Chapter 14 Exercises: Health Misinformation — From Snake Oil to Anti-Vax

Section A: Historical Context

Exercise 14.1 — Patent Medicine Analysis

The following list of claims appeared on patent medicine labels in the early twentieth century:

"Cures cancer, cholera, and all manner of internal diseases."
"Guaranteed to restore youthful vigor and vitality."
"Nature's own remedy — no chemicals, no drugs, only pure herbal goodness."
"Three bottles of Dr. Humphrey's Revitalizing Elixir cured my paralysis of five years' standing." — [Testimonial from Missouri]

(a) For each claim, identify which specific rhetorical technique it employs from the marketing playbook identified in the chapter.

(b) Identify an equivalent contemporary health product or claim for each technique. Do not use the same product for more than one technique.

(c) Why do these techniques persist across more than a century of regulatory change? What does their persistence tell us about the psychological needs they address?

Exercise 14.2 — Regulatory Timeline

(a) Construct a timeline of U.S. federal health regulation from 1906 to 2000, identifying at least six major legislative milestones. For each, describe what regulatory problem it addressed and what gap remained.

(b) The Dietary Supplement Health and Education Act (DSHEA, 1994) is described in the chapter as having created a regulatory gap. Evaluate the arguments for and against DSHEA: what were the policy goals of the legislation, and what were its unintended consequences?

(c) Compare the U.S. regulatory approach to dietary supplements with the European Food Safety Authority (EFSA) model. What are the practical differences? Which approach better protects consumers? Which approach better respects consumer autonomy?

Exercise 14.3 — The Elixir Sulfanilamide Case

The 1937 Elixir Sulfanilamide disaster killed 107 people when a pharmaceutical company dissolved an antibiotic in a toxic solvent.

(a) How did the disaster expose the limitations of the 1906 Pure Food and Drug Act?

(b) Why was the FDA powerless to prevent the disaster under the then-existing law?

(c) What does this case tell us about the relationship between regulatory frameworks and public health outcomes? How does it inform our understanding of the importance of pre-market safety evaluation?

Section B: Why Health Misinformation Kills

Exercise 14.4 — Herd Immunity Mathematics

The measles herd immunity threshold is estimated at 93-95% vaccination coverage. Consider a population of 100,000 people.

(a) At 95% vaccination coverage, how many people are susceptible to measles? How many vaccinated individuals are needed to protect one unvaccinated individual?

(b) If coverage declines to 88% (the UK post-Wakefield minimum), how many additional susceptible individuals are there compared to the 95% threshold?

(c) Model a simple measles outbreak scenario in a population with 88% vaccination coverage and a basic reproduction number (R0) of 15. How many cases would you expect in the first generation of transmission from a single imported case? (Use: Expected cases = R0 × proportion susceptible)

(d) At what vaccination coverage rate does measles transmission cease? Show your calculation.

Exercise 14.5 — Cancer Treatment Delay

Johnson et al. (2018, JAMA Oncology) found that patients with resectable cancer who used alternative medicine as primary treatment had a 5.68-fold higher hazard of death compared to those receiving conventional treatment.

(a) Explain what "hazard ratio" means. What does a hazard ratio of 5.68 specifically indicate about the risk of death?

(b) The study found a survival rate of 54.2% vs. 78.3% at 5 years for alternative vs. conventional treatment. Convert this to an absolute risk difference and a number needed to harm. Interpret these statistics.

(c) Critics argue that the comparison is confounded — patients who choose alternative medicine may differ systematically from those who choose conventional medicine in ways that independently affect survival. Identify three plausible confounders and explain how each could bias the estimated effect.

(d) How would you design a more rigorous study to estimate the causal effect of alternative medicine use on cancer survival? What are the practical and ethical obstacles to such a design?

Exercise 14.6 — COVID Infodemic Mortality

Design a study to estimate the number of COVID-19 deaths attributable to vaccine hesitancy driven by misinformation. Your design should address:

(a) The counterfactual: What vaccination coverage would have been achieved without misinformation?

(b) The dose-response relationship: How does the level of misinformation exposure correlate with vaccination intention?

(d) What are the fundamental methodological challenges in attributing deaths to "misinformation" rather than to vaccine hesitancy per se?

Section C: Vaccine Hesitancy

Exercise 14.7 — Three Cs Analysis

For each of the following populations, analyze which of the three Cs (complacency, convenience, confidence) is the primary driver of vaccine hesitancy, and propose a specific intervention tailored to that driver.

