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According to Attis and Mollan, it was difficult to establish science in Ireland originally due to a variety of possible reasons: They speculated that perhaps one major reason for this was the lack of Enlightenment values such as rationality and personal autonomy in Irish culture (2004). There, to date has been little Irish research on the extent of the culture of pseudoscience and on how prevalent it may be in society (Vincent, & Furnham, 1996). However, anecdotally, in many newspapers you can see advertisements for reflexology, acupuncture, homeopathy, chiropractic or astrology, just to mention but a few popular examples. One columnist for the Irish Times expressed his disbelief on the topic of the establishment of pseudoscientific courses in third level institutes of education;
UCD and IT Tallaght are among Irish institutions offering courses that turn academia into quackademia and which should not be included in any serious curriculum
Pseudoscience can be defined as "claims presented so that they appear [to be] scientific even though they lack supporting evidence and plausibility" (Shermer 1997). In contrast to this, science is "a set of methods designed to describe and interpret observed and inferred phenomena, past or present, and aimed at building a testable body of knowledge open to rejection or confirmation" (Shermer 1997). Complementary and alternative medicines (CAM) are medical and health-care systems, practices and products which are not considered part of conventional medicine. Complementary medicine is generally regarded as treatment that is used alongside conventional medicine and alternative medicines are used in place of conventional 'western' medicine (Griffith, & Tengnah, 2010).
In health care there has been a sea change toward an evidence-base and scientific knowledge. This is captured in the following quotation:
When asking questions about therapyâ€¦ we should try to avoid the non-experimental approaches, since these routinely lead to false-positive conclusions about efficacy. Because the randomized trial, and especially the systematic review of randomized trials, is so much more likely to inform us and so much less likely to mislead us, it has become the "gold standard" for judging whenever a treatment does more good than harm
Sackett, Rosenberg, Muir-Gray, Haynes, & Richardson, 1996
There have also been social movements towards consumer rights (Schutz, Rivers, and Ratusnik, 2008), to product expectations, to healthy, natural, organic product expectations (Enis 2010) and for some people there has been a movement in terms of thinking. The Irish Skeptics Society is an example of this change, established in 2002 (Irish Skeptics Society 2010). In summary, medical treatments are expected to be effective and high quality and have the literature to back up their efficacy; Whereas non-medical treatments or pseudoscience have not been supported by quality research endeavours.
There cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.
(Angell and Kassirer 1998)
The outline of the problem is the dichotomy of critical thinking and evidence-based lifestyles that some Irish people are pursuing and the pseudoscientific lifestyles that other people may be following. Why is it that some people are predisposed to pseudoscience and not to the scientific method, when for others positivism seems to be the 'right' way? Another important point to note is how in a study by Bassman and Uellendahl (2003), they found high levels of use of alternative therapies in groups of people with anxiety disorder, depression, panic disorder and in general psychiatric outpatients. This could suggest that vulnerable groups in society are at risk from the damaging aspects of some pseudoscience treatments. However, there is a place in our society for relation or hobby therapies. Although, the problem for science is when people turn to alternative medicines and forego their medical treatments. It is in these circumstances that some people can get hurt or even lose their lives. For instance, the E.U is introducing a directive effective from the beginning of May banning the sale of hundreds of herbal remedies after serious concerns over their efficacy and safety. One of the herbal remedies being banned is aristolochia, after it caused kidney failure in two U.K. citizens (Aronson, 2001).
Why do people use CAM?
In a review of the literature it became apparent that there were two modes of understanding CAM usage: Using a psychological lens and also a sociological lens. From a societal perspective, it has been argued that greater emphasis is now placed on expectations of self-agency and choice in the matter of health care and other welfare citizen rights (Newman and Vidler, 2006). This effect has come from a turn to neo-liberalism ideologies away from welfare state underpinnings (Taylor-Gooby, 1998). In an overview, cosmopolitanism consumerism is a very popular construct proffered by social sciences (Lee, 2010) which puts people in our nation-state in a quest for world-citizenry, in a word; ultraimperialism (Burns, 2010) . It is a worldview with an emphasis "on a heterogeneous plurality as opposed to the homogeneity imposed by the state" (Sherman, 2010). Putting a liquid modernity angle on this allows for heterogeneity in people and their world views, as well as a patchwork of modernities, multiple globalising processes and a plurality of worlds. Bauman's late modernity or liquid modernity is a continuation of modernity, rather than being a distinct and new age, like post modernity. It is a chaotic time for people in that people are not fixed in place and time: People can nomadically shift through social positions, values, partners, jobs and so on, becoming tourists in their own lives (Bauman, 2000). This could be used to explain the rising rate of separation in Irish partnerships, or even how people create social identities such as being an alternative medical advocate.
It could be argued then that some Irish people derive their identity from the market, rather than from a sense of belonging. As described by Bauman above, people carve their identity and sense of self from fleeting relations and contingent outlooks. Therefore not only do people have an increased emphasis on individual responsibility for health, but they are also engaged in various forms of health consumerism (Leontowitsch, Higgs, Stevenson, & Jones, 2010).
