The Pervasiveness and Policy Consequences of Medical Folk Wisdom in the U.S

www.nature.com/scientificreports OPEN The pervasiveness and policy consequences of medical folk wisdom in the U.S. Matthew Motta1* & Timothy Callaghan2 Medical folk wisdom (MFW) refers to widely held, but factually inaccurate, beliefs about disease, immunity, pregnancy, and other medically-relevant topics. Examples include the idea that fasting when feverish (“starving a fever”) can increase the pace of recovery, or that showering after sex can prevent pregnancy. The pervasiveness of MFW, and whether or not it—like other forms of medically- relevant misinformation—shapes Americans’ health behaviors and policy preferences is an important and under-studied question. We begin this research by proposing and validating a novel measure of MFW; including a short-form scale suitable for administration in public opinion surveys. We fnd that nearly all Americans—irrespective of socio-economic status, political orientation, and educational background—endorse at least some aspects of MFW. Concerningly, and consistent with the idea that folk wisdom challenges scientifc expertise, we additionally fnd that those highest in MFW tend to place less value on medical expertise and the role experts play in shaping health policy. However, this skepticism does not appear to translate to peoples’ health actions, as MFW appears to have an inconsistent efect on public participation in healthy behaviors. In the age of “fake news” and the anti-vaccine movement, social scientists have taken interest in the efect of medically-relevant misinformation on Americans’ health behaviors—e.g., consulting and heeding advice from medical professionals1—and health policy orientations—e.g., attitudes towards universal vaccination require- ments for public school children2. In most prior research, misinformation typically takes one of two forms: (1) misperceptions, or the rejection of scientifc consensus on a particular issue2–4 (e.g., that childhood vaccines can cause autism), or (2) the endorsement of conspiracy theories1,5–7 (e.g., that pharmaceutical companies and the government conspire to create demand for unnecessary treatments). Social scientists have made great strides in studying the efect of misinformation on health behaviors and policy attitudes. However, we believe that our understanding of medically relevant misinformation is incomplete. Specifcally, we argue that while an important line of research traces the historical and anthropological origins of what we call medical folk wisdom (MFW)8–11, few have attempted to study its pervasiveness or consequences. Sometimes referred to colloquially as “old wives tales,” we defne MFW as popular, yet inaccurate, information about a wide range of medically relevant topics, which are thought to have ancient origins and spread via word of mouth from parents to children12–15. We caution that while our conceptualization of MFW focuses on medical inaccuracy, we recognize that inaccurate beliefs may nevertheless be culturally, traditionally, or historically signifcant to subgroups in the population. For example, the idea that not eating when one has a fever can speed recovery (known as “starving a fever”) can be traced back to at least the mid sixteenth century. In A Short Dictionary for Young Beginners, Medieval lexicographer John Withal noted that “fasting is a great remedy for a fever,” based on the idea that digesting food increases ones’ body temperature, while avoiding food can decrease it 16. Although digestion certainly can increase body temperature, eating when sick can help replenish calories burned as the body’s immune system fghts a fever. Nevertheless, more than 600 years later, the apparent pervasiveness of this belief continues to prompt debunking eforts from high profle outlets like Scientifc American, WebMD, and the Harvard Medical School16–18. Past research on MFW and related topics including folk medicine 9,10,19 and Complementary and Alternative Medicine (CAM)11 has found that folk beliefs are prevalent among socio-economic and racial minorities in the US, 12–15 and are associated with skepticism toward advice from medical experts12,13. Furthermore, research has found that folk medical beliefs ofen rely on oral transmission, are based on coherent systems of thought and 1Department of Political Science, Oklahoma State University, Stillwater, USA. 2Department of Health Policy and Management, Texas A&M University, College Station, USA. *email: [email protected] SCIENTIFIC REPORTS | (2020) 10:10722 | https://doi.org/10.1038/s41598-020-67744-6 1 Vol.:(0123456789) www.nature.com/scientificreports/ Folk theory Evidence % Endorsed Exposure to rhinoviruses, irrespective of weather conditions, causes people to catch colds1. People are more likely to catch colds in winter5, but that’s because we spend more time indoors3. “Exposure to cold weather can cause you to catch a cold” 49% (S1), 46% (S2) Cold weather is associated with decreased immune responsiveness in mice 2, and more favorable survival conditions for viruses6, but there is little evidence that exposure to cold