Yes. I argued that the causes for the malaise are over-determined, and medical liability and close-mindedness are both reasons. There are integrative and functional doctors who are more willing to prescribe off-label medications. But they are rare and I haven’t researched them in depth yet.
The causes for the malaise are over-determined but include among other reasons: institutional inertia & red tape, lack of funding for repurposing generic drugs, regulations that often force companies to test only one new drug at a time against the standard of care (SoC), oncologists who refuse to deviate from SoC due to some combination of fear of medical liability and close-mindedness and coordination problems amongst pharmaceutical companies.
But if there were 10x more clinical trial results, there’d be a greater universe from which one could prescribe off-label medications, and the quality of off-label recommendations would be higher. And the FDA certainly is a blocker there.
Great article! A related thought occured to me after I read the ‘Death Of Cancer’ by Vince DeVita. One reason the NCI program was successful is because the NCI operated a research hospital; the hospital was free for the patients in exchange for their participation in clinical research programs. Physician-scientists developed protocols, including combination chemotherapy, while basically experimenting on patients in ways that would not be allowed today. With our current regulations, its inconceivable that combination chemotherapy could’ve been developed.
My takeaway from that was that perhaps we could re-create a similar institution, but for dogs, as a circumvention measure [I continue to think that the best animal disease model for humans are humans]. The failure mode of such a research program would of course be that treatments are developed in a very targeted manner for dogs that doesn’t translate to human cancers.
A pan cancer research program that experiments on dogs on the other could be more promising in that the learnings would translate to humans much more readily.