Original title "Proposing an NIH High-Leverage Trials (HILT) Program: Large-scale Research for Repurposing and Supplements" compressed to fit within title limits.
> 7: Related: Proposing An NIH High-Leverage Trials Program. One of the biggest problems in US drug development is that nobody has any incentive to spend money studying anything that can’t be patented, so supplements, certain small molecules, and new uses for old drugs never get a chance at FDA approval. Nicholas Reville discusses the obvious solution - that the government fund these as a public good. But he adds a few new things I didn’t know - first, that many of these can be justified as cost-saving (ie since the government pays for lots of health care, if a new trial lets them replace an expensive branded drug with a cheap off-patent alternative, they can recoup the cost of the study). And second, that this has already happened - in 2008, the National Eye Institute did a study like this to prove that a $50 older drug worked just as well as a $2000 newer drug, and saved the government $40 billion (“for context, NIH’s entire annual budget is ~$50B”).
Original title "Proposing an NIH High-Leverage Trials (HILT) Program: Large-scale Research for Repurposing and Supplements" compressed to fit within title limits.
From https://www.astralcodexten.com/p/links-for-february-2026
> 7: Related: Proposing An NIH High-Leverage Trials Program. One of the biggest problems in US drug development is that nobody has any incentive to spend money studying anything that can’t be patented, so supplements, certain small molecules, and new uses for old drugs never get a chance at FDA approval. Nicholas Reville discusses the obvious solution - that the government fund these as a public good. But he adds a few new things I didn’t know - first, that many of these can be justified as cost-saving (ie since the government pays for lots of health care, if a new trial lets them replace an expensive branded drug with a cheap off-patent alternative, they can recoup the cost of the study). And second, that this has already happened - in 2008, the National Eye Institute did a study like this to prove that a $50 older drug worked just as well as a $2000 newer drug, and saved the government $40 billion (“for context, NIH’s entire annual budget is ~$50B”).