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Quackery, often synonymous with health fraud, is the promotion [1] of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, qualification or credentials they do not possess; a charlatan or snake oil salesman". [2] The term quack is a clipped form of the archaic term quacksalver , derived from Dutch : kwakzalver a "hawker of salve" [3] or rather somebody who boasted about their salves, more commonly known as ointments. [4] In the Middle Ages the term quack meant "shouting". The quacksalvers sold their wares at markets by shouting to gain attention. [5]
Common elements of general quackery include questionable diagnoses using questionable diagnostic tests, as well as untested or refuted treatments, especially for serious diseases such as cancer. Quackery is often described as "health fraud" with the salient characteristic of aggressive promotion. [1]
Psychiatrist and author Stephen Barrett of Quackwatch defines quackery as "the promotion of unsubstantiated methods that lack a scientifically plausible rationale" and more broadly as:
"anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word "fraud" would be reserved only for situations in which deliberate deception is involved. [1]
In addition to the ethical problems of promising benefits that are not likely to occur, quackery might cause people to forego treatments that are more likely to help them, in favor of ineffective treatments given by the "quack". [6] [7] [8]
American pediatrician Paul Offit has proposed four ways in which alternative medicine "becomes quackery": [9]
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. However, the FDA makes little distinction between the two. To be considered a fraud, it is not strictly necessary for one to know they are misrepresenting the benefits or risks of the services offered. [10] [11]
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. 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. Some remedies contained substances such as opium, alcohol and honey, which would have given symptomatic relief but had no curative properties. Some would have addictive qualities to entice the buyer to return. The few effective remedies sold by quacks included emetics, laxatives and diuretics. Some ingredients did have medicinal effects: mercury, silver and arsenic compounds may have helped some infections and infestations; willow bark contains salicylic acid, chemically closely related to aspirin; and the quinine contained in Jesuit's bark was an effective treatment for malaria and other fevers. However, knowledge of appropriate uses and dosages was limited.
The evidence-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." [12] [13]
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. [12] [14]
With little understanding of the causes and mechanisms of illnesses, widely marketed "cures" (as opposed to locally produced and locally used remedies), often referred to as patent medicines, first came to prominence during the 17th and 18th centuries in Britain and the British colonies, including those in North America. Daffy's Elixir and Turlington's Balsam were among the first products that used branding (e.g. using highly distinctive containers) and mass marketing to create and maintain markets. [15] A similar process occurred in other countries of Europe around the same time, for example with the marketing of Eau de Cologne as a cure-all medicine by Johann Maria Farina and his imitators. Patent medicines often contained alcohol or opium, which, while presumably not curing the diseases for which they were sold as a remedy, did make the imbibers feel better and confusedly appreciative of the product.
The number of internationally marketed quack medicines increased in the later 18th century; the majority of them originated in Britain [16] and were exported throughout the British Empire. By 1830, British parliamentary records list over 1,300 different "proprietary medicines", [17] the majority of which were "quack" cures by modern standards.
A Dutch organisation that opposes quackery, Vereniging tegen de Kwakzalverij (VtdK), was founded in 1881, making it the oldest organisation of this kind in the world. [18] It has published its magazine Nederlands Tijdschrift tegen de Kwakzalverij (Dutch Magazine against Quackery) ever since. [19] In these early years the VtdK played a part in the professionalisation of medicine. [20] Its efforts in the public debate helped to make the Netherlands one of the first countries with governmental drug regulation. [21]
In 1909, in an attempt to stop the sale of quack medicines, the British Medical Association published Secret Remedies, What They Cost And What They Contain. [22] [a] This publication was originally a series of articles published in the British Medical Journal between 1904 and 1909. [24] The publication was composed of 20 chapters, organising the work by sections according to the ailments the medicines claimed to treat. Each remedy was tested thoroughly, the preface stated: "Of the accuracy of the analytical data there can be no question; the investigation has been carried out with great care by a skilled analytical chemist." [22] : vi The book did lead to the end of some of the quack cures, but some survived the book by several decades. For example, Beecham's Pills, which according to the British Medical Association contained in 1909 only aloes, ginger and soap, but claimed to cure 31 medical conditions, [22] : 175 were sold until 1998. The failure of the medical establishment to stop quackery was rooted in the difficulty of defining what precisely distinguished real medicine, and in the appeals that quackery held out to consumers.
