I was going to write a detailed post about a recent paper published in the journal JAM Internal Medicine, but since Dr. Novella at Science-Based Medicine has already covered it quite well, I just wanted to share a few tidbits.
Oliver J, Wood T. Medical Conspiracy Theories and Health Behaviors in the United States. JAMA Intern Med. Published online March 17, 2014
I have often pointed out that the advocacy and use of alternative therapies is primarily about ideology and belief rather than what is demonstrably effective at preserving and restoring health. People choose alternative therapies either out of desperation or out of a philosophical perspective that conflicts, to a greater or lesser degrees, with the philosophy of science and science-based medicine. I’ve reviewed this philosophical conflict before. There is a spectrum of degrees of conflict, but at its alternative medicine becomes a kind of religion or faith healing.
The significance of this is that such an ideology is often not responsive to conflicting facts or evidence, and criticism generates the kind of irrational anger usually seen when one criticizes a religious belief system. This has implications for how to effectively combat pseudoscience and quack therapies when simply pointing out the contrary evidence is likely to fail or even strengthen belief in them.
This JAMA paper explores a different aspect of the ideological nature of alternative medicine, the degree to which people believe in absurd medical conspiracy theories, and the extent to which this correlates with the use of alternative therapies.
The study presented people with six conspiracy theories about medicine. It should go without saying (though it clearly does not) that these theories are nonsense, and there is strong evidence contradicting each of them.
- The Food and Drug Administration is deliberately preventing the public from getting natural cures for cancer and other diseases because of pressure from drug companies. (37% agree, 32% disagree)
- Health officials know that cell phones cause cancer but are doing nothing to stop it because large corporations won’t let them. (20% agree, 40% disagree)
- The CIA deliberately infected large numbers of African Americans with HIV under the guise of a hepatitis inoculation program. (12% agree, 51% disagree)
- The global dissemination of genetically modified foods by Monsanto Inc is part of a secret program, called Agenda 21, launched by the Rockefeller and Ford foundations to shrink the world’s population. (12% agree, 42% disagree)
- Doctors and the government still want to vaccinate children even though they know these vaccines cause autism and other psychological disorders. (20% agree, 44% disagree)
- Public water fluoridation is really just a secret way for chemical companies to dump the dangerous byproducts of phosphate mines into the environment. (12% agree, 46% disagree)
My own experience as an advocate for science-based medicine, like Dr. Novella’s, would have led me to think belief in these ideas would be even greater than this survey indicates, so there is at least some reason for optimism. Still, this is a depressingly high level of belief is some pretty extreme, and manifestly absurd, ideas. Undoubtedly, the agreement would be even higher with more plausible, though still false, theories about the “Medical Establishment.”
In addition to the general assessment of belief in these theories, the study looked at associations between level of belief and use of alternative therapies. The kinds of associations evaluated were quite limited, and it would be interesting to tease out the relationship between belief in malign conspiracies in government and conventional medicine and the use of particular alternative therapies. Still, the results are intriguing.
For example, of those who did not believe in any of the six conspiracy theories, 13% said they use herbal remedies. However, for those who believed in 3 or more of the theories, 35% said they use herbal medicine. A similar correlation was seen for use of sunscreen and vaccines, purchasing of organic foods, and other alternative healthcare practices.
This does not, of course, suggest that using alternative therapies is a sign of being a conspiracy nut. It does, however, suggest there is a relationship between distrust of healthcare providers, scientists, and government and the use of alternative therapies. It also implies, though it doesn’t prove, that the more extreme this distrust, the more likely one is to turn to alternatives.
This isn’t surprising, of course, but it does challenge the notion of integrative medicine, which seems to be gaining wider popularity. This notion says that alternative and science-based medical therapies are all indistinguishable tools in a healthcare toolbox, and one can freely and rationally choose among them without prejudice. The reality, however, is that there are deep ideological and philosophical difference between the approach of science and the alternatives, and choosing one often involves some degree of rejection of the other. For the most ridiculous and pseudoscientific of alternative therapies, such as homeopathy, energy medicine, and so on, acceptance involves a fundamental rejection of the core principles of science. For more plausible interventions, such as dietary supplements, their use does not necessarily conflict in a fundamental way with a scientific approach, though it may still indicate a lack of thorough understanding of and commitment to the use of scientific evidence to make healthcare decisions.
I think exploring the relationship between ideology, philosophy, and faith and the use of alternative therapies is a productive way to understand the fundamental reasons some such therapies persist even when there is good reason to think they are useless or even harmful. A better understanding of why people turn to these methods can hopefully inform a more effective strategy for guiding people towards the most effective healthcare available, that based on good science.