Evidence is Our North Star

From  Changing Minds Podcast | National Resource Center for Academic Detailing

Teaser/Abstract

"How do we stay the course and stay rooted in facts amidst a major disruption impacting the healthcare landscape? 'Godfather' and originator of academic detailing Jerry Avorn joins the show to share his reflections on the current state of healthcare; the history of treatment and medications prior to rigorous study; his new book, Rethinking Medications; the critical importance of treating evidence, facts, and science as our collective North Star; and where we can look to a future where there is hope of correcting our course back towards the kind of evidence-based clinical care and health policy that we need, now more than ever!"

Source: Changing Minds podcast (NaRCAD), Episode 15, May 22, 2025. Host: Bevin Amira (temporary host, standing in for podcast creator Anna Morgan-Barsamian). Duration: 26 minutes. Produced by NaRCAD (National Resource Center for Academic Detailing), a program of Boston Medical Center.

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SUMMARY

This compact but substantive 26-minute episode finds Dr. Jerry Avorn in conversation with NaRCAD's Bevin Amira — an audience deeply embedded in the academic detailing community. Unlike most other entries in this archive, the episode is less about explaining academic detailing to outsiders and more about reflecting on its 40-year history, the 2025 systematic review that affirms it works, the current threat to evidence-based medicine from political actors, the pre-evidence era of medicine as a source of historical hope, and Dr. Avorn's vision for what academic detailing could yet become. The full transcript is publicly available via NaRCAD.

BACKGROUND

Dr. Avorn traces academic detailing to a 1979 grant application — written only a couple of years out of residency, when he didn't fully know what a grant was — that led to his landmark 1983 randomized controlled trial published in the New England Journal of Medicine. He describes his greatest source of satisfaction as watching a single idea, born as "a gleam in the eye of a very young internist," replicated, validated, and eventually adopted internationally. The interview is conducted before an audience that already knows the field deeply; the conversation assumes shared context rather than explaining fundamentals.

KEY FINDINGS

The 2025 academic detailing systematic review. Dr. Avorn highlights a 2025 paper published in JAMA Network Open by his colleague Benjamin Rome and collaborators at Alosa Health, which conducted a systematic review of all adequately designed studies of academic detailing. The review concludes — as the Cochrane Collaboration did in a 2007 review of the first 70-odd randomized trials — that academic detailing does improve prescribing. Both papers are linked in the podcast description. This represents the strongest updated evidence base for academic detailing's effectiveness.

The current political moment as the worst in 40 years. Dr. Avorn states plainly that the current healthcare policy environment is the worst he has experienced in his 40-plus years in medicine — worse than the Nixon era, worse than Reagan-era cutbacks. He identifies the core problem as the displacement of evidence by political authority: what is true is no longer determined by researchers, clinicians, program managers, and scientists using time-tested rules of evidence, but rather by what political leaders declare to be true. He draws an explicit parallel to the Soviet Union's treatment of facts, citing the epigraph of his book — drawn from a book about Soviet propaganda, selected two to three years before the 2024 elections — which reads: "We have access to more information and evidence than ever, but facts seem to have lost their power."

The thalidomide case as historical hope. Asked for examples of evidence-free medical practice from the past that might offer perspective on the present moment, Dr. Avorn discusses the pre-1962 era in the United States, when drug companies could market any product they chose without demonstrating safety or efficacy. He describes FDA physician investigator Frances Kelsey, who refused to approve thalidomide despite industry pressure and libertarian objections that she was stifling innovation and limiting patient freedom of choice. By holding fast to evidentiary standards, Kelsey spared tens of thousands of American women, infants, and families from the severe fetal malformations thalidomide caused in other countries. The 1962 legislation that followed — requiring FDA to demand evidence of efficacy before approval, the first such requirement by any government anywhere — was then replicated by countries around the world. Dr. Avorn uses this episode to argue that the standards that are currently under threat were themselves established in living memory, and that course corrections from periods of medical irrationalism are historically possible.

A ray of hope: the course correction. Dr. Avorn's cautiously optimistic prediction, offered as of the spring of 2025, is that the consequences of ignoring science, equity, and access will become visible to the American public within a year, triggering a demand for course correction. He grounds this hope not in politics but in the permanence of the tools themselves: "Facts matter. Evidence matters. We have tools to know what we ought to be doing in healthcare, whether it's about quality improvement programs like academic detailing or about actual specific therapeutics. No one can ever make them go away."

IMPLICATIONS

For the academic detailing community. Dr. Avorn's vision for the future of academic detailing is a world in which "doctors, patients, healthcare systems, and governments all agree on one very obvious fact: that patients do better when we give them evidence-based treatments that have been well studied." He explicitly rejects the mechanisms through which payers and systems currently attempt to shape prescribing — memos, formulary restrictions, coverage limits based on rebate arrangements — in favor of education: "You don't get better use of evidence by mailing people memos or by limiting their choices. You get it by teaching clinicians how to do their job better, which frankly is the reason most of us went into healthcare in the first place." He argues that achieving this vision would address not only quality but also cost and access simultaneously, since evidence-based prescribing eliminates spending on expensive treatments that are no better than available alternatives.

For anyone grappling with medical misinformation. The episode's central theme — that evidence is the North Star, not a political position — is presented as the value that unites the academic detailing community and that offers a path forward through a period of institutionalized medical disinformation. Dr. Avorn's argument is that this value is more durable than any particular government or political moment, and that history repeatedly shows courses can be corrected when the damage of abandoning evidence becomes undeniable.