Accepted for publication at Social Psychology (April 2018)
[For citation, please refer to authoritative final version in print]
Powerful Pharma and its Marginalized Alternatives?
Effect of Individual Differences in Conspiracy Mentality on Attitudes towards Medical
Pia Lamberty & Roland Imhoff
Social and Legal Psychology, Johannes Gutenberg University Mainz
Johannes Gutenberg University Mainz
Social and Legal Psychology
Binger Str. 14 – 16
55122 Mainz, Germany
Phone: +49 06131 39-39291
Total word count: 7795
Number of tables: 5
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 1
Number of figures: 3
Only little is known about the underpinning psychological processes that determine medical
choices. Across four studies, we establish that conspiracy mentality predicts a preference for
alternative over biomedical therapies. Study 1a (N= 392) and 1b (N = 204) provide correlational
support, Study 2 (N = 185) experimentally tested the role of power: People who endorsed a
conspiracy mentality perceived a drug more positively if its approval was supported by a
powerless (vs. powerful) agent. Study 3 (N = 239) again showed a moderating effect of power
and conspiracy mentality on drug evaluation by comparing analytic versus holistic approaches.
These findings point to the consequences of conspiracy mentality for health behavior and
Keywords: conspiracy mentality; generalized political attitudes; health behavior; health related
cognitions; illness beliefs
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 2
Humans must deal with the fact that they are vulnerable and in principle may fall prey to
diseases or infections. In contemporary Western societies, the dominant method to deal with
illness and disease can be subsumed under a biomedical model which addresses a
symptomatology at a molecular level. Alongside this dominant approach in Western societies,
there exists a plethora of complementary and alternative medical (CAM) approaches. Many of
these presumably are based on a more holistic understanding of human nature beyond the
biomedical micro-level (e.g., Hyland, Lewith, & Westoby, 2003). A personal holistic view of
health (i.e., a health philosophy that aims for an integration of mind, body and spirit) is one
important predictor of positive attitudes towards complementary and alternative medicine – and
even a better predictor than for example dissatisfaction with the medical outcome (Siahpush,
1998). In the present paper, we address the question of individual psychological differences that
make people prone to favor one over the other. We focus on a generalized political attitude,
conspiracy mentality, and how it affects the evaluation of medical approaches based on the
apparent power asymmetry between the dominant biomedical approach and its less powerful
Even though complementary and alternative medicine is very popular, the empirical
evidence for healing success is often missing. Almost 26% of the Europeans had used
complementary or alternative medicine at least once during the last 12 months (Kemppainen, et
al., 2017) with homeopathic or naturopathic remedies being the most popular forms (Horneber et
al., 2012). This popularity is particularly noteworthy as homeopathy has no measurable effects
beyond placebo (Ernst, 2010). Choosing homeopathy instead of evidence-based medicine may
thus put people’s health at risk if they reject or delay treatments proven to be safe and effective
(see Table 1). In addition to the risks of not taking the relevant effective medicine, some
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 3
alternative products may even be harmful in and of themselves, even if the label “natural” seems
to imply that a drug is harmless. In cancer-chemotherapy, herbs can cause serious harm or
interact with evidence-based medicines (Ernst, 1998). Given these risks in the absence of
evidence of any actual benefit begs the question why exactly people turn their interest and
investment to such approaches.
Most of the publications we reviewed, showed that women, higher educated and people
with anxieties or chronic diseases are more likely to use alternative healing methods and reject
established approaches such as vaccination or antibiotics (see Table 2). Another frequently
discussed aspect are economic reasons, as US-Americans who were unable to afford
conventional medicine chose CAM instead (e.g., Barnes et al, 2008). Although the rise of the
alternative health market may be perceived as an effect of a general dissatisfaction with
conventional medicine, evidence for this connection was only weak (see Table 2). Above
demographical factors, researchers have discussed several psychological influences that explain
why people turn to alternative healing methods (e.g., Astin, 1998; Galliford & Furnham, 2017;
Oliver & Wood, 2014; Siahpush, 1998; Vincent & Furnham, 1996). Based on the empirical
evidence, it can be concluded that ideological-philosophical motivations seem to be more
important for medical decision making than pragmatic considerations (for exceptions see Table
2). Holding anti-science sentiments was, for example, linked to a stronger use of alternative
medicine (see Table 2). Another ideology that might be important for health attitudes is
conspiracy mentality. Conspiracy mentality describes a mindset or generalized political attitude
that can be encapsulated in the idea that “whatever happens in society […] is the result of the
direct design by some powerful individuals and groups” (Popper, 1966; p. 265). Although
various conspiracy theories seem bewilderingly different and diverse at first sight, research has
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 4
established that agreement with such theories is a highly consistent tendency on which people
differ, a monological belief system (Goertzel, 1994). Endorsing one conspiracy theory is highly
predictive of endorsing another (e.g., Bruder et al., 2013), even if these two are mutually
exclusive (Wood, Douglas, & Sutton, 2012). Previous research has established that the belief in
conspiracy theories is linked to perceiving any position of high power as a cue to suspicion (e.g.,
Imhoff & Bruder, 2014). For example, the belief in conspiracy theories was associated with
prejudicial attitudes towards people perceived as influential, such as managers or the pharma
lobby, as well as social groups, such as Americans or Jews (e.g., Bilewicz, Winiewski, Kofta, &
Wójcik, 2013; Imhoff & Bruder, 2014; Kofta & Sedek, 2005). Translating this mindset to the
realm of medical cure allows the prediction that the extent to which people endorse a
conspirational worldview is associated with a preference for alternative over biomedical
approaches. Evidence for this assumption on a more specific level is already apparent: People
who believed in medical conspiracy theories (e.g., “The CIA deliberately infected large numbers
of African Americans with HIV”) were more likely to take herbal supplements or vitamins
(Oliver & Wood, 2014). In addition, people who were confronted with anti-vaccination
conspiracy theories, were less willing to vaccinate themselves or their children (Jolley &
Douglas, 2014), an effect mediated by feelings of powerlessness. Going beyond the narrow focus
on specific medical conspiracy theories, the current paper aims at establishing a link between a
general conspiracy mentality (independent of specific content) and health attitudes.
