Corporate interests corrupt clinical trials, physicians and universities, undermining the foundation of evidence-based medicine. Philosopher Leemon McHenry and psychiatrist Jon Jureidini argue that the principles underlying Popper’s philosophy of science can protect clinical research from corporate malfeasance in a capitalist economy.

Evidence-based medicine was a paradigm shift that is often praised as one of the greatest achievements of medicine in the twentieth century. This radical change in medical practice is based on epistemological hierarchies of evidence, from opinions of respected authorities, mechanistic reasoning and reports of expert committees at the bottom to various levels of observational studies and finally to randomized, placebo-controlled clinical trials at the apex. Randomized, placebo-controlled clinical trials, recognized as the gold standard of clinical experimentation, generally maintain their position in the hierarchies because when well-designed and well-conducted, they provide a basis for assessing harms and benefits, and help deter extravagant claims of efficacy and safety.

Quite apart from the philosophical difficulties with the very concept of evidence-based medicine, there is one practical problem that has been the main obstacle in its implementation.  The validity of the paradigm depends on reliable data from clinical trials, of which approximately 90% are conducted by the pharmaceutical industry.  Given the strong financial incentive to design, conduct and report the trials to guarantee favorable outcomes in the study drug, evidence-based medicine is betrayed at every step of the process.  The result is a crisis of credibility.