weather causes colds “Consuming more than the daily recommended amount of vitamin C can A recent meta-analysis found that vitamin C, and excess consumption of it 55% (S1), 49% (S2) prevent illnesses like infuenza and the common cold” (e.g., via supplements), does not reduce incidence of the common cold4 Eating chicken soup may reduce respiratory infammation, but it has no “Eating chicken soup can help people recover from illnesses more quickly” 66% (S1), 63% (S2) known medicinal benefts regarding its ability to fght infections7 Hand washing is an efective way8 to prevent the transfer of germs that cause “Not washing one’s hands can help increase immunity to disease” disease. Poor hygiene and not washing one’s hands does not9,10 act as a natural 38% (S1), 37% (S2) form of inoculation Neither vitamin C11, nor multivitamins19 have been shown to reduce cold inci- “Taking multivitamins daily can help prevent catching illnesses like the com- dence. Some studies12 fnd benefcial efects of Zinc when taken immediately 62% (S1), 72% (S2) mon cold” at the outset of a cold, but with the important caveat13 that (1) these claims are disputed, and (2) Zinc does not prevent colds Ginger in its natural form can have health benefts14. However, there is no “Carbonated drinks, like ginger ale, can cure stomach aches” 63% (S1), 62% (S2) evidence15 that sugar sweetened beverages like ginger ale ofer much relief “Women cannot become pregnant by having sex during menstruation (or “on While women may be less likely16 to become pregnant while having sex during 30% (S1), 28% (S2) their period”)” menstruation, sex during menstruation can result in pregnancy17 Although white spots (known as leukonychia) can occur for a number of “White spots on one’s fngernails are indicative of not consuming enough diferent reasons, the most common is minor injury18 to the fngernail area. 58% (S1), 54% (S2) Vitamin C” Vitamin defciencies are not thought20 to be responsible for leukonychia Showering afer sex will not21 help prevent pregnancy. In fact, research suggests that the act of rinsing the vagina afer sex may actually push sperm fur- “Showering afer sex is an efective way to prevent pregnancy” 15% (S1), 13% (S2) ther up through the cervix22. Tat said, cleaning yourself afer sex can protect from some infections like UTIs23 Consistent medical research24,25 suggests that cracking knuckles is not cor- “Cracking one’s knuckles can cause arthritis” 49% (S1), 47% (S2) related with degenerative changes associated with arthritis While the idea of fasting to stop a fever dates back to the 1500 s, it is not based in scientifc consensus26,27. Fevers increase body temperature and metabolism “Not eating when one has a fever (sometimes called “starving a fever”) can and thus burn more calories. Eating can actually help to replace the calories 37% (S1), 33% (S2) reduce the amount of time it takes to recover” that are lost due to the fever. Tat said, research in mice28 suggests the impor- tance of eating may depend on the root cause of the fever, with it proving benefcial for infuenza but detrimental for bacterial infections Table 1. Folk theory veracity assessment and endorsement summary. For brevity and ease of interpretation, we do not include Table-specifc references (in brackets) in the main text of this manuscript. A fully-referenced version of Table 1 can be found in the Supplementary information. action, and vary across regions and cultural subgroups within a population 8–11,19. Critically however, eforts to quantify the prevalence of MFW, as well as its behavioral and policy consequences throughout the American public are incredibly rare in previous literature20. Tis omission is important. If MFW is in fact widespread, we might expect MFW to have a number of important implications for health policy (e.g., the rejection of expert-backed policies), and public health more generally (e.g., unwillingness to participate in healthy behaviors). Whether or not this is the case, of course, is an open empirical question. Previous research leads us to believe that MFW could play a powerful role in shaping Americans’ health behaviors and policy attitudes. Te expert discounting hypothesis begins with the premise that most medical folk theories, like “starving a fever,” are inconsistent with the best available scientifc evidence. In Table 1, which we discuss in more detail shortly, we describe several prominent medical folk theories, and provide assessments of their accuracy. Indeed, while folk theories—like other forms of misinformation1,4,5,7—may have some elements of scientifc truth, they are largely inconsistent with the best available medical evidence. Tis incongruence creates an opportunity for those who endorse some (or many) aspects of MFW to hold negative views toward the scientifc community. Negative views toward the scientifc community may lead indi- viduals to express higher levels of opposition to the role that scientifc experts play in the policymaking process, and/or to be less likely to practice medically recommended health behaviors in their own lives2.

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