From a psychological perspective it has been concluded that advocates of alternative methods prefer to exercise autonomy in their purchases of treatments rather than being subject to the control of their doctor. The findings also explained that older patients sought CAM out of desperation as the conventional medical care for their chronic conditions had not helped. People also were attracted to the amount of time offered by CAM practitioners (Leontowitsch, Higgs, Stevenson, & Jones, 2010). Further research suggest it is possible that the failure of orthodox medicine is the strongest motive for seeking complementary treatment but that, once treatment has been experienced, other more positive factors become more important (Vincent, & Furnham, 1996).
Applying the scientific method in psychology to a public health scenario
There is increasing concern among the health professions about the use and effectiveness of complimentary therapies and the safety of herbal remedies in particular (As outlined earlier). This has led to calls for regulation to be tightened to lessen their impact on public health as it is difficult for members of the public to identify remedies of adequate quality (Council and European Parliament Directive, 2004). This is captured effectively in a recent Irish Times headline;
Hundreds of herbal remedies for EU-wide ban amid safety fears
In response to these worries the endeavour undertaken in this study is to preliminarily explore the models of attitude and behaviour in the areas of medical and non-medical treatments. Drawing from the literature on behaviour and public health campaigns there are five major theories that can help. There is Prochask and diClement's (1982) Stages of Change, Rosenstock's (1966) Health Belief Model, Witte's (1992) Extended Parallel Processing, the Social Norms Approach and finally Fishbien and Azjen's (1975) Theory of Reasoned Action, which developed into the Theory of Planned Behaviour (Ajzen, 1985). Health in the biopsychosocial model is made up of physical, mental and social aspects. When it comes down to understanding health there are a few types of behaviours; health behaviour; illness behaviour; sick-role behaviour; health-impairing behaviours; and health protective behaviours and these behaviours are impacted by outcome beliefs, expectations, ease of control of actions, susceptibility and severity of the illness. With these models at our disposal, how can we interpret the findings of this study to aid us in a potential future public health campaign? What aspects of people's beliefs and attitudes should we target, in order to promote empowered, self-determined proactive health behaviours? This will be tentatively discussed in the final section of this study.
IRAP and REC
The Implicit Relational Assessment Procedure (IRAP) is still a relatively new measurement technique that builds on IAT (Implicit Attitude Testing (IAT; Greenwald, McGhee, & Schwartz, 1998)) and REP (A technique derived from Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001)) techniques to further the reliability of data collected on attitudes. The rationale is to reduce the response times to stimuli to significantly decrease the social desirability and audience confounds to implicit attitudes (Greenwald, McGhee, & Schwartz, 1998). Vahey et al (2010) go on to say that "Implicit measures all seek to capture attitudinal biases before they are obscured by the bifurcating deliberative processes underlying self-reported attitudes". In particular the IRAP is able to disentangle verbal biases about pseudoscience treatments and medical treatments making it especially useful for our investigation of alternative/ medical-healthcare attitudes through verbal networks.
The more consistent a framed construct is for the participant the faster their responses. The opposite effect is hypothesised for inconsistently framed constructs (Vahey et al 2010). Also, according to the REC model, Relational Elaboration and Coherence model (Cullen, Barnes-Holmes, Barnes-Holmes, & Stewart,2009), the more a class of prescribed IRAP responses corresponds and coheres with the participant's predominant history of relational responding in everyday life the faster their latencies.
It may be interesting to look at what exactly elaborate relational responses might be also. It is tentatively defined as reasoning from your own experiences and schemas as to what explicit preferences you should have to relational stimuli, such as medical treatment + unreliable or faith healing + effective. It is this reasoning that Barnes Holmes et al (2010) speculate mediates a person's explicit preferences from their implicit ones. From the literature, I believe that the construct of 'Need for Cognition' will be a variable that will explain a proportion of variance in the data. Need for Cognition is an individual's tendency to engage in and enjoy effortful cognitive endeavours (Cacioppo et al 1996). I believe that people high in need for cognition will look at the world more sceptically and more analytically, whereas people low on this construct will be more likely to rely on others and heuristics.
I also believe this will be an opportunity to explore relationships between variables in the Relational Elaboration and Coherence Model: A Relational Frame Theory. This is still a very new and un-validated model which could benefit from the study of its variables and the relationships between them. In the REC model, the IRAP captures spontaneous and automatic evaluations, whereas explicit measures capture more carefully considered reactions. It is assumed that participants usually "reject" their immediate and brief relational responses (or automatic evaluations) if they do not cohere with their more elaborate and extended relational responding (Barnes-Holmes et al 2010).
People who have positive attitudes toward pseudoscience treatments on the IRAP will have less positive attitudes toward medical treatments and the opposite will be predicted for people who are sceptical of pseudoscientific treatments.
Participants who read the card with the statement "Only non-educated people believe in non-medical treatments" in other words people who are exposed to the manipulation will have increased bias on the explicit questionnaire but not on their implicit scores, whereas participants in the control group will not have as big a bias in their explicit scores.
Theorising from the REC model, people who are in favour of pseudoscientific treatments in the group that read the card "Only non-educated people believe in non-medical treatments" will have divergent scores on the IRAP and the explicit analogue.
The need2 for cognition will mediate participants' answering on explicit test.