Looking back on 2025

Reflections on the challenging year that was.

As the calendar year wraps up, I would like to use this last essay of 2025 to reflect on the year we have just experienced. I would like to do this less to catalogue the year’s events and more to use this space, as I often try to do, to think in a systematic way about the world around us and what it means for how, and why, we do what we do. Events move quickly; the public debate often moves quicker still. Understanding what happens and why can be a challenge, one that calls for time and space to reflect, to think through the moment and its implications. The end of the year is such a time, and The Healthiest Goldfish aspires to be such a space, where we make an effort, together, to understand what is happening and the ideas that are driving the present moment.

So, what happened in 2025?

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On connecting too many dots

Ensuring the integrity of the associations that support our conclusions.

In 2020, a number of 5G masts were set on fire in the UK because of a belief that gained traction online linking 5G to the spread of COVID-19. Whoever committed this arson seems to have been motivated by the connecting of a series of “dots.” First (dot one), that 5G towers may weaken the immune system; second (dot two), that this made people more vulnerable to COVID; third (dot three), that 5G therefore, in a way, “caused” the pandemic.

It is easy to connect dots in ways that seem logical to us but do not withstand scrutiny. Sometimes these connections start with a fundamental misconception (such as that 5G weakens the immune system, which it does not), sometimes they start with correct, or at least plausible, information but go astray somewhere along the way. This was arguably the case with hydroxychloroquine during the COVID-19 pandemic. Early observational studies suggested there might be some benefit to its use. This was amplified rapidly through media and politics. But large RCTs, such as the RECOVERY trial, found no benefit. Nevertheless, hydroxychloroquine was touted for its supposed effectiveness, even as the data did not support this hype. The initial, plausible data point suggesting hydroxychloroquine may have some utility was quickly connected to other dots that had no bearing on its actual effectiveness, leading many to draw the wrong conclusions about the drug.

Closer to home, there has been much critique leveled at social science, in particular, for perhaps connecting too many dots, for making causal inferences too glibly. Are we maybe too quick to assert that a particular upstream neighborhood condition causes an individual health indicator? Are we connecting too many dots there? Is this, in part, why we have a replication crisis? We cannot avoid these questions if we are to shape a science worthy of the work we are trying to do, the world we are trying to create.

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Thinking outside the algorithm

On creating a better climate of ideas

Thinking back to when the internet was new is to remember a time when the world was promised an era of radical openness. The World Wide Web, we were told, would connect us and, in doing so, help us to better think, understand, and imagine. In some ways, the internet has delivered on this promise. It has linked anyone with web access to a flow of information that—in its speed, dynamism, and sheer complexity—resembles thought itself, a kind of global hive mind augmenting our ability to engage with everything, everywhere, all at once.

This Substack is, perhaps, a case in point, a small part of the great river of words and data that is the internet in 2025. The conversations, ideas, and connections that are the heart of The Healthiest Goldfish are enabled and deepened by the online world we have created, a world that has indeed opened new opportunities for how we communicate.

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Toward a more inclusive public health rhetoric

On embracing language that unifies in pursuit of health

In recent years, public health has engaged in a process of self-reflection about the language with which we communicate our ideas and engage with the public. This has involved asking at times uncomfortable questions, including whether efforts toward inclusive rhetoric in public health have had the effect of, in some cases, being exclusionary by acting more as progressive signifiers than as words and phrases that expand public health’s tent. This conversation has been informed, in part, by the 2024 election, in which the language of progressivism came under scrutiny for its role in possibly alienating elements of the public who might otherwise have been receptive to a message that aligns with many of public health’s preferred policies. In my role as dean of the School of Public Health at Washington University in St. Louis, I have had the privilege of being part of conversations with the school community about the signs and statements we embrace in our pursuit of health and how we can shape a style of communication that helps build a big-tent movement for health. Informed by these conversations, I wanted to revisit some ideas about how we can shape a rhetoric of trust and inclusion in public health, to build a movement that can create a better, healthier world.

