Last week, SBM’s fearless founder Steve Novella wrote what I considered to be an important post about the danger of conspiratorial thinking to science-based medicine (SBM), noting that anything that threatens the institutions of science and that conspiratorial thinking is a huge threat to science. He correctly noted one example of pseudoscience that is based on conspiratorial thinking, namely the antivaccine movement. Indeed, I once noted that all antivaccine views—and, no, I’m not going to qualify that statement, as I do mean all antivaccine views—are ultimately based on, or, in the case of the vaccine-hesitant at least supported by, a grand conspiracy theory that six years ago I dubbed “the central conspiracy theory of the antivaccine movement.”

What is that conspiracy theory? Regular readers will recognize it immediately when I characterize it. In brief, the central conspiracy theory of the antivaccine movement is that vaccines are dangerous (and, in many tellings, ineffective) but that “they” are hiding the evidence of that harm and ineffectiveness. Who are “they”? Obviously “they” include the CDC, the FDA, big pharma (of course!), the medical profession, the press, and pretty much everyone else outside of the select, small group of those who are enlightened and thus privy to this “hidden knowledge.” Although it seemed odd at the time to many, in retrospect it shouldn’t have been (and wasn’t) so strange how soon after the COVID-19 pandemic hit antivaxxers made common cause with COVID-19 deniers. Of course, I’ve discussed the importance of conspiracy theories in medical quackery, especially the antivaccine movement and COVID-19 denial, several times before. This time, however, I’d like to broaden the discussion.

Obviously, I agree with Steve regarding the danger of conspiratorial thinking to SBM. Where we differ (and some might even view it as quibbling, more of a different in emphasis rather than substance) is that, to me, Steve doesn’t go far enough. If there’s anything that the pandemic has taught me, with the help of Mark Hoofnagle, it’s that all science denial is rooted in conspiracy theory. Steve mentioned, for instance, flat earthers and QAnon. QAnon, of course, is basically the ur-conspiracy theory for the age of Donald Trump, a conspiracy theory so adaptable that it can be all things to all people, even as others have pointed out that Q is very much akin to the old Jewish Blood Libel conspiracy theory, rebranded and revamped for the Facebook century, with more than a dash of the Satanic panic of the latter decades of the last century. Remember, at its heart, the QAnon conspiracy theory claims that there is a secret cabal of Satan worshipers (who are also pedophiles) who secretly rule the world behind the scenes from positions of power in the government, banks, news media, entertainment industry, and church. (Oh, and they’re also cannibals, killing children for the adrenochrome in their blood.)

In addition to the antivaccine movement, Steve also mentioned QAnon (of course!), alternative medicine supporters, and the flat earth movement. Now let me readjust the emphasis and introduce what I would like to refer to as the central conspiracy theory of science denial. It’s basically the central conspiracy theory of the antivaccine movement, just much broader.

The central conspiracy theory of science denial

I begin this section by restating the central conspiracy theory of the antivaccine movement: Vaccines are harmful (and don’t work), but “they” are hiding the evidence of this. Now, let’s take the title of a book that was among the things that got me interested in investigating the claims and appeal of alternative medicine: Kevin Trudeau’s book, Natural Cures “They” Don’t Want You to Know About, originally published in 2005, which, unsurprisingly, was the year when I first started blogging in earnest on my first blog. The central premise of the book was, of course, that there are “all-natural” cures for basically all illnesses, be they serious or less so, including cancer, herpes, arthritis, AIDS, acid reflux disease, phobias, depression, obesity, diabetes, multiple sclerosis, lupus, chronic fatigue syndrome, attention deficit disorder, muscular dystrophy, but that these “cures” are being intentionally “hidden” and “suppressed.” And who’s “hiding” and “suppressing” these “cures”? It is, of course, the usual suspects: The FDA, the Federal Trade Commission (FTC), the CDC (in the case of vaccines and “natural cures” for vaccine-preventable diseases), the major food and drug companies, and, of course, the entire medical profession, all in an effort to protect the profits of these industries and the authority of governmental agencies and the medical profession.

Now let’s look at a sampling of various forms of science denial and the conspiracy theories associated with each of them:

Lest supporters of so-called “complementary and alternative medicine” (CAM), more recently rebranded as “integrative medicine” or “integrative health” think that they are immune and that many of their beliefs aren’t rooted in conspiracy theories, just take a look at some of the leading lights of the movement, such as Deepak Chopra or Mark Hyman, both of whom have engaged in conspiratorial thinking and embraced forms of pseudoscience rooted in conspiracy theories. For example, Deepak Chopra has long engaged in a form of evolution denial in which he denied that genes are deterministic that I used to write about regularly 14 years ago, the better to support his idea that the universe has “consciousness” and “purpose.” Mark Hyman, of course, co-authored an antivaccine book with Robert F. Kennedy, Jr., and that didn’t stop the Cleveland Clinic from hiring him to start a “functional medicine” clinic.

