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Conspiracy theories having to do with medicine are quite common, and we’ve written about them here before, particularly among the antivaccine movement. I even coined a term, the “central conspiracy theory of the antivaccine movement” and argued that the entire antivaccine belief system, as disparate as the individual beliefs and subsidiary conspiracy theories that make it up can be, can basically be boiled down to the contention that vaccines are dangerous but “they” are hiding it from you. Who are “they”? They’re the CDC, medical profession, big pharma, and the rest of government who, in the central conspiracy theory, “know” that vaccines cause autism and all manner of harm but are covering up the evidence. That’s why the antivaccine propaganda and conspiracy movie disguised as a documentary VAXXED resonated so much, telling, as it did, the story of the “CDC whistleblower“, who supposedly revealed that the CDC “knew” that the MMR vaccine greatly increased the risk of autism in African-American boys but “covered it up” in the study in which that result was supposedly found. That this “evidence” came in the form of an incompetent reanalysis of a CDC-published paper by a biochemical engineer turned clueless epidemiologist named Brian Hooker mattered not at all. In this, the “CDC whistleblower” conspiracy theory very much resembled the Simpsonwood conspiracy theory from the early 2000s, in which Robert F. Kennedy, Jr. pushed a claim that the CDC “knew” that thimerosal in vaccines was causing autism but covered it up at a conference at the Simpsonwood conference center near Atlanta in 2000.

I started thinking about conspiracy theories in medicine again because the COVID-19 pandemic has resulted in a massive proliferation of conspiracy theories about coronavirus, its origin, its spread, potential treatments, a possible vaccine, and more spreading at a magnitude that I’ve never seen conspiracy theories reach before. I just spent my last two posts discussing the conspiracy theories of Judy Mikovits, a disgraced virologist who is claiming that she was unjustly targeted for her work claiming that a retrovirus was associated with chronic fatigue syndrome and might be the cause, when in fact her results were spurious and likely fraudulent. She even managed to bring Anthony Fauci into her conspiracy theories not just once, but twice. Her Plandemic video went viral in a huge way, to the point where people whom I had thought reasonable were sharing it on Facebook, Twitter, Instagram, and other social media. Then there are the conspiracy theories that SARS-CoV-2, the coronavirus that causes COVID-19, originated in a virology laboratory in Wuhan, China, and don’t even get me started on the conspiracy theories about Bill Gates, 5G, and the pandemic, hydroxychloroquine as a treatment for COVID-19, or the flu vaccine as a predisposing factor for the disease. Then I saw a project at The Atlantic that is almost enough for me to consider subscribing again after a lapse of over a decade after The Atlantic‘s miserable reporting on the H1N1 pandemic. It’s called Shadowland, and it gave me an excuse to discuss conspiracy theories as a topic in general and then relate them to medicine. Just as antivaccine pseudoscience is rooted in conspiracy theories, I contend that medical pseudoscience in general can be understood much better if you realize that, like antivaccine beliefs, damned near all quackery is also rooted in conspiracy theory.

It’s also important to recognize that there are, in fact, real conspiracies. They exist. For example, Big Tobacco did conspire to deceive the public about the adverse health effects of smoking. That is indisputable. The 9/11 terrorists did conspire to destroy the World Trade Center and Pentagon. Volkswagen did conspire to cheat emissions tests. The big differences tend to be that real conspiracies have evidence demonstrating them and tend to be a lot more limited, while conspiracy theories persist and, seemingly, mutate despite there being no clear evidence to support them. More on that later.

Q and antivaccine conspiracy theories

At this point, after over three years of its existence, nearly everyone has heard of QAnon, but I bet a lot of people don’t really know what the Q conspiracy theory is. Oddly enough, I was blissfully unaware until Shadowland introduces its subject matter thusly:

America owes its existence, at least in part, to conspiracy thinking. In the colonies, a theory was born that King George III was plotting the enslavement of all Americans. Even without evidence, this theory helped tip the scales toward revolution.

