There are moments in history when institutions that once felt unshakable begin to look less certain. Institutions that produce knowledge, institutions that train generations of scientists and physicians, institutions that helped society decide what was true, what was safe, and what could be trusted.

For long stretches of time, those institutions function so well that we stop thinking about them at all.

They become part of the background infrastructure of civilization, like electricity or clean water. Quietly essential, rarely questioned.

But history reminds us that institutional trust is not permanent.

There have been periods when the structures that once safeguarded science and medicine began to drift away from their original purpose, sometimes gradually, sometimes invisibly, sometimes in ways that only become clear years later.

When that happens, the consequences extend far beyond a single organization because scientific institutions are not only producers of knowledge, they are also the keepers of credibility, and credibility is fragile.

Once trust begins to erode, whether through corruption, political pressure, institutional self protection, or failures of oversight, the public doesn’t just question one policy or one decision, they begin to question the entire system that produced it, and that’s when the situation becomes much more complicated.

Criticism of institutions can be necessary, even essential for science to correct itself, but at the same time when trust collapses completely, it becomes very difficult, if not impossible, for scientific knowledge itself to function in society, So we’re left with a difficult balance.

How do we examine institutional failures honestly without undermining the foundations of science and medicine themselves?

How do we confront problems without abandoning the very systems that help us solve them? And perhaps most importantly, what responsibility do individuals have when the institutions around them begin to falter and sometimes fail.

Scientists, journalists, physicians, and citizens all have a role.

History offers clues. There have been periods when world leading scientific institutions deteriorated under political pressure or ideological control, when ethical standards were bent or even ignored, when some people remained silent and others chose not to. In those moments the future of science did not depend on institutions, it depended on individuals.

On the scientists who protected their data, on the journalists who kept investigating, on the people who refused to normalize what they knew was wrong.

Eventually institutions can recover. History shows that too, but it’s rarely automatic. It depends on what survives during the difficult period.

Evidence, records, professional ethics, independent scrutiny, and a public that still believes the truth is worth defending.

Today’s conversation is not about proving that we are living in any particular historic moment.

Analogies can be illuminating, but they can often oversimplify. Instead, this is a thought experiment. What happens when systems that were once anchored to trust begin showing signs of strain? How do we recognize the difference between ordinary institutional imperfection and something more serious, and what should responsible people do if they begin to see these warning signs?

My guest today is investigative journalist Katherine Eden. Katherine has spent much of her career examining systems that appear trustworthy on the surface but look very different when examined closely. Her reporting has uncovered corruption inside parts of the global pharmaceutical supply chain revealing how regulatory systems that were meant to protect patients sometimes failed to do so.

More recently she has continued to investigate questions surrounding oversight, ethics, and accountability within institutions responsible for safeguarding public health.

Her work raises difficult and uncomfortable questions. Not only what can go wrong inside complex systems, but how societies respond when those problems come to light.

So today we’re gonna explore a larger question together.

If institutions that were once anchored scientific trust begin to weaken, what do responsible people do next?

Katherine, welcome.

Thanks. It’s great to be here with you.

So let’s start. From your perch stepping back, the big picture, what is happening?

Trust has cratered in the institutions, the premier institutions that the US has relied on for a generation to keep us safe, whether it’s the CDC, HHS, FDA, and of course, the premier research institution the world over, NIH.

And that really set the stage for essentially a takeover of those institutions by, some might say skeptics, others might say cynics, but people who are willing to discard proven science and to promulgate theories that are unproven, unscientific as fact. And so what we’re seeing right now is this struggle over what is truth inside of the scientific and medical fields. This is a moment where doctors and scientists out in the field are mobilizing to defend what they see as fact and evidence based science and medicine. You know? And for a journalist, it is a very challenging place to be because we are documenting what is happening and at the same time trying to define or illuminate what is true and what is not. You know, it is a sort of constant struggle to do that at this moment.

Kathryn, I think one of the things you’re saying here is that it’s not just one or even two institutions. It’s half a dozen global institutions all at the same time being rocked, whether it’s the CDC, the WHO, the NIH, HHS, and then their subcommittees in vaccines and other areas, it appears that this is a simultaneous failure much greater than anything we’ve had in the history of modern science.

That’s absolutely true, Jay. And in fact, it’s even bigger than that because these are institutions that the entire world has relied on to opine on what is safe, what is effective.

And now, of course, the US has pulled out of the WHO, which is, you know, and pulled out of supporting tremendously important public health systems such as PEPFAR and other programs that have supported infectious disease containment and have provided treatment for literally the entire world. So we’re now beginning to see what global health looks like without the bedrock of US support, and it’s a pretty frightening picture.

