morriswalters wrote:The approval rate for drugs will always be too slow.
I'm confused by this statement. Do you mean that it's impossible for drugs to be approved too quickly? Or that there will always be people who want the approval rate to be faster than it currently is? Or something else?
EMTP wrote:Old does not mean safe.
Agreed! But my current impression is that the FDA does little to no safety-related testing of things that have been consumed for long periods, like salt, sugar, or wheat (all of which have credible health risks). Grandfathering things in like that is not optimizing public health, and I'm troubled by health-related regulatory agencies whose incentives are not lined up with public health. (For example, my impression is that several sugar replacements are healthier than sugar, but are required to have warnings because they're not zero risk, which is a misuse of the FDA's ability to warn.)
And we haven't even started talking about alcohol or tobacco!
EMTP wrote:These decisions aren't easy, and I'm not sure we want to leave them exclusively in the hands of corporation boards, marketing executives, and the public.
Exclusively? Of course not. I imagine most people would like to hire a medical expert to make that sort of decision for them. I also agree with the implication that private interest announcements and public interest announcements are often difficult to separate, especially when medical commerce is involved.
Most importantly, I agree that the decisions are not easy. We should expect most technologies to be tradeoffs- altering your blood makes it both less likely to have heart attacks and more likely to have intestinal bleeding- but most people naturally want to think about technologies as good or bad. Either nuclear power is cheap and clean- and not risky- or it's risky, and also expensive and dirty. From the outside, it seems possible that it could be cheap, clean, and risky, or expensive, dirty, and not risky, but very few people hold that impression.
The FDA seems like it plays into that fallacy- either drugs are safe and effective, or unsafe and ineffective. Drugs that are unsafe but effective, or safe but ineffective don't seem to have a place. (Why would you want to approve either of those? The first kind may be better than the next best option for some patients, and the second kind of drug may be effective for something, but what or for who is not known yet.)
And so free flow of information seems like it could be a significant solution, especially if that came with a clear separation of risks and rewards. Requiring transparency seems more flexible than requiring veracity (beyond basic anti-fraud requirements).
EMTP wrote:I'd be curious:
I'm not an expert in that field, and so can't defend any of my examples very far.
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