Here’s a question to which I thought I would roughly know the answer, give or take a decade:
When was evidence based medicine fully introduced? That is, the medical profession relying on the results from clinical trials more than their own experience. Me, I’d have thought early 1950’s or similar. Round about the time new drugs were becoming available.
Nope. 1991.
Until then doctors would take guidance from more the most senior doctor in the room, or rely on their own (or anecdotal) opinion. Indeed, the introduction at the time received from pushback from doctors who thought they knew better. In fact, teaching about clinical trials in medical school only started in the 1980’s.
Anyway, I found all this interesting… and it might explain why there are so many doubters about the safety and effectiveness of vaccines.
Until there is a principle higher than that of making money I will take what Big Pharma has to say with a pinch of salt - all they’re interested in is making money. On the one hand they manufacture harmful things like pesticides that cause things like cancer, and on the other they sell you the pills to ‘treat you’ 
You just have read any of Ben Goldacre’s books to realise that your scepticism is well placed. But unfortunately drugs can be very effective and thus far there isn’t much of an alternative to the development, testing and production by pharma companies. It is fortunate that UK and European legislation prevents direct marketing…
I’d add that the goal of evidence based testing and review is to remove the potential bias in pharma companies own product testing. Such blind testing, peer review, meta-analysis rises above the pharma own preferred view of outcomes, side-effects and effectiveness.
Plus I’d add that new drugs continue to be our most powerful weapon against many diseases, and vaccines our most powerful weapon against viruses. In the high cost of investment, high risk of failure the drug companies do deserve some level of profitability. But we could do without their historic record of continuing to produce harmful products even when testing and outcomes point to them being harmful.
I think I’ve talked myself into the claim “its a bit complex”
Bit like the anti virus quacks and the data world, brothers in arms.
clinical trial data can be skewed or biased in favour of the outcome desired. Information can be withheld or manipulated as required.Then another trial is announced to say you shouldn’t have taken the drug that was so highly recommended with a clinical trial. The system is unfortunately just as full of holes as the opinion of a senior doctor.
The most transformative discoveries were made before we had clinical trials. Of course the methods used would now be considered unethical or quacky. But underlying that derision is a suppression of innovation due to financial self interest of incumbents.
I think what you mean is that badly designed or run clinical trials can have inherent bias or the results can be badly interpreted - intentionally or by simple poor understanding. That is why peer reviews are critically important - similarly meta-reviews are key. Clinical trials that are well designed, run and interpreted are essential and critically important - and are not full of holes.
I’m also interested in your claim that most transformative discoveries were made before clinical trials. Is that really true or is it an inherent bias borne out of knowledge only of the big discoveries such as smallpox vaccine, penicillin and aspirin? What about mRNA use in vaccines or cancer treatment drugs like dostarlimab? (Yes, I had to look that up.) In addition, there were many disastrous drugs put out into the market prior to trials - one thinks of thalidomide. It was hailed as a miracle cure for morning sickness if I remember correctly.
I think the entire system is full of holes. From manipulation of peer-review to cohort choice and meta analysis skew towards whatever cognitive bias/group-think exists. Any data can be fixed to a desired end and means.
In terms of transformative discoveries I am thinking Freud, Jung, Einstein, Newton, da Vinci, Pasteur, Curie et al.
We also have the mysteries of homeopathy and acupuncture, which appear to work but are impossible to research and peer review because there are simply too many variables.
Didn’t most of them do the easy stuff at the start - the truly complex stuff came later. I know enough about Newtonian physics to know it is mostly a vast simplification of the nature of stuff. You missed a whole pile of greats - Copernicus, Planck, Bhor, Tesla, etc. Ground breaking stuff that led to the really complex stuff.
And as for Freud & Jung - I’m not sure many hold much faith in their work nowadays.
BTW homeopathy does not work. Or rather it works as well as any placebo works - in other words, once in a while, surprisingly well.