I sat down with Dr. Peter Hotez, one of the world’s leading vaccine scientists and a tropical disease physician, and by the end of our conversation I found myself thinking about two very different things at once: why we’ve stopped trusting scientists, and why so many of my patients are walking around with an undiagnosed parasite.
Those two topics might sound unrelated. They are not. Both come down to the same root problem: a system that isn’t built to look for the answer, and a public conversation that rewards the loudest voice instead of the most accurate one.
The Trust Problem Didn’t Come From Nowhere
I graduated medical school in 2006. Back then, there was an earned respect for institutions and for the scientists inside them. That doesn’t mean science was ever perfect, or that debate should stop. It means there was a baseline trust that allowed disagreement to happen productively.
Somewhere along the way, that baseline eroded. Part of it is social media. An influencer with five million followers can now out-argue someone with seven years of postgraduate training, regardless of who is right. Part of it, as Dr. Hotez pointed out, is more deliberate: a group actively working to discredit mainstream science because discrediting it was good for business. Ivermectin, hydroxychloroquine, fenbendazole — anti-parasitic drugs bought cheap in bulk, repackaged, and sold behind a very expensive telehealth visit. If you’re selling snake oil, you need people to distrust the medicine that actually works.
But it’s also fair to ask: was the communication from health agencies good enough? Dr. Hotez didn’t let the CDC and FDA off the hook either. When the mRNA vaccines rolled out, the public was told they were protective, full stop, without being told why boosters might eventually be necessary or why “masks off” later became “masks on.” People were treated like they couldn’t handle the underlying reasoning. Most people can. I’d argue most people want it. When you explain the why, you build trust that survives the next piece of new information. When you don’t, every course correction looks like a lie.
Here’s a sobering statistic Dr. Hotez shared: when Research America surveys the public and asks people to name a single living scientist, 75% of Americans cannot. Ask them to name an institution where biomedical research happens, and it’s largely a blank stare. Scientists have made themselves invisible, and invisibility makes it easy for bad actors to cast them as villains.
The fix isn’t complicated, scientists and clinicians need to be out there, communicating directly, in some depth, without condescension, and without waiting for a five-minute cable news hit to do it. That’s the whole reason platforms like this one exist.
The Parasite Nobody Is Testing For
This is the part of the conversation that I think more people need to hear, because it’s not theoretical — I see it in the clinic regularly.
There is a parasite called Toxocariasis (not to be confused with toxoplasmosis) that Dr. Hotez estimates may affect somewhere around 5–6% of the US population. It comes from a worm that lives in the intestines of stray dogs and cats. The eggs get shed in feces, become viable in soil within about a week, and children come into contact with them in low-income neighborhoods especially, though it is not confined to them.
Once ingested, the larvae migrate through the body:
- Through the lungs, contributing to wheezing and asthma
- Through the brain, contributing to developmental delays (a form so subtle it’s called “covert toxocariasis”)
- Presenting with eosinophilia on routine bloodwork — an elevated eosinophil count is often the only clue
And here’s the problem: pediatricians are rarely trained to look for it. The diagnostic tests are, in Dr. Hotez’s words, decades old. There’s no simple checkbox on a standard lab requisition. It requires a specific antibody test, ordered by a physician who already suspects it — which means if you don’t look, you don’t find it.
This is precisely the pattern I see in my own practice. Patients present with persistent GI distress, elevated eosinophils, unexplained iron deficiency anemia, or a symptom picture that resembles inflammatory bowel disease — and every standard test comes back “negative.” Not because nothing is there, but because nobody ran the right test.
Some numbers worth sitting with:
- A study in rural Alabama found 34% of stool samples tested positive for hookworm
- Toxocariasis may be the most common helminth infection in the United States
- Ascaris and toxocariasis are among the leading environmental contributors to asthma
None of this is confined to low-income countries. It’s here, it’s under-tested, and it’s frequently misattributed to something else entirely.
