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How the Growth of Denialism Undermines Public Health

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How the Growth of Denialism Undermines Public Health READING BETWEEN THE LINES How the growth of denialism undermines public health Espousing unproved myths and legends is widespread during the festive season, but some groups hold views contrary to the available evidence throughout the year. This phenomenon, known as denialism, is becoming more elaborate and widespread, and poses a danger to public health, say Martin McKee and Pascal Diethelm hristmas is a are not. Unfortunately, time when many confusion is encouraged entirely rational by the liberal use of the people whose term, such as when the views are based current British govern- Csolidly on empirical evi- ment uses the term “def- dence the rest of the year icit deniers” to attack suspend their critical fac- critics of its economic ulties and say things they policy, a group that now know to be untrue. Just in includes large num- case any young children bers of distinguished have picked up their par- economic researchers, ents’ copy of the BMJ, we among them several won’t go into detail except to Nobel laureates.8 say that the subject of these Although contempo- falsehoods traditionally rary usage of the term originates in the far north.1 is relatively recent, the Such stories are harmless concept of denialism and those telling them will, has been recognised when their children reach GERARDOGARCIA/REUTERS for several decades. A an appropriate age, abandon chapter entitled “Denial the pretence. Yet other people hold views that Denialism and its history of reality” in a 1957 book describing the are equally untrue and do so with an unshake- The term “denialism” has been coined to p henomenon of cognitive dissonance notes able faith, never admitting they are wrong describe this phenomenon. First popular- how “. groups of scientists have been known however much contradictory evidence they ised by the American Hoofnagle brothers, to continue to believe in certain theories, sup- are presented with. one a lawyer and the other a physiologist, porting one another in this belief in spite Some of these views are harmless, but it involves the use of rhetorical arguments of continual mounting evidence that these o thers cost lives. It is easy to think of con- to give the appearance of legitimate and th eories are incorrect.”9 It highlights, in par- temporary examples. “HIV is not the cause unresolved debate about matters generally ticular, the importance of selectivity, whereby of AIDS.”2 “The measles, mumps, and rubella considered to be settled.6 The term can be “one aspect of the process of dissonance reduc- vaccine cannot be considered safe.”3 “Second traced to people who deny the existence of tion [is] obtaining new cognition which will be hand smoke is simply an irritant and there the Holocaust, but it has subsequently been consonant with existing cognition and avoid- is no conclusive evidence that it is danger- applied much more widely. Denialism can ing new cognition which will be dissonant ous.”4 And, with potentially the greatest be recognised by the presence of six key fea- with existing cognition.” The extent to which consequences for our species, “the evidence tures (box).6 7 It is, however, important not to selectivity influences our views is now widely that the world is warming is inconclusive, confuse denialism with genuine scepticism, recognised, not least as a result of a best sell- and, if not, the evidence that global warming which is essential for scientific progress. ing book containing many examples of what is is caused by anthropogenic carbon emissions Sceptics are willing to change their minds termed “confirmation bias.”10 One explanation is unproven.”5 when confronted with new evidence; deniers is that confirmation bias is how we deal with BMJ | 18-25 DECEMBER 2010 | VOLUME 341 1309 READING BETWEEN THE LINES evidence that challenges our Change inappropriately ref- strongly held beliefs and that erenced a statement on a would otherwise threaten our report about the sensitivity self perceived status as intel- of the rainforest to changes ligent and moral individuals. in rainfall rather than the relevant primary research. Approaches to denialism This inconsequential refer- Recent cognitive research, encing error, in a report of some taking advantage of more than 900 pages, was advances in brain scanning, then used to undermine the has shed light on the neuro- entire report.18 logical processes whereby indi- Deliberate falsehoods are viduals interpret a message rarely used to convince peo- according to who is the mes- ple that something is true, senger. People subconsciously but rather are used to seed suppress recognition of clearly doubt about the actual truth. contradictory messages from For example, although only politicians that they support, 18% of Americans believe yet easily identify contradic- that President Barack tions from those they oppose.11 Obama, a church going However, simply ignoring rel- Christian, is a Muslim, an evant evidence is insufficient. additional 43% are unsure.19 Evidence, including authori- Media commentators don’t tative corrections, that contra- actually say that that Obama dicts strongly held views can, is a Muslim, they just say that paradoxically, reinforce those they don’t know whether he views.12 Thus, research in the is or he isn’t, while consist- United States has found that ently using the president’s registered Republicans who full name: “Barack Hussein are exposed to evidence on the Obama.” In the health arena, importance of social determi- this approach is commonly nants of health are less likely found in debates about vac- to support collective action to cines, where denialists play address them than are those As with vaccines, you can never be sure on the argument that “you not exposed.13 can never be sure” when it Yet denialism involves more than someone initiative would have redefined a relative risk comes to the very small risk of complications accumulating a collection of individual errors of less than two as being not statistically sound of vaccinations. in information processing. Increasingly, it because of the potential for unrecognised takes on the form of social movements in confounding and was designed to exclude The spread of denialism which large numbers of people come together research on the risks associated with passive Of course, there have always been people who and propound their views with missionary smoking, which typically yield a relative risk have held strong views in the face of over- zeal.14 These views combine exploitation of the of 1.3-1.6.16 Other efforts seek to redefine con- whelming evidence to the contrary. Indeed, genuine uncertainty that characterises scien- cepts as essentially unresearchable, such as the Flat Earth Society, although a shadow of its tific research with the use of simple falsehood. in an industry funded report on alcohol that former self, still exists. However, the world has Denialists emphasise the limitations of stated: “violence is a nebulous concept.”17 changed in recent decades in three important st atistical associations for establishing causal- Selective use of the scientific literature is ways, each facilitating the spread of denialism. ity, which are well recognised by aetiological another approach used by denialists, who The first is the birth of web 2.0, which has epidemiologists, yet ignore other criteria that either promote methodologically flawed transformed the internet from a closed pub- are used to ascertain whether a relationship is research that supports their world view over lishing platform into an interactive tool allow- likely to be causal, such as biological plausibil- more methodologically sound papers or ing intensive exchange of ideas. People who ity, consistency, and strength of association.15 undertake intensive searches of papers they might once have clung on to dissenting views They may also try to change “the rules of the oppose for anything that might cast doubt on in isolation can now locate individuals with game,” such as in the now notorious example the quality of the science. A now notorious similar views within seconds. Social media when the tobacco industry sponsored efforts example is “Amazongate,” in which a report enable communities of denialists to grow by to define “good epidemiology practice.” The by the Intergovernmental Panel on Climate feeding each other’s feelings of persecution by 1310 BMJ | 18-25 DECEMBER 2010 | VOLUME 341 READING BETWEENCHRISTMAS THE LINES 2010: READING BETWEEN THE LINES When a seemingly bizarre story appears in the media that risks undermining public health, health professionals should ask: “why is this story appearing now?” a corrupt elite. This is encouraged by cynicism tackle HIV/AIDS in east Africa had to address CHARACTERISTICS OF DENIALISM with existing political systems. In one study, concerns that promotion of condoms was a Identification of conspiracies: Denialists argue for example, the people who were most likely covert attempt to control the population. It that scientific consensus arises not as a result of independent researchers converging on the to believe in 9/11 conspiracy theories were may be necessary to accept that there are some same view but instead because researchers those who were disaffected and disengaged people who cannot be convinced, but there 20 have engaged in a complex and secretive with the political system. Such cynicism is will be many who can. conspiracy. They are depicted as using the growing, a development that should not be This leaves those cases where denialist peer review process to suppress dissent rather
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