There’s been a lot of political rhetoric recently about “not leading from behind.” But in the area of pharmacologic medical treatment, that’s precisely what we’ve been doing—for years.

It’s been an odd but understandable quirk of our health care system that most of the newer, often safer and more effective, drugs are put into clinical practice overseas years before they make their way onto our teeming shores. Odd, because we like to think of ourselves as leaders and innovators, and because many of these wondrous new therapies originate here. Understandable, because we are risk averse and courtroom avid.

We’ve set up an elaborate series of hoops and boondoggles designed to maximize safety, which is good—what we call due diligence. But there is risk versus benefit in how thoroughly we scrutinize the risk versus benefit of the treatment we’re vetting. And if you’re a pharmaceutical firm facing a citizenry willing to play the Great American Legal Lottery each time it falls from a cliff in the wilderness because there wasn’t a sign posted and a fence planted, you don’t innovate; you wait. You wait for some one else to accept the small risks first and reap the early benefits as reward.

Some would argue we’re cautious and they’re foolish; yeah … that’s the ticket.

Only a cynic would think we’re timid and view them as expendable.


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