Beyond the prescription: Engaging with alternative health beliefs

How Behavioural Science can guide healthcare professionals in addressing alternative health beliefs

Steven Bartlett, host of the Diary of a CEO podcast, is under pressure from a BBC investigation that suggested he failed to challenge guests when they shared minority positions on health, including that cancer can be treated with a keto diet, COVID vaccines are harmful, and conditions like autism and polycystic ovarian syndrome can be reversed through diet.

Another widely criticised podcast with millions of followers is The Joe Rogan Experience, where he once suggested the COVID vaccination was ‘“gene-therapy” and his guests have, according to journalist Ammad Butt, “spouted nonsense related to health, pandering towards conspiracy theories”.

What is the impact of popular podcasts such as these covering these topics? It is hard to track exactly but a doctor writing in The Guardian sets out the way that patients come in to his surgery saying they need blood tests to check their magnesium levels, after seeing on TikTok that it is the cause of symptoms such as tiredness, only to find that their levels are normal. More worrying, the report suggests, are those coming in that have actively chosen to not take medication, instead choosing to take different supplements or alternative therapies based on advice they picked up online.

What then should we be doing to engage with people that have alternative health beliefs? This is a very real question not just facing doctors but many other healthcare professionals such as pharmacists and dentists. There is surely a danger that people who hold these sorts of minority beliefs risk feeling alienated within conventional healthcare systems, particularly if perspectives are dismissed or minimized. And of course if patients perceive their minority beliefs are being invalidated, they may be less likely to seek medical advice or adhere to treatments.

Health inclusivity does need to extend to groups that hold alternative or non-mainstream health beliefs. But just how do we best do this? Behavioural science offers us some pathways to explore this, and we start with an alternative health movement that has been gaining ground, that of ‘crunchies’.

Crunchies

The concept of ‘crunchy’, as set out recently in the New York Times (NYT), relates to a lifestyle that is centred on natural living, avoiding processed foods, favouring organic products, and embracing alternative health approaches. Emerging from the 1970s countercultural movement, the term is closely associated with health-conscious and back-to-nature living. Over time, it has broadened out to represent a broad cultural identity related to wellness, sustainability, and parenting practices.

In modern contexts, the NYT suggests that "crunchy moms" have become particularly prominent, often rejecting conventional medical advice, questioning the safety of vaccines and fluoride, and advocating for attachment parenting methods such as co-sleeping and extended breastfeeding. Holistic and natural remedies are favoured over conventional medicine, and their preferences reflect a deep-seated scepticism of modern industrial systems, including healthcare, food production, and government regulation. The NYT suggests that social media platforms have amplified the reach of this movement, creating communities of like-minded people sharing practices and challenging mainstream narratives.

The crunchy movement has recently found a political ally in Robert F. Kennedy Jr. and his ‘Make America Healthy Again’ (MAHA) movement, which emphasises natural health, criticism of pharmaceutical companies, and opposition to vaccine mandates. His message resonates strongly with many of this group, who see his advocacy as a reflection of their fears of toxins and distrust of industrialised health systems. During COVID his prominence provided a rallying point for many people in the US and further afield, questioning mainstream medical advice.

There is much in these arguments that is understandable – few would argue against legitimate concerns regarding over-reliance on processed foods, the environmental impact of industrial agriculture, and the growing disconnect between people and the natural sources of their nutrition.

But at the same time, there are real concerns about some of the routes being taken by MAHA advocates, such as the growing acceptance of raw milk consumption in the US, despite FDA warnings about its dangers. While advocates argue that raw milk offers health benefits through probiotics and enzymes destroyed during pasteurization, health officials emphasise the significant risks from dangerous pathogens (aside from the risks related to Avian Flu).

How do we counter minority beliefs about health?

The issues encapsulated by the crunchy movement are often framed as ‘health misinformation’, primarily driven by content on social media. The conventional means to address this are strategies such as prebunking and debunking which involve exposing audiences to weakened versions of ‘misinformation’ alongside corrective information to build cognitive resilience.

Health literacy campaigns are another consideration, of course, challenging some of the narratives surrounding wellness and alternative health by equipping individuals with the critical skills to evaluate health-related claims, distinguish credible information from falsehoods, and make informed decisions.

While these approaches have been found to have some merit, they also have shortcomings. For example, prebunking campaigns, while effective in controlled settings, will typically find it hard to scale across large populations. But perhaps more fundamentally, the focus on the individual and their cognitive processes does not seem to adequately address wider societal forces that are driving the appeal of alternative health narratives or scepticism of authority. And this is before we consider a growing body of work (such as that of Zoe Adams or Sacha Altay,) that argues the evidence for the widespread effects of misinformation on behaviour is unclear and often overstated.

The suggests that to explore the way beliefs about health operate societally, we need frameworks that help us to better understand how wider social mechanisms operate. This can then hopefully direct us towards intervention activities that more directly engage with and address these beliefs.

