📄 social_science

When conspiracies are true: exposure to documented pharmaceutical misconduct undermines institutional trust

An online experiment with 433 participants demonstrates that exposure to documented pharmaceutical misconduct significantly erodes trust across the entire health system, regardless of individuals' baseline conspiracy beliefs, without increasing general conspiracy beliefs.

Original authors: Ahoo Hekmati, Lorna Le Stanc, Emilie Salvia, Grégoire Borst, Mathieu Cassotti

Published 2026-09-28

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Ahoo Hekmati, Lorna Le Stanc, Emilie Salvia, Grégoire Borst, Mathieu Cassotti

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Trust is the invisible glue that holds public health together. When a crisis strikes, whether a pandemic or an outbreak, the success of the response depends entirely on whether people believe the people in charge are telling the truth and acting in their best interest. If citizens trust their government, their doctors, and the scientists behind the advice, they are more likely to follow safety rules, get vaccinated, and accept difficult reforms. For years, researchers have known that fake stories and baseless conspiracy theories can dissolve this trust, making people suspicious of institutions and less likely to cooperate. But a different, more complicated question has remained largely unanswered: what happens when the conspiracy is real? What is the cost when the public learns that powerful companies or officials have actually lied, hidden evidence, or broken the law?

A team of researchers at Université Paris Cité set out to explore this specific territory. They wanted to know if exposing people to documented cases of misconduct within the pharmaceutical industry would damage trust not just in those specific companies, but in the entire health system. They were also interested in whether people who already believed in conspiracy theories would react differently than those who did not. The study focused on a phenomenon known as the "spillover effect," where a scandal involving one group causes people to lose faith in other, unrelated groups that are part of the same system. The researchers hypothesized that seeing proof of wrongdoing by drug makers might make people question the integrity of public health authorities, government ministries, and even the safety of mandatory vaccines.

To test this, the researchers recruited 433 adults for an online experiment. The participants were randomly split into two groups. The first group, the experimental group, watched a seven-minute video compilation detailing real, documented scandals. The video included news segments and court evidence regarding the Servier Laboratories trial, where the company faced charges for hiding the dangers of a weight-loss drug that led to hundreds of deaths. It also covered the case of Purdue Pharma and its role in the opioid crisis through the marketing of OxyContin. The video concluded by listing other major pharmaceutical companies that had faced massive legal settlements for similar misconduct. The second group, serving as a control, watched a seven-minute documentary about the use of artificial intelligence in architecture, a topic completely unrelated to health or corporate wrongdoing.

Before and after watching their assigned video, every participant answered a series of questions. They rated how much they trusted the pharmaceutical industry, public health authorities, the Ministry of Health, scientific research institutions, and the safety of mandatory vaccines. They also answered questions about their general tendency to believe in conspiracy theories. The researchers then compared how the trust levels of the two groups changed after viewing the videos.

The results were clear and striking. The group that watched the video about real pharmaceutical misconduct showed a significant drop in trust across the board. Their faith in the pharmaceutical industry itself fell the most, which was expected since the video targeted those companies directly. However, the damage did not stop there. The same group also reported lower trust in public health authorities, the Ministry of Health, scientific research, and the safety of mandatory vaccines. In contrast, the group that watched the video about architecture showed no such decline; their trust levels remained stable. This confirmed that the exposure to real-world scandals caused a spillover effect, eroding confidence in the entire health ecosystem, not just the companies that committed the crimes.

Perhaps the most surprising finding concerned the role of pre-existing beliefs. The researchers had wondered if people who already suspected the world was full of secret plots would be more easily swayed by this new information, or if they would be the only ones to lose trust. The data showed that this was not the case. The drop in trust happened equally among everyone, regardless of whether they started the study with high or low levels of conspiracy beliefs. The evidence of misconduct was so compelling that it updated the views of all participants, making them more skeptical of the system. Furthermore, watching the video about real conspiracies did not make people more likely to believe in fake conspiracy theories. The study found that general conspiracy beliefs remained unchanged, suggesting that these beliefs are a stable part of a person's mindset and are not easily triggered by learning about actual scandals.

The study suggests that the cost of corporate misconduct is far higher than just a damaged reputation for a single company. When a pharmaceutical giant is proven to have acted unethically, it casts a shadow over the entire chain of public health, from the scientists who test drugs to the government officials who approve them. The researchers found that this erosion of trust is a systemic issue that occurs regardless of a person's political leanings or their history of believing in conspiracy theories. It is a direct response to the behavior of institutions. The findings imply that preventing this kind of widespread distrust requires more than just fighting misinformation; it demands rigorous oversight and accountability. If the private sector is allowed to act with impunity, the public trust necessary to protect the entire population may crumble, leaving society vulnerable when it needs to act together the most.

