Jerry Avorn's Latest Thought Piece: "Provenance"

Jerry Avorn, MD,  Professor of Medicine, Harvard Medical School, Co-founder and Special Adviser, NaRCAD,  Author, “Rethinking Medications: Truth, Power, and the Drugs You Take.”

When I was younger, I used to think "provenance" referred to a lovely part of southern France, or maybe to a divine presence that was watching over us all the time. Then I learned it actually means the source of something: a work of art, a book, perhaps an idea. And that such provenance has two key dimensions: how rigorous is the information on which it’s based, and who is trying to purvey that art or idea to a potentially unsuspecting customer.
 
For decades, my colleagues and I – at NaRCAD, Alosa, and throughout the global academic detailing community – have obsessed over issues of provenance in trying to develop the very best messages we could about the benefits and risks of medications: Where was that study published? Who did the work?  And by far the most important: How rigorous was its methodology?

Like-minded evidence synthesizers around the world would focus on confidence intervals, effect sizes, control groups, and clinical implications, trying to boil down these complex and often delicate ideas to help busy clinicians do the best job they could in making therapeutic decisions for and with their patients.

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Then came 2025, and the nation went through the looking glass.  Legally constituted laws were overridden, constitutional rights were no longer sacrosanct, official budgets turned out to not really be budgets after all. In our world, some of the most basic principles of medical science describing the effectiveness and harms of medical products got tossed aside at the highest levels of government. In statements that would have seemed familiar to George Orwell, in discussing topics from vaccines to mifepristone federal and state officials could in fact declare that 2 + 2 = 5. We should have seen this coming years ago, when a presidential spokesperson introduced the toxic concept of “alternative facts,” or the nation’s most widely-watched news channel got caught repeatedly lying about imaginary plots to rig voting machines.
 
Truth just isn’t what it used to be.  For our community of academic detailers, that’s a problem, and an opportunity.

As we’ve seen, autism has become a focal point for medical product disinformation. Citing a very thin evidence base that none of us would consider reliable, senior administration officials recently declared leucovorin to be a promising treatment for this challenging condition. And the chief of the nation’s health apparatus, with no training at all in science, continued to claim that vaccines cause that condition, while the President himself blamed it on a mother’s use of acetaminophen during pregnancy – a contention that was as cruel as it is baseless. This is what medical risk-benefit communication has come to in 2025.

Paradoxically, this loss of respect for rigorous evidence comes as both bad news and good news for evidence-based academic detailing. Bad news, of course, because overworked primary care clinicians now have to spend precious time they don’t have on new conversations like, “No, Mrs. Jones, little Jimmy’s autism is not your fault,” and explaining that mifepsristone is an effective way to terminate a pregnancy, and vaccines are among the safest and most effective treatments we have to offer, even if the Surgeon General of one state (Florida) is now moving to abolish mandates for their use in children.

​The situation at present is much healthier in countries where evidence-based medicine and unbiased educational outreach aren’t at risk of being mowed down by demagoguery and autocracy-defined science. But even our international colleagues shouldn’t become too complacent; a year ago I never would have expected these grotesque distortions to have become entrenched so quickly here, either.

So where’s the good news? The current chaos makes what we do even more vital, and even more precious. Just as sources of nutritious food and clean water are most needed when people are hungry and surrounded by contaminated slop, a pure source of information untainted by ideology or junk science is even more valuable when people are getting constantly spammed by medical untruths. If it ever were to happen that randomized double-blind trials (an increasingly quaint concept) do one day show that leucovorin cures autism, I know our academic detailing community would be out there educating people about its proper use. And if there is solid epidemiologic evidence that perhaps healthy young people don’t all need constant Covid boosters (which may well be true), we’ll be out there saying that too. 

Unlike our leaders in Washington, our academic detailing programs will continue to encourage evidence-based medical policies, not policy-based medical evidence. As NaRCAD has been saying for years, we’re just ambassadors of the best data, wherever that leads. And at a time of rampant disinformation, that will be more important than ever.

Read more of Jerry's recent media pieces here:
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"Corporate support cannot make up for threats to the NIH budget: Pharmaceutical money comes with strings"  Stat10 | October 22, 2025
 
WBUR's OnPoint Podcast: Will TrumpRx Actually Lower Drug Prices? On Point with Meghna Chakrabarti, featuring Jerry Avorn, MD | October 16, 2025

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