Trust is a fragile yet critical resource for any institution. At the end of the day, civilization is mostly built on a handshake and a mutual agreement to follow the rules. This includes trust that designated experts have the expertise they claim, are competent, and are acting appropriately in the interest of others, rather than exploiting their position for self-dealing. A critical loss of trust leads to the collapse of institutions and even nations.
This is why perhaps the most insidious and long lasting damage that will be done by the recent shakeup of our federal institutions, specifically with regard to healthcare, will be a loss of trust. A recent survey indicates this is already happening. At present, trust in government health institutions is still moderately high:
“Majorities of U.S. adults say they feel mostly positive toward the CDC (65%), their state public health department (60%), and their local public health department (63%). Majorities of adults across political parties also trust these agencies’ health recommendations a great deal or somewhat, including 77% who trust CDC recommendations, 80% who trust their state health department’s recommendations, and 82% who trust their local health department’s recommendations.”
I would argue that ideally these numbers should hover around 90% or higher, but I guess the bar has been set so low recently that a roughly two-thirds level of trust is considered good news. The survey also shows that the situation is likely to get worse:
“More than four in ten U.S. adults (44%) say having the new leaders in charge of federal public health agencies will make them trust health recommendations coming from these organizations less than they used to. Smaller shares say leadership changes will make them trust recommendations more (28%) or about the same (27%) as they used to. Views are divided along partisan lines, with most Democrats saying they will lose trust (76%) and a majority of Republicans saying they will gain trust (57%).”
It may seem obvious that there is a strong partisan reaction to new federal leadership – but that should not be the case when it comes to science, healthcare, or any area that is supposed to be based on objective data and not politics. When it comes to priorities, most Americans in this survey agree, at about the 80% level – we need to tackle chronic illness, improve infant mortality, address addiction, and improve water safety. We want the same things – the difference is in who we trust.
Making science partisan is one of the primary problems here (an issue that goes beyond healthcare). When experts become political appointees, how can they properly command trust. Trust has to be earned and maintained, and one of the ways to do that is to follow a merit-based and transparent process, not an arbitrary political one. Institutions like the CDC are supposed to be insulated from partisan politics.
We have spent a great deal of space recently writing about RFK Jr. as the new HHS secretary, because he is uniquely incompetent and dangerous in this position. But he is not a one-off or an aberration. Part of the reason his appointment deserves so much attention is because he represents the ultimate expression of trends we have been warning about at SBM since our creation.
One of those trends is the rise of conspiracy theories, which have always been simmering in the background of American culture but have been given rocket fuel by social media and algorithms designed to suck people down conspiracy rabbit holes. Conspiracy theories are all about not trusting authorities, experts, and those in power. It is a pathological distrust, a narrative that elevates distrust to the ultimate virtue.
Another trend has been the rise of so-called alternative medicine as if it were a valid endeavor (something other than just a rebranding of snake oil and health fraud). CAM also survives by sowing distrust in science, scientists, expertise, and institutions. It is an overt attempt to shift trust from legitimate expertise to gurus and the fringe.
CAM and conspiracy theories also work hand-in-hand with the healthcare freedom movement, which is ultimately about diverting trust away from regulations. This movement exploits the language of freedom, but really it is only about the freedom of con artists and snake oil peddlers to operate unimpeded by any consumer protection.
All of these trends are operating together and playing off of each other. Don’t trust experts, scientists, or healthcare professionals. Don’t trust the government or corporations. Don’t trust the media or the mainstream narrative. Trust only the gurus with the compelling narrative, telling you exactly what you want to hear and selling you false hope. RFK Jr. is the embodiment of all that.
What we are seeing is what happens when the conspiracy theorists and snake-oil peddlers are not just freed from any regulation, but are handed the reigns of regulation. There are many layers to the harm that will be done, but perhaps the greatest harm will be a death blow to any public trust in institutions.
The counternarrative will be that these institutions lost the public trust all on their own, but this is transparent nonsense. Sure, science and healthcare are hard, requiring complex calculations with imperfect data, and there will always be mistakes and malfeasance to point to. Many people point to the botching of our handling of COVID as an example, and I think it is a good example – but not in the way they intend.
The scientific and medical response to COVID, a novel virus causing a rapid pandemic, was actually quite impressive. All along the way experts admitted – this is a novel virus, there is still much we don’t know, we are building this plane as we are flying it, etc. They made the best judgements they could with the information they had erring on the side of saving lives.
And all along the way, sniping from the sidelines, were the conspiracy theorists, healthcare freedom advocates, gurus, and charlatans sowing as much distrust in the system as possible, turning everything into a conspiracy, hyping fake treatments, and stoking as much anger as possible. They demonized Anthony Fauci to put face on their conspiracy theories. Then they have the audacity to claim that the resulting lack of trust was the fault of the experts themselves. They used the distrust they cultivated to justify themselves.
I would never argue that science is perfect, that the institutions of medicine are beyond criticism, or that there weren’t mistakes in hindsight in how COVID was handled. Of course there were mistakes. This is hard, and we are imperfect.
This gets to one of the greatest challenges of being and advocate for SBM and scientific skepticism in general. Trust is complicated, and we do not advocate for blind trust or unlimited trust. But we need a mature, eyes-open, transparent trust (trust but verify). We need to recognize the value of expertise, of evidence-based regulations, and of standards. We need to trust in a logical and tested process. But we also need to maintain a healthy skepticism towards all of it, constantly question and examine the system, and explore ways to make it work better. This requires judgement, nuance, and hard work. It’s easier to just burn it all down and go with what feels good – and that’s what we are experiencing right now.
