There are people that think that we could have much faster medical progress via a basically libertarian approach: decrease or abolish government regulation of drug development. Or permit companies to market new drugs without first proving that they work.
Nutritional and herbal supplements are barely regulated at all: so by this argument there should be all kinds of medical progress stemming from that area. But it hasn’t happened. supplements are mostly useless, yet people buy them anyhow. There’s very little regulation of medical developments in third world countries – why aren’t they a a fount of medical progress? But that’s an unfair comparison: we know why they’re not.
So why is drug development harder than making a better cellphone or laptop?
People are complicated, evolved rather than designed, product of a recipe rather than a spec. We know something about human biochemistry and physiology, but far from everything. We know enough that some ( a few) of our new ideas about treating disease work – but most don’t, including most of those that everybody involved just knew had to work. It’s fair to say that we don’t have a good interface spec.
Next, the consequences of failures can be considerably more serious. The equivalent of the blue screen of death is .. death. Developing a new drug is more like developing avionics than apps: we don’t want planes to crash, and we’ve succeeded – but not through a unregulated market.
Knowing some history gives perspective. In 1900, few of the drugs in the pharmocopoeia actually worked. Doctors were not yet in the African-American. Why did they have customers? Why did doctors even exist? Why did literally thousands of years of low regulation result in almost no progress? The Romam Empire had low marginal tax rates too, and good security of private property most of the time – why so little progress?
Mostly, as far as I can tell, doctors existed was because people didn’t understand regression to the mean. You go to the doctor when you feel worse than average: after he does something you are eventually closer to average. Or if he did nothing, which was safer. Big pharma started out as frauds – they had nothing better. But being a fraud worked, and it still works. One of my correspondents had an MD tell him that the pharmaceutical industry was rotten to the core, doctoring all kinds of studies, and spinning results. True.
Nobody regulated psychologists, so the free market scotched Freudian analysis – in your dreams.
Anyhow, it is surely possible to materially improve the efficacy of drug development, of medical research as a whole. We’re doing better than we did 500 years ago – although probably worse than we did 50 years ago. But I would approach it by learning as much as possible about medical history, demographics, epidemiology, evolutionary medicine, theory of senescence, genetics, etc. Read Koch, not Hayek. There is no royal road to medical progress.