Trust in Medicine in the Crisis of Epistemic Authority: Evidence from a Refused-Knowledge Community

The COVID-19 pandemic accelerated a broader crisis of epistemic authority in medicine, fostering the emergence of refused-knowledge communities as socially credible alternatives to official healthcare. This study examines the sociocognitive factors associated with extrainstitutional care-seeking among members of a Facebook health community promoting therapeutic protocols misaligned with the clinical guidelines approved by the Italian Ministry of Health. A cross-sectional survey was administered between June and September 2022 to a purposive sample of members of the #TDC19 Facebook group (N = 574). Path-analytic mediation models were estimated to test the role of trust in official medicine, digital health literacy, and overconfidence as mediators of the relationship between refused-knowledge beliefs and extra-institutional care-seeking. Endorsement of refused-knowledge beliefs was positively associated with extra-institutional care-seeking. A significant indirect association via trust in official medicine emerged, while digital health literacy and overconfidence did not yield significant indirect effects. Perceived COVID-19 severity was indirectly associated with care-seeking via trust in official medicine. Lower trust in official medicine thus emerges as a relevant but not exhaustive correlate of extra-institutional care-seeking, which remained directly associated with refused-knowledge beliefs after adjustment for trust. The #TDC19 case illustrates how refused-knowledge communities driven by licensed physicians reconfigure rather than reject the expert/lay boundary, redirecting trust toward outsider professionals. Rebuilding trust in official medicine may require addressing the structural conditions of its erosion rather than focusing exclusively on individual health beliefs.