British patent medicines lost their dominance in the United States when they were denied access to the Thirteen Colonies markets during the American Revolution, and lost further ground for the same reason during the War of 1812. 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. [16] [25] 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. This was mirrored by similar growth in marketing of quack medicines elsewhere in the world.
In the United States, false medicines in this era were often denoted by the slang term snake oil, a reference to sales pitches for the false medicines that claimed exotic ingredients provided the supposed benefits. Those who sold them were called "snake oil salesmen", and usually sold their medicines with a fervent pitch similar to a fire and brimstone religious sermon. They often accompanied other theatrical and entertainment productions that traveled as a road show from town to town, leaving quickly before the falseness of their medicine was discovered. Not all quacks were restricted to such small-time businesses however, and a number, especially in the United States, became enormously wealthy through national and international sales of their products.
In 1875, the Pacific Medical and Surgical Journal complained:
If Satan has ever succeeded in compressing a greater amount of concentrated mendacity into one set of human bodies above every other description, it is in the advertising quacks. The coolness and deliberation with which they announce the most glaring falsehoods are really appalling. A recent arrival in San Francisco, whose name might indicate that he had his origin in the Pontine marshes of Europe, announces himself as the "Late examining physician of the Massachusetts Infirmary, Boston." This fellow has the impudence to publish that his charge to physicians in their own cases is $5.00! Another genius in Philadelphia, of the bogus diploma breed, who claims to have founded a new system of practice and who calls himself a "Professor," advertises two elixers of his own make, one of which is for "all male diseases" and the other for "all female diseases"! In the list of preparations which this wretch advertises for sale as the result of his own labors and discoveries, is ozone!
— Pacific Medical and Surgical Journal Reprinted in the Boston Medical And Surgical Journal , vol. 91, p. 373
One among many examples is William Radam, a German immigrant to the US, who, in the 1880s, started to sell his "Microbe Killer" throughout the United States and, soon afterwards, in Britain and throughout the British colonies. His concoction was widely advertised as being able to "cure all diseases", [26] and this phrase was even embossed on the glass bottles the medicine was sold in. In fact, Radam's medicine was a therapeutically useless (and in large quantities actively poisonous) dilute solution of sulfuric acid, coloured with a little red wine. [25] Radam's publicity material, particularly his books, [26] provide an insight into the role that pseudoscience played in the development and marketing of "quack" medicines towards the end of the 19th century.
Advertising claims similar [27] to those of Radam can be found throughout the 18th, 19th, 20th and 21st centuries. "Dr." Sibley, an English patent medicine seller of the late 18th and early 19th centuries, even went so far as to claim that his Reanimating Solar Tincture would, as the name implies, "restore life in the event of sudden death". Another English quack, "Dr. Solomon" claimed that his Cordial Balm of Gilead cured almost anything, but was particularly effective against all venereal complaints, from gonorrhea to onanism. Although it was basically just brandy flavoured with herbs, the price of a bottle was a half guinea (£sd system) in 1800, [28] : 155 [b] equivalent to over £38 ($52) in 2014. [23]
Not all patent medicines were without merit. Turlingtons Balsam of Life, first marketed in the mid-18th century, did have genuinely beneficial properties. This medicine continued to be sold under the original name into the early 20th century, and can still be found in the British and American pharmacopoeias as "Compound tincture of benzoin". In these cases, the treatments likely lacked empirical support when they were introduced to the market, and their benefits were simply a convenient coincidence discovered after the fact.
