> There was the other article sitting around recently asking why the rate of blockbuster drugs have slowed down. Getting even the level of confidence required n

> There was the other article sitting around recently asking why the rate of blockbuster drugs have slowed down. Getting even the level of confidence required now is hugely expensive. Requiring higher confidence is an expensive choice that must be weighed closely. Not just expensive but also potentially unethical. Consider this: post-exposure prophylaxis for HIV. It's used both for sexual and non-sexual exposure to the HIV virus. It's a month-long series of antiretrovirals (the exact protocols used differ). It's effective if you start taking it within 72 hours of exposure. The drugs themselves have been tested for use by people who are HIV+, but nobody has done clinical trials on using them as post-exposure prophylaxis. We know it works, but we don't know how well because testing would be unethical. You'd have to take half the people who are exposed and give them placebo and put them at risk of getting HIV. At a certain point, you have to throw the dice and say "given the evidence we have, this is what we are going to do". (The fact that such judgement calls are being distorted by evidence being intentionally withheld by drug companies is disgraceful though.)