This chapter examines two components of biomedical research from which therapies emerge: the phenomenon of evidence-based medicine and the business of clinical trials. These are the apparatuses of truth making in medicine. They define what counts as “good” medicine. Through them, research findings from experimental studies are converted into best evidence for treatment. That conversion is the first of the four transformations that constitute contemporary medicine.

This chapter shows how evidence from clinical trials emerges, how those findings determine insurance reimbursement patterns and then treatment standards, and how those organize the work of doctors. It ends with a look at the specter that hangs over these engines of innovation and evidence: the fact that the pharmaceutical and biotech industries and the for-profit market for technologies have a growing impact on shaping research agendas and thus on shaping treatments.