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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