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Comment by seanmcdirmid | Hacker News Reader

They do fast track drugs if studies show overwhelming success, and it is no longer ethical to keep it from the control group.

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Other areas of medecine do do things in a rush - like an ambulance breaking the speed limit to maybe save one guy. Yet we wouldn't allow breaking the speed limit when delivering a new treatment to save thousands of lives.

There are reasons why drug approval can be slow and conservative: https://en.wikipedia.org/wiki/Thalidomide_scandal

Yet the harm from that (10,000) was in many ways tiny compared to the harm from not deploying treatments that turn out to be good.

For example 780,000 people died of polio between 1988 and today. Yet for all that time there has been a cheap, low risk, well tested, near 100% effective vaccine (many in fact). And polio is probably one of the better cases because governments and charities have been pushing it pretty hard.

The polio vaccine has been approved by the FDA during all of that time. Therefore, I don't understand how the deaths during that time provide evidence that the FDA should approve drugs faster.

Edit: Also, polio eradication efforts where a Manhattan project style heroic effort.

What's really inefficient is that every trial needs to spend (hundreds of) millions on writing up the whole thing, IRBs and FDA (and additional authorities) paperwork, recruiting, data analysis, etc. while these could all be standardized. (There are companies that do this, but they are just expensive middlemen. There was a great substack (?) post detailing a lot of these, but now I can't find it.)

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