I haven’t been impressed by most exhibits I’ve seen at community health fairs. I’ve seen many exhibits that I believe were a disservice to visitors. But my Cal State LA undergraduate students, working together in small groups, have developed the most interesting, illuminating health fair exhibits I’ve seen. On five occasions in three different courses since 2012, I gave students an assignment to create health fair exhibits on campus that promote critical thinking about health-related topics. I called it the Health Street Smarts Fair (HSSF) assignment.

In this column, I discuss: (1) my concerns about health fairs, (2) my vision for the HSSF assignment, (3) some of my favorite student-curated HSSF exhibits, and (4) prospects for skepticism activists to adapt the HSSF model to create street smarts fairs for skeptical outreach in community or school settings. In a follow-up to this column (Part 2), I’ll discuss issues for educators and skeptic activists to consider if they are interested in adapting the HSSF model. 

My Concerns about Health Fairs

Health fairs were common community events before the pandemic and probably will be afterward. According to a 1997 paper published in the Journal of Community Health Nursing:

One community health strategy used across the country to meet the demands for health promotion, education, and prevention is a health fair. A health fair can be defined as a voluntary, community-based, cost-effective event used to detect health problems, identify risk factors, and provide educational information and supportive resources to promote healthy lifestyles of its participants. Community members are encouraged to explore, at their own pace, health exhibits and information presented in a highly visible, easily accessible, interactive learning environment. The goal is to arouse awareness about health and health problems and stimulate the interest of community members to adopt behaviors that will improve health and reduce health risks and accidental injury.

The aim of a health fair is to attract large numbers of well people who can benefit from health promotion, generate a sense of partnership within the community, and enhance health communication among the community and multidisciplinary health. (p. 2)

Visitors can benefit from health fair exhibits when they receive accurate health information, useful gift items, and appropriate screenings such as screening for hypertension among adults. But they can be harmed when health fair exhibits promote inappropriate health care, exploit attendees, and spread misinformation.

Some vendors have promoted potentially counterproductive screening tests directly to consumers at various community sites. In 2014, the consumer advocacy organization Public Citizen: “urged 20 hospitals in eight states to sever their relationships with HealthFair Health Screening because the company’s heavily promoted, community-wide cardiovascular health screening programs are unethical and are much more likely to do harm than good.” HealthFair issued a sixteen-page defense of its package of six cardiovascular screenings. Half of the defense consisted of testimonials from satisfied patients. HealthFair vigorously defended its promotion of noninvasive ultrasonic duplex doppler examination for the clinical evaluation of the carotid arteries. Nevertheless, the February 2, 2021, Final Recommendation Statement Screening for Asymptomatic Carotid Artery Stenosis by the U.S. Preventive Services Task Force (USPTF) stated: “The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population.”

Former Rancho Santa Margarita, California, chiropractor Susan H. Poon unlawfully took personal identification information of attendees at health fairs at various UPS warehouses and Costco locations. Poon was convicted in June 2021 of defrauding health insurers Anthem and Aetna out of $2.2 million in a three-year scheme that included submitting fraudulent prescriptions containing fabricated medical diagnoses of dependents of UPS and Costco employees.

In the late 1980s and early 1990s, I attended health fairs in Ohio where chiropractors offered a free method of screening visitors for the need for chiropractic treatment. The screening procedure involved a S.A.M. (Spinal Analysis Machine) consisting of two scales, one for each foot, for the prospective patient to stand on simultaneously. The chiropractors used the device to look for differences in weight readings, postural abnormalities, and apparent leg length differences supposedly suggestive of spinal abnormalities that should be treated with a program of spinal adjustments. Stephen Barrett, MD, suggested that apparent leg length differences are “more likely caused by slight variations of hip position or of normal spinal muscle tension.” He also wrote about a free evaluation he received in 1993 from a chiropractor using the machine.

Exhibits promoting extraordinary claims can be found even at scholarly conferences. Paul Offit, MD, discussed an exhibit he noticed at an infectious disease symposium in New York City touting the extraordinarily silly homeopathic product Oscillococcinum as better than placebo for treating influenza symptoms. The absence of an active ingredient in Oscillococcinum makes it suitable for use as a placebo.

