Better in their words…

In an op-ed Krutika Kuppalli attempts to dump the responsibility for the loss of prestige and respect currently being suffered through by physicians around the US and elsewhere on persons other than those in the profession, or in public health.

Her article, “Rise of anti-science rhetoric has fundamentally changed the relationship between doctors and patients And it’s getting worse” represents a textbook exercise in projection of guilt and shame.

Her article will not help anyone. So here is a reality-based open letter that might help. Share with your current or ex-physicians.

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To the clinicians, pediatricians, infectious disease physicians, primary care doctors, nurses, and allied health professionals who feel the quiet weight settle in the exam room before the conversation even begins:

You recognize the moment. The guarded posture when the word vaccineappears. The polite distance where trust once lived. The questions that arrive already sharpened by experience. You feel the emotional toll not because you lack resilience, but because something foundational between medicine and the people it serves has fractured.

Recent commentary has described this fracture as a rise in “anti‑science rhetoric,” a disinformation problem, a failure of federal messaging, or a pathology of public mistrust. That framing is incomplete. The deeper truth is harder, and it is this: medicine did not merely suffer a loss of public respect during COVID‑19.

It spent it.

This letter is written not to accuse, but to tell the truth plainly—and to offer a path back to legitimacy that does not depend on silencing patients, out‑messaging critics, or waiting for public memory to fade.

The Trust Did Not Collapse Spontaneously

Patients did not suddenly abandon reason. They watched how medicine behaved when power, fear, and uncertainty converged.

They watched uncertainty about falsehoods converted into certainty on command. They watched professional disagreement pathologized. They watched physicians punished for asking questions their training required them to ask. They watched parents dismissed from practices for exercise their rights to decline a medical intervention. They watched livelihoods, schooling, travel, and sometimes access to care made conditional on compliance with policies still evolving in real time.

You can debate legal definitions. You can argue whether the phrase “near crimes against humanity” goes too far. What cannot be denied is the moral architecture patients observed: coercion enforced by institutional authority, justified by appeals to an emergency, and insulated from correction by professional silence.

A profession that participates in coercion cannot demand deference afterward.

You feel the emotional toll because you now stand at the human interface of that moral injury. Patients deliver their verdict not with slogans, but with folded arms and refusal. They are not rejecting science. They are responding to betrayal. And they expect you to change, or become irrelevant.

The Central Failure Was Not Vaccines. It Was How Medicine Spoke About Them

Vaccinology has never been a moral binary. It is a technical discipline governed by endpoints, time horizons, host variability, pathogen evolution, and uncertainty.

Yet during COVID‑19, much of medicine abandoned that precision. “Effective” became a slogan instead of a claim with boundaries. Trial endpoints were cooked with window counting biases and treated as universal truths. Transmission was promised when disease mitigation was measured. Waning protection was reframed as moral failure rather than immunologic expectation.

You did not need to deny vaccine benefit to tell the truth. You needed to say—clearly, early, and consistently—what was known, what was unknown, and what could change. Many did not.

Patients noticed. And they have not forgotten.

They noticed when asymptomatic and presymptomatic transmission were invoked without proportionality. They noticed when PCR positivity was treated as synonymous with infectiousness. They noticed when models replaced measured outcomes in policy but were defended as settled fact. They noticed when dissenters were caricatured rather than debated.

They noticed when doctors and nurses did not stand up to defend their jobs when OSHA threatened their very livelihoods – all for a vaccine that did not prevent transmission.

Precision builds trust. Slogans destroy it.

COVID Exposed a Longstanding Pattern

COVID did not invent this legitimacy crisis. It revealed it.

Pertussis vaccine protection wanes. Mumps immunity wanes. Influenza effectiveness varies by season. Measles vaccines perform well to reduce symptoms, but vaccine failure occurs AND asymptomatic transmission is real. So why the exclusion of the unvaccinated from schools in which measles may inevitably enter?

Every physician knows this. Every physician trained in evidence‑based medicine understands that effectiveness is conditional, not absolute.

And if they do not know this, but the public does (and they do), medicine will have a longstanding problem until they reform.

Medicine has long relied on oversimplification in public-facing communication, assuming the public could not tolerate nuance. COVID demonstrated the opposite. People can tolerate uncertainty and being part of the decision-making given bona fide options.

They have proven that they cannot, and will never, tolerate being managed with falsehood.

This Is Moral Injury, Not a Communication Problem

The exhaustion you feel is not cured by better talking points or mindfulness apps. It has a name: moral injury—the distress that arises when one is compelled to act, or remain silent, in ways that violate one’s ethical core.

You know what medicine is supposed to be. You know what it became in moments of crisis. That dissonance is what walks into the room with you.

You will not out‑communicate a legitimacy crisis. You must resolve it.