Technical Summary: When Conspiracies Are True

Problem Statement
While extensive literature documents how unfounded conspiracy theories erode trust in public institutions and science, there is a significant gap in understanding the impact of exposure to "real conspiracies"—events supported by substantial empirical evidence and judicial convictions. The pharmaceutical industry, frequently the subject of both conspiracy narratives and documented misconduct, serves as a critical case study. The authors investigate whether exposure to documented pharmaceutical scandals reduces trust not only in the industry itself but also in the broader ecosystem of health governance, including scientific institutions, public health authorities, and mandatory vaccines. Furthermore, the study examines whether pre-existing conspiracy beliefs moderate this erosion of trust or if the effect is uniform across the population.

Methodology
The researchers conducted an online pretest-posttest experiment with a final sample of 433 participants (N = 433), randomly assigned to either a Real Conspiracies condition or a Control condition.

Stimuli: Participants in the experimental condition viewed a 7-minute video compilation detailing documented misconduct in the pharmaceutical industry. This included the Servier Laboratories trial regarding the drug Mediator (charges of aggravated deceit and involuntary manslaughter) and excerpts from a documentary on Purdue Pharma's OxyContin marketing practices. The video concluded with a list of other implicated companies and settlement amounts. The control group watched a 7-minute documentary on AI in architecture.
Measures: Participants completed measures before and after the video intervention. Key dependent variables included trust in:
1. The pharmaceutical industry.
2. Public non-governmental scientific research institutions.
3. Public health authorities.
4. The Ministry of Health.
5. Scientific research as a source of information.
6. Mandatory vaccines.
- A general conspiracy belief scale (Adolescent Conspiracy Belief Questionnaire) was also administered to test for moderation and potential increases in conspiracy ideation.
Analysis: The authors employed linear mixed-effects models for each measure, including fixed effects for Condition, Session (pre/post), and their interaction, with a random intercept for participants. Familiarity with the companies was included as a covariate. Planned contrasts and Holm–Bonferroni corrections were used for post-hoc analyses.

Key Results

Reduction in Trust: Exposure to documented pharmaceutical misconduct significantly decreased trust in the pharmaceutical industry itself (interaction $\beta = -0.55, p < .001$ ). Within the experimental condition, trust also decreased significantly from pre- to post-test for public health authorities, the Ministry of Health, scientific research institutions, scientific research generally, and mandatory vaccines (all $p < .05$ ).
Spillover Effect: The negative impact extended beyond the directly implicated industry, with significant pre-to-post declines observed in the experimental group for all five complementary trust measures. However, when comparing the experimental and control groups directly at the post-test, the differences were not statistically significant for trust in research institutions ( $p = .130$ ), the Ministry of Health ( $p = .347$ ), scientific research ( $p = .151$ ), and mandatory vaccines ( $p = .093$ ). Significant post-test differences between conditions were only found for trust in the pharmaceutical industry itself.
Role of Baseline Conspiracy Beliefs: Pre-existing conspiracy beliefs were associated with lower overall trust levels across all domains. However, these beliefs did not moderate the effect of the exposure. The decline in trust occurred uniformly regardless of whether participants held high or low baseline conspiracy beliefs.
Stability of Conspiracy Beliefs: Exposure to real conspiracies did not increase participants' general conspiracy beliefs (interaction $p = .077$ ), suggesting that documented scandals do not fuel further conspiratorial ideation.

Key Contributions

Empirical Evidence on Real Conspiracies: The study provides experimental evidence that "real" conspiracies (documented scandals) produce a measurable erosion of institutional trust, distinct from the effects of unfounded conspiracy theories.
Systemic Spillover: It demonstrates a "spillover effect" where misconduct by private sector actors (pharmaceutical companies) leads to significant within-subject trust declines across adjacent public institutions (Ministry of Health, public health authorities) and scientific pillars. While the direct between-group differences at post-test were not significant for all measures, the pattern of significant pre-post declines in the experimental group (absent in controls) indicates a system-wide sensitivity to misconduct.
Independence from Conspiracy Mentality: The findings challenge the notion that only those prone to conspiracy theories are vulnerable to trust erosion. The study shows that even individuals with low baseline conspiracy beliefs update their trust downward when confronted with evidence of real misconduct.

Significance and Claims
The authors argue that their findings highlight the fragility of institutional trust in the face of real-world scandals. They claim that misconduct in the private sector should be viewed not merely as reputational damage to a single company, but as a system-level threat to public trust.

The study suggests that trust erosion is a performance-based response to institutional behavior rather than solely a function of cognitive biases or misinformation. Consequently, the authors posit that addressing trust deficits requires more than just combating conspiracy theories or improving analytical reasoning; it necessitates robust oversight, accountability mechanisms, and transparency that anticipate cross-institutional contamination. The results imply that the cost of pharmaceutical misconduct extends far beyond the industry, potentially undermining compliance with public health measures and the legitimacy of the entire health governance system.

Technical Summary: When Conspiracies Are True

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