This book explores how pharmaceutical evidence is designed, interpreted, and used, drawing on positivist, constructivist, critical realist, pragmatist, feminist, and decolonial traditions. It shows how dominant evidence paradigms often struggle to account for time, population heterogeneity, patient experience, and context across contemporary therapeutic and care settings. Rather than treating these dimensions as downstream complications, the book advances an evidence ecology approach-understanding evidence as an interacting system of methods, institutions, and social worlds-and offers a framework for aligning scientific rigor with access, uptake, and sustained therapeutic impact across diverse settings. * A conceptual framework showing how different philosophical positions influence evidence creation, interpretation, and governance. * A practical toolkit for translating those stances into study designs, evaluation metrics, and strategic decision frameworks. * A bridge between academic reflection and professional application, enabling researchers, policymakers, and industry teams to align evidence with ethics, culture, and context.