Abstract
This is the fourth of four articles discussing medical sociological concepts that might be of use for medicine
Conspiracy theories around health and medicine are a feature of 21st-century societies. Although always present in certain online and real-life groups, medical conspiracy theories expanded rapidly during the coronavirus pandemic of the early 2020s. 1 In a way this is not surprising as conspiracy theories and delusions have long accompanied pandemics; the Antonine Plague and the Black Death both featured conspiracy theories, which became outriders for the apocalyptic horsemen of the era. During pandemics, individuals become uncertain not only about infectious disease risk, but also whether they can trust those around them. This distrust can extend to authorities and healthcare professionals. In the midst of death and the possibility of social breakdown, health authorities can become governed by a utilitarian mindset that will sometimes seek to sacrifice the few for the good of the many. Some might even attempt to cover up the true scale of the problem. If you feel that you are, or at least could be part of the few, you will probably feel paranoid.
Conspiracy theories generally provide explanations for events by arguing that the events are caused in some way by the secretive involvement of evil and powerful groups, such as doctors or public health professionals. 2 These groups usually manage to hide their role in the incident, though traces of their involvement can be detected by those individuals who are sensitised to it. Medical conspiracy theories set up a struggle between the forces of good (the individuals who detect and resist the medical conspiracy) and evil (those responsible for it). Any statements by healthcare professionals that the conspiracy does not exist are taken as signs that the conspiracy is attempting to deflect attention away from itself. Conspiracy theories therefore are often anti-scientific and cannot easily be falsified – evidence that the phenomenon does not exist may only serve to increase belief in the phenomenon. Conspiracy theories are not benign. They can result in beliefs that are both wrong and harmful. Their harm can be active (they encourage people to engage in a dangerous health-related action) or passive (they encourage people not to take up a potentially life-saving treatment).
Contemporary medical conspiracy theories sometimes have an interesting anti-capitalist dimension to them. Conspiracy theorists can view health professionals’ involvement in the conspiracy as stemming from health professionals’ need to accumulate profit. They can also view health professionals as forming a professional class that is seeking to acquire and exert power over non-medical groups within the society. Medical involvement in the conspiracy can be seen as extending into industry, universities and politics – the institutions of contemporary capitalism. Medical conspiracy theories therefore sometimes provide individuals and group with theories of professional social control. As such, they are often strangely familiar to individuals with an interest in medical sociology. 3 Conspiracy theories can seem like sociological theories that have in some ways gone sideways or out of control. Many ‘mainstream’ sociological theories are suspicious of medicine and science, seeing these subjects primarily in terms of their social control function and their class interests.
As noted, conspiracy theories can proliferate during pandemics. Perhaps more broadly, it is fair to say that they can proliferate especially freely during apocalyptic eras, and periods when end-time thinking comes to dominate. During these periods accurate information flows can decrease while uncertainty and confusion can increase. Individuals can turn to theories that help them to make sense of these times of tumult; and once they have such a theory, they can strongly resist attempts to disconfirm it. It has been said that during pandemics individuals develop ‘crippled epistemologies’, 2 knowing very few things, most of that being wrong, and all of it being strongly believed. Conspiracy theories can provide existential security, 4 though, allowing people to feel that in a world that is dissolving there is certainty and purpose behind the patterns of existence, even if that purpose is malevolent in nature. Conspiracy theories are also partly a product of – and responsible for – broader situations of uncertainty about medical knowledge. They can spread in societies where scientific authority is under attack, undermined by a proliferation of knowledge claims, erosion of authority and constant argument over truth.
Although conspiracy theories are often harmful (either intentionally or unintentionally), it is not the case that they are always unjustified. 2 Conspiracies do in fact exist; capitalism in fact even has a word to describe the tendency for institutions to scheme and collaborate with one for the purposes of harming the public – ‘cartel’. In certain circumstances, paranoia is a useful response to the complexity and uncertainty of modern societies and their institutions such as medicine. As the saying goes, just because you’re paranoid doesn’t mean that they’re not after you.
Medical conspiracy theories can spread in a networked way. Some medical conspiracy theories seem to appear simultaneously in many different social networks, their diffusion ripples forming patterns similar to a handful of stones being flung into water. You can see similar diffusion patterns with non-communicable diseases. 5 Others are more obviously started at a single point, and then spread by defined individuals. Individuals who start or spread medical conspiracy theories are called conspiracy entrepreneurs. 6 Conspiracy entrepreneurs can be true believers; they can be opportunists; or they might be something in between. 7 Some just delight in causing chaos. Conspiracy theories flow across social networks in the same way that money, information or viruses do; this is referred to as their contagion potential. In the pandemics of the past, conspiracy theories spread slowly as people were unable to travel more than a few miles a day. Today, medical conspiracy theories can spread instantly across the world, given its networked nature. Social media is important here in the early part of the 21st century. Social media facilitates the rapid, effectively instantaneous, diffusion of conspiracy theories about medicine. It also enables the easy formation of communities centred around the conspiracy theory, who can then act as an echo chamber to reinforce and radicalise each other’s beliefs.