The end of the road for the quack medicines now considered grossly fraudulent in the nations of North America and Europe came in the early 20th century. 21 February 1906 saw the passage into law of the Pure Food and Drug Act in the United States. This was the result of decades of campaigning by both government departments and the medical establishment, supported by a number of publishers and journalists (one of the most effective was Samuel Hopkins Adams, who wrote "The Great American Fraud" series in Collier's in 1905). [29] This American Act was followed three years later by similar legislation in Britain and in other European nations. Between them, these laws began to remove the more outrageously dangerous contents from patent and proprietary medicines, and to force quack medicine proprietors to stop making some of their more blatantly dishonest claims. The Act, however, left advertising and claims of effectiveness unregulated as the Supreme Court interpreted it to mean only that ingredients on labels had to be accurate. Language in the 1912 Sherley Amendment, meant to close this loophole, was limited to regulating claims that were false and fraudulent, creating the need to show intent. Throughout the early 20th century, the American Medical Association collected material on medical quackery, and one of their members and medical editors in particular, Arthur J. Cramp, devoted his career to criticizing such products. The AMA's Department of Investigation closed in 1975, but their only archive open to non-members remains, the American Medical Association Health Fraud and Alternative Medicine Collection. [30]
"Medical quackery and promotion of nostrums and worthless drugs were among the most prominent abuses that led to formal self-regulation in business and, in turn, to the creation of the Better Business Bureau." [31] : 1217
"Quackery is the promotion of false and unproven health schemes for a profit. It is rooted in the traditions of the marketplace", with "commercialism overwhelming professionalism in the marketing of alternative medicine". [32] Quackery is most often used to denote the peddling of the "cure-alls" described above. Quackery is an ongoing problem that can be found in any culture and in every medical tradition. Unlike other advertising mediums, rapid advancements in communication through the Internet have opened doors for an unregulated market of quack cures and marketing campaigns rivaling the early 20th century. Most people with an e-mail account have experienced the marketing tactics of spamming – in which modern forms of quackery are touted as miraculous remedies for "weight loss" and "sexual enhancement", as well as outlets for medicines of unknown quality.
In 2008, the Hindustan Times reported that some officials and doctors estimated that there were more than 40,000 quacks practicing in Delhi, following outrage over a "multi-state racket where unqualified doctors conducted hundreds of illegal kidney transplants for huge profits." [33] The president of the Indian Medical Association (IMA) in 2008 criticized the central government for failing to address the problem of quackery and for not framing any laws against it. [33]
In 2017, IMA again asked for an antiquackery law with stringent action against those practicing without a license. [34] As of 2024, the government of India is yet to pass an anti-quackery law. [35]
In 2014, the Government of India formed a Ministry of AYUSH that includes the seven traditional systems of healthcare. The Ministry of Ayush (expanded from Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy), is purposed with developing education, research and propagation of indigenous alternative medicine systems in India. The ministry has faced significant criticism for funding systems that lack biological plausibility and are either untested or conclusively proven as ineffective. Quality of research has been poor, and drugs have been launched without any rigorous pharmacological studies and meaningful clinical trials on Ayurveda or other alternative healthcare systems. [36] [37]
There is no credible efficacy or scientific basis of any of these forms of treatment. [38] A strong consensus prevails among the scientific community that homeopathy is a pseudo-scientific, [39] [40] [41] [42] unethical [43] [44] and implausible line of treatment. [45] [46] [47] [48] Ayurveda is deemed to be pseudoscientific. [49] [50] [51] Much of the research on postural yoga has taken the form of preliminary studies or clinical trials of low methodological quality; [52] [53] [54] there is no conclusive therapeutic effect except in back pain. [55] Naturopathy is considered to be a form of pseudo-scientific quackery, [56] ineffective and possibly harmful, [57] [58] with a plethora of ethical concerns about the very practice. [59] [60] [61]
Unani lacks biological plausibility and is considered to be pseudo-scientific quackery, as well. [62] [63]
While quackery is often aimed at the aged or chronically ill, it can be aimed at all age groups, including teens, and the FDA has mentioned [64] some areas where potential quackery may be a problem: breast developers, weight loss, steroids and growth hormones, tanning and tanning pills, hair removal and growth, and look-alike drugs.
In 1992, the president of The National Council Against Health Fraud, William T. Jarvis, wrote in Clinical Chemistry that:
The U.S. Congress determined quackery to be the most harmful consumer fraud against elderly people. Americans waste $27 billion annually on questionable health care, exceeding the amount spent on biomedical research. Quackery is characterized by the promotion of false and unproven health schemes for profit and does not necessarily involve imposture, fraud, or greed. The real issues in the war against quackery are the principles, including scientific rationale, encoded into consumer protection laws, primarily the U.S. Food, Drug, and Cosmetic Act. More such laws are badly needed. Regulators are failing the public by enforcing laws inadequately, applying double standards, and accrediting pseudomedicine. Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist. [65]
For those in the practice of any medicine, to allege quackery is to level a serious objection to a particular form of practice. Most developed countries have a governmental agency, such as the Food and Drug Administration (FDA) in the US, whose purpose is to monitor and regulate the safety of medications as well as the claims made by the manufacturers of new and existing products, including drugs and nutritional supplements or vitamins. The Federal Trade Commission (FTC) participates in some of these efforts. [68] To better address less regulated products, in 2000, US President Clinton signed Executive Order 13147 that created the White House Commission on Complementary and Alternative Medicine. In 2002, the commission's final report made several suggestions regarding education, research, implementation, and reimbursement as ways to evaluate the risks and benefits of each. [69] As a direct result, more public dollars have been allocated for research into some of these methods.