Yet conspiracism here and around the world has destroyed great institutions, eradicated knowledge, endangered democracy, and ended lives. Now—fueled by the internet, partisan media, and the 45th president of the United States—paranoid thinking is more powerful, and more dangerous, than ever, threatening not just individual facts, but the idea that empirical truth exists at all.

The rise of mainstream conspiracism is the result not just of bad information or bad politics or bad thinking, but of systems built to stoke paranoia and to profit from mistrust. This project is an attempt to illuminate the forces that have created this unreality—and chart a course for how we might feel our way out.

It’s important to realize this last fact here. To those not familiar with antivaccine conspiracy theories, it might seem odd that antivaccine activists have so easily made common cause with COVID-19 conspiracy theorists on the surface, until you realize that antivaxxers have always made common cause with epidemic and pandemic conspiracy theorists. They did it in 2009 with the H1N1 pandemic. They did it during the Ebola outbreaks in 2014. They did it when Zika virus was spreading and leading to microcephaly in the babies of pregnant women infected with the virus. One conspiracy theory that antivaxxers always embrace whenever there are outbreaks of a new disease with the threat of a pandemic is the claim that the disease will be used as a pretext to impose “forced vaccination” on everyone (for example, as stated here nearly two months ago by antivaccine activist Lyn Redwood on RFK Jr.’s Children’s Health Defense website).

To illustrate what I mean about conspiracy theories, I consider it important to look at a conspiracy theory that isn’t related to medicine, and Adrienne LaFrance’s article on the QAnon conspiracy theory, “The Prophecies of Q“, is as good a place to start as any, if only for my education as well. I’ve been paying attention to these matters long enough to have watched the birth of multiple conspiracy theories in real time, including “9/11 Truthers,” the Simpsonwood conspiracy theory, H1N1 conspiracy theories, and the “CDC whistleblower conspiracy theory.” Oddly enough, though, I didn’t pay much attention to the Q conspiracy theory as it arose in 2016 and 2017. The introduction, however, should sound familiar:

If you were an adherent, no one would be able to tell. You would look like any other American. You could be a mother, picking leftovers off your toddler’s plate. You could be the young man in headphones across the street. You could be a bookkeeper, a dentist, a grandmother icing cupcakes in her kitchen. You may well have an affiliation with an evangelical church. But you are hard to identify just from the way you look—which is good, because someday soon dark forces may try to track you down. You understand this sounds crazy, but you don’t care. You know that a small group of manipulators, operating in the shadows, pull the planet’s strings. You know that they are powerful enough to abuse children without fear of retribution. You know that the mainstream media are their handmaidens, in partnership with Hillary Clinton and the secretive denizens of the deep state. You know that only Donald Trump stands between you and a damned and ravaged world. You see plague and pestilence sweeping the planet, and understand that they are part of the plan. You know that a clash between good and evil cannot be avoided, and you yearn for the Great Awakening that is coming. And so you must be on guard at all times. You must shield your ears from the scorn of the ignorant. You must find those who are like you. And you must be prepared to fight.

You know all this because you believe in Q.

Don’t see it? Let me make a few minor changes:

If you were an adherent, no one would be able to tell. You would look like any other American. You could be a mother, picking leftovers off your toddler’s plate. You could be the young man in headphones across the street. You could be a bookkeeper, a dentist, a grandmother icing cupcakes in her kitchen. You may well have an affiliation with an evangelical church. But you are hard to identify just from the way you look—which is good, because someday soon dark forces may try to track you down. You understand this sounds crazy, but you don’t care. You know that a small group of manipulators, operating in the shadows, pull the planet’s strings. You know that they are powerful enough to abuse children by forcing them to take toxic vaccines without fear of retribution. You know that the mainstream media are their handmaidens, in partnership with the government, big pharma, and the medical-industrial complex. You know that only Andrew Wakefield, Del Bigtree, RFK Jr., Stanislaw Burzynski, Joe Mercola, and a band of resisters stand between you and a damned and ravaged world in which most of our children are autistic because of vaccines and adults are dependent on big pharma. You see plague and pestilence of vaccine-, GMO-, 5G-, and pharma-caused chronic diseases sweeping the planet, and understand that they are part of the plan. You know that a clash between good and evil cannot be avoided, and you yearn for the Great Awakening that is coming. And so you must be on guard at all times. You must shield your ears from the scorn of the ignorant. You must find those who are like you. And you must be prepared to fight.