We propose that the well-established institutionalization of the biomedical approach in
virtually all parts of the health care system creates a perception of it as the more or less
undisputable and therefore powerful approach. Although this is an empirical question, this notion
is directly in line with the World Health Organization’s definition of alternative healing methods.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 5
By that definition, alternative medicine is precisely characterized by its lower influence on
society, its social status as not being part of the traditional treatment canon of a culture and its
lack of integration into the health system (WHO, 2018). This assessment is also reflected on a
more anecdotal level: within the so called “big pharma conspiracy theory”, it is often claimed
that alternative treatment methods are suppressed by different powerful agents (e.g., the Food
and Drug Administration, drug companies; see Shermer, 2006). The claim that alternative
approaches are less influential than biomedical approaches can also be found in social science
literature (e.g., Broom & Tovey, 2007; Gale, 2014). In this article we will additionally
empirically establish that people perceive alternative approaches as less powerful and from there
delineate the hypothesis the people high in conspiracy mentality will be particularly prone to
support such alternative treatments.
The present research
In two large correlational studies, we systematically established that conspiracy mentality
was related to greater refusal of biomedical therapies and greater openness to alternative and
complementary approaches (Study 1a and 1b). An additional experimental Study 2 showed that
alternative approaches were perceived as more powerless and directly tested the role of
perceived power behind a certain therapeutic approach. We reasoned that conspiracy mentality
should moderate the positive evaluation of this new drug in that people high in conspiracy
mentality showed more positive reactions when its approval was favored by a low vs a high
power group. A final pre-registered within-subjects experiment (Study 3) sought to further
strengthen this logic and explored the evaluation of different drugs depending on interindividual
differences in conspiracy mentality. We report how we determined our sample size, all data
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 6
exclusions (if any), all manipulations, and all measures in the study. An overview of all studies
included in this paper as well as all materials and raw data are available at OSF.
Study 1a and Study 1b were conducted to test the relationship between conspiracy mentality
and attitudes towards different therapeutic approaches in two cultural settings: Study 1a was
conducted in Germany, Study 1b in the USA. First, we inquired participants’ evaluation of many
diverse therapies for illness and second, we focused on three candidates that were the most
prototypical for the respective approaches. For all measures, we predicted that conspiracy
mentality would be a positive predictor of attitudes towards CAM and a negative predictor of
attitudes towards biomedical therapies. Study 1b was conducted to bolster the generalizability of
our findings in a different cultural context: the United States. Whereas in Germany almost all
citizens are provided with comprehensive health insurance coverage, many patients in the United
States have only limited access to biomedical treatment due to its costs and the lack of health
insurance. Complementary and alternative medicine is thus often attractive for US patients as a
low-cost alternative (e.g., Barnes, Powell-Griner, McFann, & Nahin, 2004; Ridic, Gleason, &
Ridic, 2012). For example, having a public health insurance as well as the inability to afford
conventional medical care were linked to a reduced use of alternative treatments among
American citizens (Barnes, et al., 2004). Replicating our findings in a social setting enriched
with rational reasons to switch to alternatives of biomedical medicine (e.g., of an economic
nature) constitutes a particularly conservative test of the hypotheses and would speak to the
robustness of the association between conspiracy mentality and medical choices.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 7
Methods and results for Study 1a
Participants. Following recent recommendations regarding the minimum sample size to
receive stable correlations (n = 250; Schönbrodt & Perugini, 2013), four hundred and one
participants from Germany completed an online survey. They did so voluntarily and without
monetary incentives. The link was posted on social networking sites (e.g., Facebook, Twitter,
Google+). Nine participants were excluded from the analysis because they indicated that their
data should not be used. Three hundred ninety-two participants (154 men, 237 women, 1 other;
Mage = 35.53 years, SDage = 11.08 years) remained in the sample. Most of the participants had a
relatively high level of education (216 had a university degree and 96 had the highest German
high-school degree ‘Abitur’).
General Health Behavior. We asked participants to specify their general health
behavior. Specifically, we designed items that indicated where they typically search for illness-
related information (e.g., Family doctor, Internet), what kind of health service provider they have
previously visited and whether they have previously actively demanded alternative instead of
conventional treatment methods (Questionnaire available on OSF).
Conspiracy Mentality. Conspiracy Mentality was measured with a twelve items scale
(Imhoff and Bruder, 2013; e.g., “Most people do not see how much our lives are determined by
In Study 1a as well in Study 1b, all scales were presented in a fixed order. We explicitly decided against
counterbalancing the order of scales as we were interested in individual differences that should not be confounded
with specific order conditions, as recommended for differential research. This invites speculations whether
participants interpreted the conspiracy mentality items in close connection to the medical sphere and people who
strongly oppose the power of pharma companies had these in mind when endorsing the notion of powerful others
plotting in secret. To rule this out, we conducted an additional Study A with conspiracy mentality and ratings of the
37 different therapeutic approaches, randomly varying which of the measures appeared before the other (N = 400).
Results revealed that the correlations between conspiracy mentality and the perceived usefulness and use of the
medical approaches were unaffected by this order manipulation (Data and Results are available on OSF).
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 8
plots hatched in secret”). Responses were given on a 7-point Likert scale ranging from 1
(strongly disagree) to 7 (strongly agree).
Attitudes towards different medical approaches. We included three scales to measure
participants’ attitudes towards different medical approaches separately for homeopathy (e.g.,
“There is lots of evidence that shows the effectiveness of homeopathy to treat illnesses”), herbal
medicine (e.g. “The division between nature and chemistry, which is often stressed in herbal
medicine, is arbitrary and not very helpful”) and vaccination (e.g., “There are no studies showing
that vaccines are harmless”). Participants rated the extent that they agreed on a 7-point scale (1 =
strongly disagree, 7 = strongly agree).
