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This piece appeared in the December 2004 issue of the 'Skeptical Adversaria', the newsletter of ASKE, the Association for Skeptical Enquiry.

A recent article in the Guardian informs us that the Office of Fair Trading is cracking down on 'fake psychics, peddlers of "miracle cure" potions and lottery scam operators…as part of a new crackdown on fraudsters'.

The article continues, 'The OFT yesterday published its draft setting out its aims and objectives, and said swamping out swindles that have conned Britons out of millions of pounds was one of the crucial issues. The watchdog said it intended to give priority to two scams: misleading ads that make false claims about health and beauty products, and charlatan clairvoyants and psychics who write to people who are down on their luck in an attempt to persuade them to pay for their services'.

I expect sceptical readers will immediately bring to mind at least two questions that they would like to ask the OFT. Firstly, does OFT have reliable criteria for distinguishing a charlatan clairvoyant or psychic from one who isn't a charlatan? Secondly, will they be including homeopaths, acupuncturists, reflexologists, crystal healers, iridologists, kinesiologists, colour therapists, etc. amongst those responsible for 'misleading ads that make false claims (surely a 'misleading ad' always does) about health and beauty products. I expect that readers will be sufficiently worldly-wise to anticipate the answer 'no' to both questions. But how do we set about explaining this?

Well, it would be modesty to the point of hypocrisy for me not to mention an article that appeared in the Skeptical Intelligencer, 2002 entitled 'Healing and therapy in the age of mass affluence'. In this article I tried to understand how it can be that healing practices and remedies can flourish, sometimes indefinitely, when they are intrinsically ineffective and sometimes even cause harm. The key concept is 'perceived authenticity', not just of the remedies themselves, but especially of those who prescribe them. Although the article did not discuss clairvoyants and psychics, the analysis I presented is apposite to their activities also.

Consider the general case of the patient-therapist interaction (I am using the term 'therapist' in its broadest sense). The patient presents with a set of symptoms or complaints; the therapist carries out his or her assessment on the basis that he or she has the expertise to understand why the patient is suffering; on that basis also, he or she prescribes the remedy. Hence, each participant in this interaction occupies a role (therapist or patient) that is recognised by the broader social context; that is society has a set of expectations about how each of them is to behave. (Because they are in an interaction their roles can be said to be 'reciprocal'.)

We can take this analysis further by introducing the idea of 'authenticity'. Because the roles of the two participants are prescribed by society, the question can be raised at any time as to whether the two individuals involved are authentic in the roles that they are presumed to occupy. This question is of concern not only to society but also to the individuals themselves. This is obviously so in the case of the therapist, who will have usually undergone training, have appropriate qualifications, and so on, and the patient needs to be assured of this. But the patient's authenticity is also of concern to him or her. Many consultations in general medical practice are about problems and complaints that may simply be part of normal living. The person is certainly suffering and therefore can be said to be a patient (from the Latin for 'suffering') in the general meaning of the term, but the doctor's opinion may be 'There's nothing really wrong with you'. This can come as a great relief to many people but some will feel upset at the intimation that 'The doctor thinks I'm wasting his time' - i.e. 'I'm not an authentic patient'. There is also a set of expectations concerning the behaviour of people deemed to be in the patient (or sick) role, such as resting, complying with medication, and doing nothing to jeopardise their recovery.

The social scientist may aver that not only are the roles that these people occupy, or aspire to, social constructs, but also the illness itself and the treatment prescribed. Hence matters of authenticity are settled by reference to the rules, customs and definitions that are implicitly and explicitly provided by the social context in which the interaction takes place.

I imagine that most sceptics will accept this to a point but will consider that the pivotal issue around which the question of authenticity revolves is the efficacy of the treatment prescribed, plus considerations such as its safety. (In the sceptical literature, from time to time questions are also raised about the authenticity of certain illnesses.)

For my own part (unless I am myself suffering from an illness, in which I case I don't give a hoot) the latter stance is too simplistic; I prefer the first approach but accept the importance (indeed the necessity) of authenticating the treatment by reference to science (process) and, more especially, well-controlled clinical trials (outcome).

Nowadays, in the case of mainstream medicine and related fields, authentic practice tends to be equivalent to evidence-based practice (though it is acknowledged that, while necessary, this is not a sufficient criterion; additional matters include the questions 'how effective?' and what are the costs?).

Unorthodox practitioners, as I discuss in my aforementioned article, have to rely on other methods of authentication but these are, fortunately for them, easily accessible in the political, economic, social, and cultural environment provided by modern society. But to access them requires that they are organised and attain a critical mass or presence. Hence the snake oil salesman who claims he can cure baldness and impotence may be drummed out of town, whereas the 'registered homeopaths' (reflexologists, crystal healers, clairvoyants, astrologists, etc.) are free to ply their trade, may counter any criticism their practices attract by referring to 'unqualified practitioners', call for official recognition of their organisations and registers to 'protect the public from 'cowboys', and so on. And they can do all of this without having to demonstrate that they actually do what they claim to do!