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JCHLA / JABSC 38: 51-52 (2017) doi: 10.5596/c17-011
Gorman SE, Gorman JM. Denying to the grave: why
we ignore the facts that will save us. New York:
Oxford University Press; 2017. Hardcover: 312 p.
ISBN 978-0-19-939-660-3. Price: USD $29.95.
Available from:
As librarians, we tend to view medical decision-
making through the framework of health literacy,
which the Canadian Public Health Association’s
Expert Panel on Health Literacy defines as “the ability
to access, understand, evaluate and communicate
information as a way to promote, maintain and
improve health in a variety of settings across the life-
course” [1]. For some time, I have felt that health
literacy does not fully explain many individual
healthcare decisions. Why are some of my highly
educated friends so keen on cleanses and fad diets?
How can a family member with an advanced science
degree express skepticism about vaccines? Why, in my
home province of Alberta, did a toddler die of
meningitis after his parents refused to seek appropriate
medical care [2]?
Research also suggests that factors other than
health literacy may be at play; a recent Israeli study
found that parents with higher levels of
communicative and critical health literacy were
actually less likely to vaccinate their children [3].
With the above examples in mind, I picked up Sara
and Jack Gorman’s Denying to the Grave: Why We
Ignore the Facts that Will Save Us, which delves into
some of the cognitive science behind false health
beliefs. The authors are well positioned for the task:
Sara is a public health expert and writer whose work
focuses on health communication, global public
health, mental health, and psychology; her father and
co-author, Jack, is a former academic psychiatrist.
The authors begin with the premise that people who
hold anti-scientific health beliefs are not stupid or
uneducated. They also emphasize that the problem is
not simply a lack of information or of the basic skills
to critically appraise it. Instead, they argue that these
beliefs are shaped by cognitive and psychological
tendencies that are generally adaptive from the
perspective of evolutionary psychology (the tendency
to find community among like-minded people and to
follow charismatic leaders, for example), but in the
case of certain health belief systems, are being applied
in a maladaptive way. They also look at some
common sources of cognitive error and bias.
Individual chapters are devoted to the psychology
behind conspiracy theories and charismatic leaders, as
well as common sources of cognitive error related to
confirmation bias; difficulties with understanding
causality, probability and risk; and our tendency to
avoid complexity. Examples drawn from various
health beliefs help to illustrate these concepts in
action. The authors conclude with several suggestions
for addressing these problems.
I found the book provided an accessible and
compelling overview of the complex reasons why
people embrace false health beliefs. Beyond
healthcare, I found that the chapters on conspiracy
theories and charismatic leaders were highly relevant
to recent political developments around the world,
such as Brexit and the U.S. election.
For anyone who has studied cognitive biases, some
of the later chapters might be a bit redundant, but I
appreciated how the authors emphasized the adaptive
nature of these biases in our evolutionary history;
discussed why these biases work well for simple
decisions, but fail us in the face of complexity; and
made the case that simply accusing people of wrong
thinking will not eliminate these biases. For medical
librarians, this book offers a useful complementary
framework to health literacy for understanding how
people assess health information and make decisions.
The authors employ several examples of false
health beliefs, some of which work better than others.
The anti-vaccine examples provided new insight into a
familiar issue, while the authors’ introduction to the
AIDS denialism movement provided a parallel
example on a topic where I was not previously
knowledgeable. However, other examples, such as
their contention that there is a movement opposed to
the use of electroconvulsive therapy to treat
depression, were not really fleshed out; they seemed to
assume a level of knowledge that readers might not
possess. Their use of the anti-GMO and anti-nuclear
JCHLA / JABSC 38: 51-52 (2017) doi: 10.5596/c17-011
movements as examples of anti-science beliefs seemed
to me one-sided; while much of the opposition to
GMOs and nuclear power may be driven by emotion
rather than science, there are legitimate scientific
concerns about the safety of nuclear power plants and
the ethics of genetically modified organisms, which
the authors did not really acknowledge.
