Lilienfeld, S. O., & Basterfield, C. (2020). The jigsaw puzzle of fraudulent health claims: Missing psychological pieces. Social Science & Medicine, 259(5), Article 112818. https://doi.org/10.1016/j.socscimed.2020.112818

Reviewed by Eilis O’Connell-Sussman MA, BCBA, LBA-NY
Association for Science in Autism Treatment

With the simple click of a mouse, modern day consumers are exposed to thousands of claims of cures, wellness, and solutions. As our society advances with the timely distribution of any information right from your computer screen, we are falling deeper and deeper into a world of misinformation and fraudulent health claims for numerous diseases, disorders, and more. Dr. Lilienfeld was a strong advocate for scientific, evidenced-based treatment and The Jigsaw of Fraudulent Health Claims: Missing Psychological Pieces (Lilienfeld & Basterfield, 2020) added to his legacy of work combating pseudoscience in the field of psychology, our society at large, and particularly the autism community.  Here, Lilienfeld and Basterfield (2020) highlighted the article by MacFarlane et al. (2020) that drew from multiple disciplines of psychology (health, physiological, social cognition, and persuasion) to provide readers with a five-fold framework explaining individual vulnerability to believing fraudulent health claims and proposed remedies. Lilienfeld and Basterfield (2020) applauded MacFarlane et al. (2020) for their contribution to dispelling fraudulent health claims while providing three additional considerations to their framework, to further ensure mitigating predispositions to misinformation within healthcare knowledge.

Lilienfeld and Basterfield (2020) described and supported the five major psychological drivers that have a susceptibility to fraudulent health claims described by MacFarlane et al. (2020). These include “visceral influence” (motivational cues that can evoke strong psychological responses that impair an individual’s cognitive abilities); affect (an emotive quality that labels actions or items “good” or “bad”); nescience (the absence of knowledge or awareness); misinformation (false or inaccurate information making it difficult to distinguish between evidence and fraudulent claims); and norms (social standards or rules about how members of a community should behave). MacFarlane et al. (2020) includes a more thorough description of each of the above-mentioned drivers. This framework provides a foundation of how best to present counterevidence to fraudulent health claims that fit certain psychological profiles. Lilienfeld and Basterfield (2020) identify three amendments to the MacFarlane et al. (2020) review to further understand the susceptibility to fraudulent health claims that include individual differences in cognitive styles and personality; innumeracy and statistical illiteracy; and persuasive appeals drawing on logical fallacies and commonplaces, which are described in detail below.

Lilienfeld and Basterfield (2020) discussed how certain individual differences may make people particularly susceptible to fraudulent health claims and how this knowledge can support interventions to be directed towards cognitive styles and personalities that are at greater vulnerability to misinformation. Human thinking can be categorized into two different modes: System 1, or type 1, is fast, intuitive, and guided by “if-then” thinking (e.g., if the treatment worked for one person, then it must be effective) and system 2, or type 2, which is slow, reflective, and guided by analytic processing (i.e., the interaction between the data and the analyzer, Lilienfeld & Basterfield, 2020). The authors hypothesized that a greater reliance in system 1 thinking may affect one’s belief in unsupported claims. It could be further hypothesized that if families are feeling stressed and worried about an autism diagnosis and/or the urgency of accessing help for the child as quickly as possible, they may begin to rely on their system 1 thinking processes. Interventionists can understand the different systems of thinking at play and better disseminate their information to fit a person’s predominant thinking system (e.g., providing evidence-based treatments in succinct formats for system 1 thinking styles).

