' of their treatments by establishing their own rules of conduct and installing their own disciplinary councils, thus hoping to gain formal acceptance from the government and the health insurers.
Internationally, during this period many societies with the same character and goals as the Dutch Society gradually lost public support and ceased to exist. For some time, it seemed as though this would be the fate of the VtdK as well, since in 1976 the Society had practically run out of money and its rolls had dropped to a mere 300 gray-haired members. The Monthly itself did not appear for three years.
There was to be a restart however, stimulated by the emergence of new forms of quackery called 'alternative medicine.' The term was first used in the Netherlands in 1974 and would acquire broad acceptance, in spite of the VtdK calling it 'fashionable' and nothing but a thin camouflage for the same old quackery.
The Society Today
In 1979, after a period of reflection resulting in the amendment of its bylaws, the Society decided to focus primarily on the evaluation of alternative 'medicine', an industry that, despite the lack of any evidence supporting the effectiveness of its 'cures', had grown on an unprecedented scale. The Society invariably takes an uncompromising stance against this contemporary quackery and ensures that its voice is heard in commentaries on radio and television and in publications in newspapers and magazines. For example, at the initiative of the Society, the Commissariat for the Media in 1991 fined two public broadcasting companies (AVRO and NCRV) because they had accepted money from homeopathic firms for the appearance of pro-homeopathic 'scholars' in their television programs. In 1992 the Society held a well-attended Congress on Alternative treatment for cancer. In 1992 and 1993 the Society tried in vain to stop the teaching of homeopathy at the Free University of Amsterdam. A list of the Twenty Greatest (Dutch) Quacks of the Twentieth Century was published by the Society in 2000, which gained wide media attention with the previously mentioned cancer doctor, Cornelis Moerman, occupying first place on the list.
Since 2004 the Society grants an annual award, the 'Meester Kackadorisprijs,' (1) to institutions, individuals or companies that have contributed significantly to the spread of quackery in the Netherlands. Already the prize is feared by many fellow travelers of alternative medicine. Amongst the laureates were health insurance companies, journalists, broadcasting companies, an organization funding (pseudo-) medical research and the Vice-Chancellor of the Free University. Persons who have excelled in the fight against quackery may be awarded the 'Bruinsma-Brothers-Medal of Honour'.
The Society is taken quite seriously by its opponents: a well-known female faith-healer, then active in the town of Tiel, even compared the Society to the organization of Dutch Nazis (the NSB) in World War II. The Society has also been the subject of numerous lawsuits. VSM, a manufacturer of homeopathic drugs, filed action against the Society in 1995 and demanded the Society cease making negative statements on homeopathy in general and VSM products in particular. The judge ruled against the company. More lawsuits followed, some more successful than others. One ongoing case is especially important, because it involves the right of the Society to label an alternative practitioner, who can show no evidence of the efficacy of her treatments, a 'Quack.' Mrs. Sickesz, an 83-year old doctor and inventor of so-called 'orthomanual medicine' (an extension of osteopathy, with which she was unhappy) issued a claim against the Society because she objected to her entry in the list of Twentieth Century Quacks, in which she held seventh place. (Sickesz treats patients for autism, depression and schizophrenia with manipulation of cervical vertebrae and the 'tongue-bone' and has also trained many doctors.) The primary court ruled that the qualification 'quack' for Mrs Sickesz was lawful, but on appeal in 2007 this decision was overturned. The court ordered the publication by the Society of a very costly correction in two national newspapers, which brought the Society on the brink of bankruptcy once again. Numerous donations from members and non-members succeeded in averting this threat for the time being. The Society filed a complaint about this ruling at the Court of Cassation and Members of Parliament asked questions in the House of Commons about it. Fortunately, since then membership of the Society has increased significantly. The Court of Cassation is expected to give its decision in April 2009. (2)
The Society now has a membership of over 1800 and is probably the largest of its kind in the world. It publishes a quarterly, operates a web site (www.kwakzalverij.nl) and is a source of information for media, citizens and students alike. Members of its board have published several books on alternative medicine. On a national level, the Society co-operates closely with Skepsis, the Dutch branch of the worldwide collective of Skeptical clubs, founded in the wake of the foundation of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP) in 1976. Today, in most countries these skeptical clubs are the main organizations fighting quackery. Some organizations such as the VtdK exist, but they are relatively small and young enterprises (such as Health Watch in the UK and the Committee Against Health Fraud in the US), therefore it is probably safe to say that the VtdK is the Mother of all anti-quackery societies. (3)
1. Meester Kackadoris was the name of quack doctor in a 1631 short comedy.
2. The Court of Cassation ruled in favor of the VtdK (May 15, 2009), saying that the VtdK was allowed to use her own definition of quack (unscientific healer, without the implication of intentional deceit) and that the VtdK could not be held responsible for journalists that used the term quack in a more derogatory sense. On July 13, 2010 a disciplinary court struck Sickesz from the register after a complaint from a patient who went to see her for problems caused by a fall from a horse and who was diagnosed by Sickesz with 'beginning schizophrenia.'
3. An earlier version of this article was published in Evaluation & the Health Professions, vol. 32, nr. 4 (2009), p.343-348.