The more evidence behind a therapy, the less the public trusts it

4/3/2026 at 3:11:28 PM

> Trust is not rebuilt with meta-analyses. It is rebuilt in exam rooms, one patient at a time, by physicians willing to say... "Let’s talk about what the evidence actually shows".... If we can’t have that conversation, we are not practicing medicine.

I agree. But that conversation can't happen where appointments are restricted to 20-minute segments, and trust cannot be established within a system where patients are forcibly changed to different doctors / medical systems based on the business requirements of insurance companies.

The doctors I know (all ~10 I can think of off the top of my head) have left, or are trying to leave, direct patient care. They haven't been allowed to practice medicine, as so defined, for years.

(This is in the USA, by the way. If you live in a country with a different model, count your blessings and fight like hell to keep it.)

[Edit: Actually, two of my acquaintances included in the number above have switched (or thought about it - it's been a couple of years since I saw one of them, and I don't know if he pulled the trigger) to concierge care. Look it up, if you don't know what that means. It may be the last remaining rump of traditional medical practice, but it's not sustainable / scalable, and is arguably a prisoner's dilemma defection which hurts the system as a whole.]

by eszed

4/3/2026 at 6:08:33 PM

> But that conversation can't happen where appointments are restricted to 20-minute segments, and trust cannot be established within a system where patients are forcibly changed to different doctors / medical systems based on the business requirements of insurance companies.

And the frequency of visits. The recommended one visit every three years for 18-64 year olds isn't going to build much trust.

by zardo

4/3/2026 at 5:21:40 PM

The secret is to find independent doctors who have their own private practice and who have hospital admit privileges. Also physicians who take cash payment and operate outside a big health organization or who have affiliations with them but don’t answer to them.

by jxramos

4/4/2026 at 3:26:42 PM

You're right, but local independent physician business model is being destroyed by insurance requirements. I have an uncle who ran an office like that for 20+ years. He employed two nurses, a receptionist, and a full-time coder (for those of you who don't know, that job is the translation layer between medical services and insurance companies). I don't know the economic details, but lately he was spending too much of his own time arguing with insurance company medical "experts", and facing hiring a second coder. He closed his practice, and semi-retired. He's bitter, and doesn't think there's any route to physician independence beyond cash-pay / concierge care. (He's not a speciality that lends itself to that model.)

by eszed

4/3/2026 at 5:42:04 PM

The danger is whether they keep up with the field or just continue what they learned in their time in medical school. At least with a major hospital they are surrounded by other experts in the field including a batches of newly trained doctors.

by asdff

4/3/2026 at 6:23:57 PM

There’s an OBGYN we’ve long had a relationship with who takes on residents and cross pollinates with them for a win win knowledge transfer. They also volunteer overseas with charitable medical efforts. Those are probably interesting avenues for keeping up with things from the outside to some degree I imagine.

by jxramos

4/3/2026 at 5:29:03 PM

I feel like distrust in general is on the rise. We used to just acknowledge that in some areas we have no idea. Therefore, we'd trust others who do. With the internet in its current state, everybody seems to have an idea all whilst it becomes more and more apparent that big institutions might not only have your wellbeing in mind. So we become frustrated with the fact that we can't seem to trust one thing, search comfort in communities whilst forgetting that we probably shouldn't trust them blindly as well. So who do we trust? Might just be easier to follow the ideas of likeminded people or that influencer you find cool than the big pharma systems. The sadest thing is, those influencers also want to make money off of you. Who cares about humans anymore? I think it's justified that everybody gets confused in this world..

by Leomuck

4/3/2026 at 5:38:09 PM

We dumped people all this information in these recent decades, which was great, but never taught them critical media theory to actually vet the firehose and identify high quality information from bad or troll posts or straight up propaganda. They think they are doing research, but it is more like walking into a saloon and listening to whatever might be said and running with it.

by asdff

4/3/2026 at 7:50:37 PM

Personally I don't trust big pharma or the natural or alternative medicine people who want to sell me things.

Pharma has shown itself untrustworthy too many times, and in general I don't trust big institutions with financial entanglements to have my best interest at heart.

I do have personal experience with some plant medicines being extremely effective at certain things. While most of the time it's hard to prove, some are so obvious that it makes me open to the possibility that the less obvious ones also may be helping. I use plant medicines all the time because they are free or cheap and relatively harmless like real food, in fact they often are food.

That said if I get in a car accident I will go to the hospital. It's not all or nothing.

by lithocarpus

4/3/2026 at 4:12:38 PM

I think a lot of studies are actually illegitimate. I think scientists all admit this, which is why peer-review, disclosing conflicts of interest, sharing your data, reporting all your measures BEFORE you collect data, not lying with statistics, etc are all being asked for (and often not done). This is why scientists often weight for meta-studies and replication before trusting any finding.

