Conspiracy theories

Note from Trixie: This post was guest-written by my soul's other half, the secret twin mind my body has engorged. I (she) and she (I) are two halves of a whole. But I am beginning to feel the two halves come together.

She is a family doctor with a medical practice in North Philadelphia. She takes care of patients, teaches medical students, and is trying to rocket launch an independent research program funded by the National Institutes of Health. She is immensely hopeful that the new administration will raise funding levels dramatically.

And this post was written with the hopes that cyberspace might have interesting feedback on her research ideas.
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My research ideas are sometimes unorthodox. The NIH would prefer I use the word novel.

I am interested in investigating the origin of conspiracy theories. Particularly those that impact on health disparities, access to healthcare, and health outcomes in patients infected with the Human Immunodeficiency Virus.

My research began during my fellowship. There I worked closely with a mentor who guided me to do fine scientific work in the methods the field uses to measure adherence to HIV medication. In the field, adherence can be defined as how faithful someone is about taking their medicines on a daily basis. More broadly, we also examine other health outcomes, for example, how regularly a patient returns to the pharmacy to pick up his prescriptions, how often the patient comes to see the doctor, and other healthy parameters like these.

These parameters (or health outcomes) are poorly impacted by the presence of certain specific conspiracy beliefs. Prior research by a group in California has shown that subjects who believe that AIDS was created by the government are less adherent to their prescribed HIV medicines.

To the lay person who is not infected with HIV, this may seem downright ludicrous.

I can hear what you are thinking. If you have an infection that can be treated with a medication, why would you avoid taking the medicine?

A person who doesn't take medicine to treat HIV and AIDS will DIE! Right?!

But a great deal of evidence has shown that those types of messages and scare tactics don't improve adherence. And in most cases, scolding a patient about poor prior adherence makes things worse.

On the other hand, increases in trust in the doctor and the health system seem to improve adherence. And the presence of conspiracy beliefs about medicine, the government, and healthcare poorly impact on health outcomes.

It has puzzled researchers and doctors for years why there are large racially-based health disparities in the United States and in other parts of the world. Lots of people believe that this must be largely related to poverty.

But this is not entirely the case.

Specifically, my data (and lots of other data) has shown that levels of adherence are not related to income at all. People with higher incomes and more money still have impediments to taking their medicine on a regular basis.

In other words, even if we control for income and other factors that are used to measure poverty, there are still large unexplained disparities in health outcomes so that black people are sicker with poorer outcomes than people who are white.

Little research has been done to understand the conspiracy beliefs and their impact on health outcomes so far. And most of what has been done has outlined the scientific basis of what I've written above.

I am interested in a much earlier part of the series of events that lead up to these poor health outcomes.

I would like to examine the historical context from where these conspiracy beliefs come. More specifically, I would like to conduct interviews with subjects who endorse this type of beliefs to understand their knowledge about and reaction to events in this country's history: the Tuskeegee syphilis experiment, assassinations of African American civic leaders and leaders with history of support for African Americans, lynchings, and even slavery.

If our government, federal or local, can allow or purport these types of events, how can we not believe they would be capable of making a virus to systematically...

I will stop there mid-sentence to strongly emphasize that I do not believe the government has manmade the HIV virus or intentionally infected anyone with HIV or purposely withheld medication based on racial prejudice.

I am simply trying to outline an argument that a person could make in endorsing the possibility of this type of event.

Amends need to be made on a grand scale. I'm talking about apologies that need to come from our federal government that funded historic research projects, like the Tuskegee syphilis experiment.

National conversation about all of these tragic events in our country's history must be stimulated. We all need to talk about these things in a very public way that opens the door to greater understanding of each other.

As I said before, my ideas are sometimes unorthodox. I have hope that now is the time we can begin what will be a long process of healing.

*References and data are available upon request.