Of course, we’ve always had snake oil salesmen. We’ve always had patent medicines, odd electric probes and copper bracelets. That’s partly because placebos work, and partly because when someone isn’t feeling well, it’s tempting to seek relief and belief.

In the last fifty years, peer-reviewed and tested medicine has gotten dramatically more effective at the same time that these regulated medicines have spent a fortune on ads and marketing. As a result, the sham snake oil purveyors have worked hard to copy the scientific umbra and language of tested and regulated treatments. And thanks to aggressive lobbying, in many countries, the folk remedies are nearly unregulated.

So we’ve got greedy public pharma companies, with a tested product and an ad budget that often exceeds their R&D budget (industry wide, it approaches half of R&D). They’re using every tool they can to sell something expensive that sometimes works. And then we have folk medicine companies that are responding to the high prices and ad influx by raising their own prices and sharpening their own ads, blurring the gap and grabbing some of the trust that people have in verified and tested results.

Belief is useful and placebos work. But you can see the widening gap here. It’s hard to tell from the website or ad which are the actual focused, tested, double-blind and effective treatments, and which are simply scams. A cheap benign placebo is a bargain. One that costs too much or hurts you is not.

If someone tells you that they’re offering a diagnostic test of your micro-biome and has you send in a sample for scientific analysis and testing, it’s almost certain that they’re doing nothing of the sort. If there’s a simple device you can buy online for $100 or so, it is likely that it doesn’t cure pain the way they say it does. If a practitioner insists that they have powers that transcend the laws of physics or reason, they’re actually only offering you the power of suggestion. And yes, if a famous doctor insists that an expensive over-the-counter magical bean is what you need, think twice.

Regulated medicine has gotten dramatically more effective in the last few decades. Folk medicine hasn’t changed at all, even if it costs ten times more than it used to, and even if the packaging and hype is significantly more sophisticated.

And so: targeting people in distress, charging ever more and honing the sales pitch to make it ever sharper.

It’s a shame that the folks who do this don’t have the self-respect and generosity it would take to be honest about what they’re offering. Instead, they hide behind a facade of jargon and process that conceals the fact that they’re simply making it up. That oil isn’t essential, except in the way it makes a profit.

There are few areas of our lives where we tolerate this much fraud. Because we really want it to be true.