Achim Mortsiefer, MD, general practitioner (GP) in Cologne, Germany, understands why some patients don’t trust their doctors. Sometimes, he thinks, it’s justified.

“The economization of modern medicine is dangerous for the trust in the physician-patient relationship and also the relationship the patient has with health services in general,” Mortsiefer, who is also a professor and a chair of general practice and patient-centeredness in primary care at Witten/Herdecke University, Witten, Germany, told Medscape News Europe.

Patients increasingly doubt that doctors act in their best interest, he said, citing rushed appointments and prescriptions issued without meaningful discussion. What worries him is that primary care is drifting from continuity and personal relationships toward more fragmented, transactional care.

For Mortsiefer, the danger is not only that patients lose faith in individual doctors but also that they begin looking elsewhere for care that feels more personal and empathetic. He and other experts who spoke with Medscape News Europe see this trust vacuum feeding a booming market for wellness and alternative medicine — and, in some cases, creating openings for unproven therapies, misinformation, and antiestablishment messages that borrow from the language of wellness.

A Legacy of Eroding Trust

Trust in health systems across Europe varies between countries, from more than 70% in Norway and Switzerland to less than 50% in Greece and the UK. People who feel their primary care professional spends enough time with them are almost 90% more likely to trust the healthcare system.

Institutional trust has been in decline since the late 1950s, Stephanie Baker, PhD, professor of sociology at City St George’s, University of London, London, England, told Medscape News Europe. Her research explores the intersection between society, technology, and culture in relation to health and medicine.

“Distrust of experts and elites proliferated among health and wellness influencers in the 21st century due to a series of incidents and scandals that received widespread attention, presenting the scientific and medical establishment as compromised by financial and political incentives. The erosion of trust was further accentuated by the pandemic.”

Baker’s research points to food, health, and industry controversies that contributed to this climate of distrust, including the British government’s initial reassurances over mad cow disease; global food fraud scandals involving fake apple juice, melamine-tainted milk, and horsemeat sold as beef; and concerns about the food industry influence over nutrition science. Such episodes, she has argued, helped reinforce the view that expert institutions could be shaped by commercial and political interests.

Filling the Gap With Wellness

That erosion of trust, combined with frustration over access, cost, and impersonal care, has fed a boom in alternatives to mainstream medicine.

Catherine Tebaldi, PhD, linguistic anthropologist and postdoctoral researcher at the University of Luxembourg, Esch-sur-Alzette, Luxembourg, isn’t surprised by the rise in antiestablishment sentiment.

“Mainstream healthcare in Europe is in crisis for a lot of people; it’s unaffordable and it’s dehumanizing. We obviously need to be doing better to give people a reason to trust their healthcare provider, such as making sure everyone has access to a sympathetic primary healthcare doctor and ensuring they can build a proper relationship with them,” she told Medscape News Europe.

Failure to do that helps explain why some alternatives hold appeal.

“An herbal remedy or an alternative therapy can offer people not only a more affordable solution but personal care. And I don’t think they’re always wrong for seeking it out,” she said.

The market is already substantial. Forecasts project the global complementary and alternative medicine market will grow from USD $181.4 billion in 2024 to USD $1.73 trillion by 2034.

When Wellness Turns Political

Tebaldi, who studies how the far right adopts the language and imagery of wellness culture, says ideas about natural health, purity, strength, and tradition can become political when applied not only to individuals but also to nations.

“Health is this metaphorical thing about the national body, not just a person,” she said, in reference to the Make Europe Healthy Again movement, which advocates for a Europe “where health flows from its roots — heritage, tradition, and the wisdom of the people.”

For Tebaldi, that language reflects how appeals to natural health and tradition can merge with exclusionary ideas about nationhood, race, and belonging.

“It’s about going back to tradition to make the nation strong and healthy. A lot of it, though, is pro-nationalist for White women, anti-immigration, anti-Blackness, and anti-Islam.”

Baker sees similar overlaps between wellness discourse, conspiracy thinking, and far-right politics.

“The wellness movement grew out of a dissatisfaction with the medical system and has long been susceptible to misinformation and alternative views,” she said.

“Both conspiracy theorists and many wellness practitioners distrust the system. The far right shares this view, and their messaging dovetails with the emphasis on purity in wellness discourse. Cleansing the body becomes a microcosm of cleansing the state.”

Edzard Ernst, MD, PhD, Germany-based physician and former professor of complementary medicine at the University of Exeter, Exeter, England, says alternative medicine can in some instances be described as post-truth healthcare. “It fits the Zeitgeist where truths and untruths have become indistinguishable,” he told Medscape News Europe.

“Most of the time, I find it quite amusing and am keen to learn what sort of nonsense will be promoted next. Is it dangerous? Yes, some of it, no doubt.”

Yet dismissing alternative medicine as nonsense may do little to persuade patients who already feel medicine is not listening to them.

Earning Trust Back

Mortsiefer’s answer to the issue isn’t more information or louder warnings. It is a different kind of clinical encounter.

During a recent consultation with a patient who wanted to lose weight, Mortsiefer said the easy response would have been to agree and list the risks for excess weight, such as heart disease and diabetes.

Instead, he used the Positive Health approach, developed in Netherlands and now being trialed in Germany. The framework encourages GPs to discuss health holistically, including quality of life, mental well-being, and daily functioning, rather than focusing only on disease or risk.

“The point was not to say, ‘You need to lose weight,’ but to ask, ‘What would you do if you were lighter?’ My patient told me she’d go swimming, and when she spoke about it, her eyes lit up. I asked her: ‘How can we reach your goal weight together? How can I support you?’”

For Mortsiefer, consultations are important opportunities to build trust and learn more about his patients and how he can support them.

“In my practice, if something is wrong, the process of decision-making is done together. We all love the easy solutions to take a pill and be all better, but that’s not right,” he said.

“In my view, we need strong primary healthcare-led systems, where everyone can see their own doctor and have good communication. It’s our chance to turn the tide in the right direction.”

Ernst agrees that if doctors want to be trusted, they must earn it.

“Doctors who have time, sympathy, and empathy with their patients and do what they are taught to do — namely provide them with the best treatment and advice — are normally trusted.”

Mortsiefer, Baker, Tebaldi, and Ernst reported no relevant financial relationships.