A second potential barrier identified is innumeracy and statistical illiteracy, or the lack of basic math knowledge and applications of that knowledge to the evaluation of everyday claims in relation to probabilities (Lilienfeld & Basterfield, 2020). Deficiencies in these areas can lead to a weak system 2 thinking, and thus individuals may rely on their intuitive, “if-then” thinking within system 1 (Lilienfeld & Basterfield, 2020). Studies have shown that many health consumers are more likely to select an intervention when the benefits are framed in relative terms versus absolute, which can be used by supporters of pseudoscience to dramatize the hazards of conventional medical interventions (Lilienfeld & Basterfield, 2020; Hux & Naylor, 1995). Many proponents of fraudulent health claims rely on testimonial and anecdotal information, which may be more convincing versus quantitative data to certain audiences. Many pseudoscientific interventions geared towards autism utilize testimonials for support but do not have scientific evidence to back their claims, or poorly designed research studies that are difficult for families to decipher. Understanding people’s difficulties with mathematical skills and propensity for qualitative forms of support can help interventionists better disseminate information, such as using visual aids (e.g., pictographs) for quantitative data.

Lastly, persuasive appeals are explored in the form of logical fallacies (errors in thinking), and commonplaces (commonly accepted, oversimplified beliefs) in Lilienfeld and Basterfield’s (2020) final amendment. Both can appeal to the system 1 thinking by exploiting the “if-then” thinking style. Ten frequently used logical fallacies and commonplaces that appeal to our intuition and wishes are explored. Many of these logical fallacies are evident in pseudoscientific treatments within the autism community and are important to be able to identify for warning signs. The non-exhaustive list is as follows:

  • Anecdotal fallacy: Error of assuming that because product A appeared to help one or more people, it is effective;
  • Bandwagon fallacy (ad populum fallacy): An error of assuming that because product A is popular or widely utilized, it is effective (e.g., the gluten free diet);
  • Fallacy of exaggerated conflict: Error of overstating the extent in which scientists disagree on a given claim, and then presuming the lack of consensus calls the claim into question;
  • Genetic fallacy: An error of accepting or rejecting the validity of a claim solely based on its origin instead of judging it based on merit (e.g., a pediatrician told me that a gluten free diet is effective, so it must be true);
  • Hyman’s fallacy: Before seeking an explanation on how a phenomenon works, we should first make sure it is real. This is an error of asking how a treatment works before verifying that it works to begin with, or “placing the cart before the horse”;
  • Nirvana fallacy: Error in assuming that because a discipline is imperfect, it should be rejected thus presuming the alternative solution is superior;
  • Glittering generalities commonplace: Stating product A in entirely positive terms without acknowledgement of the potential negative effects or side effects (sadly, proponents of many biomedical “treatments” such as cannabis and chelation often bypass informed content by glossing over concerns);
  • Goddess within commonplace: Appealing to a magical spiritual essence humans possess and is neglected by conventional disciplines, such as medical medicine;
  • Science commonplace: Utilizing technical-sounding terms and concepts to conceal an unscientific discipline as a genuine science. Perhaps, one of the most obvious examples would be treatments that boast being “evidence-based” without any evidence of peer reviewed research.

Drs. Lilienfeld and Basterfield (2020) build upon the MacFarlane et al. (2020) framework to combat the growing support of fraudulent health claims with helpful amendments to ensure research can test the effectiveness of future interventions. Combating pseudoscience requires an understanding of complex, multifaceted psychological thinking that with understanding can lead to more individualized and successful interventions. As fraudulent health claims continue to spread within the autism community, it is important for professionals to identify susceptibilities compassionately and individualize their approaches to promoting evidence-based care.

References:

Lilienfeld, S. O., & Basterfield, C. (2020). The jigsaw puzzle of fraudulent health claims: Missing psychological pieces. Social Science & Medicine, 259(5), Article 112818. https://doi.org/10.1016/j.socscimed.2020.112818

MacFarlane, D., Hurlstone, M. J., & Ecker, U. K. H. (2020). Protecting consumers from fraudulent health claims: A taxonomy of psychological drivers, interventions, barriers, and treatments. Social Science & Medicine, 259(5), Article 112790. https://doi.org/10.1016/j.socscimed.2020.112790

Citation for this article:

O’Connell-Sussman, E. (2021). Review of The jigsaw puzzle of fraudulent health claims: Missing psychological pieces.  Science in Autism Treatment, 18(9).

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