Articles

Reflexive doubt

Those of us who study, practice and write about medicine cherish the hope that explaining the science behind medicine (or the lack of science behind “alternative” treatments) will promote a better understanding of medicine. Certainly, I would not bother to write about medical topics if I did not believe that promoting science based medicine would lead to increased understanding of medical recommendations and decreased gullibility in regard to “alternative” remedies. Nonetheless, lack of scientific knowledge is not the only reason for the current popularity of “alternative health. Indeed, many advocates and purveyors of “alternative” health are impervious to the scientific evidence. What else might be going on?

Belief in “alternative” medicine is a complex social phenomenon. Like any complex social phenomenon, the explanation cannot be reduced to a simple answer. But I would argue that there is an important philosophical component, developed by and promoted by advocates of “alternative” health. That philosophical component is the rise of reflexive doubt. Simply put, among a significant segment of society, it has become a badge of honor to question authority.

As an obstetrician, I am most familiar with its expression among childbirth activists. They recognize that many people hold the common sense belief that modern obstetrical practice has made birth safer, and have worked ceaseless at undermining this common sense view. Craig Thompson, a professor of marketing, has examines this tactic in his paper What Happens to Health Risk Perceptions When Consumers Really Do Question Authority?:

…[U]sing the natural childbirth community as a context … helps us understand how groups of people come to deeply believe in anti-establishment risk norms… Natural childbirth activists believe that low-tech midwifery … provides the best labor outcomes, except for in a small percentage of high risk cases. They also believe that the medical practices of childbirth pose a host of unnecessary and avoidable risks…

…Childbirth reformers interpret … innovations … as unnecessary intrusions whose primary function was enabling physicians to display technical skill…

… During the past 50 yr., many obstetric interventions that were once deemed to enhance the safety of birth or to improve postpartum outcomes—shaving of the women’s pubic region; mandatory intravenous drips … enemas …have all been discarded as ineffective, unnecessary, and in some cases, potentially harmful. The natural childbirth community invokes this historical legacy to argue that many contemporary obstetric interventions are likely to meet a similar fate.

In other words, the apparent success of modern obstetrics is illusory. Innovations were unneeded and developed simply to enrich physicians. Moreover, obstetrics has been mistaken in the past so no one should trust it in the present. Therefore, questioning the claims of physicians, and reflexively doubting explanations is not merely necessary, but is the mark of and “educated” and “empowered” consumer of health care.

Such tactics may have originated with the “natural” childbirth movement, but they have arguably reached their apogee with the vaccine rejectionists. That’s why millions of parents consider take former Playboy Playmate Jenny McCarthy a reliable source on vaccination. No one argues that she has any formal training in immunology or even that she understands the science behind vaccination. That’s not necessary. She is admired by a community that has come to believe that reflexive doubt is a sign of sophistication and education.

As Hobson-West explains in Trusting blindly can be the biggest risk of all': organised resistance to childhood vaccination in the UK, vaccine rejectionists generally ignore the actual scientific data, focusing instead on whether parents agree with health professionals or refuse to trust them. Agreement with doctors is viewed as a negative and refusal to trust is viewed as a positive cultural attribute:

Clear dichotomies are constructed between blind faith and active resistance and uncritical following and critical thinking. Non-vaccinators or those who question aspects of vaccination policy are not described in terms of class, gender, location or politics, but are ‘free thinkers’ who have escaped from the disempowerment that is seen to characterise vaccination…

This characterization of vaccine rejectionists can be unpacked even further; not surprisingly, vaccine rejectionists are portrayed as laudatory and other parents are denigrated.

… instead of good and bad parent categories being a function of compliance or non-compliance with vaccination advice … the good parent becomes one who spends the time to become informed and educated about vaccination…

… [vaccine rejectionists] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment…

The ultimate goal is to become “empowered”:

Finally, the moral imperative to become informed is part of a broader shift, evident in the new public health, for which some kind of empowerment, personal responsibility and participation are expressed in highly positive terms.

So vaccine rejectionism, like most forms of “alternative” health is about the believers and how they would like to see themselves, not about vaccines and not about children. In the socially constructed world of vaccine rejectionists, risks can never be quantified and are always “unknown”. Parents are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are “educated” and “empowered” by taking “personal responsibility”.

As Prof. Thompson notes in regard to believers in “natural” childbirth:

Importantly, their beliefs are far more than an abstract system of thoughts. The natural childbirth model shapes childbirth choices by being accepted as a structure of feeling…

…The risks singled out by the natural birth model express cultural anxieties over the unintended and dehumanizing consequences of technology; the loss of individual independence through the workings of complex ‘expert’ systems; and a political project of supporting midwifery over the socially-accepted knowledge of the medical establishment.

Similarly, the purported “risks” of vaccination express cultural anxieties over unintended or dehumanizing consequences of technology, expert systems, and supporting self “education” over the accepted knowledge of the medical community.

In counseling patients about the claims and remedies of “alternative” health, we may need to do more than simply explain the  underlying science (or lack thereof). We may need to  address the philosophical beliefs about the value of reflexive doubt. Reflexive doubt is not laudatory in and of itself and it certainly is not a sign of being “educated.” It is just a mindless rejection of authority, with potentially devastating consequences.

Posted in: Science and Medicine

Leave a Comment (485) ↓