What happens when the institutions designed to protect public health become sources of harm and mistrust? And how can healthcare rebuild trust when science, politics, and lived experience collide?
In this episode of Mending Medicine, Dr. Donald Berwick and Dr. Kedar Mate sit down with Dr. Rachael Bedard to explore the intersection of healthcare, incarceration, public health, and institutional trust. Drawing on her experience caring for incarcerated patients at New York City’s Rikers Island, Bedard examines how deeply entrenched systems resist change—and what it takes to challenge them.
From developing compassionate release pathways for older incarcerated adults with serious medical conditions to helping facilitate the release of 1,500 people from Rikers Island during the early weeks of COVID-19, Bedard shares how advocacy, collaboration, and moral urgency can drive meaningful systemic change.
The conversation also examines the rise of Robert F. Kennedy Jr. and the Make America Healthy Again (MAHA) movement, asking what growing skepticism toward medical institutions reveals about the failures of modern healthcare. Bedard challenges medicine’s tendency to overstate scientific certainty and explores why rebuilding public trust may require greater humility, openness to competing perspectives, and a fundamental shift from treating disease to promoting health.
Together, they discuss:
- Healthcare Behind Bars: What Rikers Island reveals about the intersection of incarceration, aging, chronic illness, and systemic injustice.
- Changing Systems in a Crisis: How advocacy networks helped secure the release of 1,500 incarcerated individuals during the initial COVID-19 surge.
- The Crisis of Institutional Trust: Why movements like MAHA resonate with communities that feel harmed or abandoned by established healthcare institutions.
- Science, Certainty, and Skepticism: How medicine’s claims of certainty can undermine credibility and why acknowledging uncertainty matters.
- Rethinking Healthcare Reform: What it takes to move beyond diagnosing systemic failures toward building institutions worthy of public trust.
How do we transform systems that have lost the confidence of the people they serve? And what would healthcare look like if it embraced scientific humility, moral responsibility, and a broader definition of health?
Mending Medicine is hosted by Dr. Donald Berwick and Dr. Kedar Mate and brought to you by the ABIM Foundation. Through candid conversations with leaders, reformers, and practitioners, the series explores how large-scale healthcare transformation actually happens—and why lasting change requires more than identifying what’s broken.
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