CAM Health Beliefs. To additionally use an established scale, we measured general
attitudes and beliefs towards CAM with the CAM Health Beliefs Questionnaire (CBHQ; Lie &
Boker, 2004; “The physical and mental health are maintained by an underlying energy or vital
force”) on a 7-point scale ranging from 1 (do not agree at all) to 7 (fully agree).
Support for and usage of different medical approaches. We predicted conspiracy
mentality and the scales introduced above to correlate meaningfully. Such correlations, however,
may also be driven by semantic overlap between the respective scales more so than by
conceptual overlap. To have a maximally conservative test of our hypotheses regarding the
association between conspiracy mentality and attitude towards powerful vs. powerless medical
approaches, we constructed a list of 37 different medical approaches (see Table 4), presented
these approaches in random order and asked participants to rate how useful they though this
approach was on a scale from 1 (not at all useful) to 7 (very useful) and how often they use such
an approach on a scale from 1 (never use it) to 7 (use it frequently).
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 9
After giving informed consent, participants specified their general health behavior,
completed the scales measuring their support for and usage of different medical approaches,
attitudes towards vaccination, homeopathy, herbal medicine, and the CBHQ before filling in the
conspiracy mentality scale and giving demographic information about age, gender, education,
occupation, political orientation, religious affiliation, parenthood, and a subjective estimate of
their own data quality (“Yes, I have completed the study earnestly and you can use my data” vs.
“I have not participated only out of curiosity”).
The zero-order correlations (Table 3) confirmed that conspiracy mentality was negatively
related to attitudes towards vaccination and – on the flipside – positively associated with the
appreciation of homeopathy, herbal medicine and complementary and alternative medicine in
general. The effects were very large with conspiracy mentality explaining between 46 and 55
percent of the variance in attitudes towards these medical approaches. Speaking to the
convergent validity of these scales, the intercorrelations showed the expected pattern of positive
correlations among positive evaluation of all alternative approaches and negative correlation of
all these with pro-vaccination attitudes.
As a precautionary measure against inflation of the correlation due to semantic overlap of
the scales, we also analyzed the relatively semantic-free single items of support for 37
therapeutic approaches. Given the sample size, correlations above |r| ≥ .161 met the Bonferroni-
corrected threshold of p = .0014. As Table 4 shows, 36 out of 37 correlations (except for
physiotherapy) were significantly different from zero. As expected, conspiracy mentality was
negatively related to attitudes towards all biomedical therapies, even if these were just named
without any semantic embedding. Equally expected, conspiracy mentality positively predicted
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 10
attitudes towards clear complementary and alternative therapies. Importantly, we had
hypothesized that conspiracy mentality predicted not only attitudes but also behavior in that
conspiracy mentality correlated with the likelihood of usage of alternative and complementary
medicine. Again, 32 out of 37 correlations were significantly different from zero and the
direction of these correlations largely mirrored the results for the attitudes with one exception.
More specialized biomedical treatments showed no correlation, likely due to the lack of variance
of actual usage.
Conspiracy mentality not only predicted attitudes and frequency of usage of different
therapeutic approaches but also health behavior in general. On a descriptive level, we found
differences in conspiracy mentality between all different information seeking strategies. As
expected, participants who used the internet as their first source of health-related information
scored higher on conspiracy mentality than those who used a family doctor as first source of
information, t(287) = 4.69, p < .001, dCohen = -0.553, 95% CI [-0.788; -0.318]. Participants who
indicated a greater variety of having visited complementary and alternative practitioners also
scored higher on conspiracy mentality, r = .445, p < .001, 95% CI [.356; .534]. The 29 percent of
the participants who had at least once actively asked about alternative treatments as a
replacement for conventional methods scored higher on conspiracy mentality (M = 4.52, SD =
1.44) than those who had never asked about those kind of treatments (M = 2.79, SD = 1.31),
t(390) = 4.58, p < .001, dCohen = -1.257, 95% CI [-1.473; -1.040].
Method and results for Study 1b
Participants. Two hundred eleven US-Americans recruited via Amazon MTurk
completed the online survey in exchange for $1. Seven participants were excluded from the
analysis because they indicated that their data should not be used. Most of the remaining
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 11
participants (N = 204; 105 men, 87 women; Mage = 36.66 years, SDage = 11.79 years) had a
relatively high level of education (117 had a university degree).
Measures and Procedure
We used English translations of the scales from Study 1a with one variation. For the 37
different medical approaches, we asked for how useful participants saw the approaches
concerning their efficacy in the treatment of physical illnesses (as in Study 1a) as well as how
much they thought they knew about these methods. The scales were presented in the same way
and order like in Study 1a. The only exception was that we included a measure for intuitive
that was presented after the scales measuring attitudes towards different
Study 1b largely replicated Study 1a (see Table 3 and 4). Conspiracy mentality correlated
positively with support for complementary and alternative medicine and negatively with attitudes
towards biomedical approaches, even though effect sizes were smaller than in Study 1a. For the
efficacy ratings of the 37 therapeutic approaches, also a similar pattern as in Study 1a appeared,
but again to a lesser extent. Subjecting the (r-to-z-transformed) correlations with conspiracy
mentality of all 37 therapeutic approaches in this study to a correlation analysis with the same
indicators from Study 1a revealed a relative robust pattern with a vector correlation of r = .65, p
< .001, 95% CI [.41; .80]. As in Study 1a, conspiracy mentality was associated with higher
efficacy ratings for alternative therapies and lesser efficacy ratings for biomedical therapies. We
had speculated a priori whether people high in conspiracy mentality simply had less knowledge
This measure of intuitive mind-body dualism (Forstmann & Burgmer, 2015) was included for exploratory purposes
and will not receive further attention. Mind-body was unrelated to conspiracy mentality, r = .061, p = .405, and only
correlated with attitudes towards vaccination, r = .221, p = .002.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 12
about biomedical therapies (and therefore also less knowledge about its effectiveness). Contrary
to this speculation, people high in conspiracy mentality did not report less knowledge about
biomedical therapies but claimed to know more about complementary and alternative medicine.