Individuals and non-governmental agencies are active in attempts to expose quackery. According to John C. Norcross et al. less is consensus about ineffective "compared to effective procedures" but identifying both "pseudoscientific, unvalidated, or 'quack' psychotherapies" and "assessment measures of questionable validity on psycho-metric grounds" was pursued by various authors. [70] : 515 The evidence-based practice (EBP) movement in mental health emphasizes the consensus in psychology that psychological practice should rely on empirical research. [70] : 515, 522 There are also "anti-quackery" websites, such as Quackwatch, that help consumers evaluate claims. [71] Quackwatch's information is relevant to both consumers and medical professionals. [72]
There have been several suggested reasons why quackery is accepted by patients in spite of its lack of effectiveness: [73]
As technology has evolved, particularly with the advent and wide adoption of the internet, it has increasingly become a source of quackery. For example, writing in The New York Times Magazine , Virginia Heffernan criticized WebMD for biasing readers toward drugs that are sold by the site's pharmaceutical sponsors, even when they are unnecessary. She wrote that WebMD "has become permeated with pseudomedicine and subtle misinformation." [115]
Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability or evidence of effectiveness. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.
Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths or homeopathic physicians, believe that a substance that causes symptoms of a disease in healthy people can cure similar symptoms in sick people; this doctrine is called similia similibus curentur, or "like cures like". Homeopathic preparations are termed remedies and are made using homeopathic dilution. In this process, the selected substance is repeatedly diluted until the final product is chemically indistinguishable from the diluent. Often not even a single molecule of the original substance can be expected to remain in the product. Between each dilution homeopaths may hit and/or shake the product, claiming this makes the diluent "remember" the original substance after its removal. Practitioners claim that such preparations, upon oral intake, can treat or cure disease.
Naturopathy, or naturopathic medicine, is a form of alternative medicine. A wide array of practices branded as "natural", "non-invasive", or promoting "self-healing" are employed by its practitioners, who are known as naturopaths. Difficult to generalize, these treatments range from the pseudoscientific and thoroughly discredited, like homeopathy, to the widely accepted, like certain forms of psychotherapy. The ideology and methods of naturopathy are based on vitalism and folk medicine rather than evidence-based medicine, although practitioners may use techniques supported by evidence. The ethics of naturopathy have been called into question by medical professionals and its practice has been characterized as quackery.
The National Council Against Health Fraud (NCAHF) was a not-for-profit, US-based organization, that described itself as a "private nonprofit, voluntary health agency that focuses upon health misinformation, fraud, and quackery as public health problems."
Bastyr University is a private alternative medicine university with campuses in Kenmore, Washington, and San Diego, California. Programs include naturopathy, acupuncture, Traditional Asian medicine, nutrition, herbal medicine, ayurvedic medicine, psychology, and midwifery.
The National Center for Complementary and Integrative Health (NCCIH) is a United States government agency which explores complementary and alternative medicine (CAM). It was initially created in 1991 as the Office of Alternative Medicine (OAM), and renamed the National Center for Complementary and Alternative Medicine (NCCAM) before receiving its current name in 2014. NCCIH is one of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the United States Department of Health and Human Services.
Stephen Joel Barrett is an American retired psychiatrist, author, co-founder of the National Council Against Health Fraud (NCAHF), and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific skepticism.
Quackwatch is a United States–based website, self-described as a "network of people" founded by Stephen Barrett, which aims to "combat health-related frauds, myths, fads, fallacies, and misconduct" and to focus on "quackery-related information that is difficult or impossible to get elsewhere". Since 1996 it has operated the alternative medicine watchdog website quackwatch.org, which advises the public on unproven or ineffective alternative medical remedies. The site contains articles and other information criticizing many forms of alternative medicine.
Chromotherapy, sometimes called color therapy, colorology or cromatherapy, is an alternative medicine that is considered pseudoscience and quackery. Chromotherapists claim to be able to use light in the form of color to balance "energy" lacking from a person's body, whether it be on physical, emotional, spiritual, or mental levels. For example, they thought that shining a colored light on a person would cure constipation. Historically chromotherapy has been associated with mysticism and occultism.