One can also look at other forms of denial not related to science and see the same characteristic of having a conspiracy theory at the root. My favorite example is Holocaust denial, about which I used to write extensively back in the day. The conspiracy theory behind Holocaust denial is, of course, that the Jews (and often Communists, whom antisemites often view as more or less synonymous with Jews as having been created by “international Jewry”), who suppress/falsify/manipulate the evidence showing the Holocaust didn’t happen/killed many times fewer than 6 million Jews for their own nefarious purposes, namely control, power, and money. (Holocaust deniers even refer to the “Holocaust industry” in much the same way that quacks and antivaxxers refer to big pharma.). Unfortunately for Holocaust deniers, their motivation is very transparent. As Holocaust historian Deborah Lipstadt once described, “the real purpose of Holocaust revisionism is to make National Socialism an acceptable political alternative again.”

Of course, then there are other forms of denial, such as the aforementioned flat earth movement, as discussed by Steve last week:

As absurd as all this is, and as jaded as I have become about the limitlessness of human gullibility, I was surprised by the popularity of the Flat-Earth conspiracy. This is the notion that the entire scientific community, along with the aerospace and commercial airline industries, not to mention everyone with a telescope, is engaged in a multi-century conspiracy to convince the world that the Earth is roughly a sphere when in fact it is flat. This is an excellent example of how conspiracies need to become exponentially more absurd as you challenge their premises. If the Earth is flat, then it would collapse under its own gravity. So therefore – gravity must also be a conspiracy. That’s right, gravity.

The Flat-Earth conspiracy is so grand, in fact, that it functions as an ultimate conspiracy. An ultimate conspiracy is one so large that it essentially breaks truth. If the world can be lying about something so fundamental as the shape of the planet, then you cannot believe anything. “They” can be lying about anything and everything, there is no truth, there are no facts, and you can then justify every other conspiracy because no matter how grand they are, they pale in comparison.

But why do conspiracy theories and science denial fit together so well, hand-in-glove? Why do I argue that all science denial is conspiracy theory, when you strip away the camouflage and reveal its core? The reason is simple. Science denial, whatever the motivation for the denial, requires conspiracy theory, because of the very characteristic that Steve cites above.

Why is the central conspiracy theory necessary for science denial?

Let’s look at some examples of science denial and ask: Why is a conspiracy necessary for each of them? It is not for nothing that evolution is considered the central theory of biology, so important is it to our understanding of life. Let’s say that you “question” evolutionary theory, that you don’t want to believe that evolution, by natural selection and other forms of selection, is the central driving force that produced the diversity of life. How, then, do you explain the fact that, a completely negligible minority aside, biologists overwhelmingly support the theory of evolution as the central organizing principle of their scientific discipline and generally don’t argue that evolution by natural selection is critical, but how critical? Let’s look next at climate science. You doubt climate science and refuse to believe that humans are primarily responsible for the no longer gradual increase in global temperature over the last several decades? How do you explain the fact that, a completely negligible minority aside, climate scientists overwhelmingly support the hypothesis that human activity is the primary driver of global warming and generally argue not about whether human activity is driving global climate change but rather about how much and if it’s any longer possible to slow or stop the change in climate in time to avert catastrophe? Let’s circle back again to antivaccine pseudoscience. If you believe that vaccines cause autism, sudden infant death syndrome, infertility, alterations in your DNA, and even the death of teenaged girls (Gardasil, of course), how do you explain the fact that, a completely negligible minority aside, scientists and physicians overwhelmingly have concluded that vaccines are safe and effective and do not cause any of those problems?

It takes a conspiracy theory, of course, to explain why experts so overwhelmingly reject your worldview, because, surely, it can’t be because you’re just plain wrong, right? Surely, the reason why nearly all the relevant experts in the relevant scientific field reject your viewpoint and beliefs and the evidence reported in the the scientific literature in that field overwhelmingly rejects—or, at minimum, emphatically does not support—your beliefs is because there’s a vast conspiracy to suppress them and they are in on it. Again, surely it can’t be because you’re just plain wrong, can it?

Of course not.

Then, of course, besides an explanation for why science rejects your viewpoint, conspiracy theories, conspiracy theories make you the hero. Not only do you and your fellow conspiracy theorists possess “hidden knowledge” that the rest of the world does not (or foolishly rejects), but you are the hero fighting against a vast and evil cabal seeking to suppress that hidden knowledge. I like to point to the example of someone like antivaccine activist Kent Heckenlively. As I’ve put it before, every story must have a victim, a hero, and a villain, and a conspiracy theory lets someone like Mr. Heckenlively portray himself as the hero fighting the villain (big pharma, the government, etc.) for the “victims” (the “vaccine-injured” children). Indeed, Mr. Heckenlively even imagined himself Aragorn, son of Arathorn, in The Lord of the Rings, marching to the Black Gate of Mordor on a doomed mission that he didn’t expect to survive, all in order to distract the Dark Lord Sauron, so that Frodo and Sam could complete their mission. You see the same sort of fantasy in QAnon believers, who think themselves heros “protecting the children.” It’s a powerful combination, an explanation for why your views are rejected by science and the ability to paint yourself as a hero seeking to bring to light hidden knowledge and bring down a great evil.