Unlike in Study 1a, the clear majority of participants sought illness-related information
on the internet before recruiting any other information channels (69%). The only simple effect
for which the number of people in the cells allowed a robust comparison, was between people
who sought information in the internet first (conspiracy mentality: M = 4.64, SD = 1.17) and
those who first inquired with a family doctor (M = 4.61, SD = 1.36). However, this difference
was far from significant, t(177) = -0.146, p = .884, dCohen = -0.032, 95% CI [-0.325; 0.261].
Unlike Study 1a, there was no link between number of visited complementary and alternative
practitioner and conspiracy mentality, r = .043, p = .556, 95% CI [-.100; .180], but a significant
correlation between conspiracy mentality and the likelihood to visit a physician with additional
training in alternative medicine, r = .295, p <.001, 95%[.164; .416].
We found strong support for the notion that individuals’ inclination to endorse and use
biomedical vs. complementary and alternative medicine depends on their level of conspiracy
mentality. Participants who endorsed conspiracy beliefs did not only reject virtually all
biomedical therapies but by the same token showed greater support for virtually all its
alternatives. Importantly, this was independent of semantic overlap of scales and not only true
for attitudes but also for actual (self-reported) usage. The results of Study 1a and 1b are thus in
line with our reasoning that conspiracy mentality predisposes individuals to distrust powerful
groups, also has a marked effect on their medical decisions by making them reject the seemingly
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 13
almighty and powerful biomedical model and turning to various seemingly less powerful
In accordance with our theoretical assumptions, we were able to replicate the findings of
Study 1a for another cultural context. The robustness of these correlational pattern – even though
the size of the effect was different – is particularly noteworthy as Study 1b was conducted in a
cultural context in which many other, rational reasons exist to prioritize alternative over
biomedical treatment. Whereas alternative and complementary therapies often come with the
burden of out-of-pocket payments in the German healthcare systems, they may constitute low-
cost alternatives in the US system (see Barnes et al., 2004). Nevertheless, conspiracy mentality
remained a significant but smaller predictor of such preference for alternative medicine over
There were some noteworthy differences. The correlations with health information
seeking behavior and previous health service customer choices were largely independent of
conspiracy mentality in Study 1b. One finding concerned the fact that most of our participants
reported to search for information on the internet first and these participants did not differ in
conspiracy mentality from those who visited a doctor. This might be less due to cultural
differences but potentially an idiosyncrasy of our specific sample. MTurkers might be
particularly affine to the online world and seek information there first, independent of their level
of trust in the biomedical system.
Despite, these differences, the first two studies converged in establishing a correlation
between conspiracy mentality as a generalized political attitude and markedly positive attitudes
towards alternative and complementary medicine, as well as self-reported usage of such
therapies. We had delineated our hypothesis based on the perceived power asymmetry between
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 14
the biomedical model and its alternatives. To test this notion, we measured and manipulated this
directly in Study 2.
To test the causal role of the presumed power of its proponents in the effect of conspiracy
mentality, we manipulated directly in Study 2 whether the identically drug was proposed for
approval by either a pharmaceutical consortium (high power condition) or an interest group of
affected patients (low power condition). We hypothesized that conspiracy mentality would be
related to a more negative evaluation of the drug in the former than in the latter condition. Given
that the link between more positive evaluations of complementary and alternative approaches
and conspiracy mentality resulted from the lower perceived power of the alternative approaches,
the link between conspiracy mentality and the positive evaluation of an herbal drug should be
canceled out if participants were confronted with a more powerful version of CAM. Following
the logic of the Testing-a-Process-hypothesis-by-an-Interaction Strategy (TPIS), the link
between conspiracy mentality and the evaluation of the herbal drug weakened in the high power
condition, because the more positive evaluation of the herbal drug for conspiracy believers was
due to the perceived lower power of alternative healing approaches (for a discussion of the use of
TPIS for testing processes by interaction see Jacoby & Sassenberg, 2011).
Participants. Based on a priori power calculations with G*Power (Faul, Erdfelder,
Buchner, & Lang, 2009) while assuming a small effect size of f 2= .15, at least N = 107
participants should be included in the analysis. One hundred eighty-nine participants from
Germany completed an online survey. They were recruited via social networks, E-Mail and
online bulletin boards. Four participants were excluded because they indicated that their data
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 15
should not be used. One hundred eighty-five participants (50 men, 131 women, 3 other, 1
missing; Mage = 29.50 years, SDage = 8.94 years) remained in the sample. Ninety-seven
participants had a university degree, followed by 69 with a university entrance high school
Independent variable. Participants read a short text about a new herbal medicament that
would receive approval in near future. The fictitious herbal medicament “HTP 530” contained
the active substance hydroxy-L-tryptophan from the rainforest plant Griffonia simplicifol.
Participants were informed that the drug was considered to be a natural alternative for the
treatment of various diseases (anxiety, nervousness, mild depression and gastritis). Furthermore,
they read that numerous studies confirmed the efficacy of HTP 530. Participants were randomly
assigned to information that the development of herbal drug HTP 530 was either supported by a
pharmaceutical consortium (high power condition) or by an interest group of affected patients
(low power condition).
Conspiracy Mentality (α = .92). The measure of conspiracy mentality was identical to
Evaluation of HTP 530 (α = .92). The allegedly newly developed drug HTP 530 was
evaluated on five items on a 7-point semantic differential (e.g. “should get a medical products
license/ should get no medical products license” or “has a huge effect/ has no effect”).
Support for and perceived influence of different medical approaches. We used the
same 37 items as in Study 1a to measure support for different medical approaches and asked
participants to rate how useful they thought these approaches were on a scale ranging from 1 (not
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 16
at all useful) to 7 (very useful) and how powerful they perceived representatives of each of the
medical approaches on scale from 1 (not at all powerful) to 7 (very powerful).
