Conspiracy Nation: How the Growing Trend of Unfounded Beliefs Hurts Patients

John Watson


July 21, 2017

False Notions, Real Victims

In late June, NASA found itself in new territory, brought there not through space exploration but rather via nonsense, when it had to confirm that, despite what people were saying, it was not actually operating child slave colonies on Mars.[1]

That a spokesperson for one of the world's foremost scientific organizations felt compelled to refute such an outlandish claim—in response to growing allegations on the Internet—encapsulates the double-bind of the Information Age. As we've gained unprecedented access to wide swaths of knowledge, so too have the doors been thrown open to misrepresentations, delusions, and outright lies, ingredients that come together in a particularly toxic form in the various conspiracy theories gaining popularity globally.

"The Internet has become an echo-chamber where we self-select for our preconceived notions rather than challenge them, finding like-minded people who share our beliefs and validate them," said David Robert Grimes, PhD, a cancer researcher and physicist at Queen's University Belfast and the University of Oxford. "This might explain precisely why conspiracy theories are flourishing across all sides of the political and social spectrum."

When conspiracy theories are directed at healthcare, their impact can be considerable. According to survey results published in JAMA Internal Medicine,[2] approximately half of Americans believe in at least one major medical conspiracy, the most widely accepted of which is idea that the US Food and Drug Administration is suppressing natural cures for cancer to benefit drug companies.

As they gain cultural traction, medical conspiracies threaten to harm patients on multiple fronts.

"It is so often peddled at vulnerable people, and it is contemptible," said Grimes, whose writing for The Guardian and The Irish Times debunking popular conspiracies earned him the John Maddox Prize for supporting sound science. "Usually, it's used to bolster the product they're pushing, be it cannabis oil or homeopathy. These fictions kill people, and it's heartbreaking to see their consequences directly."

As they gain cultural traction, medical conspiracies threaten to harm patients on multiple fronts. The relative strength of someone's belief in medical conspiracies has been associated with an avoidance of traditional medications, influenza shots, and attending annual checkups.[2] HIV-positive black males who believe the conspiracy that AIDS was created in a government laboratory are reported to have unprotected sex at higher rates[3] and be more likely to not adhere to antiretroviral therapy[4] than counterparts who don't share their beliefs. Misconceptions regarding the contraction of Ebola virus have been found to deter treatment and contribute to its spread,[5,6] whereas popular conspiracies that Zika virus was caused by genetically modified mosquitoes hamper one of the most viable efforts to control it.[7]

Antivaccine Movement

Yet when it comes to the link between conspiracies and otherwise avoidable adverse health outcomes, probably no example has caused more harm than the theory that doctors routinely give vaccines to children that they know to cause autism. This belief stems from a 1998 study linking the measles, mumps, and rubella (MMR) vaccine to autism by former physician Andrew Wakefield, which The Lancet  later retracted for being "utterly false." Nevertheless, the discredited link persists to this day, in part due to distressed parents seeking answers that a variety of conspiracy theorists are more than willing to furnish.

The most recent example of the MMR vaccine conspiracy theory's frustratingly persistent lifespan is found in Minnesota, where a measles outbreak among Somali-American immigrants has since reached a peak with nearly 80 cases. An infectious disease that the United States declared eliminated in 2000 has come roaring back, due in large part to fearmongering and pseudoscience aimed at a community of recent arrivals.

"You had people like Andrew Wakefield and then Mark Blaxill, another conspiracy theorist, showing up in Minnesota in the midst of this outbreak and saying, don't listen to public health officials when they tell you to get vaccinated because they are lying," said Paul A. Offit, MD, director of the Vaccine Education Center at The Children's Hospital of Philadelphia. "I really don't see how that's legal."

Other recent examples highlight how antivaccine campaigns have contributed to infectious disease outbreaks. The first few months of 2015 saw four measles outbreaks in the United Sates, the most prominent of which was linked to Disney's California theme park, with a large portion of the infected noting religious or philosophical objections to immunization. Similarly high numbers of people refusing vaccinations contributed to pertussis outbreaks in five states. In a 2016 Medscape commentary, Offit noted that claims that HPV vaccines cause chronic disease are also without merit and threaten to curtail our ability to prevent certain cancers.

"There is not a year that goes by when we don't see a child come in to this hospital who suffers or dies from a preventable disease invariably because their parents chose not to vaccinate them, because they read bad information on the Internet by these antivaccine groups," he said.

Is There a Cure for Conspiracy Theories?

Dr Offit, the co-inventor of the rotavirus vaccine, has been a vocal critic of the antivaccine movement. It's a role that has come at a distinct personal cost, as he has found himself the target of frivolous lawsuits, hate mail, and death threats, as well as being accused of being complicit in the very same conspiracy he's attempting to refute. Yet it has also given him insights into conspiratorial thinking and ways to potentially intervene against it.

While he receives daily phone calls about vaccines, he estimates that only a small percentage are from that distinctly new Information Age archetype, "the citizen scientists who believe that you can Google anything online and know a theory just as well as anyone who gives you advice, even if they have an expertise and experience that you don't have."

For the sizable majority who don't fit this description, Dr Offit believes that there is considerable room for healthcare professionals to become effective communicators of scientific truths. Although some evidence suggests that health messaging built around the negative effects of preventable diseases is counterproductive at increasing vaccination,[8] Dr Offit feels that physicians can bring an important missing element to such discussions.

"What those studies are lacking is the compassion that comes with the clinicians explaining the argument."

There is also some evidence that the promotion of analytic thinking can counter conspiratorial thinking.[9] Dr Grimes sought to lend such efforts the weight of real-world numbers in a 2016 mathematic model study.[10] His analysis was built from the basic assumption that conspiracies would require a heroic secret-keeping ability in order to not out one's involvement. By conservative standards, Grimes estimated that the minimum number of people involved in the vaccine and suppressed cancer cure conspiracies would ensure that they were exposed after just over 3 years, information he hopes will have persuasive value.

"Often patients don't know what to believe, and this is where a chat can make a world of difference, providing reassurance and correcting misconceptions."

Yet, underlying Grimes' research is a slightly more difficult truth. People believe in conspiracies because conspiracies exist and are then exposed. One Edward Snowden can bring to light a massive eavesdropping program that calls into question the role of government agencies. For historically oppressed groups like black Americans, it is perhaps an understandably small mental leap to believe that HIV/AIDS was created as a weapon against them when one considers the well-documented horrors of the Tuskegee syphilis experiment. And then there is the foundational supposition of many medical conspiracies—that "big pharma" is out to make a profit from illness—which is hard to dispute in a time when executives like Martin Shkreli and the EpiPen price-gouging controversy are front-page news.

Conspiracy theories by their very nature give a sense of control and insight to the powerless.

"Conspiracy theories by their very nature give a sense of control and insight to the powerless. And while the beliefs might be wrong, the animus sometimes has a grain in truth," said Grimes. "And indeed, few would argue that some of the conduct of drug companies is beneath contempt. Yet this doesn't render them guilty of all vices. The reality is that the problems we face in healthcare are nuanced, and there are much more shades of gray than black and white."

In a time when a fractured media landscape and increasingly polarized populace act as an accelerant to conspiratorial beliefs, more and more clinicians may find the need to explain that nuance to skeptical patients.


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