Historically, medicine’s power rested on a specific kind of cultural authority—the ability to determine not only what diseases exist, who has them, and what to do about it, but also what counts as evidence or truth. In “The Social Transformation of American Medicine,” first published in 1983, the Princeton sociologist Paul Starr describes two pillars of professional authority: legitimacy and dependency. Legitimacy provides a basis for why people accept influence over their lives; dependency refers to the harm they’re likely to face if they don’t accept it. Starr argues that authority is, paradoxically, characterized by the power to compel or persuade—but it is undermined by the need to resort to either. If you have to talk people into believing that you’re right, it’s because they don’t think that you are.
Medicine is undergoing a kind of unbundling. Specialized services can now be accessed à la carte from many sources other than doctors—even if some are bad for our health. The upshot is that medicine can no longer take its cultural authority for granted. In today’s fractured and fractious health-care system, doctors must convince patients of the value of their expertise, and at times they must outcompete other kinds of providers. We may need to accept that we are no longer the high priests of health care. Perhaps, instead, it’s time to think of ourselves as what we have always been: healers.
The medical profession wasn’t always powerful. For decades after the nation’s founding, doctors had competition from homeopaths, herbalists, apothecaries, midwives, and religious healers—not to mention mothers. Some doctors worked second jobs. Benjamin Rush, a physician and a Founding Father, encouraged students at the country’s first medical school, the University of Pennsylvania, to cultivate a farm, so that they could eat even when business was bad. Otherwise, he told them, you might harbor “an impious wish for the prevalence of sickness in your neighbourhood.”
In the nineteenth century, doctors started to consolidate their authority by standardizing, and encouraging, medical education. Most states passed medical-licensing laws, although they were unevenly enforced. But during the populist era that followed the election of Andrew Jackson—one of Trump’s favorite Presidents—many states repealed licensing requirements altogether, amid a surge in suspicion of élites and expertise. Not until the twentieth century did medical schools, medical societies, and medical boards—three types of institutions that can buttress a profession—coalesce to give doctors a new level of influence.
Some of today’s challenges to medical authority, including political shifts and technological changes, began outside the medical field. But others seem like reactions to long-standing shortcomings. Tens of millions of Americans don’t have a primary-care doctor, and, in much of the country, wait times to see a physician reached new highs this year. More than half of U.S. counties don’t have a psychiatrist. Many people wish that their medical providers spent more time trying to understand them. Meanwhile, medical errors are estimated to harm hundreds of thousands of Americans each year.
The multibillion-dollar field of menopause care, which has historically been understudied and underfunded, hints at what’s happening to health care as a whole. There has been an explosion of investment: between 2019 and 2024, venture-capital funding for women’s health more than tripled, and women now have access to care that they previously didn’t have. But these funds are not necessarily flowing to medical professionals; in some cases, so-called menopause influencers are exploiting a “menopause Gold Rush.” “The slowly dawning realisation that these women might be slightly underserved . . . has unfortunately coincided with the high-water mark of aggressive capitalism,” the author Viv Groskop argued in the Guardian. The BBC journalist Kirsty Wark has warned that many women are promised relief from “debilitating symptoms if they buy specially branded supplements, teas, and even pyjamas.”
Worthwhile efforts to make medicine more convenient and accessible can sometimes lead to care that is diluted and extractive—partly because businesses can be untethered from the ethics that guide the medical profession. For many health-care startups, selling pills and products is tidier than the comprehensive forms of care offered at traditional medical practices; writing prescriptions is more scalable than building relationships. Last year, Cerebral, which called itself the fastest-growing mental-health company in history, agreed to pay millions of dollars in fines for overprescribing addictive A.D.H.D. medications. Last month, following a Wall Street Journal investigation, executives at the mental-health startup Done Global were found guilty of aggressively pushing Adderall. At the trial, one clinician testified that she was “just stamping” prescriptions without conducting follow-up patient visits. According to a former executive, the C.E.O. had encouraged employees to “bend laws” and told them, “Whoever is the first person to get arrested, I’ll buy you a Tesla.”