Diagonalism as knowledge formation

One route that appears to have promise is the notion of Diagonalism. A relatively recent term, it has been used to describe groups whose political beliefs cut across traditional left-right divisions, blending elements from seemingly opposing perspectives to form a more complex, hybrid ideological stance.

In the health sphere, Diagonalism reflects a long-standing distrust of ‘hierarchical’ healthcare systems (such as governments, scientific bodies, and healthcare providers) and emphasises the value of horizontal relationships in offering trusted advice, where individuals turn to peer networks, influencers, and decentralized communities. This shift reflects broader societal disillusionment with institutional authority, as scandals and failures to address public concerns erode confidence in traditional sources of expertise.

While Diagonalism democratises access to knowledge, surely a good thing, the downside is that it can simultaneously devalue expertise, making it easier for minority beliefs to proliferate. Naomi Klein highlights how Diagonalist grievances, such as opposition to vaccines, distrust of corporate motives, and scepticism toward industrialized health systems, are frequently co-opted by far-right political movements, embedding health beliefs within these broader ideological frameworks.

That means on the one hand, that there are legitimate concerns about the impact of corporate overreach and public health inequities. But on the other hand, trust in horizontal sources can bypass traditional checks concerning accuracy of claims. This tension underscores Diagonalism’s potential to empower grassroots health movements whilst simultaneously risking fragmentation and polarization of knowledge.

Participatory Health and Democratic Engagement

Like them or not, podcasts like The Diary of a CEO and The Joe Rogan Experience provide platforms where people can engage directly with health-related information, bypassing traditional gatekeepers such as healthcare providers, governments, or academic institutions. This shift arguably reflects a broader societal trend toward decentralized, horizontal trust, where people seek to actively participate in discussions about their well-being rather than relying solely on ‘vertical’ expert opinions. The participatory nature of these platforms resonates with a desire for health knowledge to be accessible and collaborative rather than monopolized by institutional power.

This movement challenges traditional hierarchies of knowledge by enabling laypeople to challenge established narratives about medicine, nutrition, and wellness. And of course, given that health questions often lack definitive answers, this makes them particularly resonant in these spaces, allowing for diverse voices and perspectives to contribute and fostering a democratised process of inquiry. For example, online forums or social media discussions about vaccine safety or dietary trends often bring together individuals with varying levels of expertise, often creating a rich and complex set of perspectives.

There are clearly upsides here. By encouraging people to engage actively with their health, these platforms can foster a sense of agency and empowerment. They also pressure traditional institutions to become more transparent and responsive to public concerns, as seen in movements advocating for drug price transparency or patient-centred care models.

However, the democratisation of health information also carries risks. The lack of rigour in many participatory spaces can amplify a set of beliefs apparently unhindered by a clear understanding of the risks, such as beliefs relating to reduced take-up of vaccines, raw milk drinking as well as unfounded dietary trends. While the impacts of this on actual behaviours is contested there is nevertheless the challenge of how healthcare professionals handle these perspectives when voiced by patients they encounter.

What can health providers do?

There is a delicate balancing act for healthcare professionals and organisations when to engage with alternative health beliefs. But the Diagnonalist nature of the cultural mechanisms discussed above indicates that healthcare professionals could adopt participatory and empathetic strategies that reflect these cultural shifts around health knowledge formation.

There are in fact plenty of good examples of participatory and trust-building strategies to address these very issues. The World Health Organization, for example, has launched a Mythbusters initiative to tackle common myths about COVID and engages with user questions in real-time, fostering dialogue instead of top-down messaging. Professor Heidi Larson at the London School of Hygiene and Tropical Medicine established The Vaccine Confidence Project collaborates with a range of peer based networks and influencers to build trust in vaccines. The National Health Service (NHS) England has online forums where patients share experiences and discuss healthcare improvements directly with providers, ensuring public input shapes decision-making. On platforms like TikTok, healthcare professionals such as Dr. Jennifer Lincoln (@drjenniferlincoln) engage with a range of health beliefs by sharing evidence-based yet empathetic responses to popular health concerns.

It is clear therefore that there is a great deal of activity underway – the challenge is to understand how to make this relevant to the nature of the organisation (across the public and private sector) and develop them as integral to good practice rather than something that is added on as an afterthought.

Concluding comments

There is a strong case that the rise of alternative health narratives embodied by the crunchy movement cannot be fully understood without examining the horizontal trust networks bypassing traditional institutions. Engaging with this requires more than focusing on cognitive strategies like prebunking or health literacy, as while these approaches may be effective in addressing individual processing of information, the challenge is that they do not seem to adequately address the wider cultural dimensions that drive trust and belief formation. It is becoming apparent that healthcare organisations and professionals need to engage directly with the social spaces where alternative health narratives are discussed, recognizing their dual role – not only as amplifiers of scepticism but also as opportunities for meaningful dialogue.

By treating these platforms as entry points for collaboration and then engaging in ways that are grounded in empathy and cultural awareness, providers can surely find ways to better respond to public concerns while also promoting evidence-based health guidance.