And it’s more than global health standards.

It also includes all of the funding levers for which the United States had been the primary source. I read recently, this is March right now, the US NIH has not given a single cancer grant this year.

You can’t run modern science without the economics that support the long term research studies and the long term recruitment of individuals to enter the system.

So we’re not just seeing an attack on trust and credibility, we’re also seeing a full scale attack on the underlying source of support for science itself.

Absolutely. As well as a disregard for the ethical standards and the scientific rules of engagement and the, you know, evidence based approaches that the US has been so instrumental in helping the entire world develop. So this will have a seismic impact on science for who knows how long, certainly a generation. You know, will we come back stronger? Will we come back better?

That’s something we’re gonna discuss today.

So you knew seismic, which I think is a good metaphor for an earthquake. There’s the fault line where the major damage is taking place and then there’s these, you know, waves of shock waves going out from that place. And so at the core, if you undermine what is true or what is an effective scientific process, if you give up on statistics and data or if you modify ethical rules to do things that are clearly unethical, suddenly you’re infecting all of scientific work, not just infecting the global health present problems. And so that’s what I’m hearing you say, that this is way more than it appears when you look at it.

You know, I recently did an article which exposed how the CDC under Robert F. Kennedy Jr, who is our health secretary now, the head of HHS, how the CDC circumvented its own ethical guidelines in order to fast track a study into the potential harms of the hepatitis B vaccine birth dose in Guinea Bissau.

And there was an outcry around the world about this study, which people likened to the infamous Tuskegee syphilis study from the 1930s, which completely violated ethical standards, in fact helped create today’s ethical standards for clinical studies. But anyway, as part of this reporting, I interviewed an Australian hepatitis B expert who was very vocal about the shortcomings of this study because the study proposed to not provide the hepatitis B vaccine birth dose to half of the fourteen thousand infants it planned to enroll in order to study what it alleges are potential secondary harms. He was very vocal in saying that this study would lead to the death of infants in Guinea Bissau. And he said he was speaking up because many of his U. S. Colleagues could not.

So, you know, for me, the strangeness of the reporting that essentially, you know, at this moment, I have to go to Australia to find sometimes, in some cases, to find scientists and doctors that are willing to speak out about what is happening because there is so much institutional fear and personal fear in the scientific realm. You know, it makes it challenging, but I think it’s just emblematic of what’s happening right now.

Well, a climate of fear obviously had a stunting effect way bigger than anybody can see. Right? So you really can’t measure the number of people that don’t speak up. You can simply note that there should be a lot more of them. For our listeners, Guinea Bissau is a small country in Africa. It’s not a name that many people hear, so I just wanted to tell our listeners it’s a country, not a city. You know, the idea that a Tuskegee level ethical breach where people who should be treated and by intentionally not treating them, you know you will injure a statistical number of people without their consent is about as bad a breach of ethics as you can allege.

It would be the equivalent of doing a controlled group study giving some people parachutes and another group of people with defective parachutes to see which parachute method is better. It is literally that kind of failure. So if we’re at that level, Catherine, it doesn’t seem like there’s any place to go down from there. That’s about as bad as it gets.

Well, unfortunately, what my reporting historically has taught me is that there’s usually I’ll just quote the seventeenth century poet John Milton, in the lowest deep there is usually a lower deep. And I suspect that, you know, we will get there because what’s happening is they’re pushing through these unethical studies and other sort of half baked research because they’re trying to create a new and different scientific record, one that they can point to to justify dramatic, unparalleled changes to the US vaccination schedule. Now we’ve seen some of that. There’s been some reporting that the anti vaccine efforts are not popular with the American public, and so we may see them slightly in advance up to the midterms.

But, you know, overall, the effort is to create just a different scientific record that can justify a whole new set of claims. Then you can kind of legitimize a lot of almost anything. And as we know, RFK Jr. Supporters, many of them have gone on the record saying they think we should abolish all vaccines.

You know, the more the merrier. The infectious diseases are good for all of us because they prime our immune system. Those are some of the claims. So how far could this go?

I don’t know.

Very far, I think.

This is a signal of a much bigger issue. Right? So when you look at this failure and you look at the corollary failures, we’re facing a situation where we’ve never been in these kind of waters before with modern science.

Where do we go?

That is a great question.

You know, I will say that to some extent, the scientists and doctors are pushing back and we’ve got a lot of them running for office.

We’ve got obviously some doctors and scientists already in office but not enough. So some are so infuriated by this erosion of what they see as truth that they are going to run for office. So there’s that.

