Why is Health Fraud a Problem?
Health Fraud—the marketing or selling of remedies that have
not been proven safe or effective. Mounting evidence suggests that the harms arising from fraudulent health remedies is largely underappreciated.
Harms include interactions with conventional medications, and opportunity costs from delaying or not seeking evidence-based treatment, which is a particular concern in cancer patients. Harm also arises through risk compensation—when health remedy messaging (e.g., “promotes natural immunity”) undermines individual perceptions of the risk associated with a relevant risky behaviour (e.g., vaccine hesitancy).
Recent studies have also uncovered widespread ingredient substitution (e.g., with undeclared plant or animal taxa), toxic contamination (e.g., with heavy metals such as lead, cadmium, & arsenic), and high rates of adulteration with conventional pharmacological agents (e.g., warfarin & paracetamol).
Moreover, the demand for miracle health remedies is also a major driver of the illicit trade in endangered animals, through traditional remedies that use animal body parts such as rhino horn, bear bile, and pangolin scales.
What is VANMaN?
A five-fold framework for countering Fraudulent Health Claims
The VANMaN framework is a structured taxonomy of psychological drivers that make consumers susceptible to fraudulent health claims—claims about the health benefits of remedies that are ineffective, untested, or harmful.
This framework outlines several psychological barriers that impair the effectiveness of intuitive interventions, such as providing factual information. It also outlines several psychologically-informed strategies for protecting consumers.
This taxonomy presents a congruent and parsimonious framework for applying psychological theory in the design of interventions to protect consumers. The numerous predictions contained within the taxonomy thus form an extensive research agenda.
* The full details of the VANMaN taxonomy can be found here. Alternatively, if you are a professional working to address fraudulent health claims, but do not have access to academic publications,
you may contact me here to request a copy.
Visceral influences are motivational cues that can elicit strong psychological responses and thus impair cognitive abilities. Examples of visceral influences are pain avoidance, sensation seeking, financial stress, cravings associated with addiction, and biological needs such as hunger, thirst, and sexual desire.
The cumulative impacts of visceral influences—increased focus, reduced perception of risk, reduced fluid intelligence, and increased impulsiveness—conspire to impair a consumer’s cognitive ability to detect a fraud, and to consider the information necessary to objectively determine the safety and authenticity of a health remedy.
The dominant approach to protecting consumers is to pre- emptively raise awareness about the existence, and format, of recent health frauds, in the hope that people can actively detect and avoid misleading visceral influences. However, even where people are able to avoid visceral cues the effectiveness of awareness raising interventions is hampered by two key psychological barriers, namely the illusion of attention and emotional motivators.
Affect is the emotive quality of “goodness” or “badness” that becomes associated with an action or item.
Affective associations may be evolutionarily adaptive (e.g., bad smells can indicate infection) and are often culturally derived (e.g., taboos about physical contact with a certain object.
Several attributes of affective decision making can be manipulated to make consumers susceptible to fraudulent health claims. One attribute is that affective evaluations of risks and benefits tend to be negatively correlated—even when the nature of the benefits is both distinctively and qualitatively different from the nature of the risks. For example, if antibiotics are portrayed as low in risk, this contributes to the perception that they are also high in benefit.
The obvious intervention to overcome irrational affective associations is to counteract them with affective comparisons that accurately depict the known risks and benefits of the fraudulent health remedy compared to conventional medicine. However, considerable care should be taken to ensure messages are sufficiently targeted and do not backfire.
Nescience is the absence of knowledge or awareness.
Nescience makes consumers susceptible to health fraud because people intuitively generate, or uncritically accept, spurious causal associations between actions and outcomes (e.g., remedy X cured illness Y) without considering that such associations might be coincidental, meaning that evidence to determine causality is lacking (i.e., evidence that excludes other causal explanations for an outcome).
The seemingly obvious intervention to overcome nescience is to provide information on what works and what does not. This so-called information deficit model intuitively leads practitioners to launch awareness-raising campaigns. However, numerous studies have shown that awareness campaigns are generally ineffective at altering behaviour.
However, most awareness campaigns are generally ineffective because they seldom target the specific psychological barriers (other than knowledge) preventing the uptake of the desired behaviour. Three psychological barriers that specifically relate to nescience include the illusion of causality, the illusion of confidence, and the illusion of knowledge.
Misinformation makes it difficult to distinguish between evidence-based medicines and fraudulent remedies and thus can have dire consequences for public health.
Aspects of the contemporary media landscape have facilitated the dissemination of misinformation. Social media is especially amenable to spreading misinformation because people are more likely to share stories that elicit emotional arousal.
Social media is also increasingly being used to spread disinformation—misinformation disseminated with the intent to deceive, often for political or financial motives.
Effectively informing consumers requires that practitioners adopt psychologically informed approaches to debunking misinformation. To this end, two notable psychological barriers that operate to impair efforts to refute misinformation, are the continued influence effect and motivated reasoning.
Social norms are rules or standards about how members of a community should behave. For rules to be considered social norms (hereafter referred to as norms), they must be supported and “enforced” by a sufficient portion of a community.
Human impulses towards conformity and social inclusion are so fundamental that community norms can become an intrinsic part of our individual sense of identity.
One approach to changing a harmful behaviour is a norm appeal—a message that aims to change an undesirable behaviour by highlighting a behavioural norm.
To design effective norm appeals, practitioners need to distinguish between injunctive norms (what others approve or disapprove of doing), descriptive norms (what people typically do), and perceived norms (what individuals believe about the real descriptive and injunctive norms).
However, two major barriers that prevent norm appeals from influencing behaviour are misperceived norms and logical fallacies.