After indicating their informed consent, participants completed the conspiracy mentality
scale and read the vignette about the development of HTP 530, completed the evaluation of HTP
530, the items on support for and perceived influence of different medical approaches, somatic
, and completed demographic questions and a subjective estimate of their
own data quality. At the end of the study, participants were debriefed.
First, we wanted to make sure that people indeed perceived the biomedical approaches as
more powerful and influential compared to the alternative ones based on the power ratings of the
37 single therapeutic approaches. As hypothesized, biomedical approaches (M = 5.64, SD =
0.94) were perceived as more influential in society than alternative approaches (M = 3.76, SD =
0.79), t(180) = 21.835, p < .001, dCohen = -2.165, 95% CI [-2.532; -1.798]. These findings
underline the claim we made before now on an empirical level: Alternative approaches are
perceived as less influential – even when measured with single item measurements without any
We had included the Somatic Symptom Experiences Questionnaire (SSEQ; Herzog et al., 2014) for exploratory
purposes. Past research suggested that somatic symptoms were linked to the use of complementary and alternative
medicine and somatizers were more likely to seek out various health care alternatives (Astin, 1998). It might be the
case that people who report somatic symptoms do not trust the medical systems anymore because the biomedical
approach does not take into account the role of social factors or individual subjectivity which is responsible for their
suffering. Therefore, we expected that also conspiracy mentality would be linked to the experience of somatic
symptoms. As hypothesized, high scores on the SSEQ were correlated with conspiracy mentality, r = .250, p = .001,
95% CI [0.108, 0.391].
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 17
Additionally, we asked participants to estimate the perceived effectiveness of each
approach. Overall, the average intraindividual correlation between power and effectiveness was
positive, r = .38, 95% CI [.249, .497], t(180) = 14.37, p < .001, indicating that – on average –
participants perceived power and influence as positively related to effectiveness. More relevant
to the current issue was whether these (r-to-z-transformed) intraindividual correlations showed
the expected negative correlation with conspiracy mentality, suggesting that people who endorse
conspiracy theories associate power with effectiveness to a lesser extent. Although the
correlation was in the expected direction and statistically significant, the effect was small, r =
-.15, p = .040, 95% CI [-.29, -.01], but generally supporting our reasoning: the correlation
between perceived power and expected effectiveness was tending more towards the negative the
more participants endorsed a conspiracy mentality.
As in Study 1a and 1b, the perceived efficacy of different therapeutic approaches was
associated with conspiracy mentality. As indicated by comparatively high vector correlations, the
pattern of correlations between conspiracy mentality and the effectiveness ratings of the 37
therapeutic approaches was virtually identical to Study 1a, r = .93, p < .001, 95% CI [.87; .96].
Twenty-seven out of 37 correlations were significantly different from zero (see OSF). As
expected, conspiracy mentality was negatively related to attitudes towards biomedical therapies
and positively predicted attitudes towards complementary and alternative approaches.
To test our central hypothesis that the power of support groups moderated the relation
between conspiracy mentality and evaluation of a fictional drug, we conducted a multiple
hierarchic regression model (effect coding of the experimental manipulation: -1 = low power, 1 =
high power condition). In line, with our hypothesis, the evaluation of HTP 530 was not only
predicted by conspiracy mentality, β = .281, p < .001, 95% CI [.139; .419] (Step 1, R2= .079), but
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 18
this association was also moderated by power as indicated by a significant interaction, β = -.161,
p = .024, 95% CI [-.297; -.021] (Step 2, ΔR2= .026). The experimental variable itself had no main
effect, β = -.07, p = .512. The conditional effect of the experimental power manipulation was
non-significant for people low (-1 SD; B = 0.17, SE = 0.14, p = .251, 95% CI [-0.13; 0.16]) or
average on conspiracy mentality (B = -0.07, SE = 0.10, p = .512, 95% CI [-0.21; 0.08]), but
significantly negative for people high (+1 SD) in conspiracy mentality, B = -0.30, SE = 0.15, p
= .040, 95% CI [-0.43; -0.16].
More central to our current argument, the relation between conspiracy mentality an
evaluation of a natural remedy by a low power group supported by a low power group, B = 0.63,
SEb= 0.15, p < .001, 95% CI [0.35; 0.92], was significantly attenuated when the identical drug
was supported by a high power group, B = 0.19, SEb= 0.14, p = .17, 95% CI [-0.08; 0.46] (See
Figure 1). Thus, people with a conspiracy mindset favored the same drug if supported by low
power agents over when it was supported by high power agents.
Study 2 replicated the association of conspiracy and attitudes towards alternative, natural
remedies. Importantly, people high in conspiracy mentality evaluated the application of the
natural preparation HTP 530 even more positively when its approval was supported by a low (vs.
a high) power group. This further supports the notion that it is at least in part the perceived high
power of the biomedical model that motivates people high in conspiracy mentality to seek
alternative treatment. Study 2 further bolstered the generalizability of this claim by establishing
that alternative approaches are indeed perceived as less powerful compared to orthodox ones and
by showing that the intra-individual correlation between perceived power and perceived
effectiveness tended more towards the negative with increases in conspiracy mentality.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 19
One limitation of Study 2 is that we merely presumed that the two conditions differed above
all in perceived power. It is perceivable, however, that participants did not primarily perceive the
pharmaceutical company as more powerful than the patient group but as more self-interested.
The pharma company presumably supported the drug was for financial interests, whereas the
patients were likely motivated by an actual interest in healing efficacy, which might not be
necessarily more altruistic but arguably perceived as more legitimate. Previous research has
established the perception of ulterior motive and perceived morality of the agent as a critical
factor in interpersonal suspicion (Van Prooijen & Jostmann, 2012). We thus conducted an
additional Study 2b to a) provide a manipulation check of perceived power and b) test for the
alternative possibility that the two conditions differed in perceived self-interest or benevolence.
