Public confidence in medicine has not collapsed in Europe. Instead, researchers say the bigger problem may be a widening gap between scientific authority and what patients can understand and act on. 

A survey conducted by the Piepoli Institute for FNOMCeO — Italy's national federation of medical associations — toward the end of last year found that trust in medicine in Italy remains extremely strong, at around 86%. Trust in primary care doctors is also high, at 81%. Yet this strong confidence is accompanied by a substantial gap in understanding, with two out of three respondents (64%) saying that experts speak in a language that feels too far removed from everyday life.

The most recent Eurobarometer report — a public opinion survey commissioned by the European Commission to measure views across the European Union — also released in 2025, reiterated that science is becoming a "foreign language" for many people in Europe: 53% of respondents said that science is so complicated that they don't understand much of it, up 7 percentage points from 2021. Added to that is a sense of unease at the pace of change, with 63% of European Union citizens saying science is suggesting lifestyle changes too quickly, and a perception that experts are not accessible enough: Nearly half of Europeans (48%) say experts do not spend enough time explaining their work to the public.

The issue, therefore, does not appear to be a collapse in trust, but rather the difficulty of turning trust into understanding and guidance.

Is the Problem Real?

"There is evidence of a debate surrounding a decline in trust in science, but little evidence of an actual decline in public trust," said Martin W. Bauer, professor of social psychology and research methodology at the London School of Economicswho participated in the 4-year European project Poiesis — Trust in Science, which concluded in 2025. "Rather, there is a risk of excessive trust: blind and unjustified public trust in science, or tolerance of technocracy," he told Univadis Italy, part of the Medscape Professional Network.

Bauer, who spent many years editing the international scientific journal Public Understanding of Science, is currently working on an article based on the results of the Poiesis project. "We argue that trust in science is based on the image of science, and that different images of science underlie different reasons for trusting or distrusting science. Furthermore, the image of science varies depending on people's social distance from science itself," he explained.

A similar view comes from Massimiano Bucchi, professor of sociology of science and communication, science, and technology at the University of Trento, Italy, where he also directs the international Scicomm master's program in communication of science and innovation: "The data tell us that there is no crisis of trust in science, even if at certain times there are those who tend to use unfounded stereotypes suggesting that citizens are ignorant, semi-illiterate, and disillusioned. What is often lacking is an awareness of the importance of acquiring communication skills, since speaking to the public is not the same as speaking to colleagues," Bucchi told Univadis Italy, drawing on data collected by his Science, Technology, and Society Observatory at Observa — Science in Society, an independent Italian research center that has tracked public opinion on these issues for years.

This disconnect is not just a cultural or media issue. In clinical practice, it can have very concrete consequences.

When Institutions Become Politicized

An increasing number of studies suggest that, when faced with a hesitant or misinformed patient, confidently listing scientific data is often not enough — and can even backfire. In a clinical setting, if patients trust their doctor but do not understand the medical language being used, they may still turn to unqualified sources that feel emotionally closer and more reassuring. 

According to Heidi Larson, professor of anthropology and risk and decision science who divides her time between the London School of Hygiene and Tropical Medicine in England and the University of Antwerp in Belgium, similar dynamics also operate at the social level, helping shape the response to crises and, in turn, the success or failure of public policies — for example, in vaccination, an area in which she has long been active as founder and director of the Vaccine Confidence Project, launched in 2010.

"Scientists and scientific information find themselves in an increasingly complex ecosystem, where people's perceptions of what constitutes reliable scientific evidence are influenced by a myriad of other people and factors, including politics, religion, culture, and personal beliefs. Faced with this complexity, the public turns to friends, family, journalists, and others for help in filtering and interpreting the enormous amounts of information available," Larson told Univadis Italy. In 2021, she also launched a second project, the Global Listening Project, which conducted a large-scale survey in 70 countries on trust in institutions, the results of which are available online.

This project explores what Larson calls the "ecosystem of trust," with the aim of generating insights that can make societies more resilient and better equipped to handle crises such as the COVID-19 pandemic. "The main problem facing science is the loss of its ability to influence decisions," she said. "Our work suggests that the core of the current challenge for science is not a loss of trust, but rather trust placed in unreliable sources. High levels of trust can be dangerous when placed in institutions and individuals who are misinformed or lack good intentions. In this regard, it is particularly problematic when social institutions become politicized and support policies and behaviors that run counter to the scientific consensus," Larson said, echoing what she wrote a year ago in an opinion piece in Nature, with a clear reference to events in US politics.

Empathy Over Argument

If part of the problem lies in trust shifting toward unreliable sources, the question becomes how to help people navigate information more effectively.

Starting from that premise, cognitive scientist Stephan Lewandowsky of the University of Bristol in England has studied the idea that people need tools and training to quickly identify poor-quality information or information that is distracting or harmful to individuals and communities. "We must teach people to ignore this information," he told Univadis Italy. It's a fascinating idea, but not an easy one to put into practice.

A more pragmatic approach — especially in the clinical setting, and particularly around vaccines — is the empathy-based approach that Lewandowsky has developed and tested in trials involving several hundred healthcare professionals. Empathy is often considered as a personality trait, or at best a "soft skill." But in this context, it becomes a crucial clinical tool that can be taught using a method called "empathic refutational interviewing" (ERI), also developed during the European project JITSUVAX.

The basic premise of the ERI technique is that disinformation takes root in people's fears, ideologies, and identity defenses — what researchers call "attitudinal roots" —and that attempts to correct false beliefs while ignoring these roots can trigger a defensive reaction in hesitant patients, leading them to reject the doctor's message.

Instead, hostility can be defused and the patient's attention gained — even within a few minutes — by following four steps: 

• Active listening, to bring fears and their roots to the surface (for example, fear of needles, distrust of the pharmaceutical industry, or moral concerns)
• Validating the patient's emotions, even acknowledging any "partial truth" underlying their fears, without endorsing misinformation or anti-scientific claims
• Politely and diplomatically explaining why the patient's idea is inaccurate, using a plausible alternative narrative that does not challenge their identity or worldview — in other words, their "attitudinal root"
• Presenting the data (for example, the severity of the preventable disease or the effectiveness of the treatment)

As Lewandowsky reports, doctors and nurses who participated in 60- to 90-minute training modules said they not only felt more confident in their communication skills, but also better prepared — that is, more confident in their ability to actively refute the myths brought up by patients. Healthcare providers also found that the ERI technique, by providing a clear structure for the conversation, helped prevent visits from turning into exhausting and unproductive debate over opposing views.

The point, then, is not to persuade citizens and patients to trust science more in the abstract. Surveys suggest that, to a large extent, that trust already exists. The challenge is to make it actionable — to transform it into understanding, guidance, and informed adherence.

Rather than a crisis of trust in science, European research points to a crisis of translation: between expert knowledge and everyday life, between authority and understanding, and between scientific evidence and the beliefs people bring to it. It is in that space that clinical empathy becomes not optional, but an essential part of care.

Massimiano Bucchi and Martin Bauer reported no conflicts of interest. Heidi Larson disclosed that funding for the Global Listening study came from the John D. and Catherine T. MacArthur Foundation, GSK, and Moderna. Stephan Lewandowsky disclosed that he is a nonexecutive director of Communiflex Ltd., which trades as JITSUVAX Training, a not-for-profit spinout company created to extend the impact of the JITSUVAX project through training healthcare workers in the UK and Europe. He also noted that a longer disclosure statement is available online. 

This story was translated from Univadis Italy, part of the Medscape Professional Network. 

This article is part of an ongoing, year-long Medscape series examining the decline of public trust in medicine. More content is available here.