Why has trust in medicine declined?

A recent California op Ed misses the point

One of my best friends is an accountant. He knows about as much about medicine as I know about double entry bookkeeping, which is next to nothing.

Early in the COVID pandemic, he asked me about the rules. He was not trying to make a political point. He was trying to make sense of what he was being told.

Why did he need to wear a mask while waiting for a table at a restaurant, but not while eating? Why did his two year old need to wear a mask at daycare, but take it off to nap? Why were playgrounds locked up? Why could people exercise on the beach, but not sit there with their family?

And perhaps most damaging of all, why was protest described by many as a public health imperative, while keeping a business open was treated as reckless?

That is when a lot of ordinary people started losing trust. Not because they suddenly became anti science. Not because they were too stupid to understand public health. Because they could see the inconsistency, the hypocrisy, and the moving goalposts.

The California Medical Association recently published an op ed by Dr Alex McDonald warning about the politicization of medicine. In many ways, I agree with him. Physicians should be concerned when patients make medical decisions based on “identity and partisanship” rather than evidence. Political leaders should not use medicine as a tribal weapon. Patients should not distrust effective treatments simply because the wrong person endorsed them.

But that is exactly the problem with the piece.

It treats the collapse of trust as if it began with Trump, RFK Jr., Casey Means, or Elon Musk’s purchase of Twitter. The withdrawn Casey Means nomination was unfortunate, but it was a symptom of the disease, not the cause.

During the COVID pandemic, patients watched public health become inseparable from politics. They watched leaders defend restrictions with absolute certainty, then redefine the goal when those restrictions failed, lingered, or caused obvious collateral damage. They watched dissenting physicians and scientists treated not merely as wrong, but as dangerous.

Schools are the clearest example. By March 30, 2020, almost every public school district in the country was closed. Then, in the summer of 2020, the Trump Administration pushed to fully reopen schools that fall, pointing to guidance from the American Academy of Pediatrics (AAP), which emphasized the benefits of in-person education. Shortly thereafter, the AAP changed its position, distancing itself from Trump and calling for a more cautious approach.

By January 2021, 53.4 percent of United States K 12 students were still in virtual only schools. Even after schools largely reopened, restrictions continued. CDC research found that from August 2021 through June 2022, more than 14.6 million students were affected by an estimated 25,907 COVID related school closure events. California kept school masking requirements until March 2022.

A later review found that school reopenings in low transmission areas with appropriate mitigation generally were not followed by increased community transmission. Yet parents who wanted schools open were often treated as reckless or anti-science. It turned out they were actually correct.

The same selective certainty applied to lockdowns more broadly. California maintained business restrictions through June 2021, with vaccine card verification requirements for many activities until Spring 2022. Mask mandates also persisted into February of 2022, and were required on airplanes until April 2022.

Sweden is a good example of why this mattered. They aggressively re-opened schools and businesses and their overall performance complicated the confident story that strict lockdowns were the only rational path.

California should be especially humble here. While Governor Gavin Newsom imposed those sweeping restrictions on businesses, schools, and ordinary life, he was also caught dining at the French Laundry with executives from the same California Medical Association that published this op ed. People remember that. They remember being told to sacrifice by leaders and institutions that seemed to view the rules as optional for themselves.

They also remember AB 2098, a law allowing COVID misinformation by physicians to be treated as unprofessional conduct. Newsom signed it. A federal court later preliminarily enjoined enforcement against some plaintiffs because the law was unconstitutionally vague.

So when the CMA now publishes an essay warning that politicians should stay in their lane, some of us have questions. Which lane was the CMA in when its executives dined with Newsom at a fancy restaurant while ordinary Californians were being told to cancel normal life?

This is not how trust is rebuilt.

When Dr. McDonald wonders why Americans don’t trust vaccines, he needs to look at both sides of the political aisle. Americans were repeatedly told that the COVID vaccine prevented the spread of COVID. This was false. President Biden blamed the unvaccinated for prolonging the pandemic and supported mandates that affected large portions of the workforce. The White House later warned unvaccinated Americans of a winter of severe illness and death.

Americans were also told the COVID vaccine was safe. While it largely was, political leaders were also quick to dismiss emerging evidence of the risk of cardiac complications in young men. When dissent is suppressed, Americans start to wonder what other half-truths and misinformation they are being fed. Institutional trust erodes quickly.

Americans clearly saw this suppression of free speech. Federal officials in the Biden Administration regularly communicated with social media companies about censoring COVID discussions. The Fifth Circuit found that some officials had coerced or significantly encouraged platforms. Mark Zuckerberg subsequently said senior Biden officials pressured Meta to censor COVID content.

Patients saw all of this.

Like my friend, they wondered why schools were closed so long, why they didn’t have to wear a mask at the airport bar but they did in the airplane, and why sitting on the beach alone was illegal unless you happened to be exercising.

And then they were told that the real problem was misinformation.

The breakdown in trust did not begin with the current Presidential Administration. It was accelerated by leaders and institutions across the political spectrum, including many who spoke in the name of science while behaving with stunning political blindness.

Physicians should defend evidence. They should defend vaccines when vaccines are supported by data. They should defend the doctor patient relationship from political interference.

But they should also defend humility.

They should be willing to say that some COVID policies were wrong, some lasted too long, some were defended too aggressively, and some did real harm. They should be willing to admit that trust was not destroyed only by one political tribe.

The CMA publishing a piece like this does not rebuild trust. It reminds people why they lost it.