Consensus-Followers, Reformers, and Contrarians

When Skepticism Helps Science—and When It Hurts

The firings and resignations at the CDC this week have been cast as either overdue accountability or unwarranted political interference. Beneath the headlines, though, lies a deeper issue: how we handle scientific uncertainty. Most people tend to follow the prevailing consensus, a few visionaries push to reform it, and contrarians exploit the gaps to reject science altogether.

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Medicine has always contended with more unknowns than knowns. Scientific research is our best tool for finding answers—but its usefulness depends entirely on the quality of the research performed.

When my patients make make some spurious connection between some past event and a current problem, I bring out one of my favorite stupid jokes: “Humans are natural scientists—we’re just not naturally good ones”. We chuckle, but we physicians and researchers aren’t immune from faulty reasoning either.

In the 1970s, Archie Cochrane argued that medicine was too often guided by tradition rather than evidence. Two decades later, Douglas Altman warned about the misuse of statistics in research, saying: “We need less research, better research, and research done for the right reasons.”

In 2005, John Ioannidis’s essay Why Most Published Research Findings Are False crystallized those warnings. It showed how small studies, poor methods, selective reporting, and funding bias made much of medical knowledge provisional at best, and sometimes simply wrong.

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This self-skepticism of science has become a field unto itself, variously termed metascience or meta-research. It hasn’t yet reached the mainstream, but its influence is growing. I plan to return to this in future posts to make the concepts that separate good research from bad accessible to a lay audience—and to help readers guard against uncritical reporting in the media.

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My own awakening came later, with Vinay Prasad and Adam Cifu’s 2015 book Ending Medical Reversal. Their premise was simple: interventions often enter practice on weak evidence, only to be abandoned when stronger studies overturn them. Reading it, I kept thinking, “I used to do that,” or “I remember when that used to be done.” It was humbling.

For years I might have described myself as a consensus-follower: capable of critiquing research rigorously when I had to, but usually willing to accept the prevailing consensus. Politicized issues—climate, gender, COVID—shook me from that “dogmatic slumber,” to borrow Kant’s phrase. I’m now firmly in the reformer camp. I believe science is essential, that we’re not doing it well enough, and that we can do it better.

In addition to consensus-followers, who tend to trust the published literature, and the small but growing ranks of reformers, we have the contrarians. Contrarians are distrustful of the published literature, which is understandable, but that skepticism tends to lead them to reject science altogether, often replacing it with ideology dressed up as evidence.

Those who departed the CDC this week may have been consensus-followers, preferring the caution of following established guidelines. That’s not a failing; it’s the natural posture of most professionals when evidence is uncertain. They may have not been the reformers we really need to move us forward, but their status-quo bias still would have been useful as a bulwark against contrarian forces.

Robert F. Kennedy, Jr., is clearly in that contrarian camp. While I can agree with him on some broad goals—like making America healthier, or questioning unnecessary additives in our food— too often he leaps from reasonable doubt to wholesale rejection. Earlier this year, for example, he announced a halt to funding for mRNA research, then posted hundreds of pages of published “scientific studies”, most irrelevant or misleading. That isn’t reformist critique; it’s contrarian misuse of evidence, and it corrodes public trust.

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And that brings us back to the real challenge. Agencies like the CDC don’t operate in a vacuum. They make decisions under pressure, with incomplete data, and under constant political scrutiny. Fixing science will require uncomfortable changes in the institutions that support it—from HHS to NIH to CDC.

Consensus-followers tend to preserve the status quo. Contrarians reject the system outright. What we need are reformers: skeptics whose goal is to make science better, not blindly defend it or blindly destroy it.

Science has never been about certainty. It is provisional truth, always open to revision. That fragility makes it vulnerable to politics—but it is also what makes it worth defending and improving.