This book explores how pharmaceutical evidence is designed, interpreted, and used. It shows how dominant evidence paradigms often struggle to account for time, population heterogeneity, patient experience, and context across contemporary therapeutic and care settings, and advances an evidence ecology approach.
This book explores how pharmaceutical evidence is designed, interpreted, and used, drawing on positivist, constructivist, critical realist, pragmatist, feminist, and decolonial traditions. It shows how dominant evidence paradigms often struggle to account for time, population heterogeneity, patient experience, and context across contemporary therapeutic and care settings.
Rather than treating these dimensions as downstream complications, the book advances an evidence ecology approach—understanding evidence as an interacting system of methods, institutions, and social worlds—and offers a framework for aligning scientific rigor with access, uptake, and sustained therapeutic impact across diverse settings.
Key Features
- A conceptual framework showing how different philosophical positions influence evidence creation, interpretation, and governance.
- A practical toolkit for translating those stances into study designs, evaluation metrics, and strategic decision frameworks.
- A bridge between academic reflection and professional application, enabling researchers, policymakers, and industry teams to align evidence with ethics, culture, and context.
Table of Contents. Preface: Why Evidence Needs EcologyNow.
Acknowledgments. Introduction: Why Evidence No Longer Travels Well.
Chapter
1: The Biomedical Compact: Origins, Power, and Limits.
Chapter 2:
Reductionism and Evidence Design.
Chapter 3: Global Health, Access, and
Contextual Fracture.
Chapter 4: Real-World Evidence: Promise, Inheritance,
and Constraint.
Chapter 5: Philosophical Stances in Practice.
Chapter 6:
Methodological Consequences of Pluralism.
Chapter 7: Evidence Ecologies: A
Framework for Alignment.
Chapter 8: Designing for Coherence: Evidence
Architecture in Practice.
Chapter 9: Social and Anthropological Foundations
of Situated Evidence. Conclusion: Designing Evidence for a World That Learns.
Index
Gregory Patrick Fagan, PhD, is a global health researcher whose work examines how pharmaceutical evidence is produced, interpreted, and governed within real-world health systems. Drawing on sociology, medical anthropology, and applied epistemic analysis, he studies how assumptions embedded in evidence design shape regulation, access, and therapeutic uptake across diverse settings. He has held senior roles in global health and rare disease programs and works at the intersection of pharmaceutical development, humanitarian access, and health systems.
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