We presented the same experimental manipulation and included perceived power, perceived
influence and the intentions of the respective company (interested in common vs. personal
welfare) as dependent variable. Results from this study (N = 93) indicate that the pharma
company was indeed perceived as more powerful, F(3, 89) = 13.59, p <.001, η2 = .130, and more
influential, F(3, 89) = 5.46, p =.022, η2 = .057, compared to the patient group (Data are available
on OSF). Importantly, there was no significant difference between the two conditions in
perceived benevolence, F(3, 89) = 1.55, p =.217, 𝜂𝑝
2 = .017.
To strengthen our argumentation from Study 2 through replication and to address possible
confounds noted above, we conducted a final pre-registered within-subject experiment.
Specifically, we sought to further rule out confounds of profit-orientation that might have
contributed to the effect in Study 2 by holding this constant across all evaluated drugs (all drugs
were proposed by profit-oriented companies). We presented short descriptions of such
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 20
companies and manipulated orthogonally whether they followed a holistic or analytical
philosophical approach to medical treatment and whether they had a lot or a little power and
influence. This design provided answers to two questions: First, is an objectively equally
influential and powerful company perceived as less powerful if it follows a holistic approach?
This would further corroborate our premise that CAM approaches are perceived as less powerful.
Second, does conspiracy mentality moderate the association between a company’s power and its
drug’s effectiveness even if power is completely orthogonal to the medical philosophy (analytic
vs. holistic approach)? This can be answered by the interaction of measured conspiracy mentality
and perceived power, respectively medical approach on the evaluation of a drug. To the extent
that conspiracy mentality was associated with the actual holistic medical approach independent
of perceived power, there should be a significant interaction of medical approach and conspiracy
mentality on evaluation. If, however, conspiracy mentality was associated with the evaluation
contingent on perceived power, this would strongly speak to the role of power: Even biomedical
drugs derived from an analytical approach would be evaluated more favorable if the respective
company had only little influence and power. We pre-registered the hypotheses as well as sample
size determination and data exclusion rules (http://aspredicted.org/blind.php/?x=zybd7r).
Participants. To be able to detect even small effects, at least N = 98 participants should be
included in the analysis (Faul, et al., 2009). Three hundred seventeen participants were recruited
via mailing lists and social networks (e.g., Facebook, twitter, Google) to complete an online
survey in exchange for a chance to win a lottery of €30. As pre-registered, participants were
excluded from the analysis when they indicated that their data should not be used (n = 12) or
when they failed the manipulation check (i.e. did not recognize powerful companies on average
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 21
as more powerful than powerless companies and/ or did not recognize holistic companies on
average as more holistic than analytical companies; n = 66). Two hundred thirty-nine (54 men,
183 women, 1 other, 1 missing; Mage = 27.76 years, SDage = 8.09 years) remained in the sample.
Independent variables. The two independent variables power and medical approach were
manipulated within the text vignettes describing the four propositions for a new drug to treat
Addison’s disease. In the high power conditions, the developing company was described to
“wield enormous influence over the prescription drug and medical device markets”, whereas in
the low power condition the company “has only little market power and influence”. In the
analytical approach condition, participants read that the company followed an analytical
approach and only biomedical factors were taken into account for the development of new drugs,
whereas in the holistic condition, the philosophy of the company was described as following a
philosophy that approached humans “as a system permeable at its boundaries, whose parts
interact reciprocally through links between each other, their entirety and their environment”.
Conspiracy Mentality (α = .91). The measure of conspiracy mentality was identical to
Manipulation Check. As a manipulation check, we asked participants to rate the
respective company and their drug on the two dimensions power and medical approach with two
items on a 7-point Likert scale ranging from 1 (holistic approach/ powerful) to 7 (analytical
Evaluation. Participants indicated their support of the drug with four items on a 7-point
scale ranging from 1 (e.g., The development of the drug should not be supported by the public) to
7 (The development of the drug should be supported by the public). The reliability of the scales
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 22
ranged between α = .781 for the high power plus analytical approach vignette and α = .940 for the
low power plus analytical approach vignette.
After indicating their informed consent participants read a text about Addison’s disease.
Participants were told that they would read something about “different treatments which are all
together very promising”. Only some of the treatments could be accepted for funding by the
European Union and a new social initiative allegedly wanted to promote a more basic democratic
approach of medical funding. Therefore, we asked them to evaluate the different treatments and
the companies. Afterwards, participants completed the items tapping into conspiracy mentality
and completed demographic questions (gender, age, religion, political attitude) and a subjective
estimate of their own data quality. At the end of the study, participants were debriefed.
As a first test of our general logic, we explored whether there were crossover-effects
from one manipulation on the other one. Specifically, although their description of power and
influence was held constant, we wanted to know whether the companies who followed an
analytical approach were perceived as more powerful than those who followed a holistic
approach. To test for these cross-over effects, we calculated an rmANOVA with the factors power
and holistic-analytical as within-subject factors and perceived power as dependent variable.
Results revealed the to-be-expected significant effect of power, F(1, 235) = 1174.491, p < .001,
ηp2 = .833. More importantly for our reasoning, orthogonal to the effect of manipulated power
there was also one of medical approach on perceived power. Analytical approaches were
perceived as more powerful compared to holistic ones, F(1, 235) = 42.437, p < .001, ηp2 = .153.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 23
The interaction between power and approach did not reach level of significance, F < 1. Thus,
verbatim identical descriptions of a company’s power and influence still led to higher ascriptions
of power when paired with an analytic (vs. holistic) approach, which strongly corroborates our
theoretical point of departure, the apparent asymmetry of perceived power as a function of the
To test the role of conspiracy mentality, we subjected the average evaluation scores to an
rmANCOVA with power and holistic-analytical as within-subject factors (for all mean values see
Table 5) and conspiracy mentality as a covariate. Although conspiracy mentality was
descriptively associated with a more positive evaluation of drugs developed by powerless
companies (see Figure 3), the corresponding interaction failed to reach conventional levels of
significance, F(1, 234) = 3.032, p = .069, ηp2 = .014, as did the main effect of power, F(1, 234) =
3.771, p= .053, ηp2 = .016.
