Provenance

From The National Resource Center on Academic Detailing NaRCAD.

In a thought piece published on the NaRCAD blog in October 2025, Jerry Avorn, MD — Professor of Medicine at Harvard Medical School, co-founder of NaRCAD, and author of Rethinking Medications — argues that the concept of "provenance" has become the defining challenge for evidence-based medicine in the current political moment.

Dr. Avorn opens by tracing the word itself. "Provenance," he explains, means the source of something — a work of art, a book, an idea — and carries two essential dimensions: how rigorous is the underlying information, and who is trying to deliver it to a potentially unsuspecting audience. For decades, he writes, these questions have been at the center of the academic detailing enterprise. Practitioners at NaRCAD, Alosa Health, and the broader global academic detailing community have obsessed over the provenance of every clinical message they develop: Where was the study published? Who conducted the research? How rigorous was the methodology?

That commitment to provenance, Dr. Avorn argues, has become both more difficult and more essential in 2025. He describes a political environment in which legally constituted laws have been overridden, constitutional rights treated as negotiable, and some of the most basic principles of medical science dismissed at the highest levels of government. Citing the promotion of leucovorin as a treatment for autism on the basis of what he characterizes as a "very thin evidence base," repeated official claims that vaccines cause autism, and a presidential statement attributing autism to maternal use of acetaminophen during pregnancy — a contention Dr. Avorn calls "as cruel as it is baseless" — he argues that medical risk-benefit communication has entered genuinely new territory.

The consequences for frontline clinicians are concrete. Primary care physicians, already stretched thin, now find themselves spending time they do not have on conversations like "No, Mrs. Jones, little Jimmy's autism is not your fault" — correcting official misinformation instead of focusing on care. Dr. Avorn notes that the distortion of evidence extends to mifepristone, vaccine policy, and other areas where rigorous scientific consensus has been displaced by what he calls "policy-based medical evidence" rather than evidence-based medical policy.

He acknowledges that the situation is currently healthier in countries where evidence-based medicine and unbiased educational outreach are not under comparable political pressure, but cautions international colleagues against complacency. "A year ago I never would have expected these grotesque distortions to have become entrenched so quickly here, either."

The piece closes on what Dr. Avorn frames as a paradox: the current chaos makes the work of academic detailing more vital, not less. He draws an analogy to nutritious food and clean water — most needed precisely when people are hungry and surrounded by contaminated alternatives. A source of information "untainted by ideology or junk science," he writes, is most valuable when people are being "constantly spammed by medical untruths." He commits the academic detailing community to following the evidence wherever it leads — including, he notes, if rigorous trials were ever to show that a currently contested treatment genuinely works, or if solid epidemiological evidence were to suggest that healthy young people do not need constant COVID boosters. "Unlike our leaders in Washington, our academic detailing programs will continue to encourage evidence-based medical policies, not policy-based medical evidence."