A Blueprint for Legitimacy

What follows is not a branding strategy. It is a reform agenda—personal and institutional—that can restore medicine’s standing only if physicians choose courage over comfort.

1. Replace Slogans With Endpoints

Never use the word effective without stating the endpoint, the population, the time horizon, and the evidence class AND the EXCEPTIONS. Distinguish prevention of severe disease from prevention of infection. Distinguish trial outcomes from post‑authorization realities. Speak like a scientist, not a spokesperson.

2. Tell the Truth About Uncertainty in Real Time

Do not confess uncertainty retroactively. Build it into consent as it exists now. Document it. Honor it. Patients do not fear uncertainty; they fear manipulation and they are now immune to gaslighting.

3. End the Practice of Firing Patients for Disagreement

Dismissal for informed refusal is coercion, not cooperation. It puts the profitability of the practice before patient rights. READ THAT LAST SENTENCE AGAIN. It teaches patients that compliance, regardless of personal risk, is the price of care. If you want legitimacy, keep the respect-based relationship intact, document informed refusal, and continue to treat.

Tell every patient what we know you tell your family in secret.

4. Make Informed Consent Real Again

Consent is not a signature. It is not a “formality”. It is a deeply abiding social contract between doctor and patient. Lying or coercing a patient violates that social contract. Informed consent it is comprehension of alternatives, risks, unknowns, and follow‑up. Standardize consent discussions that include what is known, what is not, and how recommendations may change.

Call your patients the day or two after they start a new medicine and check for adverse reactions. Record them and report them. That’s not optional.

To fail to do so is to project: “I’m too busy to care”.

5. Practice Epistemic Humility Without Submission

Say: Here is the evidence. Here is how strong it is. Here is where it is weak. Here is my recommendation. The decision is yours. That is not weakness. That is medicine.

You set the tone for your relationship with each patient with every word and deed.

6. Separate Public Health Goals From Bedside Ethics

Population risk reduction does not override individual rights. When policy and individual patient welfare conflict, the physician’s duty is to the patient in front of them.

This is non-negotiable. People are not cattle. Treat them as such.

They deserve your full attention, your full understanding of their health, your full and irrevocable care.

7. Demand Transparent Evidence Grading

Support guidelines that publish full evidence tables, certainty ratings, conflicts of interest, and dissenting opinions. Defend the right to critique without retaliation.

You yourself are a patient. As are your family members. You may need dissent one day.

8. Treat Adverse Events as Clinical Realities, Not Reputational Threats

Investigate harms aggressively. Report them honestly. Care for injured patients without insinuation. Minimization breeds generalization.

Yes, this is redundant to the earlier mention. Because repetition helps you learn.

9. Reject Model Supremacy

Models inform decisions; they do not rule them. Distinguish modeled inference from measured outcome in plain language.

Simulations are not data. They are hypotheses. Never, ever confuse the two.

10. Restore the Patient as a Moral Equal

Parents and patients bring values, histories, and constraints. Treat those inputs as essential data, not noise.

“Your time” with your patient is not yours. It’s theirs. Never forget that.

11. Build Visible Accountability

Publish your practice’s consent standards, allow patients to change forms they sign, end your insipid and self-destructive dismissal policies, and seek ye not conflicts of interest. Create patient councils with real influence. Let patients see how ethics are enforced.

And let them guide you on their understanding.

12. Choose Truth Over Institutional Loyalty

If you overstated certainty, say so. If you stayed silent under coercion, say so. Then change your conduct and invite scrutiny.

Doctors who have lost their respect of their patients by lying to them during COVID-19, or from 1986-2026 about the safety and efficacy of pediatric and other vaccines owe their patients an apology.

They will accept it, and you, with open hearts, open minds and open arms.

You will also have to learn to forgive yourself.

That’s the hard part.

Because then you will change and never repeat the lies you told yourself: the false justifications for not knowing what you, among all people in society, should have known.

Call for Wholescale Reform of Medical Education

You know what they did to you. You are not your education. You are not your profession. You are yourself. The curious you. The one that wonders.

Don’t just think outside the box.

Understand this, and heal thyself: THERE IS NO BOX.

What Redemption Looks Like

Redemption is not applause from institutions. It is a parent who returns after years away. A patient who says, Thank you for telling me the whole truth. A moment when you leave the exam room knowing you honored both science and conscience.

Legitimacy does not return because the public becomes quieter. It returns when physicians become braver—braver about precision, braver about uncertainty, braver about refusing coercion, braver about seeing patients as equals.

If you want respect, earn it the old way: competence, honesty, courage, and care.

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This letter is written in the belief that medicine can be reformed not by force, but by integrity. The front door back to trust is open. Physicians must choose to walk through it.

We are waiting.

With enduring expectations for improved norms, mores and values,

Your patients

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