The late medical ethicist and pediatrician William G. Bartholome included in his talk at the 1988 National Health Fraud Conference in Kansas City a discussion of the concentric circles of Hell described in Dante’s Inferno. Thinking about those circles reminds me of the importance of combating health fraud and quackery.
The first (outermost) circle, called Limbo, is reserved for the otherwise virtuous who failed to accept Christ. If your idea of Heaven is the RMS Titanic in all its glory, Limbo would be the steerage deck.
But as you go deeper into Hell, accommodations get increasingly dreadful. Within the seventh circle of Hell, immersion in a river of boiling blood and fire is a relatively tame fate. Supposedly it’s even worse in the region where inhabitants are forever stuck in scorching sand and showered with flakes of fire.
The seventh circle is designated for violent people. But there are even deeper circles for supposedly worse people. Yes, even worse!
I’ll spare you a description of the eighth and ninth circles, but their inhabitants might regard the seventh circle as a realm of luxury.
Dante envisioned the eighth circle for the conscious frauds (sorcerers, astrologers, false prophets, alchemists, thieves, corrupt politicians, perjurers, impostors, and other intentional deceivers) and the ninth circle for the treacherous: those who betray others in social relationships.
I’m not sure I have a solid grasp of Dante’s distinction between the fraudulent and the treacherous, but I agree with this point Dr. Bartholome made about Dante: He took fraud seriously.
So do I. However, I’m not sure I think about fraud quite the way Dante did.
First, I don’t see fraud as categorically worse than violence (although it’s clear that some frauds cause more harm than some violent acts).
Second, I don’t see fraud as limited to intentional deceit—even though legal dictionary definitions of fraud such as the definition at law.com refer to intentional deceit or perversion of truth.
When Bernie Madoff intentionally deceived his clients and made off with their money, it’s clear that he defrauded them.
When health care providers intentionally bill third-party payers for services that they know they didn’t provide, that’s fraud. (It’s called health insurance fraud or health care fraud and, as I’ll explain, it’s not the same as health fraud.)
But what about people who strongly believe in their own false or misleading promotional claims for health-related uses of products or services? Is it fraud—or the equivalent of fraud—when promoters truly believe the baloney they promote?
I suggest that being a well-meaning dupe is no excuse for deceptively promoting health products and services. Indeed, being a true believer in your cherished nonsense gives you an advantage in projecting sincerity, which enhances the illusion of credibility and therefore makes you more effective at misleading unsuspecting people.