Welcome to Wellness Feudalism

DIY Health in the Age of Institutional Collapse

At first glance, they don’t look like they belong in the same cult. One is barefoot in Topanga Canyon doing a parasite cleanse on Instagram Live, selling tinctures she brewed under the Leo full moon and warning her followers not to trust Western medicine (or fluoride). The other is in Palo Alto, wearing a continuous glucose monitor and compression sleeves under his Vuori joggers, microdosing psilocybin between Zoom calls and cold plunges and running A/B tests on his REM cycles. One believes in energy alignment. The other believes in algorithms. But peel back the branding, and you’ll find they’re driven by the same thing: a near-religious faith in the body as a site of control, purity, and truth---and a total collapse of trust in health systems.

The modern wellness landscape is full of these strange bedfellows. Raw milk. Adaptogens. Keto. Functional medicine. Metformin. NAD IV drips. Tongue scraping. Neurofeedback. Testicle tanning. All promising what the clinic failed to deliver: answers, agency, and a sense of being heard. What used to live on the fringe now lives in your group chat: biohacking bros swapping mitochondrial stacks with yoga moms who think sunscreen is a psyop.

RFK Jr., bless his raspy little heart, didn’t invent this ideology even though he’s become a kind of spiritual poster child for it---a man who speaks fluently in the dialects of suspicion, sanctimony, and science-ish rebellion. A little bit granola, a little bit libertarian, he’s less an architect of health policy than a figurehead for a broader cultural mood where millions of people, disillusioned with healthcare, are turning inward, sideways, and sometimes upside-down in search of care, safety, and control.

This story isn’t really about him, though. It also isn’t really about pseudoscience. It’s about the larger cultural moment where American healthcare has failed so thoroughly that many people would rather take horse paste from a libertarian YouTuber than go to the ER. It’s about how wellness became the new religion, supplements became currency, and the body became a bunker. It’s a story of collapse.

The Long Decline

Trust in American healthcare didn’t disintegrate all at once. It was a slow erosion beneath growing confusion, contradiction, and unmet expectations. Forty years ago, most Americans still generally believed that the healthcare system, however flawed, was at least trying to work for them. But today, even those who dutifully carry insurance cards and refill their statins on time describe the system with a mix of exasperation and dread. They don’t feel taken care of. They feel like they’re being processed.

This is structural. Since the 1990s, the U.S. healthcare system has undergone massive shifts---economic, bureaucratic, and cultural---that have left many Americans feeling alienated from the institutions meant to safeguard their health.

For starters, healthcare has become significantly more corporatized. Over the past three decades, independent physician practices have steadily disappeared, absorbed into large hospital systems or private equity-backed networks. According to the American Medical Association, the share of physicians working in private practices fell from 60% in 2012 to just 47% in 2022---the lowest ever recorded. By early 2024, a report from the Physicians Advocacy Institute found that more than three-fourths of physicians were employed by hospitals, health systems, or other corporate entities. To patients, this shift has been palpable. The family doctor who used to know your name is now part of a 15-person team rotating through your MyChart inbox. The hospital that used to be locally run is now part of a national chain with its own branding department and call center script. Continuity of care has become harder to come by. So has basic human connection.

At the same time, the economics of care have only gotten more bewildering. Insurance premiums rose more than 300% between 1999 and 2023, far outpacing wages. Even people with insurance often avoid care for fear of the bill. Middle-class families---the ones who tend to “do everything right”---find themselves crowd-funding surgeries or disputing $4,000 bills for 12 minutes of medical attention.

Public agencies haven’t fared much better. The opioid epidemic, for example, revealed how government regulators, alongside pharmaceutical companies and parts of the medical profession, could all be complicit in mass harm. During the COVID-19 pandemic, early missteps in messaging---especially on masks, testing, and school closures---deeply eroded confidence, particularly when seized upon by skeptics. While much of the guidance was based on evolving science, that nuance was lost in the noise. The result was a politicized, polarized, and fragmented media environment in which no single institution retained narrative authority. Everyone had their own version of what was real.

And then there’s the bureaucracy. What sociologists call “technocratic drift”---the shift from relationships to protocols---has made the system feel colder and harder to navigate. You’re no longer guided through the experience of being a patient. You’re navigating a maze of billing codes, prior authorizations, and digital portals. This has surprisingly far-reaching implications, because personal trust has traditionally served to create trust in the broader system---what sociologist Anthony Giddens would call an “access point” into an otherwise impersonal institution. But when those individual relationships break down, the whole thing goes with it. Without that human anchor, trust in the system collapses. Modern healthcare may still be competent, even compassionate. But it rarely feels personal. And trust, at its core, is personal.

What we’re left with is a kind of quiet institutional detachment. People still use the system, but many no longer believe in it. They show up to appointments the way they show up to the DMV: out of necessity, not trust. And when something serious happens---a diagnosis, a decision, a crisis---more and more Americans look elsewhere for guidance, community, or a plan B.

As much as academics and health professionals like to scratch our heads and point fingers over this, it’s actually a predictable outcome of a system that’s come to prioritize efficiency, profit, and control over the slower work of relationship and care. And once that trust breaks down, it’s not easily patched over by a PR campaign. In fact, it creates the perfect conditions for something else to grow in its place---something more personal, more improvisational, and often, more dangerous.

