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Grandiose claims were made for what could be humble materials indeed: for example, in the mid-19th century revalenta arabica was advertised as having extraordinary restorative virtues as an empirical diet for invalids; despite its impressive name and many glowing testimonials it was in truth only ordinary lentil flour, sold to the gullible at many times the true cost.

Even where no fraud was intended, quack remedies often contained no effective ingredients whatsoever.

Unproven, usually ineffective, and sometimes dangerous medicines and treatments have been peddled throughout human history.

Theatrical performances were sometimes given to enhance the credibility of purported medicines.

Referring to the Flexner Report, he said that medical education "needs a good Flexnerian housecleaning." For example, David Gorski criticized Brian M.

Berman, founder of the University of Maryland Center for Integrative Medicine, for writing that "There [is] evidence that both real acupuncture and sham acupuncture [are] more effective than no treatment and that acupuncture can be a useful supplement to other forms of conventional therapy for low back pain." He also castigated editors and peer reviewers at the New England Journal of Medicine for allowing it to be published, since it effectively recommended deliberately misleading patients in order to achieve a known placebo effect.

The science-based medicine community has criticized the infiltration of alternative medicine into mainstream academic medicine, education, and publications, accusing institutions of "diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology." R. Donnell coined the phrase "quackademic medicine" to describe this attention given to alternative medicine by academia.From the early 19th century "home-grown" American brands started to fill the gap, reaching their peak in the years after the American Civil War.British medicines never regained their previous dominance in North America, and the subsequent era of mass marketing of American patent medicines is usually considered to have been a "golden age" of quackery in the United States.Quackery is often described as "health fraud" with the salient characteristic of aggressive promotion.

Since it is difficult to distinguish between those who knowingly promote unproven medical therapies and those who are mistaken as to their effectiveness, United States courts have ruled in defamation cases that accusing someone of quackery or calling a practitioner a quack is not equivalent to accusing that person of committing medical fraud.

The few effective remedies sold by quacks included emetics, laxatives and diuretics.