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A call for structured heterodoxy in medicine and public health

On doing the difficult work of engaging in conversation

The past few years have underscored the consequences of rigid orthodoxies in medicine and public health. The COVID-19 pandemic was followed by a deep erosion of trust in medicine and public health, fueled in part by shifting guidance during the pandemic and the enforcement of policies (e.g., lockdowns) that were seen in retrospect as heavy-handed.

Vaccination, one of the sentinel achievements of public health, has become a flashpoint, with hesitancy growing in part because community concerns about ever-growing vaccine schedules and about potential (even if unfounded) side effects, seemed to be unheard. Dietary guidelines, long promoted as settled science, later proved partly misguided, helping to energize movements like “Make America Healthy Again” that thrive on challenging expert authority. And in areas such as addiction, where abstinence-only orthodoxy dominated for decades, people were pushed away from services that could have saved lives until harm-reduction strategies forced a course correction. Taken together, these experiences have fueled challenges of orthodoxy in medicine and public health and have led to alienation from the very people we aim to serve. This should make us pause and ask: How can medicine and public health preserve the value of consensus while creating space for dissent that builds trust and advances knowledge?

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Idea Factories

How understanding where “our” ideas come from can help us have better ideas

This piece was co-authored by Dr Nason Maani, and is cross-posted here.

The very business of writing a Substack blog is to generate ideas, to hope that some people read them, that they provoke reflection, and generate even other ideas. Because fundamentally ideas are the raw material of progress, the foundation that then can become action. In the spirit of being self-reflective about this idea generation, we launched a series we have been calling Ideas about Ideas, reflections about where these very ideas come from. In our last Ideas about Ideas post, we talked about the social life of ideas. Today, some reflections on the structures that give rise to ideas, that perpetuate ideas.

It can be tempting to think of ideas as if they arrive to us, as individuals, in flashes of insight or inspiration. But most ideas are not born that way. Instead, they are products that have been made. Ideas have funders, deadlines, and production targets. They are the output of networks, incentives, and institutions within which we all live. And that has implications for how we understand the ideas that we ourselves have, and how we engage with, absorb, agree or disagree with the ideas of others.

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We should talk

On doing the difficult work of engaging in conversation

We live in bubbles. And our bubbles think and speak in similar ways. We spend most of our time talking with people who think like we do, who see the world through lenses not unlike our own. This is true across our professions, our social circles, and our political affiliations.

A recent study found that, “A large proportion of voters live with virtually no exposure to voters from the other party in their residential environment,” communities where nearly everyone they interact with votes and thinks the same way. While more and more attention is being paid to these “partisan echo chambers,” the pattern extends beyond politics. We see it in how we socialize, the workplaces we choose, the schools where we send our children, the churches we go to — or do not. There are many consequences of this siloing of our daily lives, but perhaps none is more consequential than the fact that our conversations tend to reinforce what we already believe.

I have written before about the importance of understanding people with whom we disagree. It is tempting to treat “understanding” as a purely intellectual exercise — something that happens at a comfortable distance. But understanding demands more than the dispassion of so stating it. It requires conversation.

Talking with people whose worldviews diverge sharply from our own is hard work. It makes us uncomfortable. It demands restraint, humility, and a willingness to listen without rushing to correct. It can feel safer to avoid the exchange altogether. Yet without conversation, we never truly experience the pluralism that we may claim to value as a core of our open-minded approach to understanding all people. Absent conversion we run the risk of remaining ensconced in our own bubble, mistaking comfort for clarity.

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On finding courage to stay the course

Part 2 of 2. The importance of doing what we do, even in difficult times

Last week I wrote about this moment of challenge. I suggested that in such a moment there are in some ways two competing impulses. The first: Should we rethink what we do, how we do it? Are there things we should do differently, and why? The other side of that is courage. What about all the things that we do, have done very well, that also may be under pressure? How can we have the courage to stand for things that matter to us? How do we find that courage? So, building on last week, this is about the second part of this formulation: courage.

Most of us admire courage. We admire it in others and aspire to it in ourselves. When faced with setback or danger, everybody wants to rise to the occasion. Nobody wants to feel like they have fallen short.

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