Note: This article was originally published in Skeptic magazine. Space limitations resulted in omitting some of what I wanted to say. I’m taking advantage of having a blog to publish the entire article as originally submitted.


On an episode of Mythbusters, Adam Savage was shown a video clip that contradicted his memory of something he had said. He responded, “I reject your reality… and substitute my own.” He was joking. Unfortunately, the world is full of people who reject reality and who are not joking.

James Randi tells a story about a TV program that featured Uri Geller doing his standard trick of bending a key. Afterwards, the program’s host said it couldn’t possibly have been a trick because Uri had “never touched” the key. The host was then shown the recorded program, which proved that Geller clearly had the key in his hands, for two-and-a-half minutes. Instead of admitting having been wrong, the host exclaimed, “Well, that’s not how it happened.”

One of my own ancestors was a pro at this kind of thing. I’ll call her Aunt S (for stubborn). She had once tried tinned sardines, hated them, and refused to ever touch sardines again. One day she came into my grandmother’s kitchen when she was frying up some large fresh sardines a friend had brought her. Aunt S ate some, proclaimed them tasty, then asked, “What kind of fish were those, Mary?” My grandmother told her they were sardines. She protested, “No they weren’t! I don’t eat sardines!”

Then there was the man I encountered on an Internet discussion group who denied the entire material world! He claimed there was only an imaginary world that we had all agreed on through some kind of cosmic mind-meld when we were disembodied spirits roaming the void between incarnations. Nothing was real; we had only agreed to pretend that it was. We had agreed on every detail from the color of the sky to what would happen to each of us throughout our imaginary lives. (Why bother? Maybe because eternal disincarnate spirits get really bored?)

There are those who deny the reality of evolution, the reality of the Holocaust, the reality of the Moon landing, and the reality of 9/11. I knew that. I’d even heard of the Flat Earth Society. But until recently, I had never realized how many people reject the germ theory.

My first encounter with one of these people was when a chiropractor told me, “Germs don’t cause disease: if they did, we’d all be dead.” He believed all disease was caused by misalignments of the spine. He had never been immunized. He said he simply could not catch any infectious disease as long as he kept his spine straight. He was so convinced germs couldn’t hurt him that he would be willing to walk into the midst of an Ebola epidemic with no protection. He knew he would emerge unscathed.

The chiropractor was confused by the fact that when people are exposed to a disease, not everyone gets sick. Why do some people get sick and not others? A simplistic mind says everyone has access to the same germs, so if some people don’t get sick that must mean the germs can’t be the cause. That’s a fallacy easily refuted by thinking of speeding and auto accidents. If 100 people speed and only 30 of them have accidents, that doesn’t mean speeding wasn’t the cause of those 30 accidents.

I thought the chiropractor was an anomaly, and I didn’t take him too seriously. But then I met the raw food lady (I’ll call her RFL) and discovered a whole new world of germ theory denial. She declared, “Vaccinations create wealth for the drugging profession, but they do not bring health or prevent disease, ever.” She explained that doctors manipulate statistics to make it “look” like vaccines work and big corporations censor the media and hide the truth from us.

The truth, for her, is that modern medicine is a belief system not based on science, that infectious disease is a myth, and that eating raw foods and having a healthy lifestyle is the only way to preserve health. She doesn’t wash her hands, she rarely washes her food, and she practices unprotected sex. Like the chiropractor, she would be willing to nurse Ebola patients without so much as a mask or gloves. At least she has the courage of her convictions.

This is the 21st century; how could anyone still be rejecting the germ theory at this late date? I realized she was a true believer and I knew I had no chance of altering her beliefs, but I wanted to understand what was going on in her head. We exchanged e-mails sporadically over a 2 month period. I got some insight into her thought processes and the sources of her information.

I thought she would have to admit that at least sometimes vaccinations could prevent disease. I decided to confront her with the best case for vaccinations. I pointed out that as the rate of smallpox vaccination rose, the incidence of smallpox fell until eventually it was eradicated from the entire world. She countered with evidence from 19th century epidemics that supposedly showed that as the rate of vaccination rose, the rate of disease rose. She disregards 20th century data because she thinks it’s all lies. She doesn’t admit that smallpox was eradicated because she doesn’t admit that there is any such infection. She says nothing has changed, but the doctors have just agreed not to label anything as smallpox any more – they label the same symptoms as chickenpox instead.

