Abstract

In a recent paper (Hardwick & Marsh, in press) we examine the recent tensions between the two broadly successful spontaneous orders, namely the Market and Science. We argued for an epistemic pluralism, the view that freedom and liberty (indeed the very concept of liberalism and civil society) exists at the nexus of a manifold of spontaneous forces, and that no single epistemic system should dominate. We also briefly introduced the concept of “iterative” knowledge to characterize the essentially dynamic nature of scientific knowledge. Herein lies a tension. The Market (and perhaps the prevailing culture at large) sees scientific knowledge in cumulative terms, that is, progressing to a conclusion in a linear fashion. This relatively static understanding of medical science as it relates to pharmaceutical studies can have a corrosive effect on the practice of medicine and ultimately, we believe, on the proper functioning of the market itself. In this paper we examine this tension in much closer detail by focusing upon the demands of the market, specifically the pharmaceutical industry, and the science upon which it is based. In other words, we expound upon a clash of epistemic value – one (science) that sees knowledge as essentially iterative (dynamic yet tentative) and the other (the Market) that harvests conclusive scientific knowledge (ostensibly as a fixed and firm commodity) functional to its own interests. Clinical Trials that are sharply focused with precisely determined deliverables often manifest this tension in the sharpest of relief. As a means of recovering drug development and testing costs, conclusive assessment is required to avoid creating serious financial problems for the companies themselves not to mention issues in the public interest