Gregory Patrick Fagan, PhD, is a global health researcher whose work examines how pharmaceutical evidence is produced, interpreted, and governed within real-world health systems. Drawing on sociology, medical anthropology, and applied epistemic analysis, he studies how assumptions embedded in evidence design shape regulation, access, and therapeutic uptake across diverse settings. He has held senior roles in global health and rare disease programs and works at the intersection of pharmaceutical development, humanitarian access, and health systems.

• Table of Contents. Preface: Why Evidence Needs Ecology—Now. Acknowledgments. Introduction: Why Evidence No Longer Travels Well. Chapter 1: The Biomedical Compact: Origins, Power, and Limits. Chapter 2: Reductionism and Evidence Design. Chapter 3: Global Health, Access, and Contextual Fracture. Chapter 4: Real-World Evidence: Promise, Inheritance, and Constraint. Chapter 5: Philosophical Stances in Practice. Chapter 6: Methodological Consequences of Pluralism. Chapter 7: Evidence Ecologies: A Framework for Alignment. Chapter 8: Designing for Coherence: Evidence Architecture in Practice. Chapter 9: Social and Anthropological Foundations of Situated Evidence. Conclusion: Designing Evidence for a World That Learns. Index

Gregory Patrick Fagan, PhD, is a global health researcher whose work examines how pharmaceutical evidence is produced, interpreted, and governed within real-world health systems. Drawing on sociology, medical anthropology, and applied epistemic analysis, he studies how assumptions embedded in evidence design shape regulation, access, and therapeutic uptake across diverse settings. He has held senior roles in global health and rare disease programs and works at the intersection of pharmaceutical development, humanitarian access, and health systems.

• Table of Contents. Preface: Why Evidence Needs Ecology—Now. Acknowledgments. Introduction: Why Evidence No Longer Travels Well. Chapter 1: The Biomedical Compact: Origins, Power, and Limits. Chapter 2: Reductionism and Evidence Design. Chapter 3: Global Health, Access, and Contextual Fracture. Chapter 4: Real-World Evidence: Promise, Inheritance, and Constraint. Chapter 5: Philosophical Stances in Practice. Chapter 6: Methodological Consequences of Pluralism. Chapter 7: Evidence Ecologies: A Framework for Alignment. Chapter 8: Designing for Coherence: Evidence Architecture in Practice. Chapter 9: Social and Anthropological Foundations of Situated Evidence. Conclusion: Designing Evidence for a World That Learns. Index

Gregory Patrick Fagan, PhD, is a global health researcher whose work examines how pharmaceutical evidence is produced, interpreted, and governed within real-world health systems. Drawing on sociology, medical anthropology, and applied epistemic analysis, he studies how assumptions embedded in evidence design shape regulation, access, and therapeutic uptake across diverse settings. He has held senior roles in global health and rare disease programs and works at the intersection of pharmaceutical development, humanitarian access, and health systems.

• Table of Contents. Preface: Why Evidence Needs Ecology—Now. Acknowledgments. Introduction: Why Evidence No Longer Travels Well. Chapter 1: The Biomedical Compact: Origins, Power, and Limits. Chapter 2: Reductionism and Evidence Design. Chapter 3: Global Health, Access, and Contextual Fracture. Chapter 4: Real-World Evidence: Promise, Inheritance, and Constraint. Chapter 5: Philosophical Stances in Practice. Chapter 6: Methodological Consequences of Pluralism. Chapter 7: Evidence Ecologies: A Framework for Alignment. Chapter 8: Designing for Coherence: Evidence Architecture in Practice. Chapter 9: Social and Anthropological Foundations of Situated Evidence. Conclusion: Designing Evidence for a World That Learns. Index