I told her that the smallpox virus can be seen on electron microscopy of the fluid from the blisters. She said it was just cellular debris. I told her the smallpox and chickenpox viruses are distinctive and have been fully analyzed and can be easily told apart. Their entire genomes have been sequenced. No one could possibly confuse them with cellular debris. She wasn’t convinced. She quoted Dr. Vivian Vetrano:

As Natural Hygienists, we know that there is no such thing as a viral disease. There are simply states of impaired health with cell degeneration. That the virus is an entity and that it occasions cellular degeneration is a moot question. The so-called viruses may simply be the various toxic debris that Hygienists have been condemning and shouting about for many years. Not wanting to keep the toxin in the bloodstream, the body may find a means of encapsulating it in a protein membrane and injecting it into a cell to get it out of the bloodstream. Eventually these toxins pervert the metabolism of the cell and cause cellular degeneration. The virus may be only encapsulated protein, the body having surrounded it with a membrane to prevent an excess from upsetting the system. The modern high protein diet may be the reason for so-called viral infections.

RFL went on to explain that

Smallpox is a disease that is instituted by and for the body for purposes of body purification. Its causes are the same as all other diseases — toxemia. Therefore, it cannot be transmitted and it cannot be “prevented” by means of injecting serums or poisons into the bloodstream.

Epidemics like the Black Death, to her mind, can be fully explained by toxemia due to the inadequate diet of the victims. I never did get a coherent explanation of why epidemics stopped even though the diet didn’t change, but she remains confident her explanation is correct.

One cause for all disease. Vague unidentified toxins. A conspiracy to hide the truth from the public. A simple cure by diet. The red flags were multiplying.

I asked where I could read more about how toxemia caused all diseases. She referred me to a book by J.H.Tilden, MD, Toxemia Explained. The full text is available online.  Don’t bother reading it unless you are interested in history.

This book was written in 1926, before modern vaccines, before antibiotics, and before randomized controlled trials. Essentially before modern scientific medicine. Tilden did no experiments. He “thought” about disease and came up with a hypothesis: enervating habits allow toxic metabolic waste products to accumulate in the body, and this is the one cause of all disease. Then he proceeded to advise people about health without doing any kind of testing to determine whether his hypothesis was true or false, or whether following his recommendations really made a difference. It is all speculation, and the facts it is based on are largely pre-scientific errors and distortions. It was not entirely unreasonable for him to think that way in 1926, but his ideas have been completely superseded by 8 decades of advances in microbiology, genetics, histology, immunology, physiology, and other disciplines.

RFL wants to believe Tilden so badly that she blithely jettisons the last century of scientific progress (who says time travel isn’t possible?). Then somehow she gets beyond Tilden’s diet advice to another new paradigm. She is convinced humans are not omnivores, but frugivores, because we don’t have the claws and fangs to kill an antelope. She admits Eskimos survived on meat alone, and even an all-meat diet is preferable to the terrible American diet; but meat is still way inferior to fruit.

She thinks meat does not contain all the nutrients necessary to sustain healthy human life, (even though I showed her evidence that it does). She says meat contains insufficient carbohydrate and fiber, and the excess protein in meat causes demineralization of the bones, and our body chemistry is not equipped to digest meat (!?). She eats nothing but raw fruit and an occasional salad, and is convinced this keeps her in optimum health – although she is still learning from experience and continues to make improvements in her regimen.

She says one of our biggest mistakes is cooking food. “If eating cooked food were healthy, we’d all be healthy.” Cooking apparently produces toxins that our cells can’t handle. Animals were not meant to eat cooked food. She says wild rabbits don’t get sick (!) because they eat only raw food. I didn’t get a chance to ask her about tularemia, but I’m sure she could have explained that away somehow.

As the creationists say about the theory of evolution, she says that germ theory is “only a theory.” I asked her to look at the gazillions of animal and human experiments that support the germ theory. You find a germ that is only present in animals suffering from a specific illness. You isolate that germ. You inject the germ into half of a group of animals and only that half gets sick. You do this over and over. You cure them with antibiotics. You fulfill all of Koch’s postulates. You accumulate a huge body of data to validate the germ theory from every possible angle. You use it to make predictions, and the predictions are accurate. Never mind – it’s all worthless. In her opinion, the people doing the experiments are believers in a false paradigm and they are not doing the science right and they are fooling themselves or lying.

She calls medicine a “foul, fraudulent, flaw-ridden menace.” It isn’t based on REAL science, as evidenced by the fact that it doesn’t work(!?). The sickest people are the ones who most rely on doctors, drugs, herbs, remedies, etc. (Well, yes! But that’s because they’re sick, not why they’re sick.) She claims that if the medical system had wanted to eliminate disease, it could have accomplished that centuries ago by figuring out the best fruit diet to follow. Instead, it seeks only to perpetuate disease by “managing” it. It is an uncaring entity dedicated to making money, and is extremely destructive to humanity.

She thinks there are other ways of determining truth besides what the medical establishment sees as “proof;” for instance, our ancestors learned what to eat by practical experience. She thinks Pasteur was asked by the French government to find out why drinking fermented alcohol causes people to get sick (the version of history I read said a distiller asked him to figure out how to keep beer from going sour after fermentation). She thinks drugs kill cells, even over-the-counter drugs, and then the bacteria come in only to mop up the garbage. She thinks drugs suppress symptoms and thereby cause further damage to the body.