(a) Upper-middle-class parents in a suburb where no one they know has ever had measles, who are aware of anti-vaccination claims but are mostly uncertain rather than ideologically opposed.

(b) Rural agricultural workers who support vaccination in principle but face logistical difficulties accessing vaccination clinics during working hours.

(d) Young adults who believe COVID-19 is not dangerous for people their age and don't see why they need to be vaccinated.

Exercise 14.8 — Hesitancy Spectrum Case Analysis

A nurse practitioner is seeing four parents for their children's well-child visits. Each parent expresses a different vaccine concern:

Parent A: "I've read about a link between vaccines and autism. I'm not sure I want to take the risk."
Parent B: "I believe vaccines work, but I'm worried about giving so many at once. Can we spread them out?"
Parent C: "I don't trust pharmaceutical companies. They're driven by profit, not patient welfare."
Parent D: "I think vaccines are fine for most people, but my family is healthy and eats well. We build immunity naturally."

(a) Place each parent on the vaccine hesitancy spectrum and identify which of the three Cs drives their hesitancy.

(b) For each parent, identify the most and least effective communication approach based on the chapter's framework.

Exercise 14.9 — Inoculation Intervention Design

Design a prebunking campaign to reduce vaccine hesitancy in a specific population of your choosing (specify the population, the vaccine, and the geographic context).

(a) Identify the top three misinformation claims your target population is most likely to encounter.

(b) For each claim, design a prebunking message that: (i) warns about the manipulation technique being used, (ii) briefly exposes the false claim, and (iii) provides the accurate information.

(d) Design an evaluation study to measure the effectiveness of your campaign. Specify the design, measures, and timeline.

Section D: The Wakefield Fraud

Exercise 14.10 — Case Analysis

(a) Why is the Wakefield case important beyond the specific false claim it generated? What does it reveal about the vulnerability of scientific communication to strategic manipulation?

(b) The Lancet published the original paper in 1998 and retracted it in 2010 — a twelve-year gap. What does this timeline reveal about the peer review process as a mechanism for catching scientific fraud? What reforms to peer review might prevent similar cases?

(c) Analyze the role of media coverage in both amplifying the Wakefield paper and (eventually) documenting the fraud. What does the comparison between coverage of the paper and coverage of the retraction tell us about media economics and epistemics?

Exercise 14.11 — The Conflicts of Interest Problem

Wakefield received £435,643 from solicitors building a lawsuit against MMR manufacturers while conducting the research. This was not disclosed.

(a) Explain how this financial conflict of interest would be expected to influence research design, data analysis, and reporting based on what psychology research tells us about motivated reasoning.

(b) Most scientific journals now require disclosure of financial conflicts of interest. Is disclosure sufficient? What additional safeguards might be warranted?

(c) Critics of pharmaceutical industry-funded research argue that the industry's financial relationship with clinical researchers creates systematic biases in the published literature. Evaluate this argument. What does the evidence show?

Section E: COVID-19 Infodemic

Exercise 14.12 — Claim Evaluation

For each of the following COVID-19 claims, evaluate the claim using the credibility framework introduced in Section 14.6:

(a) "5G towers cause COVID-19 by suppressing immune function."

(b) "Vitamin D deficiency is associated with worse COVID-19 outcomes."

(d) "mRNA vaccines alter your DNA."

(e) "Natural immunity from COVID-19 infection is stronger than vaccine-induced immunity."

For each claim: (i) Rate the prior plausibility (based on known biology and chemistry). (ii) Evaluate the quality of evidence cited by proponents. (iii) Evaluate the quality of evidence against the claim. (iv) Render a verdict and explain your reasoning.

Exercise 14.13 — The Information Asymmetry Problem

Research shows that false COVID-19 information spread faster and further than accurate information on social media platforms.

(a) Identify three structural features of social media platforms that would predict this information asymmetry (why false information spreads faster than true information).

(b) Vosoughi, Roy, and Aral (2018) found in a landmark MIT study that false news spreads "farther, faster, deeper, and more broadly" than true news. What emotional and cognitive mechanisms might explain this finding?

(c) What platform-level interventions might reduce the information asymmetry? For each, evaluate the likely effectiveness and potential unintended consequences.

Exercise 14.14 — The Bleach Ingestion Incident

Following President Trump's April 2020 comments about disinfectants, poison control centers received calls from people who had consumed or applied bleach. Health officials called this a public health emergency.

