Daniel Carpenter: belief

Transcript context

…Now, the FDA — you’ve written yourself that the main function of the FDA is often about information rather than safety. If that’s the case, why don’t we have what my colleague Robin Hanson called “the banned product store”? That is, the FDA would announce what it has approved, but say treatments or drugs or vaccines it had not approved — within reason — would be available for purchase. You just would know you were taking your chances. Why not do that — have the FDA provide the information only? I would say two things. Number one, it’s a brute mechanism, but the mechanism of what I would call approval regulation, which is, basically, the FDA as a veto player granting access to profitable markets creates very, very powerful incentives for R&D. Those are incentives that we would otherwise not have. My worry is that in the Robin Hanson case — and by the way, I haven’t read this particular case, but I’ve seen some FDA’s Good Housekeeping seal of approval. There are different ways of generating information. We want the good stuff. We want the RCTs. We want credible information. I’m happy to talk about Bayesian clinical trials, so-called, real-world evidence — that’s a term that’s thrown around a little too much without definition. But if we’re thinking about ways that, say, a pharmaceutical company can inform its potential consumers — and I mean consumers at all levels: payers, physicians, nurse practitioners, pharmacies, folks who decide on formularies, and then relevant to vaccination, the people who get the shots in their arms or whether or not they adhere to the drug — well, they’ve got other ways to do that, and that’s advertising. You could have a world in which it’s like a lemons equilibrium in which, essentially, you would have lots of bad products outcompeting good ones. For what it’s worth, in the 19th century . . . Why would they outcompete the good ones? The UK approved the Pfizer vaccine. The US hadn’t approved it yet. I would have the option of going to a special store and trying it. We would have saved thousands of lives.…

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