> 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.]

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..

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.

> 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.

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.