The puzzles of normal science are formed from, legitimated by, and assessed by the paradigm which they are operating within. Matheson has these puzzles set up out of commercial interest and illustrates how pharma is involved every step of the way in terms of gathering and selecting data, constructing drug narratives, and so forth. He also points out the “cultural” differences between the scientific community which is (more so) grounded in truthfulness and pharma which is grounded in economics.
This sets up an awkward picture in which we seem to have two paradigms operating in one puzzle. What counts as a good answer to pharma is not necessarily the same as what counts to a medical researcher. Their methods, aims, and models may differ substantially from each other yet they seem to cooperate (often) quite harmoniously. Matheson implies that this is partially because these two paradigms, although seemingly distinct from each other, blend into each other. Pharma is not straightforwardly untruthful, but its “subtle violations…arise simply from an accumulation selective or biased constructions” (Matheson 374.) Similarly, medical science is not absent of social influence and pressures.
What exactly can (and should) be done about this? Medical science is driven by the “needs” of the public making the mixture of politics and science seems quite natural. We cannot isolate medical science from our society and have it (wholly) operating under the thumb of truthfulness. The paradigm of drugs seems to have interests aside from the truth, but how can we conceive of a paradigm that does?