Once diffusion of the conspiracy theory reaches a certain level, ordinary people become more likely to encounter it. If they come to believe that the medical conspiracy theory is widely held, some of them may shift their public or private views to support it, even if they did not originally believe in it. The more that they encounter the medical conspiracy theory, the more likely they may be to shift their views. This principle is referred to as herding, and partly stems from the desire of people to imitate one another and be part of an in-group. As medical conspiracy theories are potentially harmful to the individual who believes in them, their spread may require complex contagion rather than simple contagion. Complex contagion refers to the need for the individual, on average, to require multiple points of contact with both acquaintances who support the conspiracy theory and with distant sources of information (referred to as weak ties 8 ) as well as with close contacts (referred to as strong ties) before the conspiracy theory comes to be adopted. Simple contagion, on the other hand, requires only one contact with a weak tie before the conspiracy theory comes to be believed.
What do medical conspiracy theories get wrong? First, they often fail to appreciate that many of the events that happen in life, and in relation to health, are not intentional and can happen due to bad luck or some unintended event. No pandemic in human history has been predicted. Pandemics happen almost randomly, even if doctors have a general sense of foreboding that one is due. However, many people struggle with the idea that things can happen in life simply because of luck. Some people can seek out a sense of structure, even if that structure is wrong or potentially harmful 9 . For some people, it is more existentially acceptable to believe that certain medical groups or forces are either behind or attempting to encourage a particular health disaster. Medical conspiracy theories also cannot be exited if the individual does not wish to exit them. They are the equivalent of a black hole; any evidence used to refute them will cross their event horizon and simply be sucked into them to provide fuel to make the black hole grow bigger. Furthermore, conspiracy theorists tend to overestimate the competence and ability of Public Health and medical authorities. 2 Anyone who has had to observe health professionals in action would be justifiably dubious about their ability, willingness and energy to undertake a global conspiracy to seize power from the citizens of the world and thereby become medical dictators. It is not impossible that such a conspiracy could be underway (and that this article could be a way of distracting from the conspiracy), but it is probably implausible.
In some ways, conspiracy theorists have traits and orientations that doctors are encouraged to develop during their training. They have highly critical orientations towards hierarchies and received knowledge. They can actively engage with information and refuse to accept official narratives. 3 They can have a goal of liberating the masses from their societally induced narcolepsy. As such, it has been argued that in many respects, conspiracy theorists are critical thinkers. However, while they have radical doubt about many things, they often lack radical doubt about their own beliefs. It has been said that a scientific mind is a mind that can watch itself, and it is this reflexive orientation that conspiracy theorists often lack (unless it is in relation to a concern that their mind is being secretly manipulated by the medical establishment). Some of their scepticism of modern medicine and science is justified. Science and medicine, like all institutions within capitalism, are often/sometimes (depending on your perspective) driven by the profit motive and that this clearly can conflict with a duty to the public. The reality of science and medicine is that they are professions where politics sometimes plays a role in what can be investigated and what can be said. I once talked to a Professor of Medicine who said that you can criticise and investigate anything in medical research – apart from your own institution. It is clearly the case that researchers who are externally funded – and whose salaries and mortgages depend on that funding – are not totally free, at least in certain circumstances, to be critical of their funders, or their funders’ political masters.
Conspiracy theories can have real-life consequences. 10 For example, during the coronavirus pandemic, individuals who bought into the ‘the pandemic is an attempt at medical dictatorship’ theory became anti-maskers, and refused to comply with infectious disease control measures. Some became anti-vaxxers. There were reported cases of some conspiracy theorists doing things like going to hospitals to encourage people who were being treated for coronavirus to leave. Over time, it is possible that some conspiracy theorists will build a primary aspect of their identity around the conspiracy theory, which would have the consequence of driving their actions to a place that they themselves would not be able to imagine when they first encountered the theory. The writer Cormac McCarthy in his novel The Counselor noted that ‘if you pursue this road you’ve embarked upon, you will eventually come to moral decisions that will take you completely by surprise’.
How to deal with conspiracy theories is an interesting question. 2 If they are attacked by health professionals, such attacks can often serve to strengthen the conspiracy. Some individuals who only weakly believe in medical conspiracy theories can have their beliefs strengthened if they feel that their theories are being criticised – this is what is referred to as secondary deviance within sociology. Left alone, conspiracy theories can sometimes evolve and mutate often in forgotten areas of the internet, re-emerging in a more dangerous and possibly virulent form. There are probably strategies that could be used against conspiracy theories that would work fairly well, such as getting trusted health professionals like GPs to address them during conspiracy outbreaks. There are macro-level changes that would likely help, such as increasing trust and decreasing inequality within a society, which is unlikely to happen in many systems. The truth is that medical conspiracy theories are probably going to be an ongoing feature of life in the 21st century, sometimes prevalent, sometimes dormant, ‘shaping our time’. 11 Much like the viruses that they often try to make sense of.
