Letting in Light

Second Opinion

How can doctors restore trust in medical and scientific expertise?

Illustration of a woman opening a window shade
Illustration: Chiara Ghigliazza; Portraits: Nigel Buchanan
Illustrated portrait of Dr. Beth McGinty

Dr. Beth McGinty

Livingston Farrand Professor of Population Health Sciences
Chief, Division of Health Policy and Economics
Founding Co-Director, Cornell Health Policy Center

To restore public trust in medical and scientific expertise, we need to engage in discourse about science, communicate its evolving nature and consider values that are important to people beyond their health.

Engaging in better one-on-one conversations with our patients and improving our ability to talk about science on the public stage can be hard. Most scientists aren’t trained in science communication; we’re focused on conducting rigorous research on important scientific questions. We spend a lot of time getting grants to fund our research and writing up papers to publish findings for the scientific community. We are often not incentivized, in terms of getting promotion and tenure, to communicate our work to the public.

That’s why communication is one of the pillars of the Cornell Health Policy Center. We have exceptional communications researchers (like our associate director Jeff Niederdeppe) who look at how strategic messages and news coverage shape health policy. These researchers tell us what’s salient to our audiences so that we can communicate well with legislators, health system leaders and other decision makers.

And because technical jargon can get in the way, we’re building an infrastructure that allows clinicians and scientists to learn effective storytelling techniques.

But in order to really regain — or in some cases gain — public trust in science, we need to effectively communicate the foundational principle that science evolves.

It can sound to some as though scientists are “flip-flopping.” We have to help them understand that what makes science “science” is that we test hypotheses and discard what is no longer the best available evidence.

We also need to consider people’s whole lives as well as their health. During COVID, many in the public health and medical communities were saying what they valued was saving as many lives as possible. Nobody’s going to argue the importance of that.

But many didn’t do a good job acknowledging that preventing disease transmission wasn’t the only important consideration: We also value our economic security, our children’s education, our social connections.

People want to understand why we’re recommending the things we are recommending and how the science got us there.

We often fall into the trap of thinking that accuracy is what makes for good communication. Accuracy is critical, but we also need to make it understandable and relevant to people’s decisions.

Illustrated portrait of Dr. Joseph Safdieh

Dr. Joseph Safdieh

Richard P. Cohen, M.D. Senior Associate Dean for Education
Professor of Neurology
 

Seeing a public erosion of trust in science isn’t something new. We’ve long had parents not wanting to vaccinate their children because of safety concerns. Some historically marginalized communities carry deep skepticism rooted in the legacy of harmful and exclusionary practices within science and medicine. Today, we face a new wave of conspiracy theories and podcasts influencing everything from individual health choices to national policy.

It used to be enough for our medical and physician assistant students to know the science and to comprehend it, but now we need to make sure they understand how to communicate it in a way that acknowledges where the person they’re speaking to is coming from.

That means recognizing that many patients walk into an exam room having already consumed content that says, “Don’t trust your doctor.” They must know how to navigate these conversations so that the patient feels heard and acknowledged to establish a trust that may not have been there by default.

You can’t address this with a single lecture or a checklist of talking points and simply teach, “Here is what public erosion of trust in science means, here are some examples and here are some tips and tools to confront it.” 

We are now highlighting distrust in science as a societal problem to consider throughout all phases of our curriculum. We’re starting to give classes on vaccine hesitancy. We plan to incorporate it into our clinical skills center with some of the standardized patients we see. And as we leverage artificial intelligence, we can create more sophisticated scenarios, including with chatbots designed to be simulated patients who come to us with a range of information, beliefs and feelings.

You have to understand where the patient is coming from because while it may be related to just pure mistrust in science, there might be deeper issues. It might be that the patient has a different cultural belief system and that the standard of care you’re describing doesn’t align with their values.

At the heart of it all are empathy and reflective listening. The difference between a clinician who knows the facts and one who knows how to use them is their ability to listen, understand and respond, especially when trust is on the line.

Illustrated portrait of Dr. Joseph J. Fins

Dr. Joseph J. Fins, M.D. ‘86

Chief of Medical Ethics
E. William Davis, Jr. MD Professor of Medical Ethics
 

Wading through fan mail in the Lewis Thomas (1913–1993) archives in Princeton’s Firestone Library, I wondered if the exercise was worth it. As the physician-humanist’s would-be biographer, I was certain there was more important correspondence. But I was wrong. My research in the archives suggests why scientific expertise was valued in his era.

Dr. Thomas ended his career at Weill Cornell Medicine as scholar-in-residence, where a university professorship carries his name. He led NYU and Yale medical schools, Memorial Sloan Kettering Cancer Center, won two national book awards and a Lasker Award that heralded him as the “poet laureate of 20th century medical science.”

Always at the ready with literate and clever explanations about the latest medical advance, he explained the work of science, our ignorance and its fallibility. It was the depth of his analysis and candor about the limits and potential of science that built trust as a science communicator. As early as 1980, he warned against artificial intelligence.

Like his contemporaries Carl Sagan and Stephen Jay Gould, Thomas was a rock star in a media ecosystem that valued scientists. The Lives of the Cell and The Medusa and the Snail were bestsellers; he was profiled in The New Yorker and made appearances on Nova and The Dick Cavett Show. Admiring letter writers asked for reprints of his New England Journal of Medicine essays or autographed books for school raffles or for grandchildren aspiring to be physicians.But it was more than his ideas and demeanor that made for a receptive public. Dr. Thomas wrote in the wake of the advent of antibiotics, vaccines against polio and the majesty of the Apollo moon landings. And more broadly after Sputnik, science was a bipartisan priority. During the Cold War, neither scientific elites nor their institutions were the enemy, but rather nuclear adversaries like the Soviet Union.

Although science benefited from these global tensions, Dr. Thomas recognized its existential danger. In the Institute of Medicine and the National Academy of Sciences report The Medical Implications of Nuclear War, he called for nuclear disarmament, lest we’d be “gone without a trace. Not even a thin layer of fossils left of us, no trace, no memory.”

In his day, honesty endeared Dr. Thomas to America, away from division and toward cooperative conversation. Not a bad strategy for restoring trust in medicine and science.

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