Navigating a Crisis of Trust: The 2025 William C. Stubing Memorial Lecture

This year’s William C. Stubing Memorial Lecture, presented on November 13 by The Greenwall Foundation at The Rockefeller University in New York City, examined how we can understand the nation’s crisis of trust in medicine, science, and public health and explored how bioethics can help chart a way forward. The event featured a candid and wide-ranging conversation between Robert Califf, MD, former Commissioner of the U.S. Food and Drug Administration, and Matthew Herper, an award-winning journalist and Senior Writer covering medicine at STAT. 

The conversation began with an examination of the current moment—one defined, in Dr. Califf’s view, by widespread skepticism toward the institutions that shape health care and scientific decision-making in the United States. Trust, he emphasized, is not something leaders can simply ask for; it must be earned. “If you want to be trusted, be trustworthy,” he said.

Many people’s skepticism, he noted, grows out of their day-to-day experiences with the U.S. healthcare system: difficulty getting appointments, rushed visits, and clinicians overwhelmed by administrative burdens. These encounters, he argued, can reinforce a broader belief that the system is not designed with patients at its center.

Dr. Califf also discussed the role of bioethics in moments of uncertainty and public unease. He described ethics not as an abstract academic exercise but as a practical way of organizing thinking that can help when decision-makers weigh difficult tradeoffs and navigate real-world situations in which perfect answers are rarely available. He noted that this kind of structured ethical reasoning is often missing in the spaces where it is most needed. “I am not hearing in the boardrooms of America, or the health systems of America, our government—the current government—any discussion of ethics as even an issue to be thought about,” he observed.

Dr. Califf suggested that one area of disconnect is the outsized role that autonomy plays in U.S. policy and culture. “[For] whatever reason, we’ve decided in our policies that autonomy takes precedence over everything else,” he said. This emphasis can obscure the ways individual choices affect collective risk. He pointed to examples ranging from gun violence—“How can it be that the leading cause of death in our children is guns,” he asked, “and we can’t have a reasonable conversation about it because it might interfere with some right that individuals have in the Second Amendment”—to infectious disease, asking, “Do you have a right, for diseases which kill people, to say, ‘I’m not going to get vaccinated,’ when it might imperil…your neighbors?”

Turning to the COVID-19 pandemic, Dr. Califf reflected on how the national response exposed both the realities of scientific uncertainty and the difficulty of communicating that uncertainty to the public. In critical moments, he argued, leaders must act even when the evidence is incomplete. He noted that medical experts often disagree, yet decisions still must be made. “Not making a decision is making a decision,” he said, and the stakes of hesitation can be enormous when it affects an entire population. What was missing during the pandemic, he argued, was clear communication about the degree of uncertainty: “I don’t think a good job was done expressing to people the dimensions of uncertainty that existed.”  

Dr. Califf also pointed to the dramatic reshaping of the health information landscape in recent years, where influence has shifted from traditional institutions to digital creators with vast reach. To illustrate the scale of this change, he asked the audience, “How many of you know who MrBeast is?” Noting that the YouTube creator now has 664 million followers, he added that his “grandkids all follow MrBeast carefully, and whatever he says, a few million people are likely to try to do it.” Dr. Califf urged health leaders to take this shift in health information and communication seriously. “We can say that’s ridiculous, or we can say, ‘Wait a minute, this is affecting what people do.’ If we care about their health, we need to get involved and communicate in the same way.”

Transparency, Dr. Califf argued, must be part of the solution. Institutions should openly share information—good and bad—and engage communities directly. “Maybe it’s not so bad to be transparent,” he said, “and then get the people whose lives are at stake involved in helping to find the solutions.”

Despite the depth of today’s trust crisis, Dr. Califf expressed cautious optimism about the country’s ability to find its way through. “I’m sure we’ll come out of it. I don’t know how long it will take,” he said. Returning to a Humpty Dumpty metaphor referenced earlier in the conversation, he emphasized that rebuilding will mean “put[ting] [it] back together in a different way”—one that acknowledges the digital world we now live in and the need for “regulat[ing it] in some way that returns people to more communal values about how we affect each other and how we interact with each other.”

Dr. Califf closed with a reminder that progress will require both ethical clarity and moral courage. “If the right people spoke up about the right ethics,” he said, “maybe we could get where we need to go faster.”

About  the William C. Stubing Memorial Lecture  

William C. Stubing served as President of The Greenwall Foundation for 21 years. In 2016, the Foundation established the William C. Stubing Memorial Lecture in honor of its beloved former President, who guided the Foundation to its current focus on bioethics. Previous Lectures have covered timely topics in bioethics: the opioid crisis, climate change and mental health, automation and inequity in health care, the public health and ethical challenges of COVID-19, the social inequities revealed by the pandemic, physician aid-in-dying, drug pricing, and genome editing.