Hollow Hunt for Harms

Harms of medical interventions are systematically underestimated in clinical research. Numerous factors—conceptual, methodological, and social—contribute to this underestimation. This chapter articulates the depth of such underestimation by describing these factors at the various stages of clinical research. This includes the ways harms are operationalized in research, the way trials are designed such that they are sensitive to detecting possible benefits of interventions but insensitive to detecting harms, and the secrecy with which the resulting evidence is shrouded. The net effect of these conceptual, methodological, and social factors is that our available medical interventions appear to be safer than they truly are. Medical research is tuned to overestimate benefits and underestimate harms of medical interventions.