What This Isn’t
I want to be precise here, because there’s a version of this conversation that goes off the rails into pseudoscience. There is a popular idea online — the “hygiene hypothesis” taken to its extreme — that intentionally infecting yourself with parasitic worms will calm an overactive immune system and resolve autoimmune conditions. Dr. Hotez was direct about this: the evidence is weak, and it misunderstands biology. Worms are not an underused treatment for allergic disease — they are frequently a cause of it. Toxocariasis causes asthma. The idea that we should reintroduce parasites to “recalibrate” the immune system gets the mechanism backwards.
This matters because it’s the same pattern that shows up in the trust conversation above: something that sounds sciency, spreads fast, and isn’t supported by the data.
Vaccines: What Actually Changed, and What Didn’t
A few things worth clarifying, because misinformation here runs in both directions — some of it downplaying real risk, some of it wildly overstating the vaccine schedule:
The vaccine schedule is not “75 vaccines.” That number typically comes from counting an annual flu shot every year for 20+ years as 20 separate vaccines. The actual number of distinct diseases children are vaccinated against grew from 8 (in the 1980s) to 17 today — largely because we added protection against several forms of bacterial meningitis, two vaccine-preventable cancers (cervical cancer from HPV, liver cancer from hepatitis B), rotavirus, varicella, and hepatitis A. Dr. Hotez, who trained as a pediatric resident before several of these existed, described what bacterial meningitis admissions used to look like: a meaningful number of children who didn’t survive, and many of the survivors left with permanent neurologic injury or deafness. Those diseases didn’t disappear on their own.
mRNA and recombinant protein COVID vaccine technology was not developed in a year. Coronavirus vaccine research had been underway since SARS emerged in 2002, and mRNA vaccine research had been in development for a comparable timeframe before COVID-19 arrived. The perception that these vaccines appeared overnight was, in part, a communications failure — pharmaceutical companies wrote press releases for shareholders, framing the science as a sudden miracle rather than the product of two decades of groundwork. That framing created a backlash that a more accurate story might have avoided.
Respiratory viruses are also cardiovascular threats. Both influenza and the SARS-CoV-2 virus that causes COVID-19 are associated with clot formation, increasing the risk of heart attack and stroke, not just respiratory illness. Staying current on both vaccines is also a measure of cardiovascular protection — a point I think gets lost in a conversation that’s almost entirely framed around respiratory symptoms.
Where This Leaves Us
The throughline across all of this — trust in science, undiagnosed parasitic disease, vaccine misinformation — is the same. When institutions communicate with real transparency, explain their reasoning, and are willing to say “here’s what we don’t know yet,” people extend trust. When physicians are trained to look for a condition, they find it. When they aren’t, patients get told their labs are normal for years while something treatable goes unaddressed.
None of this requires blind faith in any individual or institution. It requires the same thing science has always required: look at the evidence, ask good questions, and be honest about the limits of what you know.
A few practical takeaways:
- If you have persistent GI symptoms, unexplained eosinophilia, or iron deficiency anemia that doesn’t resolve with standard workups, ask your physician specifically about parasitic testing — it is not part of a routine panel and has to be ordered intentionally.
- Deworm household pets regularly. Stray and underwormed cats and dogs are a primary source of toxocariasis transmission to children.
- Don’t confuse the total historical vaccine schedule with an inflated headline number — look at the actual disease list, not a shock-value total.
- Stay current on respiratory vaccines (flu and COVID) with cardiovascular protection in mind, not just respiratory protection.
- Be skeptical of any claim, in either direction, that sounds scientifically sophisticated but isn’t backed by a citation you can actually check.
My thanks to Dr. Hotez for a conversation that covered more ground in ninety minutes than most people get in ninety pages. This is the kind of dialogue we need more of: direct, evidence-based, and willing to sit in the complexity instead of flattening it into a slogan.
