David Allison

Look at the sample sizes of studies of statins, randomized control studies of statins, GLP-1 agonists, vaccines, et cetera.

They're different by multiple orders of magnitude.

It's not uncommon to read these studies saying,

We're interested in the effects of protein consumption on African-American women over age 50 with diabetes and without.

So it's six in each group.

Six in each group.

You had 60,000 over there in that pharma study.

And so we have really weak data on this.

And so it's not surprising that often we don't show these big effects.

The first question is very simple.

It's the economic model of it.

Pharmaceuticals are patentable.

And the way our country works is, in general, you cannot market a pharmaceutical without the FDA's approval.

and the FDA will generally not give approval unless you've met their bar for having demonstrated as the act of Congress for the FDA's structure mandates, they must have a reasonable basis for concluding that the benefits outweigh the harms

under proposed conditions of use.

And so the FDA says, this is what it's going to take to convince us.

And it's going to be these big randomized controlled trials, as well as a few other things.

And so the companies say, we've got to do it.

Then there's the economic model that makes it feasible for them to do it in most cases.

Sometimes the reason we don't have certain drugs is not because they can't be made,