What drives modern-day plague doctors?

Whatever it is, College must act,

During the Black Death in Medieval Europe, many people came to know and fear the image of the “plague doctors,” the second-rate physicians who replaced legitimate doctors who had died or fled. Clad in ghoulish attire replete with beak-like masks, plague doctors seldom cured patients, but earned tidy sums by counting the dead after their dubious cures failed to work.

Alas, nearly 700 years later, the plague doctors are alive and well. Americans are all too familiar with “America's Frontline Doctors,” the motley crew that promotes dubious COVID-19 cures like hydroxychloroquine and ivermectin and opposes virtually all proven public health measures such as vaccines, masks and social distancing.

Here in B.C., the College of Physicians and Surgeons is currently struggling with how to handle a number of physicians who similarly reject sound medical advice in dealing with the pandemic. While many of their colleagues have spoken out about these latter-day plague doctors, few have faced any significant consequences.

Now to be fair, the Medieval plague doctors didn't know what to do about the Black Death, and neither did anyone else, which is why many legitimate physicians ran away. In contrast, today's doctors have an abundance of clinical and research evidence on how to combat COVID-19, which makes their promotion of conspiracies and quack cures all the more puzzling.

Indeed, while many psychologists have sought to understand why people promote COVID misinformation, they have centred on the fact that the promoters themselves are often misinformed. So the American Psychological Association details studies that found those who believe or share misinformation often fail to carefully consider the materials they read or hear, tend to be intuitive rather than analytical thinkers, and have limited numeracy skills.

None of those factors would likely apply to those who intentionally spread misinformation, however. For that we must look for other explanations. And psychologists have found that people who embrace conservative ideologies, especially those on the far right, are more likely to spread misinformation intentionally. But that's only part of the story.

According to a series of studies conducted by Duke University's Hemant Kakkar and Asher Lawson and published last week in the Journal of Experimental Psychology, the key factor is not political ideology, but conscientiousness. Conscientiousness, one of what psychologists refer to as the Big Five personality traits, encompasses “a broad domain of positive traits such as orderliness, impulse control, conventionality, reliability, industriousness and virtue.”

The eight studies of more than 4,600 people discovered that both liberals and conservatives who scored highly on conscientiousness measures were unlikely to share information they knew to be false. In contrast, conservatives with low conscientiousness scores displayed a significant willingness to knowingly spread false information.

This willingness to spread falsehoods was motivated by a “need for chaos” — the “drive to disrupt and destroy the existing order or established institutions in an attempt to secure the superiority of one's own group over others.” In effect, low conscientious conservatives sought to destroy their political opponents — to “own the libs,” as it were — by any means necessary. And the desire to cause chaos far outweighed any other possible motivating factor to spread falsehoods, including the desire to promote conservative values or distrust of mainstream media.

As the studies' authors note, this presents a serious challenge to the efforts to combat COVID misinformation, since traditional methods, such as fact-checking to ensure the veracity of news, will prove ineffective against low conscientious conservatives.

Which brings us back to today's plague doctors. Now I can't say for certain this analysis applies to them: I don't know anything about their conscientiousness, nor do I know if they might really believe in the snake oil they're selling. But if it's the latter, then the College of Physicians and Surgeons needs to take action, since their education has been neglected or ignored.

And if it's the former, if they're knowingly promoting falsehoods — and their propensity to cite far-right non-medical media in defence of their claims seems a dead giveaway — then, again, the College needs to take action.

Plague doctors ought to be seeking the end of the plague, not the end of those suffering with it.