It’s been argued that science denial has five characteristics:

More and more, I’m coming to the conclusion that the last four characteristics all flow from the first and that science denial is, at its heart, a conspiracy theory when you strip away all the other characteristics. I don’t claim to be the originator of this idea, either. I blame Mark Hoofnagle for influencing me.

True believers vs. grifters

Of course, even if you accept that science denial is a form of conspiracy theory, one must accept that there are…complexities. After all, there are real conspiracies in the world. The difference between conspiracy theories and real conspiracies is that real conspiracies are not, like conspiracy theories, unfalsifiable and ever-evolving in order to remain so. Real conspiracies can be discovered and proven through standard investigational techniques used by law enforcement and journalists the world over—and have been. For example, there really was a conspiracy to bring down the World Trade Center and Pentagon by flying commercial jetliners into them in 2001; it just wasn’t the Mossad and the US government who were behind the conspiracy, as “9/11 Truth” conspiracy theorists would have you believe. The petroleum industry did conspire to cast doubt upon the climate science. Big Tobacco did conspire to deny, obfuscate, and suppress the scientific evidence linking smoking tobacco products to lung cancer and other disease. These examples bring me to grifters.

Wherever you find science denial, almost inevitably you will also find grift. The antivaccine movement is a great example, with a veritable panoply of pure grifters ranging from Andrew Wakefield to Joseph Mercola to Del Bigtree to Robert F. Kennedy, Jr. to Dr. Paul Thomas to so many, many others that I really can’t name them all. The denial of oncology brings to mind all sorts of grifters selling alternative cancer cures, Stanislaw Burzynski being the most prominent one who comes to mind. Homeopaths, naturopaths, chiropractors, and other quacks who deny SBM very frequently have something to sell, usually supplements or some other “medical treatment” not based in science. Thus, feeding antiscience conspiracy theories is a strategy by which grifters hawk their wares.

Similarly, those selling an ideology also take advantage of antiscience conspiracy theories, and vice-versa. In other words, 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 or ideological end For example, fundamentalist religious activists who view the science of evolution as a threat to their worldview and their faith, willingly stoke conspiracy theories of evolution denial. Conservative free market fundamentalists, who abhor anything that would justify a larger role for government or increased government regulation, are more than happy to spread the conspiracy theory behind climate science denial. True believers in “natural” remedies are more than happy to spread conspiracy theories about the government, big pharma, and physicians “suppressing” alternative medicine. Sometimes the converse is true, as well, with science denying conspiracy theorists using ideology as a gateway through which those holding that ideology can be brought into the conspiracy theory. The most obvious example to which I like to point is how the antivaccine movement so skillfully co-opted conservative rhetoric of “health freedom,” “parental rights,” and hostility towards government mandates and regulations to attract conservatives to their opposition to vaccine mandates. Unfortunately, it’s worked spectacularly, leading in a political shift in the antivaccine movement to the right over the last several years and a disturbingly large number of Republican politicians pandering to antivaxxers or even being antivaccine themselves. Meanwhile, antivaxxers have been actively coordinating their activities and synchronizing their key messages in order to cast doubt on COVID-19 vaccines.

Science denial is a conspiracy theory

As Steve noted last week, science denial is not just a threat to SBM, but to all science and to, as he put it, “any notion of evidence, logic, facts, and reality.” The same is true of conspiracy theories. As I contemplated this post, I asked the proverbial “chicken or the egg” question: Which came first, conspiracy theories or science denial? Most likely it was conspiracy theories, which date back as far as recorded history can take us and very likely predate science. Whatever the answer, though, more and more I’m coming to the conclusion that science denial is a form of conspiracy theory and that we will not successfully mitigate science denial until we are able to understand and mitigate conspiracy theories because, even if you do not accept the proposition that all science denial is a form of conspiracy theory, it is without a doubt true that all science denial relies at least in part on conspiracy theories to support it. As we’ve seen in the COVID-19 pandemic, the conspiracy theory of science denial can have deadly consequences, consequences that, once the pandemic finally abates, will become apparent as the earth’s climate continues to warm due to human activity. Worse, as Steve also discussed, science denial has been turbocharged by social media in an unprecedented manner. Misinformation and conspiracy theories travel farther and permeate the consciousness of more people than has ever been possible for them to do before. Developing strategies to combat this tendency and bring people back to reality is arguably the existential problem of the 21st century.