“Holistic health” and “health freedom” conferences often have absurd exhibits. I visited one such exhibit featuring a wearable “energy medicine” device similar to a “power band” that could supposedly improve my strength. I anticipated that the exhibitor would demonstrate the device the way promoters of similar devices have done. Pulling down on the extended arm of a visitor successfully before and then unsuccessfully after the visitor wears the device creates the illusion that the device is empowering. 

I had already learned from videos from Richard Saunders, the Australian Skeptics, and Scam Nation that subtle differences in the pulling motion with and without the device being worn can give very different results. I had the advantage of weighing at least twice as much as the petite exhibitor. I prepared myself to resist her attempt to pull down my extended arm while I wasn’t wearing the device. I enjoyed seeing how befuddled she was by my successful resistance to her effort to move my arm while I wasn’t wearing the device. I hoped that she would eventually reconsider the value of the device she was promoting. It was probably too much to hope for, but can you blame me for trying?

My Vision for the Health Street Smarts Fair Assignment

In 2011, I was given the opportunity to develop a special topics undergraduate public health course on “Healthy Skepticism” for freshmen and sophomore students in Cal State LA’s Honors College. The proposed catalog description for the course was:

An introduction to skeptical inquiry as a foundation for drawing sound conclusions about popular claims made about health-related lifestyle practices, practitioners, facilities, products, services, and information portals. Healthy skepticism emphasizes careful consideration of scientific evidence and knowledge, and human susceptibility to deception and misperception.

The course received approval as an interdisciplinary natural science course in the university’s general education program. While that approval wasn’t ideal for attracting STEM majors who take natural science courses required in their major fields, two biochemistry majors and one biology major enrolled in the course in the Spring 2012 term along with nine students majoring in various non-STEM fields. I was also able to recruit eleven topnotch public health and pre-nursing students to take the Healthy Skepticism course as an elective. 

Right before the start of the term, I noticed an announcement that Cal State LA’s student association, Associated Students, Inc. (ASI), was organizing an on-campus outdoor health fair to be held in early May. I thought it would be good for my Healthy Skepticism students to join the fair to promote healthy skepticism to other students.

I decided to divide my class into groups of about five students with each group curating an exhibit. I contacted ASI about my interest in having my students participate as exhibitors. I requested tables and chairs for five exhibits to be added to the fair. ASI welcomed the request. My ASI liaison made the necessary arrangements. 

I decided that “health street smarts” was a more relatable label than healthy skepticism for the exhibits my students would design. I also think it fits well. The Urban Dictionary describes street smarts as having four categories: (1) getting along with others, (2) common sense, (3) self-defense, and (4) BS-detection. Common sense and BS-detection clearly relate to healthy skepticism. So does self-defense in the form of avoidance of getting hoodwinked. And getting along with others is essential to being a good exhibitor and communicator of healthy skepticism. 

I thought an ideal exhibit would be interactive like the hands-on science museum exhibits at the Ontario Science Centre, the Exploratorium in San Francisco, and the California Science Center in Los Angeles. But I wasn’t sure that I would be able to guide all groups to develop interactive exhibits the first time I gave the assignment. Thus, I encouraged but did not require exhibits to be interactive.

One of the groups came up with an interesting, informative exhibit that wasn’t interactive. The exhibit debunked ionic foot baths promoted for detoxifying the body. When people put their feet in these baths, they see the water turn brown and are led to believe they are seeing evidence of “toxins” coming out of their feet. The exhibit demonstrated that no foot is required in the bath for the water to turn brown. The effect is produced by the electrooxidation of iron to produce rust. 

My Favorite Health Streets Smarts Fair Exhibits

After I taught the Healthy Skepticism course, I gave the HSSF assignment in two other undergraduate public health courses. One of the courses, “Consumer Health,” is an elective that has this catalog description: “Overview of health-related products, services, providers, facilities, financing, misinformation, quackery, fraud, and consumer protection. Examines consumer rights, responsibilities, vulnerabilities, pitfalls, and opportunities related to purchasing decisions in the health marketplace.” The other course, “Proseminar” serves as a capstone for our B.S. in Public Health program.

