After my recent post attacking the journal Cancer which published a horrid piece on quackery, a twitterer asked me question: "Why do Sci writers go in harder on quacks than pharma?" (I think this begs the question; I don't believe that we neglect abuses among Pharma, but let's pretend that there is data to support her assertion). She continues, "My problem with selectively trashing these studies is we presume pharma studies better-so our audience does, as well. All quackery should be pilloried yet we selectively pillory the faith healer & homeopath. Why? B/C they're easier targets."
Assuming, once again, that her assertion is true, there are a number of good reasons to focus on blatant quackery above corporate malfeasance. The pharmaceutical industry, while motivated primarily by profit, is required to go through extensive scientific testing of plausible drugs and devices. This process is long, expensive, and is frequently successful at actually fighting disease. There have been many infamous cases of burying data, of inappropriate promotion of drugs, but in general, science has won; sometimes it takes years, and sometimes there is harm done, but eventually, ineffective drugs, or drugs whose risk/benefit ratio is horrible tend to die. There are of course exceptions, but not many. The very fact that drugs have been given post-marketing black box warnings or have been withdrawn from the market (sometimes despite the work of bad actors in industry) is a marker of the ultimate success of the system.
This happens because science and medicine is designed to look for faults. Sure, the system can be gamed by dishonest players, but the scientific community is more than willing to toss out a modality that proves itself wanting. Medical science, while influenced by ideology, is not ruled by it.
So-called alternative medicine and quackery works in a completely different way. Rather than asking a question and accepting an answer good or bad, altmed comes up with an answer and no amount of data will cause it to be abandoned. Despite hundreds of years of ineffectiveness, homeopathy is still used. Despite its utter implausibility and proven inutility, reiki is still practiced. There are very few if any altmed modalities that have been abandoned because of unfavorable data. They are ideologies rather than science.
It is science and plausibility that separates quackery from real medicine. Pharmaceutical companies develop and test hypotheses. Sometimes they behave badly, but generally they have been successful at helping us live better and longer. There is an entire legal infrastructure in place to prevent them from doing ill, and to punish them when they are caught. This system is far from perfect but it does work.
No system is in place to regulate or punish those who sell snake oil, and since patients are often "true believers" they are unlikely to sue quacks.
It's not a matter of choosing to go after quacks rather than pharmaceutical malfeasance. We do speak out about it; there is a regulatory structure in place to monitor pharmaceuticals, as imperfect as it may be; and pharmaceutical science is science, whereas quackery is simply immoral, made up practices profiting off the hope of people who hurt. It deserves every smack-down we can deliver.