I know you’re all wondering why this is relevant to family medicine. As some of you know, I am studying a Masters in medical anthropology and I’m always struck by how we, as a medical community, fit into the lives and experiences of our patients. We, as doctors, are only part of the story when it comes to the journey of healing and we have to understand where that patient has started from in order to be able to walk alongside them on that path. During this COVID pandemic, we hear of people protesting against masks, accusing Bill Gates of creating a vaccine that he will use to track individuals, the virus being spread by 5G masts, and China leaking COVID-19 from a laboratory in Wuhan. What I find even more fascinating is how the scientific community have retaliated in response to these conspiracy theories – by reiterating the scientific facts louder and clearer. Our society is already polarised and I’m just so sure that there is a better way to find a solution. I’ve studied what we have learnt from my reading on the HIV epidemic in the 1980s to see if it can give an insight to why conspiracy theories arise and what we can do about it as family physicians.

Why do people believe?

Conspiracy theories are often implausible but are defined by the fact that they are impossible to disprove. Occasionally, a story will come to light that seems so incredulous but has proven to be true. For example, the Tuskegee study in the U.S observed and documented the natural history of syphilis in Black males from 1932. For the following 40 years, the untreated symptoms and signs of these men were recorded and the participants were not informed of penicillin as a curative option which became available in 1947. We can also reference the forced sterilisation programmes in Peru and Zimbabwe conducted by doctors under political influence; and when Pfizer tested meningitis medications in Nigeria without informed consent. These unethical revelations do nothing to uphold the public image of the scientific/medical/pharmaceutical companies worldwide.

We often dismiss conspiracy theory believers as lacking sufficient cognitive skills to understand basic science. Therefore, as medical professionals, we often try to explain louder and slower because we feel that science is irrefutable. In truth, conspiracy theory believers come from all sorts of backgrounds as demonstrated by the very middle-class cohort of anti-vaxxers in the UK. What we do know is that the number of conspiracies increases during a time of societal upheaval where existing societal norms and power dynamics are thrown into disarray. When there are such huge uncertainties about the future, conspiracy theories become a self-soothing mechanism – a way to explain things that don’t make sense. To add to this theory, those who are religious tend not to believe in conspiracy theories, perhaps because there is another way to explain the things that seem unfair – “God works in mysterious ways.”

Ethnographic studies show that members of marginalised communities are more likely to believe in conspiracy theories. Perhaps these conspiracies act as a way to voice our suspicions and our powerlessness. When the HIV epidemic was creating mass hysteria, there were many conspiracy theories about the CIA or the Apartheid government creating the virus in a laboratory as a genocide strategy to remove gay and Black bodies. These theories were echoed in minority groups in Indonesia during the dictatorship of Suharto. Perhaps it is a safe way to express the discontent without punitive repercussions but they also act in bringing a community together by reminding each other of their collective trauma history and as a reminder to remain vigilant.

For me, in the current pandemic, there is a real focus of these conspiracies on the distrust of technology and of China – is this representing what is now considered as the modern-day power threats? Are people feeling left behind by the modern digitalised and globalised world? Are people feeling threatened by future global powerhouses? Since asking my patients now if they are able to use the internet or have access, I have been surprised at how many don’t. If the world has had to change unrecognisably in the space of three months to a new normal that is not user-friendly for you, how would you explain away that discomfort?

What can we do?

We need to stop the dichotomised dialogue between science and conspiracy theorists because it fails to address why there is even space for these misled beliefs. Dismissing the believers will reinforce the power dynamic between the haves (medical/political/scientific/pharmaceutical fields) and the have-nots (the marginalised). I don’t believe that debunking their beliefs will help for the true hardcore believers but we need to understand the social context in which this is happening. In the same way we search for the hidden agenda in our patients, we need to find it here too, however preposterous it seems and however much it ruffles our feathers, in order to create connection. These stories tell us so much about the fears of our population.