When I gave the assignment in these courses (on a total of four occasions), I required that the groups design their exhibits to be interactive and promote critical thinking. (I’ll discuss what I meant by critical thinking in my follow-up to this column.) For each course offering, each group’s exhibit had to be unique; once a group claimed an exhibit topic and got approval from me to proceed, no other group could have a similar exhibit. I gave students ideas about potential exhibits by showing them various videos about investigations by skeptics (such as the aforementioned videos about supposedly empowering wearable devices). I allotted many hours of classroom time for groups to plan interactive HSSF exhibits and get feedback from me about their plans.

I explained to students that the assignment had two instructional purposes. One purpose was to help the students learn about critical thinking by putting them in the role of exhibit guides. Another purpose was to help them learn how to evaluate the exhibits they developed as instructional interventions. In my follow-up to this column, I’ll discuss details about the evaluation component of the assignment and my other efforts to facilitate significant academic achievement through the assignment.

I scheduled each HSSF during one class meeting toward the end of the course at outdoor locations on campus where many students walk by. That worked especially well during spring semesters in Los Angeles when the weather tends to be good. Again, I arranged with ASI for tables and chairs.

Each time I gave the HSSF assignment, a group developed an exhibit involving blind-tasting comparisons of bottled and tap water along with providing cost comparisons and information about public water quality. Sometimes visitors preferred the tap water. Even when visitors preferred bottled water, exhibitors asked them to consider if the better taste was worth the cost, thereby encouraging critical thinking.

Many groups developed exhibits in which they asked visitors to make estimates of contents of different ingredients such as added sugar in different foods and beverages. They typically presented the sugar content with stacks of lumps of sugar. 

But my favorite exhibits involved deceptive claims and trickery followed by empathetic debriefings that revealed to visitors how the exhibits were misleading. These exhibits often demonstrated to visitors their vulnerability to deception.

I believe such exhibits offer visitors a valuable opportunity to learn the importance of being wary as part of health street smarts. Stephen Barrett, MD, identified lack of suspicion as making people vulnerable to quackery. Richard Feynman famously suggested to scientists what I think should apply to everyone: “The first principle is that you must not fool yourself—and you are the easiest person to fool. So, you have to be very careful about that.” In his book Don’t Get Taken, a guide to self-protection against bunco and bunkum, Robert A. Steiner offered these words of practical wisdom:

I don’t care how intelligent you are, how smart you are, how much you know, whom you know, how strong you are, how effectively you can fight, whether you carry a gun, how much you have read, how wealthy you are, or how much education you have had, you can be taken. (p. 7)

Here are some examples of my students’ you-can-be-taken exhibits:

1. “Energy medicine” device exhibits. On several occasions when I gave the assignment, a group created an exhibit hawking some kind of wearable “energy medicine” device to increase strength. Exhibitors learned from the aforementioned videos how leverage adjustments in muscle testing can convince visitors that they are stronger wearing a device than without it. My students debriefed visitors to wearable “energy medicine” device exhibits about the leverage trickery they used and that the devices are bogus.

Chiropractors practicing “applied kinesiology” use similar untrustworthy muscle testing approaches to determine whether various substances strengthen or weaken each of their patients. Differences from one test to another may be due to suggestibility; variations in the amount of force, leverage, or follow-through involved; muscle fatigue; and/or distraction. Muscle testers can mislead consumers either deliberately or unconsciously.

Some groups designed their own phony devices for their wearable “energy medicine” device exhibits. Other groups used a plastic wristband I received as an attendee of the The Amazing Meeting of the James Randi Educational Foundation. It says “JREF” in two shiny areas of the wristband that look like holograms. Imprinted along the wristband is “Placebo The Power of Belief.” 

2. Horoscope. One group designed an exhibit that effectively demonstrated the Forer Effect, which occurs when individuals rate a personality description that could apply to many people as highly accurate in applying to themselves. The exhibit consisted of twelve cards, one for each astrological sun sign. The top of each card was labeled with its corresponding sun sign. The other side of each card had the same personality description used by Bertram R. Forer in his research. After visitors selected the card for their sign and rated the accuracy of the description on the card for themselves, exhibitors revealed that all cards had the same description. The debriefings consisted of descriptions of relevant research findings suggestive of the Forer Effect. 