(a) What responsibility, if any, does a political leader bear for the health consequences of false or misleading health statements made in public forums?

(b) What were the communication failures by public health officials in the immediate response to Trump's comments?

(c) Design a communication protocol for rapidly responding to a high-visibility false health claim from a political leader. Specify: trigger criteria, response timeline, message content, spokespersons, and channels.

Section F: Alternative Medicine

Exercise 14.15 — Plausibility Assessment

Using Edzard Ernst's spectrum from "plausible but unproven" to "implausible" to "irrational," categorize and justify your categorization of:

(a) High-dose vitamin C for cancer treatment

(b) Homeopathy for flu prevention

(d) Coffee enemas for cancer detoxification

(e) St. John's Wort for mild depression

(f) Therapeutic touch for post-surgical recovery

Exercise 14.16 — The "Natural" Appeal

The "appeal to nature" fallacy is the inference that natural things are better than artificial things.

(a) Identify five pairs of examples where: (i) a "natural" substance is dangerous and the "artificial" alternative is safer; (ii) an "artificial" product provides benefits that "natural" alternatives cannot.

(b) Why is the appeal to nature psychologically compelling even though it is logically fallacious?

(c) Design a media literacy curriculum element to help high school students identify and resist the appeal to nature in health marketing. Specify the activities, discussion questions, and assessments.

Exercise 14.17 — DSHEA and the Supplement Industry

The dietary supplement industry in the United States operates under different regulations than pharmaceutical drugs.

(a) A supplement manufacturer markets "ImmuniMax" with the label claim "Supports healthy immune function." Under DSHEA, is this legal? What is the manufacturer required to disclose?

(b) A consumer researches "ImmuniMax" and finds: three customer testimonials on the manufacturer's website, a single pilot study with 12 participants, and one systematic review finding no benefit. How should the consumer evaluate this evidence?

(c) Compare DSHEA to the EU's Novel Food Regulation. Which better protects consumers? Which is more innovation-friendly? Is there a framework that achieves both goals?

Section G: Cancer Misinformation

Exercise 14.18 — The Treatment Delay Calculation

Neal et al. (2017) found that each four-week delay in cancer treatment is associated with a 6-13% increase in mortality risk.

(a) A patient with breast cancer delays starting chemotherapy for eight weeks while pursuing an alternative treatment that proves ineffective. Using the lower bound (6% per four weeks), calculate the estimated increase in mortality risk.

(b) If the patient's baseline five-year mortality risk was 20%, what is the estimated five-year mortality risk after the treatment delay?

(c) How should an oncologist communicate this risk to a patient who is considering delaying conventional treatment? Apply the risk communication principles from Section 14.9.

Exercise 14.19 — Exploitation of Terminal Illness

A stage IV pancreatic cancer patient is offered an "alternative cure" protocol costing $50,000 that claims to have produced multiple documented remissions. The patient has been told by oncologists that standard treatment options are palliative only.

(a) What are the ethical obligations of oncologists when a terminal patient indicates they intend to pursue an expensive alternative treatment?

(b) What regulatory mechanisms currently exist to protect terminal patients from fraudulent cure claims? Are they adequate?

(c) Construct an argument that in terminal illness, there is no meaningful difference between "false hope" and "appropriate palliative intervention," since neither produces cure. Then construct the best counterargument.

Section H: Health Authorities and Communication

Exercise 14.20 — Credibility Failure Analysis

Identify a specific instance of health authority communication failure (from COVID-19 or another health crisis) and analyze it:

(a) What was communicated, what was later changed, and what explanation (if any) was provided for the change?

(b) Analyze the communication failure using the risk communication principles from Section 14.9. Which principles were violated?

(c) Draft an alternative communication that would have been more consistent with effective risk communication principles. Show specifically how your version differs from the actual communication.

Exercise 14.21 — Institutional Trust Survey Design

Design a survey instrument to measure public trust in health institutions (CDC, FDA, WHO, pharmaceutical companies, academic researchers) across different population segments.

(a) Identify the dimensions of institutional trust relevant to health communication (competence, benevolence, integrity, transparency). Develop 2-3 items for each dimension.

(b) How would you ensure your instrument is not affected by social desirability bias (the tendency to give socially acceptable responses rather than honest ones)?

(c) What population segments would you oversample to capture variation in institutional trust? Justify your sampling design.

