The Seen Deaths and the Unseen Deaths

The more years that the trials go on and the larger the number of people in the sample taking the drug, the more reliable the end results as to both safety and effectiveness— and the more sick people will be left to suffer and perhaps die while these processes go on. A new drug may be tested for effectiveness against a placebo or against the effectiveness of some other drug. The latter may be a better process in terms of the validity of the end results but one such trial involving more than 30,000 people added another eight years to the testing process. A lot of people can die in eight years— and yet absolute certainty is still not achievable by human beings, no matter how much testing goes on. Moreover, these deaths during the trial period are not necessarily recouped in lives saved later over the lifetime of the particular drug or treatment, which may be superseded by new drugs or treatments for the same diseases in few or many years, as the case may turn out to be.
The incentives and constraints facing government officials in charge of testing pharmaceutical drugs are asymmetrical. Ideally, these officials could weigh the costs and the benefits equally— for example, stopping the testing process at the point where the estimated number of lives lost while waiting longer for more drug tests to be completed would exceed the estimated number of lives saved by getting more data on the drug’s safety. But neither the public, the media, nor the political leaders to whom health officials are ultimately responsible are likely to use that standard.
If a thousand children die from a new drug allowed into the market with less testing and ten thousand would die while more testing was going on, the public outcry over the deaths of those thousand children would bring the wrath of the whole political system down on the heads of those officials who permitted the drug to be approved with “inadequate” testing. But then if a hundred times as many people die while prolonged testing goes on, there will be few, if any stories about those people in the media.
For one thing, the thousand deaths attributable to the drug approved by the FDA are far more likely to be provable deaths to identifiable individuals, whose stories can make headlines. That is not true, however, of the deaths of ten thousand unidentifiable individuals whose inability to get a life-saving drug shows up only in death-rate statistics comparing what happens where the drug is available and what happens where it is not available. But statistics are never as dramatic as television interviews with distraught widows or bereaved mothers of those have who died from the side effects of a drug.
— Thomas Sowell, Applied Economics p. 91

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