For the other within-subjects factor, drugs development on the base of an analytical
approach were evaluated more positively, F(1, 234) = 26.20, p < .001, ηp2 = .101, but this effect
was contingent on conspiracy mentality, F(1, 234) = 8.22, p = .005, ηp2 = .034. The higher
participants scored on conspiracy mentality, the less positive they evaluated analytically
developed drugs, r = -.166, p = .004, 95% CI [-.27; -.05], and the more positively they evaluated
drugs developed on the based on holistic reasoning, r = .193, p = .001, 95% CI [.08; .30], to the
point where participants high in conspiracy thinking did not differ in their evaluation of both
approaches (Figure 2).
When including all participants (i.e., also those who failed the manipulation check) the predicted interaction
between power and conspiracy mentality reached conventional levels of significance, F(1, 312) = 4.317, p = .039,
ηp2 = .014. However, even if the results differed concerning their level of significance, the effect sizes were
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 24
Study 3 again established an association of conspiracy mentality with differential
evaluations of medical approaches. First, even considering identical descriptors of power and
influence companies were perceived as less powerful if they followed a holistic (vs. analytical)
approach, clearly speaking to our premise of CAM perceived as powerless. This association
might also have attenuated the effect of manipulated power. Although the idea that it is
predominantly the perceived power of a medical approach that determines the role of conspiracy
mentality in treatment evaluation received only weak support, part of the variance of subjectively
perceived power will map on the experimental manipulation of the holistic vs. medical approach.
As holistic approaches were perceived as less powerful, the fact that conspiracy believers were
more attracted to the lure of a holistic philosophy that explicitly denounced any analytic
reductionism to biochemical processes may also be partially attributable to power. Interestingly,
high conspiracy beliefs did not inverse the strong preference for analytic approaches but merely
attenuated it to the extent that people high in conspiracy beliefs did not really favor one drug
over the other. Although both these findings are comparatively weak, the exploratory analyses of
an additional dataset (see footnote 5) provided virtually identical results. This bolsters our
conviction that despite being small the effect is reliable.
Meta-analytic integration of the results
This research had to deal with the comparatively weak, albeit consistent, experimental
evidence for the role of perceived power. It is conceivable that merely including a sentence
referring to great influence on the market was not sufficiently strong as a manipulation of
perceived power of fictional drug in comparison to the daily perception of pharma giants as
powerful that likely drives the correlational effects. Due to the only weak to moderate empirical
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 25
evidence, we meta-analyzed the association between conspiracy mentality and the intraindividual
correlations between power and usefulness from Study 2, as well as the experimental effects
from Study 3 and an unpublished additional Study B
(all transformed into Fischer- Z) in a
random-effects model using the R metafor package (Viechtbauer, 2010). The overall effect of the
interplay of conspiracy mentality and power on efficacy ratings was small but reliable, Fischer Z
= -.136, p < .001, 95% CI [-.203, -.068], underpinning the role of power for the evaluation of
medical approaches depending on conspiracy beliefs (see Forest Plot on OSF).
In four studies, we found empirical support for the idea that conspiracy mentality as a
generalized political attitude also predicts medical choices and health beliefs. Conspiracy
mentality was associated with more positive attitudes towards alternative and complementary
medicine and more negative attitudes towards biomedical approaches, as well as to actual health-
relevant behavior. Previous research has repeatedly shown that the belief in conspiracy theories
is accompanied by mistrust and prejudice against powerful groups (e.g., Imhoff & Bruder, 2014).
We have hypothesized and empirically demonstrated that one of the psychological connections
between the two is the distrust against whatever is perceived as powerful. Also based on the
results of the meta-analysis, we were able to show that power played a role when it comes to the
evaluation of medical approaches.
We had conducted an additional study (Study B) similar to Study 3 but with the additional factor of profit-oriented
company vs. patient advocacy group. In this study, we only found the moderation of conspiracy mentality and
holistic medical approach. However, exploratory data analyses revealed that roughly 300 out of a total of 400
participants failed the manipulation checks of even only detecting which companies were more powerful on average.
As we had not preregistered the exclusion of participants based on this manipulation check, we conducted another
new study, the current Study 3. Exploratory analyses of the remaining 102 participants revealed that people high in
conspiracy mentality evaluated a drug more positively if it followed from a holistic approach and if it was developed
by a profit-oriented company with low power (low power of non-profit advocacy group had the opposite effect on
evaluation as a function of conspiracy mentality). The data from this study B are available on OSF.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 26
The current data highlight the importance to consider the role of conspiracy mentality in
medical prevention and intervention programs. Our research shows that conspiracy mentality is
strongly linked to medical choices. An individual's understanding of his or her illness and choice
of treatment may thus depend on ideology-related personality traits much more than on rational
considerations. Conspiracy mentality is likely to influence the unique interpretation of the root
cause of one’s ill health, symptom onset, physiologic response, and individual preferences for
providers and treatments.
Limitations and further directions
The major strength of the present research lies in its systematic investigation of the
association between a generalized political attitude and attitudes towards medical approaches
producing consistent results across a set of independent studies. However, one limitation of our
research is the cross-sectional nature of the correlational data. It would be fascinating to follow
the development of the two and risk factors for both. Within such an approach it would also be
highly advisable to overcome the present limitation of only self-reported usage by using more
direct measures of behavior or behavior sampled online via experience sampling. Future research
should also consider using experimental approaches manipulating the conspiracy mindset (see
Jolley and Douglas, 2014).