The authors’ concluding recommendations are a bit
of a mixed bag. I agreed with their call for scientists to
engage more with the public, and to communicate
scientific findings and debunk false claims in a way
that resonates better with the public. Their suggestion
that the media provide better training in scientific
reporting to their staff seems quaint in the era of self-
curated “fake news,” and while it’s a worthy goal, it
may be out of reach for many establishment news
outlets that are facing deep cuts and laying off senior
staff. However, journalism schools could certainly do
better at educating their students in scientific
The authors also suggest a complete overhaul of
how science is taught, beginning in elementary school,
so that the focus is not on dry facts and formulas, but
rather on engagement with science and a deep
understanding of the scientific process. This appears to
be already happening to some extent, with the rise of
science, technology, engineering and mathematics
(STEM) education initiatives across North America,
but there are challenges to implementation in a
fragmented system where so much of the curriculum is
controlled by provincial and state governments.
Given Sara Gorman’s expertise in public health, the
book is surprisingly lacking in suggestions for patient
education or other public health interventions. Perhaps
this reflects a larger weakness in the evidence base in
this area.
Given the strong overview of the problems around
false health beliefs, the weakness or vagueness of the
proposed solutions leads to a bit of a deflating
conclusion to an otherwise compelling book.
However, when society at large is grappling with anti-
science ideologies, fake news, and declining trust in
traditional sources of authority, it is perhaps expecting
too much to ask that this book provide strong
recommendations on a way forward. Despite this
drawback, this is an excellent guide to the landscape of
irrational health beliefs and decisions.
1. Rootman I, Gordon-El-Bihbety D. A vision for a
health literate Canada: report of the Expert Panel
on Health Literacy [Internet]. Ottawa: Canadian
Public Health Association; 2008 [cited 2017 Mar
27]. Available from:
2. Graveland B. Father gets jail in son's meningitis
death; mom gets house arrest. Globe and Mail
[Internet]. 2016 Jun 24 [cited 2017 Mar 27].
Available from:
3. Amit Aharon A, Nehama H, Rishpon S, Baron-
Epel O. Parents with high levels of communicative
and critical health literacy are less likely to
vaccinate their children. Patient Educ Couns. 2017
Apr;100(4):768-75. Epub 2016 Dec 5. PubMed
PMID: 27914735. doi: 10.1016/j.pec.2016.11.016.
Statement of Competing Interests
No competing interests declared.
Heather Ganshorn
Associate Librarian
University of Calgary
Calgary AB
ResearchGate has not been able to resolve any citations for this publication.
Objective: To investigate the relationship between parents' health literacy and decision-making regarding child vaccinations. Methods: A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Functional, communicative, and critical health literacy (HL), knowledge, beliefs, reliability of the vaccine's information resources, and vaccine's attitudes were measured. Attitudes included three types: pro-vaccine attitudes, anti-vaccine attitudes, and attitudes regarding mandatory vaccination. Path analysis was conducted to explore direct and indirect associations of compliance with childhood vaccinations and HL. Results: Communicative HL has a significant negative direct association with compliance with vaccinations (ß=-0.06, p<0.05). High functional and critical HL have significant negative indirect associations with vaccinations through parents' attitudes regarding vaccines. Higher levels of perception of reliability of informal information resources are associated with non-compliance. Conclusions: The results indicate that parents with high functional, communicative, and critical HL are more at risk of not vaccinating their children. The results are contrary to expectations in which people with high HL adopt more positive health behaviors. Practical implications: Public health professionals may need more sophisticated communication methods to transfer messages regarding vaccines to parents in order to prevent decline in vaccine coverage rates, taking into account levels of trust and health literacy.
A vision for a health literate Canada: report of the Expert Panel on Health Literacy
  • I Rootman
  • D Gordon-El-Bihbety
Rootman I, Gordon-El-Bihbety D. A vision for a health literate Canada: report of the Expert Panel on Health Literacy [Internet]. Ottawa: Canadian Public Health Association; 2008 [cited 2017 Mar 27]. Available from:
Father gets jail in son's meningitis death; mom gets house arrest. Globe and Mail
  • B Graveland
Graveland B. Father gets jail in son's meningitis death; mom gets house arrest. Globe and Mail [Internet]. 2016 Jun 24 [cited 2017 Mar 27]. Available from: her-gets-jail-in-sons-meningitis-death-mom-getshouse-arrest/article30614885/.