If you think I exaggerate, please feel free to read the apocalyptic imagery of a segment of the hardcore antivaccine movement that openly fantasizes about leaders of the conspiracy surrendering and being forced to publicly confess their “crimes.” When you understand this aspect of these conspiracy theories, the comparison frequently made between those promoting science-based medicine, including vaccines, and Nazis becomes a bit easier to understand. Obviously, the ones whose belief in the conspiracy theories behind medical pseudoscience are a small minority, but it’s a small minority that feeds the conspiracy machine, so that the conspiracy theory can infect, in a weaker form, those who are merely vaccine-hesitant or have legitimate reasons to distrust the medical profession, such as African-Americans and other marginalized people.

QAnon first burst into the national consciousness as a result of “Pizzagate,” the conspiracy theory that Hillary Clinton and other “deep state” operatives were running a child sex ring out of a Washington pizzeria called Comet Ping Pong. The conspiracy theory led a man named Edgar Maddison Welch to walk into the pizzeria with three loaded guns on December 4, 2016 to rescue the children who were the victims of this alleged sex ring, firing several rounds into a locked door to open it, there (or so he thought) to find the children being held prisoner. When he didn’t find them, he put his guns down and surrendered, but you can see how the incident could have gone very differently. Now look at what happened next:

While Welch may have expressed regret, he gave no indication that he had stopped believing the underlying Pizzagate message: that a cabal of powerful elites was abusing children and getting away with it. Judging from a surge of activity on the internet, many others had found ways to move beyond the Comet Ping Pong episode and remain focused on what they saw as the larger truth. If you paid attention to the right voices on the right websites, you could see in real time how the core premises of Pizzagate were being recycled, revised, and reinterpreted. The millions of people paying attention to sites like 4chan and Reddit could continue to learn about that secretive and untouchable cabal; about its malign actions and intentions; about its ties to the left wing and specifically to Democrats and especially to Clinton; about its bloodlust and its moral degeneracy. You could also—and this would prove essential—read about a small but swelling band of underground American patriots fighting back.

All of this, taken together, defined a worldview that would soon have a name: QAnon, derived from a mysterious figure, “Q,” posting anonymously on 4chan. QAnon does not possess a physical location, but it has an infrastructure, a literature, a growing body of adherents, and a great deal of merchandising. It also displays other key qualities that Pizzagate lacked. In the face of inconvenient facts, it has the ambiguity and adaptability to sustain a movement of this kind over time. For QAnon, every contradiction can be explained away; no form of argument can prevail against it.

And that’s a key aspect to conspiracy theories, medical or otherwise. The ones that survive and thrive are the ones that are the most adaptable, the ones that are hardest to falsify. They’re the ones that tolerate internal contradictions. QAnon has become incredibly complex, to the point where, no matter how many predictions or claims by Q (whoever Q is) are falsified, the overall conspiracy theory can’t be falsified. In this, antivaccine conspiracy theories are far less complex than Q, although extreme versions of them are almost as apocalyptic, which might limit their appeal compared to more general-purpose conspiracy theories like Q. However, given the paranoid elements, the extreme distrust of the “elites,” and the extreme belief that “something” is very wrong, it should perhaps not be surprising that, not only are antivaxxers making common cause with COVID-19 science deniers, but they are increasingly merging with QAnon conspiracy theorists. For example, Plandemic went viral largely as the result of the efforts of Zach Vorhies, an ex-Google employee and QAnon believer.

