I find the idea to be uninspired and not very feasible, but that chart?! I had no idea it was that bad. Makes you wonder how you get approval for nexium unless (a) that 1 patient is fuckin' cured, and (b) the others are advised to stop the drug immediately when it's clear they're not being helped. From its position at number 2, I doubt that is the case. I think a much more efficient way to reform clinical trials is to go after informed consent reform. The amount of red tape involved in treatment evaluation is so over the top that you can't even contemplate touching patients for under tens of millions, and you can't contemplate actually making a drug for under hundreds of millions. It's almost as if the ethicists who write informed consent rules contemplate patients who (a) aren't sick, (b) have post-graduate degrees in philosophy, and (c) are physicians who practice law on the side when they write the rules.
I shared it for two reasons: (1) dat chart (2) the idea of individual trials is actually much closer to an Asian/Oriental Medicine (AOM) or homeopathic approach to treatment. Which is not to say there's much in the way of scientific rigor in homeopathy as a modality. But as a treatment, homeopathic remedies are chosen based on a long interview process, the answers of which are marched through a flowchart of if-then statements (which are often wildly specific): Dan Ariely has a chapter or two in Predictably Irrational about how the placebo effect is still an effect, dammit, and how different cultures relate to different placebos differently. A commonality, however, is that the more involved the patient is in their own care, the stronger placebo effects tend to be. I'm of the opinion that much alternative medicine is successful because a visit to your crystal healer is a whole helluvalot more involving than a visit to your allergist. It's a lot more empowering, too - "put on this cream" will lose to "perform this sacred ritual" every time. Stuff like Nexium, by my read, exists because of the methodologies and incentives we use for drug development. There's a 6% chance it will help you with your heartburn. There's a 20% chance it'll give you diarrhea via clostridium infection. There's a small chance it'll give you acute interstitial nephritis. There's a 100% chance Pfizer gets to sell an entire bottle before you find out. And if Western medicine had more of a patient focus (like AOM) the outcomes would be better for everyone. That said, I recognize that this is basically the Universal Basic Income of drug development.