The way we develop new drugs is broken. It is unbelievably expensive and slow: it takes more than ten years and a billion dollars to get a typical drug to an approval. The world gets only a quarter as many new drugs per R&D dollar as we did in 1980.

It would be convenient, in some sense, if this was all the fault of a single governmental regulator. I believe that, unfortunately, it is not. This sequence is an attempt to explain what I believe is going on instead, and—eventually—what can be done about it.