Rebuilding Trust in Medical Science: A Narrative Review and Structural Reform Framework

Background: Public trust in medical science has eroded substantially over the past decade, not merely because of misinformation but due to deeper structural failures embedded within the pharmaceutical, regulatory, and academic ecosystems. Profit-oriented incentives, revolving-door politics, and misaligned academic reward systems have collectively undermined transparency and accountability. The COVID-19 pandemic magnified these longstanding weaknesses, exposing how institutional opacity and commercial influence can distort evidence, policy, and ultimately, public confidence.Main body: This narrative review synthesizes multidisciplinary evidence from peer-reviewed literature, national surveys, regulatory audits, and governmental investigations to identify systemic determinants of declining trust in medical science. Three domains were examined: (1) commercial practices within the pharmaceutical industry that prioritize shareholder value over patient outcomes; (2) regulatory frameworks compromised by lobbying, capture, and outdated oversight models; and (3) academic systems distorted by publication bias, funding pressures, and privatization of publicly financed discoveries. From this synthesis, a six-point roadmap is proposed to restore institutional credibility, grounded in the principles of transparency, ethics, and accountability. The framework includes independent oversight bodies, reformed approval pathways, enforceable conflict-of-interest standards, equitable funding distribution, open-access academic infrastructures, and a centralized public feedback architecture. Collectively, these measures aim to recalibrate the social contract between science and society, ensuring that biomedical progress is both ethically grounded and publicly accountable.Conclusion: Restoring trust in medical science requires more than countering misinformation. It demands structural transformation. By embedding transparency into corporate, regulatory, and academic governance, and by aligning scientific enterprise with the public interest rather than private gain, medical science can reclaim its moral authority. It offers an integrated reform blueprint to guide future policy and institutional renewal, reaffirming the ethical foundations upon which scientific credibility must rest.