Enter: the wellness industry. In place of expert consensus, we now have content creators. In place of public health infrastructure, we have protocols. Instead of doctors and nurses, we have coaches, influencers, and brand partnerships. It’s care, sort of, but it’s also commerce. And it’s booming.

We could write this off as gullibility, but that misses the point. People don’t turn away from institutions when they’re thriving, they do it when they’re drowning. Wellness, biohacking, “doing your own research”---these aren’t just trends. They’re responses to a system that has ceased to feel moral, legible, or reliable.

And the result? An entire culture quietly opting out of consensus reality when it comes to health. Not because they’re conspiratorial. Because they’re exhausted, confused, and increasingly convinced that nobody at the top is looking out for them.

Optimize or Die Trying

At the heart of this whole wellness ecosystem is a single, powerful message: you are in control of your health.

It’s a message that sounds empowering, even radical, in a country where people routinely wait months for appointments, fight with insurance over basic treatments, and rack up five-figure medical debt just for having a body. For many, the idea of control is not just appealing, it’s redemptive. It feels like a way out.

Wellness influencers, biohackers, and “functional” everything-sellers are fluent in this rhetoric. They speak in terms of sovereignty, choice, and optimization. You’re not sick, you’re out of alignment. You don’t need medication, you need to rebalance your hormones. If your child has ADHD, maybe it’s just seed oils. If you’re tired all the time, maybe it’s adrenal fatigue. If you’re anxious or depressed or inflamed, it’s because your nervous system hasn’t been regulated properly---but don’t worry, there’s a breathwork coach for that.

What all of this suggests is that health is within your control…if you just try hard enough. And if that’s true, then the inverse must also be true: if you’re still unwell, maybe it’s because you haven’t tried hard enough.

This is where the whole thing starts to curdle.

Because the truth is, we live in a world where health is shaped by forces well beyond individual willpower: polluted air, food deserts, wage insecurity, gun violence, social isolation, trauma. Structural racism. Frayed communities. Underfunded clinics. A care infrastructure so hollowed out that “just rest” has become a luxury product.

Against that backdrop, the wellness industry offers a cruel illusion: that you can bootstrap your way to health if you buy the right supplements, track the right biomarkers, cut out the right foods, avoid the right chemicals, and curate the right morning routine. Control is marketed as both a product and a virtue.

And so when people do get sick---when their cancer isn’t caught early, or their chronic illness doesn’t respond to celery juice, or their body simply doesn’t cooperate with the latest protocol---it’s not just a medical event. It’s a personal failure.

This is the dark irony of a health culture built on the fantasy of total control: when things go wrong, the blame falls on you. If you’re still sick, still tired, still anxious, it must be because you didn’t optimize hard enough. But don’t worry, because for just three payments of $199, you can…

Of course, the reality is far messier. Most people who turn to alternative health practices are doing their best in a system that routinely condescends to them, overcharges them, or simply ignores them. They’re not naive. They’re resourceful. They’re responding to a landscape that offers too few options and too many platitudes. The tragedy isn’t that they’re reaching for control, it’s that the institutions meant to care for them have offered so little that these fragile illusions feel like the most reliable option.

And yet, the consequences are real. Misinformation spreads. Legitimate illness goes untreated. People drain their savings chasing protocols built on scant evidence. In extreme cases, people die from preventable conditions because they’ve been convinced that chemotherapy is poison or that vaccines are part of a global plot. But far more often, people just suffer quietly---cycling through diets, detoxes, and diagnostics that promise salvation but deliver only more uncertainty.

They’re not just trying to get healthy. They’re trying to feel a sense of control in a world that keeps telling them they’re on their own.

Reckoning with the Void

It would be easy to end this essay with a punchline. Maybe I’d pan out and show the whole thing as an American tragicomedy of over-the-counter delusion, to let you roll your eyes at people spending $500 on a “gut reset” while their town hospital quietly shutters.

But that would miss the point. The real story here isn’t about gullibility. It’s about grief. It’s about what people do when the institutions that were supposed to care for them no longer feel trustworthy, legible, or reachable. It’s about how the pursuit of wellness becomes a kind of spiritual labor in a country that treats health as a private burden instead of a collective good.

People aren’t drinking raw milk and slathering themselves in magnesium cream and taking 14 supplements a day because they’re stupid, but because they’re trying to feel safe---and the official options don’t feel safe anymore.

If we want to understand this moment---not just mock it, or dismiss it, or make another podcast about it---we have to start there. With the ache for something trustworthy. With the longing for care that doesn’t feel like a transaction. With the quiet desperation to feel well in a world that makes wellness feel impossible.

And if we want to build something better, it starts with this simple but radical idea: institutions have to earn trust. Not demand it. Not perform it. Earn it---through transparency, humility, and actual, relational care.

That means less jargon and more listening. Less branding and more accountability. It means public health that speaks like a human, not a PDF. It means healthcare that doesn’t treat patients like problems to be solved or risks to be managed, but like people. Whole, messy, uncertain people.

Until then, we’ll keep seeing folks try to build medicine out of affiliate codes and Reddit threads, forming communities around adaptogen powders and quiet suffering. The dream of health will keep getting sold back to us as a luxury subscription plan: personalized, premium, and just out of reach.

Because people need something to believe in. And if the institutions don’t offer it, someone else always will.