Grift forever

Another characteristic of a good conspiracy theory is that there are always grifters, who might or might not be true believers, to monetize the conspiracy theory. In the case of antivaccine movement, their names are too numerous for me to list here, but foremost among antivaccine grifters are people like Andrew Wakefield, Joe Mercola, Del Bigtree, and Robert F. Kennedy, Jr. Just because these people are grifters, though, doesn’t mean that they aren’t also true believers to one degree or another. Certainly, for instance, Del Bigtree is very much a true believer, his speeches to antivaccine groups sounding very much like the sermon of a fundamentalist preacher in cadence, appeal to emotion, and style.

In the case of Q, there are also many such grifters. One featured in LaFrance’s article is David Hayes (online handle: PrayingMedic), who dons the mantle of a skeptic while cleaning up. with 300,000 YouTube followers letting him make a career of promoting Q:

Hayes has developed a following in part because of his sheer ubiquity but also because he skillfully wears the mantle of a skepticI’m not one of those crazies. Hayes is not a QAnon hobbyist, though. He’s a professional. There are income streams to be tapped, modest but expanding. On Amazon, Hayes’s book Calm Before the Storm, the first in what he says could easily be a 10-book series of “Q Chronicles,” sells for $15.29. Hayes writes in the introduction that he and Denise have devoted their attention full-time to QAnon since 2017. “Denise and I have been blessed by those who have helped support us while we set aside our usual work to research Q’s messages,” he wrote. He has published several other books, which offer a glimpse into an earlier life. The titles include Hearing God’s Voice Made Simple, Defeating Your Adversary in the Court of Heaven, and American Sniper: Lessons in Spiritual Warfare. Hayes registered Praying Medic as a religious nonprofit in Washington State in 2018.

Hayes tells his followers that he thinks Q is an open-source intelligence operation, made possible by the internet and designed by patriots fighting corruption inside the intelligence community. His interpretation of Q is ultimately religious in nature, and centers on the idea of a Great Awakening.

Of course, the antivaccine equivalent to the Great Awakening is the realization among the public that antivaxxers were “right,” that vaccines cause autism, sudden infant death syndrome, autoimmune diseases, and all the various ills that antivaxxers blame on vaccines, and that there was indeed a conspiracy to suppress the evidence implicating vaccines in all these ills. It’s a powerful cult-like belief system that is basically an invitation to opportunists looking to make a buck.

Conspiratorial thinking and elements of a conspiracy theory

I’ve alluded to the elements of a good conspiracy theory before in discussing why COVID-19 conspiracy theories are so attractive. First and foremost, conspiracy theories are about secret or hidden knowledge, knowledge that only the believers in the conspiracy theory possess, knowledge to which the average person not accepting the conspiracy theory is not privy. Holding such knowledge makes the believer feel special, superior, greater than all the “sheeple” out there who do not hold the conspiracy theory. Whether the conspiracy theory is Q, antivaccine pseudoscience, belief that there is a cure for cancer but “they” are keeping it from the people, the believer is special.

The believer is also simultaneously a victim of persecution and a hero. One element common to the most attractive conspiracy theories is that something is very, very wrong with the world and that it is not an accident that this something is so wrong. Rather, it’s wrong intentionally, usually as the result of a dark conspiracy of powerful forces that is doing causing the wrong and hiding its involvement. Naturally, the believer perceives himself to be a victim of this “wrongness,” and his waking up to his victimhood and deciding to fight against it lets him claim the mantle of hero. These elements of the conspiracy theory also make the believer feel special and heroic, because not only is he privy to secret knowledge, but he is now a warrior fighting against these dark forces to reverse his victimization by trying to make the knowledge more public and persuading others of its correctness. Conspiracy theories are thus attractive because they are an antidote to a feeling of powerlessness, explain unlikely events (such as 9/11) and even some not-so-unlikely events (e.g., the coronavirus pandemic, some variant of which has been predicted for nearly two decades since the SARS epidemic in 2002), and coping with threats.