The group designed the exhibit after I showed their class a video segment on astrology from the 1993 broadcast of “Secrets of the Psychics” featuring a visit by James Randi to a class of college freshmen. Randi gave each student a “detailed horoscope,” asked each student to rate the accuracy of the horoscope received on a scale from 1 to 5, and then revealed that every student got the same horoscope.

3. “Human Energy Field” Detection Test. I showed my classes a video of Emily Rosa’s appearance on 20/20 with John Stossel demonstrating her fourth-grade science fair project. Emily came up with a clever test of the ability of practitioners of Therapeutic Touch to detect the “human energy field” that they claim to be able to manipulate for healing purposes with hand movements inches away from their patients’ bodies. Emily became the youngest person to have research results published when her simple, elegant test of Therapeutic Touch practitioners appeared in JAMA. 

In a few of my courses, groups created exhibits using Emily’s testing procedure on visitors rather than trained Therapeutic Touch practitioners. Seated visitors put their hands through holes in an upright board and were asked in repeated trials which of their hands had an exhibitor’s hand above it on the other side of the board. Visitors tended not to be surprised that they didn’t do significantly better than chance at detecting hands above their own. Most visitors were surprised to learn that Therapeutic Touch is taught in some schools of nursing.

4. Palm Reading. One student played the part of palm reader for one group’s exhibit. He amazed several visitors with what seemed to be illuminating interpretations of what lines on their palms meant. Of course, as group members informed visitors during the debriefings, the reader acted like he had real insight but simply made stuff up. 

Prospects for Skeptic Activists to Adapt the HSSF Model

Almost all students who completed the HSSF assignment wound up having much more fun than they had expected when I first explained the assignment to them. They enjoyed the favorable attention their exhibits received from visitors. Many thought that they learned from the assignment.

Nevertheless, as I will explain in my next Consumer Health column (Part 2), I don’t think the 

assignment was as successful as I had hoped in promoting meaningful learning. Groups often made slow progress in coming up with a significant learning objective and sound rationale for their exhibits. Many groups wound up rushing to get their exhibits ready right before the scheduled fair dates.

Other educators might have more success with the assignment than I did. My next column will address details about the assignment to help educators who might want to adapt it for their courses. Serious skeptics might also be interested in the details. I’ll discuss: (1) the instructions I gave students to guide them in completing the assignment, (2) the importance of process and outcome evaluation of exhibits, (3) the grading rubric I developed for the assignment, (4) ethical considerations in conducting street smart fairs, and (5) my assessment of the strengths and weaknesses of the assignment in eliciting meaningful academic achievement. 

The HSSF idea might be applied more fruitfully by volunteer skeptic activists than as a class assignment. Working on a team to curate an interesting exhibit can be an enjoyable, productive way for skeptics to socialize. It shouldn’t be hard to attract creative, enthusiastic volunteers to participate. I am optimistic that motivated skeptics can come up with creative ways to overcome logistical challenges to creating successful street smarts fairs.

It would help to find project funding to support street smarts fairs (not limited to health topics) as skeptical inquiry outreach activities in academic or community settings. 

The biggest expenses for our HSSFs were covered for my classes. ASI paid for the table and chair setups and, in some cases, tent setups. I obtained various promotional products at no cost from the University Health Center for my students to give to visitors as thanks for stopping by and participating. Included in the instructions for the assignment is this statement: “Each group will provide supplies needed for their exhibit, but no student should spend or be encouraged to spend more than $5.00 for the design of an exhibit.”

My students set up fairs ranging from five to ten exhibits. I think small fairs like those can be useful as a skepticism outreach activity as can fairs with more exhibits. It might be feasible to set up small fairs in conjunction with CSICon, Skepticamps, or other skeptics movement events. 

Perhaps it would be worthwhile to pursue funding to support street smarts exhibits at the kind of community health fairs I have criticized. Based on what I’ve seen at such fairs, our exhibits would be the coolest.

We need to do much more to expand the skeptics movement. I hope the HSSF model can inspire constructive action.