Ernst Theodore Krebs Jr. was an American promoter of various substances as alternative cures for cancer, including pangamic acid and amygdalin. He also co-patented the semi-synthetic chemical compound closely related to amygdalin called laetrile, which was also promoted as a cancer preventative and cure. His medical claims about these compounds are not supported by scientific evidence and are widely considered quackery.
Anthroposophic medicine is a form of alternative medicine based on pseudoscientific and occult notions. Devised in the 1920s by Rudolf Steiner (1861–1925) in conjunction with Ita Wegman (1876–1943), anthroposophical medicine draws on Steiner's spiritual philosophy, which he called anthroposophy. Practitioners employ a variety of treatment techniques based upon anthroposophic precepts, including massage, exercise, counselling, and administration of substances.
Radionics—also called electromagnetic therapy (EMT) and the Abrams method—is a form of alternative medicine that claims that disease can be diagnosed and treated by applying electromagnetic radiation (EMR), such as radio waves, to the body from an electrically powered device. It is similar to magnet therapy, which also applies EMR to the body but uses a magnet that generates a static electromagnetic field.
The Ministry of Ayush, a ministry of the Government of India, is responsible for developing education, research and propagation of traditional medicine and alternative medicine systems in India. Ayush is a name devised from the names of the alternative healthcare systems covered by the ministry: ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homeopathy.
Electrohomeopathy, Electrohomoeopathy, or Mattei cancer cure is a derivative of homeopathy invented in the 19th century by Count Cesare Mattei. The name is derived from a combination of electro and homeopathy. Electrohomeopathy has been defined as the combination of electrical devices and homeopathy.
The Vereniging tegen de Kwakzalverij or VtdK is a Dutch organisation that investigates the claims of alternative medicine and opposes quackery.
Homeopathy practice is unregulated in New Zealand and homeopathic remedies are available at pharmacies, although there are calls to have them removed from sale.
Grape therapy or grape diet, also known as ampelotherapy, is a diet that involves heavy consumption of grapes, including seeds, and parts of the vine, including leaves, that is a form of alternative medicine. The concept was developed in 19th-century Germany in spas such as Bad Duerkheim and Merano. The concept has no scientific basis and is regarded as quackery by scientific institutions like the American Cancer Society.
Arthur Joseph Cramp was a medical doctor, researcher, and writer. He served as director of the American Medical Association's (AMA) Propaganda for Reform Department from 1906 to 1936. He was a regular contributor to the Journal of the American Medical Association (JAMA). Cramp was "a bitter opponent of proprietary and medicinal abuses." His three volume series on 'Nostrums and Quackery', along with his public lectures to schools, professional groups, and civic organizations across the country, helped bring awareness to the problem of patent medicines or nostrums, by subjecting the claims to scientific analysis. He was critical of the 1906 Pure Food and Drug Act, and advocated stronger regulation of product labeling and advertising. In an article announcing his death, the AMA called him "a pioneer in the fight against quackery and fraud in the healing arts."
The FDA defines health fraud as the deceptive promotion, advertising, distribution, or sale of a product represented as being effective to prevent, diagnose, treat, cure or lessen an illness or condition, or provide another beneficial effect on health, but that has not been scientifically proven safe and effective for such purposes.
I offer to cure all diseases with but one remedy, and to stop children dying of disease, for of course I cannot prevent accidents in all cases that are taken in time, and where my instructions are faithfully followed.
within the traditional medical community it is considered to be quackery
Yet homeopathy is a paradigmatic example of pseudoscience. It is neither simply bad science nor science fraud, but rather profoundly departs from scientific method and theories while being described as scientific by some of its adherents (often sincerely).
... we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect.
many naturopaths are against mainstream medicine and advise their patients accordingly – for instance many are not in favour of vaccination.
This is called action bias: doing something (or many things!) in order to not appear to be doing nothing; even when therapeutic modalities are not based on scientific evidence, we apply them nonetheless, falling prey to effort justification and sunk-cost fallacy.
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(help)Later, other photographs were taken by W. H. Sheldon, a researcher who believed that there was a relationship between body shape and intelligence and other traits. Mr. Sheldon has since died, and his work has long been dismissed by most scientists as quackery.
Mr. Sheldon, whose work has since been dismissed by most scientists, died in 1977.