It’s thus no wonder that many, if not most, conspiracy theories are ultimately hopeful. They almost always come to the present with “the people” finally “waking up” to the danger and, with the help of the conspiracy theorists spreading the “true” information about the conspiracy, “rising up” to throw off the shackles of their oppressors. We see this in antivaccine conspiracy theories, in which “They” (the CDC, Big Pharma, the medical profession) are finally taken to account for the “misdeeds” of which they’re accused. We see it in Q, bigtime, with Q’s “prophecies” leading patriots to rise up against the deep state or whatever else is the threat at the time. We see it in cancer conspiracy theories in which the “people” are waking up to, for example, “natural cures” for cancer (which are, of course, suppressed by the “cancer industry”) that don’t involve the toxicity of conventional therapies, such as chemotherapy, surgery, and radiation.

Stephan Lewandowsky and John Cook have published an excellent short e-book on recognizing conspiracy theories and countering conspiratorial thinking, The Conspiracy Theory Handbook. They identify seven characteristics of conspiratorial thinking, after first pointing out the key differences between conventional and conspiratorial thinking:

They note:

Actual conspiracies do exist but they are rarely discovered through the methods of conspiracy theorists. Rather, real conspiracies get discovered through conventional thinking—healthy skepticism of official accounts while carefully considering available evidence and being committed to internal consistency. In contrast, conspiratorial thinking is characterized by being hyperskeptical of all information that does not fit the theory, over-interpreting evidence that supports a preferred theory, and inconsistency.

This is the key difference, and these are the characteristics of conspiratorial thinking, under the mnemonic CONSPIR:

  • Contradictory: Conspiracy theorists can simultaneously believe in ideas that are mutually contradictory. For example, believing the theory that Princess Diana was murdered but also believing that she faked her own death. This is because the theorists’ commitment to disbelieving the “official” account is so absolute, it doesn’t matter if their belief system is incoherent.
  • Overriding suspicion: Conspiratorial thinking involves a nihilistic degree of skepticism towards the official account. This extreme degree of suspicion prevents belief in anything that doesn’t fit into the conspiracy theory.
  • Nefarious intent: The motivations behind any presumed conspiracy are invariably assumed to be nefarious. Conspiracy theories never propose that the presumed conspirators have benign motivations.
  • Something must be wrong: Although conspiracy theorists may occasionally abandon specific ideas when they become untenable, those revisions don’t change their overall conclusion that “something must be wrong” and the official account is based on deception.
  • Persecuted victim: Conspiracy theorists perceive and present themselves as the victim of organized persecution. At the same time, they see themselves as brave antagonists taking on the villainous conspirators. Conspiratorial thinking involves a self-perception of simultaneously being a victim and a hero.
  • Immune to evidence: Conspiracy theories are inherently self-sealing—evidence that counters a theory is re-interpreted as originating from the conspiracy. This reflects the belief that the stronger the evidence against a conspiracy (e.g., the FBI exonerating a politician from allegations of misusing a personal email server), the more the conspirators must want people to believe their version of events (e.g., the FBI was part of the conspiracy to protect that politician).
  • Re-interpreting randomness: The overriding suspicion found in conspiratorial thinking frequently results in the belief that nothing occurs by accident. Small random events, such as intact windows in the Pentagon after the 9/11 attacks, are re-interpreted as being caused by the conspiracy (because if an airliner had hit the Pentagon, then all windows would have shattered) and are woven into a broader, interconnected pattern.

Regular readers will recognize most, if not all, of these elements in antivaccine conspiracy theories, as well as various conspiracy theories spread in the service of promoting quackery, such as the conspiracy theory spread by Erin Elizabeth (Joe Mercola’s partner) that nefarious forces are out there killing “natural health” providers, starting with Jeff Bradstreet.