Laymen also correctly have an intuition that the people doing these studies aren't entirely trustworthy. What they don't have is a clear picture of how much work goes into these studies, who's doing it, what their motivations are, etc.

In my opinion studies when they can, should record videos of all data and make it publicly available online. Watching somebody do 1,000 hours of research is more proof-of-work to lay-people than some semi-coherent summary-for-a-layperson article.

by zug_zug

4/3/2026 at 4:28:54 PM

Laymen have been trained to be reflexively distrustful of everything because there's more profit and power in weaponizing fear and cynicism.

by add-sub-mul-div

4/3/2026 at 4:57:03 PM

When a political party controls the science, you end up with say, Trump pushing one set of results, and Biden pushing another. It then becomes either pick the science that agrees with your politics, or throw up your hands in frustration. The average reader probably won't be able to dig into the fundamentals of the research and pull out the salient results, nor are they guaranteed it isn't policy pushed through overstated claims. It really undermines good science. It also falls back on the researchers who push science based on politics as well, so it isn't just the politicians.

by jvalencia

4/3/2026 at 5:32:37 PM

That’s all true but it’s orthogonal to what i think you are responding to IMO.

I don’t think that studies are bunk because of corporate money, I think they are bunk because of how many studies I read. I am not a very fun person so when I see news reports about studies, I try to look them up. I find it more peaceful than memes or celebrity events. Think “coffee is good/bad for you again” style studies we read about daily.

These studies always suck. Ok, maybe 90% if I’m not being hyperbolic. It’s small sample sizes sure, but it’s also faulty logic, unsupported claims from evidence, lack of looking for alternatives, lack of ruling out confounding factors. And don’t get me started on soft-science an arts theses, I don’t have time.

I know that science moves forward mostly in millimeters, and I would agree that we have more and better scientific knowledge now than we have had in the past. But it certainly isn’t for the amount of publish-or-perish, p-hacking, storytelling, or outright fabrication.

by justonceokay

4/3/2026 at 5:51:08 PM

In my experience the lay people aren't getting a great idea of the state of the field. Like you say coffee good/bad studies. It isn't that simple. People test all sorts of things in different contexts. But maybe some are genuinely bad studies. You don't know though because science journalism is so crappy. They don't care about the merits of the study. They go "people drink coffee, maybe that would drive engagement."

The most interesting papers are not going to get popular press releases because they are so many steps removed from the context that lay people understand. They can understand "coffee good/bad." They can't understand anything about the stories we are actually telling at the bleeding edge of a field, because even our undergrads working in our labs on these projects can scarcely understand them. Second year grad students struggle to understand them. How can a science journalist who only has a bs from communications department, or the lay public, possibly understand?

So, they don't reach for those papers when they seek to write articles for engagement. And the lay public doesn't learn the state of the art, and assumes the worst of the field from what they do read about.

by asdff

4/4/2026 at 4:32:56 PM

I think a lot of people trust the person in front of them more than the evidence stack behind the recommendation. If the system feels rushed, opaque, or financially conflicted, better studies do not fix that by themselves.

by liv_intel

4/3/2026 at 6:24:30 PM

The US health system seems to suffer a bit from not trying to do what's best for the patients so you have a huge insurance bureaucracy that bankrupts people and shorter life expectancies that most developed countries. I'm not surprised people are not very trusting of it.

by tim333

4/3/2026 at 11:38:37 PM

> shorter life expectancies

It is a fallacy that US health systems cause that. Lifestyle preventatives are far more important than acute healthcare. Exercise, food, and accidental deaths matter.

The main exception in other countries is that a high average lifetime is highly dependent on babies and young children surviving.

Good healthcare helps lifetimes, but other factors dominate early deaths.

by robocat

4/4/2026 at 6:08:09 AM

30 years and nobody (pharma, govts, etc.) have not found it worth to study this properly. If it worked, would not at least some researched pick this up?

by functional_dev

4/3/2026 at 7:50:34 PM

trust then verify , which when I try to do, find myself and my questions met with every kind of push back, refusals, bullying, and outrage. a "study" is not evidence unless it is specificly cited and referenced. If the US had the best health in the world, it wouldbe one thing, but they dont, and there cost's are ruinous, so any expectations of trust, are disingenious at best.

by metalman

4/3/2026 at 6:06:32 PM

> But the response has not been better skepticism. It has been the migration of trust from one set of financially motivated actors to another.

This is the crux of it all. People want something to trust. If scientific institutions do not fuflill this role, peoppe migrate to pseudoscience, religion, pop stars, anything they can find. People will choose anything they can find to trust over remaining a sskeptic. Becsuse being a skeptic is a cognitive load that most are not really taught how to handle. It breeds anxiety, stress in people and causes/compound health/emotional issues that sometimes can then be solved better by supplying a lie to lower the anxiety and stress.

by ghighi7878

4/3/2026 at 7:48:52 PM

I thought there was evidence statins are bad for you? Bad example?

by erelong