She sees no need to evoke the “supernatural” idea that a little bacterium or dead piece of DNA can conquer a body millions of times larger and more powerful. She thinks people who are vaccinated are more likely to die earlier, of chronic disease. For pneumonia, fasting and appropriate re-feeding is much more effective than antibiotics. Diabetes can be cured by proper diet.

As if the 1926 book by Tilden weren’t outdated enough, she quotes 19th century authorities like Florence Nightingale, who said diseases were the

reactions of kindly Nature, against the condition in which we have placed ourselves. I have seen with my eyes and smelled with my nose smallpox growing up in first specimens, either in closed rooms, or in overcrowded wards, where it could not by any possibility have been ‘caught’ but must have begun [spontaneous generation?]… The specific disease doctrine is the grand refuge of weak, uncultured, unstable minds, such as now rule in the medical profession.

And she quotes Oliver Wendell Holmes, Sr., who said “If the whole materia medica could be sunk to the bottom of the sea, it would be better for mankind and all the worse for the fishes,” which was undoubtedly true in 1860. I think things have improved a bit since then; she thinks they have only gotten worse.

RFL is not alone. She is part of a large and vocal group with websites, books, and other supports for their point of view. They are convinced that raw foods and only raw foods (mainly fruit) will prevent all disease. They reject any public health measures that are based on the germ theory.

It’s very frustrating trying to carry on a discussion with someone who thinks this way; it’s like trying to grasp a cloud or wrestle with Jello. It’s as if you pointed out the brick building in front of you and she said, “What building? There’s no building there! That’s an octopus.” Even if you can intellectually understand how she came to think that, it’s hard to imagine yourself in her shoes. It feels entirely alien, and is painfully disconcerting.

Psychological defenses can protect false ideas like these from any attack. Humans are amazingly creative about rationalizing away every vestige of reality that tries to intrude on their convictions. They are like the psychiatric patient who thought he was dead. They asked him if dead men could bleed. He said no. They pointed out that he was bleeding. He said, “Wow, I guess dead men can bleed.”

If RFL gets sick she can deny that she is sick and reframe her symptoms as healthy signs that her body is eliminating toxins. She can experiment with changes in her diet until her symptoms run their course and subside; then she can give the credit to whatever she did last. “Cured with kumquats” or whatever.

In a way I can understand the attraction. If you don’t believe in germs you think they can’t get you. You remain in control of your health and are not threatened by unpredictable random events. The world seems safer and more manageable.

It’s always fun to play the “Just So Stories” game and try to explain how a trait like denial might have offered some evolutionary advantage. Usually we are better served by confronting reality, but I can imagine how reality rejection might improve reproductive success. A woman who falls in love with a man may idealize him and temporarily ignore the reality that he is a slob who drops his clothes on the floor and leaves the cap off the toothpaste. If the wrong sperm wins the race and the kid is a booby prize in the genetic lottery, the parents can reject that reality in favor of the Lake Wobegon Delusion that Junior is good-looking and above average, so they will love him anyway and bring him up successfully. If reality says you’re in a dangerous situation with no way out and you’re going to die, rejecting that reality may keep you from giving up and may improve your chances of surviving. If you’re a lousy hunter, embellishing your opinion of yourself may keep you hunting longer and trying harder, so you may end up actually getting more game. And we all know our life is finite, but we may function better if we don’t think about that constantly in our daily life.

So denying reality may have some value. As long as it doesn’t involve standing on the tracks and denying the reality of an oncoming train. And therein lies the rub: how can you know which realities are safe to deny? Isn’t it more prudent to stick to reality as much as possible?

What motivates deniers? They can feel superior because they have special knowledge, they can feel part of an elite group of cognoscenti, they can exercise their intellect and get positive reinforcement, and it gives them a purpose in life, a cause to fight for. They must find all this very satisfying.

It might be tempting to call RFL crazy; but she isn’t. She’s not out of contact with reality, she’s just rejecting one facet of reality. You may call it a delusion, but it’s not the kind of delusion that qualifies as mental illness. It’s more like the creationists’ delusion that the evidence doesn’t support evolution. There are a lot of deniers out there: they’re wrong, but they’re not crazy. You and I probably deny a thing or two ourselves. Of course, you can always deny that you do.

Other deniers, such as 9/11 deniers, can be looked at as an annoying but relatively harmless part of the human zoo. They make life more interesting for the rest of us. But people who reject the germ theory are not harmless. By rejecting vaccination, they are decreasing the herd immunity in our population and are endangering the public health of us all.

What can we do about it? Not a darn thing. These beliefs are impervious. The best we can hope for is to understand how false beliefs come about and try to avoid succumbing to any of them ourselves. And we can put the correct information out there for those who are capable of receiving it.

I wish we could reject the reality that germ theory deniers exist.



  • Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.

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Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.