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. 

The one problem confronting the doctor and patient is how to sort out the genuine science from the rigged science when the latter is crafted to look exactly the same as the former?  Medical journal articles, conference presentations, and continuing medical education programs are all dominated by the pharmaceutical industry reporting on safety and efficacy of their own products.  The companies hire for-profit contract research organizations to conduct clinical trials, academic physicians to act as clinical investigators, medical communication companies to ghostwrite publications in the names of academics, and public relations firms to create positive images of drugs for prescribing physicians and the public.  All are eager to serve their client’s best interest over those of good science and patient welfare.

It is often said that science, unlike ideology, is a self-correcting, dispassionate search for the truth.  This very point was powerfully addressed by philosopher of science, Karl Popper, when he advocated for the integrity of science and its role in an open, democratic society.  He argued that scientists should consciously and deliberately seek out errors rather than wait for them to reveal themselves.  A science of real integrity is one in which its practitioners are careful not to cling irrationally to cherished hypotheses for one reason or another and are serious about the outcome of the most stringent experiments, but this is exactly what academic medicine lacks under the sponsorship of the pharmaceutical and medical device industries. As Popper notes, “My own misgivings concerning scientific advance and stagnation arise mainly from the changed spirit of science, and from the unchecked growth of Big Science, which endangers great science.”  He concludes, affluence may be an obstacle to scientific progress -- “too many dollars may chase too few ideas.”