But, you know, we may be looking at a situation where we’re going to be in a sort of eighteenth century, nineteenth century paradigm where we’re going to see measles, God forbid polio, you know, preventable diseases making a comeback. And in fact, one of the stories that I’ve been reporting on looks at the possibility that you would have an elimination of vaccine mandates for U. S. Schools so that it would be the immunocompromised kids who would need to stay home because you would have school systems that are just infectious diseases have free range. So we’re looking at a real reversal here.

So as an investigative journalist, suddenly you’ve got one, five, ten, all these different stories all at the same time. There’s no way that current investigative journalist capacity could even begin to keep up is what I’m hearing you saying implicitly.

Well, that is the situation, for any journalist who is reporting right now. Way too many stories, too much going on.

And there are, of course, you know, at the same time that this is happening, we’re seeing a real dissolution and erosion of the reporting infrastructure. So, you know, journalism is being torn apart and practically half of all the journalists at The Washington Post were just laid off. All those journalists should be working and doing accountability journalism right now. I mean, there are so many unemployed journalists in America, all of whom should be at work.

So but for the people who are still in the game and still fighting to get these stories out, how do you tackle it? How do you do a story that makes the difference? And there is a big difference here now in the kind of mathematics of investigative journalism in order for it to have an impact. Because, you know, in the olden days, in the days of, if you look back to Woodward and Bernstein, Bernstein, they put out stories, you know, and there was scandal and shame and reaction and response.

And people got fired and people went to jail and a president resigned. And that is because the norms mattered.

Right? If you could demonstrate a violation of the norms, your story would have an impact. Now it’s quite different. We’re in a sort of post shame, post norm environment. So what kind of stories break through? Now, if you think about the Trump administration today, you can think of probably maybe about five stories that have really broken through.

Right.

Even though there’s a scandal a minute, just a handful.

So the problem has essentially got yet another dimension.

The people who see things that are worth possibly whistleblowing feel, well, if I whistleblow, nothing is going to get picked up because there’s too many other things going. There’s not enough journalists to call. I mean, how many people can call you or the Washington Post or who’s ever left at the Times, etcetera? And then they say, well, do I want to risk my career if my whistleblowing essentially never gets any traction? So what I’m hearing you describe is a system that has actually de incented whistleblowing itself.

Yeah. That is true. Although, it’s so interesting, Jay, because having now worked with whistleblowers for decades, and you know, of course, I did with my book Bottle of Lies and my work on the generic drug industry. Whistleblowers remain motivated. There are still people within the US federal government who can’t sleep at night when they know that there are massive violations of law or rules. And I’ve dealt with some on recent stories and they have made a calculation that they would risk losing a job. Now, of course, in some countries, whistleblowers risk losing their lives.

And that was a risk that one of the whistleblowers that I worked with most prominently Dinesh Takar, the former executive at REMAXY, made that calculation when he blew the whistle on his Indian drug company. But there are still people out there, and so they’re very motivating for investigative journalists. You feel, you know, those people are still out there, and you feel an obligation to them to do this work.

So, there’s a basic core of human nature that isn’t calculating cost benefit, but is behaving on a moral basis and is saying, look, I don’t care what the cost benefit is. I won’t be party to a cover up of this kind of damage, especially when you’re talking about damage to children or mothers or people who are trusting medicines. You know, we’re not, you know, we’re not talking a commercial scam as much as we are talking about the responsibility and liability that comes with not providing safe and effective medicines.

So Right.

I did two stories for Rolling Stone about the Guinea Bissau trial, the hepatitis b vaccine trial, and it was so heartening to me but also very interesting that really the scientific and medical community were absolutely determined that this study not go forward. They just felt like even in this swamp of lunacy, that was a bridge too far. And it’s hard to say with any given story when you’re gonna hit that sort of limit of human endurance, but that was a story where that vibe was very evident.

What we’ve been tracing here is not a single failure or even a single system.

It’s a pattern. The way institutions begin to drift, Not through sudden collapse, but through decisions that lower standards, obscure transparency or prioritize self protection over accountability.

And one of those challenges is that those shifts don’t always announce themselves clearly.

They accumulate, they normalize and over time, they reshape the system itself.

So in this first part, we’ve been asking how do you recognize those signals? What does it actually look like when institutions stop doing the job they were built to do?

In the second part, we take the next step.

Because recognizing the problem is only the beginning. What matters just as much is what people do in response inside institutions, around them and when necessary in opposition to them.

Where does responsibility actually sit and what has to be protected if these systems are going to recover?

That’s where we go next.