How to respond to conspiracy theories

Lewandowski and Cook conclude with a number of strategies to respond to conspiratorial thinking. Regular readers are likely familiar with debunking, which can be fact-based, logic-based, source-based, or based on fact checking. Obviously, we here at SBM do a combination of some or all of these, although I like to note that my writing is not aimed at the hard-core conspiracy theorists themselves. The likelihood of changing their minds significantly is low to non-existent. If you’re lucky you might plant a seed or two that might germinate later, but only at the cost of a lot of effort. Rather, it is likely better to inoculate those susceptible to conspiracy theories with the knowledge about the nature of conspiracy theories and other information that will make them less susceptible to a conspiracy theory. It is in this vein that I really like Lewandowski and Cook’s concept of “pre-bunking” in addition to debunking:

If people are preemptively made aware that they might be misled, they can develop resilience to conspiratorial messages. This process is known as inoculation or prebunking. There are two elements to an inoculation: an explicit warning of an impending threat of being misled, and refutation of the misinformation’s arguments. Prebunkings of anti-vaccination conspiracy theories have been found to be more effective than debunking.

Fact-based and logic-based inoculations have both been successful in prebunking a 9/11 conspiracy. This indicates some promise in logic- based prebunking, given the seven tell-tale traits of conspiratorial thinking (remember CONSPIR?). If people are made aware of the flawed reasoning found in conspiracy theories, they may become less vulnerable to such theories.

Most importantly, people need to be empowered against misinformation and disinformation:

Conspiracy thinking is associated with feelings of reduced control and perceived threat. When people feel like they have lost control of a situation, their conspiracist tendencies increase. But the opposite also applies. When people feel empowered, they are more resilient to conspiracy theories.

There are several ways to “cognitively empower” people, such as encouraging them to think analytically rather than relying on intuition. If people’s sense of control is primed (e.g., by recalling an event from their lives that they had control over), then they are less likely to endorse conspiracy theories. Citizens’ general feeling of empowerment can be instilled by ensuring that societal decisions, for example by government, are perceived to follow procedural justice principles. Procedural justice is perceived when authorities are believed to use fair decision-making procedures. People accept unfavourable outcomes from a decision if they believe that procedural fairness has been followed.

Finally, it’s also very important to recognize that many conspiracy theories are tactical. In other words, the origin of some conspiracy theories is not genuinely held erroneous beliefs, but rather they are the result of an intentional campaign of disinformation designed to produce a political end. Climate science denial is likely the most important example of a tactical conspiracy theory designed to promote a political viewpoint by casting doubt on a strong scientific consensus. As Lewandowski and Cook emphasize, while logical incoherence is one attribute of conspiratorial thinking, that doesn’t mean that all conspiracy theories are irrational. Denialist rhetoric is very effective at casting doubt on specific science that conflicts with one’s ideology, which is one reason why it can be so difficult to combat these conspiracy theories.

Getting back to Shadowland, I recommend reading the entire series. It’s a long read, with several of the articles weighing in at several thousand words (longer, even, than one of my SBM posts). As I read these articles, I kept thinking: Dealing with this sort of misinformation is exactly what skeptics have been doing for a long time, and yet, in medicine at least, such efforts are often dismissed as beneath physicians, as if countering the claims of alternative medicine, for example, are too easy to be worthwhile, as if nonsense like homeopathy were self-evidently bunk. It turns out that countering conspiracy theories is among the most difficult science communication tasks there is. (Just look at the article on 5G conspiracy theories for an example.)

In the age of the COVID-19 pandemic, it’s become so much more important than it might have seemed in the past, as well. Particularly depressing to me was the first article in the Shadowland series, an article by Jeffrey Goldberg entitled “The Conspiracy Theorists Are Winning“, mainly because it’s hard for me to argue with this conclusion given the proliferation of misinformation weaponized by political actors and amplified by social media. Goldberg paints conspiratorial thinking as an existential threat, and, in the age of COVID-19, it’s a threat to us all in a way that we never recognized before. Even if such conspiracy theories are not an existential threat, at the very least they demoralize frontline health care workers, confuse the public, and lead to behaviors detrimental to public health.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.