Exercise 14.22 — Motivational Interviewing Practice

Read the following clinical scenario and complete the exercises:

A 34-year-old mother brings her 18-month-old for a well-child visit. When the nurse practitioner recommends the MMR vaccine, the mother says: "I've been doing a lot of reading about vaccines, and I'm concerned about what I've been seeing. There seems to be a lot of parents whose kids were fine until they got vaccinated, and then suddenly they had problems. I just don't feel comfortable rushing into this."

(a) Write the practitioner's ideal MI-consistent response to this statement (3-5 sentences).

(b) The mother responds: "But I've seen the studies. There are definitely problems being covered up." Using MI technique of "rolling with resistance," write an ideal practitioner response.

(c) The mother then asks: "Can you just tell me honestly — is the vaccine completely safe?" Write an honest, accurate response that communicates effectively without dismissing the concern or overstating certainty.

Section I: Applied and Integrative

Exercise 14.23 — Comprehensive Health Misinformation Analysis

Select a current health misinformation claim (not discussed in the chapter). Write an analysis (minimum 800 words) covering:

(a) The claim's content and origin.

(b) Its classification on the plausibility spectrum.

(d) The psychological appeal of the claim (using the chapter's framework).

(e) The community through which it circulates and the network structure of its spread.

(f) Its real-world harm potential.

(g) An evidence-based response strategy.

Exercise 14.24 — Public Health Campaign Design

You have been asked to design a public health campaign to increase HPV vaccination rates among adolescents in a state where rates have been below 60%.

(a) Conduct a three Cs analysis to identify the primary drivers of hesitancy for this specific vaccine and population.

(b) Identify your primary target audiences (parents, adolescents, healthcare providers, school administrators) and the specific communication challenges for each.

(c) Design three specific communication interventions, one for each of the three Cs, specifying: message content, messenger, channel, and timing.

(d) Design an evaluation framework to measure the campaign's effectiveness. What are your primary and secondary outcome measures? What is your comparison condition?

Exercise 14.25 — Ethical Analysis: Compulsory Vaccination

Several countries and jurisdictions have adopted compulsory vaccination policies — requiring vaccination as a condition of school enrollment, employment in healthcare settings, or participation in specific public activities.

(a) Present the strongest public health and ethical arguments for compulsory vaccination.

(b) Present the strongest individual rights and ethical arguments against compulsory vaccination.

(c) Analyze the empirical evidence on whether voluntary versus compulsory vaccination policies produce different vaccination rates.

(d) Take and defend a position. Under what conditions, if any, is compulsory vaccination justified? Apply a specific ethical framework.

Exercise 14.26 — Research Design

Design a study to test whether motivational interviewing (compared to standard information provision) increases MMR vaccination rates among vaccine-hesitant parents.

(a) Specify the study design (RCT preferred), including randomization unit and procedure.

(b) Describe the intervention and control conditions in enough detail that they could be replicated.

(d) Calculate required sample size given the following assumptions: baseline vaccination rate 60%, expected effect size 15 percentage points, alpha = 0.05, power = 0.80.

(e) Address ethical considerations, including informed consent and provision of information to control group participants.

Exercise 14.27 — Platform Policy Analysis

YouTube, Facebook, and Twitter/X have all implemented policies to reduce health misinformation, with varying approaches (removal, labeling, demotion, information panels).

(a) Describe the specific policies implemented by at least two platforms for COVID-19 health misinformation. What triggered the policies? What content did they target?

(b) What does the research evidence say about the effectiveness of these interventions? (Consider: Priniski and Horne (2018), Pennycook et al. (2020), and Goldenberg (2021) as starting points.)

(c) Identify three specific unintended consequences of aggressive health misinformation removal. For each, explain how it could counterproductively increase misinformation belief or spread.

(d) Propose a platform policy framework that maximizes health outcomes while minimizing unintended consequences. Identify the values tradeoffs in your framework.

Exercise 14.28 — Synthesis Essay

Write an essay (minimum 1,200 words) responding to the following prompt:

"The history of health regulation demonstrates that the government can and should protect citizens from health misinformation. The digitally enabled scale of contemporary health misinformation creates a public health emergency that warrants aggressive regulatory response, including requirements for platforms to remove dangerous health misinformation and criminal penalties for deliberate false health claims."

Your essay should: - Trace the historical precedents for health information regulation - Evaluate the public health case for aggressive intervention - Engage with First Amendment and epistemic autonomy concerns - Consider the practical implementation challenges - Distinguish between different types of health misinformation that warrant different regulatory approaches - Take and defend a clear position