On patent medicines (with Tim Harford)

What It Covers

Tim Harford traces the rise of Lydia Pinkham's Vegetable Compound, a 20% alcohol herbal tonic marketed to women in the 1870s-1900s, examining why unproven patent medicines dominated American healthcare, how demand grew 20 times faster than the economy, and how public outrage eventually created the FDA.

Key Questions Answered

• •Quackery economics: Between 1810 and 1939, inflation-adjusted spending on unproven patent medicines grew 20 times faster than the US economy as a whole. Recognizing this pattern helps explain why alternative remedies persist today — they fill gaps left by expensive, inaccessible, or ineffective mainstream medicine, not simply because consumers are gullible.
• •Placebo mechanics and alcohol: Lydia Pinkham's Vegetable Compound was 20% alcohol — equivalent in strength to port or sherry. Many patent medicines also contained opium or chili, producing measurable physiological effects. Understanding this explains why users reported genuine relief: the compound delivered a real pharmacological response, just not the one advertised on the label.
• •Trust deficit drives alternative medicine: Nineteenth-century doctors routinely prescribed calomel, a mercury compound causing gum inflammation, gray skin, and jaw decay. Physicians also spread infection during childbirth while dismissing evidence of harm. When mainstream medicine is dangerous and dismissive, patients rationally seek alternatives — a dynamic that applies directly to modern vaccine hesitancy and wellness industry growth.
• •Viagra and research bias: A 2013 study found sildenafil — originally tested in 1889 exclusively on men for angina — may provide four consecutive hours of total pain relief for severe dysmenorrhea. The trial lost funding and was never scaled. Women's health conditions remain chronically underfunded, meaning treatments discovered incidentally in male-focused trials go uninvestigated for female applications.
• •Marketing over efficacy: The Pinkham business scaled by spending heavily on newspaper front-page advertising featuring Lydia's portrait, not by proving clinical results. A single $60 Boston Herald ad emptied their entire stock within two days. This demonstrates that perceived trustworthiness and emotional resonance — not evidence — drive health product adoption, a pattern visible in modern supplement marketing.