Health beliefs differ from culture to culture. In the Western World, the mainstream
approach is biomedical, and evidence based (Sheikh & Furnham, 2000). Nevertheless, the
biomedical approach is not the mainstream among all societies. As we are assuming that the
perceived power of a medical approach is essential for the evaluation of this approach it is
important to examine the relationship between different culture-dependent medical beliefs and
conspiracy mentality which seems to be a unidimensional consistent construct across different
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 27
cultures (Bruder, et al., 2013). Such a culture where the biomedical model is the non-dominant
approach, would be an ideal environment to put our theory to the most critical test. Here,
conspiracy mentality should be associated with positive attitudes towards biomedical therapies.
In the present article, we have shown that conspiracy mentality is linked to attitudes towards
different medical approaches. This enabled us to predict attitudes towards complementary and
alternative medicine and the likelihood of usage. As can be shown in previous research,
conspiracy mentality can be characterized as a generalized distrust against those in power. This
generalized distrust also influences medical choices.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 28
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Prototypical overview of the two main medical approaches in the Western world
Alternative or Complementary Approach
Vaccination, Antibiotics, Painkillers
Homeopathy, Naturopathy, Acupuncture
Part of medical science that applies
principles of natural sciences to clinical
practice, using scientific methods to
establish the effectiveness of that practice
(e.g., Annandale, 1998)
Medical practices that do not conform the
standards of the medical community (e.g.,
Verhoeff & Sutherland, 1995)
scientific-analytical: focus mainly on
physical processes and symptoms
holistic: aims to address the whole person
(e.g., mind, body and spirit; Fulder, 1998)
Health & Disease
Health as absence of disease (e.g., Aakster,
1986; Fulder, 1998)
Disease as imbalance between vitalizing
and destructive forces
Classification of the symptoms based on
location and etiology
Evaluation of the total person
destroy or at least suppress the
demolishing or sickening forces; working
against symptoms (e.g., Aakster, 1986;
strengthen the vitalizing forces; working with
symptoms (e.g., Aakster, 1986; Fulder, 1998)
standardized therapy (Fulder, 1998)
individualized therapy (Fulder, 1998)
efficacy must be demonstrated in clinical
trials, which are normally to be
conducted as randomized controlled trials
(e.g., Directive 2001/83/EC)
no regulations concerning demonstration of
Note. Adapted and extended from Aakster (1986). Overview of the Literature included can be found on OSF.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 35
Overview of different factors suggested to be relevant for preference for alternative methods of treatment over biomedical approaches
Reasons for CAM Use
Females more likely using CAM (e.g., Barnes et al., 2008; Downer et al., 1994;
Eisenberg et al., 1998; Kemppainen at al., 2017; for exception see Sirois & Gick, 2002)
Higher education linked to a more frequent use of CAM (e.g., Barnes et al., 2008;
Crocetti et al., 1998; Eisenberg et al., 1998; Kemppainen et al., 2017)
Higher Income linked to more frequent use of CAM (Barnes et al., 2008; Eisenberg et
al., 1998; Maskarinec et al., 2000)
Past psychological problems (e.g.,
Significant association between anxiety and use of CAM (e.g., Astin, 1999; Burstein
et al., 1999; Downer et al., 1994)
Subjects with chronic disease reported a higher number of consultations with CAM
providers than had subjects without chronic disease (e.g., Al-Windi, 2004)
with OM/ GP
General Dissatisfaction with
Mixed evidence for dissatisfaction with OM as one reason why people use CAM
(no significant association: Astin, 1999; Siapush, 1999, versus small effects of
dissatisfaction with orthodox medicine and use of CAM: Begbie et al., 1996; Sirois & Gick,
Perceiving OM as having too many negative side effects linked to the use of CAM
(e.g., Chrystal et al, 2003; Moschen et al., 2001; Tough et al., 2002)
Holistic view of health
Significant association between holistic health view and use of CAM (e.g., Astin,
1999; Siapush, 1999)
Holding anti-science sentiment linked to positive attitudes towards alternative
medicine (Siapush, 1999)
Faith in natural remedies
Faith in natural remedies linked to a stronger use of CAM (e.g., Begbie et al., 1996;
Richardson et al., 2000)
Medical conspiracy beliefs were linked to a more frequent use of CAM (Oliver &
Note. OM = Orthodox Medicine; GP = General Practitioners; CAM = Complementary and Alternative Medicine. See also Frass et al. (2012) and
Verhoef et al. (2005) for a systematic review on use and acceptance of complementary and alternative medicine. Overview of the Literature
included can be found on OSF.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 36
Descriptive Statistics and Zero-Order Correlations of the Variables in Study 1a and 1b.
Study 1a: Germany
Study 1b: USA
(1) Conspiracy Mentality
(2) Attitudes towards
(3) Attitudes towards
(4) Attitudes towards
Note. * p < .05. ** p < .01. *** p < .001.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 37
Correlation coefficients between conspiracy mentality and efficacy ratings for 37 different
therapeutic approaches in Study 1a and 1b
Study 1a: Germany
Study 1b: USA
Arts or music therapy
Bach flower therapy
Biochemical tissue salts
Progressive muscle relaxation
Note. * p < .05. ** p < .01. *** p < .001.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 38
Descriptive statistics of the four conditions in Study 3
High Power and
High Power and
Low Power and
Low Power and
Note. N = 239. All scales were measured on a 7-point scale. Higher values indicate a more
positive evaluation, a more analytical approach and less power.
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 39
-1 SD +1 SD
Evaluation of HTP530
5Low Power Support Group
High Power Support Group
Figure 1. Relation between Conspiracy Mentality and evaluation of “HTP 530” as a function of
power of support group (low power: interest group of affected patients; high power:
pharmaceutical consortium) in Study 2
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 40
Figure 2. Correlation between the evaluation of holistic approaches (black dots) as well as
analytical approaches (grey triangles) and conspiracy mentality in Study 3
CONSPIRACY MENTALITY & ATTITUDES TOWARDS MEDICAL APPROACHES 41
Figure 3. Correlation between the evaluation of low power companies (black dots) compared to
high power companies (grey triangles) and conspiracy mentality in Study 3