This is a well researched, informative and infuriating article. Within the system I cannot think of a better or more determined approach to this problem, but as this is HN I need to lay out a few points.
As we mint more billionaires they are going to do an end-run around the FDA. If I were a billionaire there is no way in hell I'd wait for a standard drug trial to progress on an FDA timeline.
Eventually one or more of the ultra wealthy is going to survive a disease that government sanctioned healthcare says is incurable. This will make its way through the network of the wealthy, and with some luck the whole process of how a drug was developed outside of the system will come out.
The bloat and overhead of the current process is intolerable. We've managed to elevate caution to a crippling set of shackles and at the same time put control of the process into the hands of people who only care about the calculus the OP so carefully describes. We pay unending lipservice to process and safety but drug companies are only act in proportion to potential liability.
> If I were a billionaire there is no way in hell I'd wait for a standard drug trial to progress on an FDA timeline.
You don't have to be a billionaire for this. There aren't many drugs which sit between proving efficacy in clinical trials and FDA approval, and ones that are like that only sit there for a few months. Of course, those could be important months for a particular patient, but there are ways to handle this. One such program is called "compassionate use". The idea is that if you have no other hope, you can be prescribed a non-approved treatment.
There aren't as many potholes in this as you seem to believe. Drugs which are proven efficacious and safe usually are submitted for approval, because it's expensive to run trials. It wouldn't be the first time a billionaire decided to do something medically unwarranted or ambiguous, but that doesn't mean it will become a norm.
Ordinary joes are already finding loopholes in the medical system, such as this article from yesterday about the popularity of old insulin pumps with an exploitable security flaw:
Eventually one or more of the ultra wealthy is going to survive a disease that government sanctioned healthcare says is incurable.
I knew a woman who used chelation to resolve issues in a child diagnosed as autistic. The world did not clamor for her story. She began finding more socially acceptable ways to describe the child that didn't ask the world to believe that a lawyer and mom had fixed the unfixable.
I have a similar story for a different condition. Nope, no one is clamoring to hear my story. Quite the contrary.
So you may find that it doesn't quite go like you think it will. A rich person might just sweep their miracle cure under the rug, claim they were "misdiagnosed" and mysteriously got better while on vacation and not admit that it was really a case of medical tourism.
There is a long history of, for example, American women from wealthy families just flying to Europe for an abortion if if it is too hard to get one here. Then poor women get back alley coat hanger abortions that leave them scarred for life because they can't afford to fly to Europe for excellent care.
Rich people who do things like that probably have the good sense to not say too much about it lest some nutjob bureaucrat try to interfere with their ability to do things like that.
They found a better name for my condition than "hypochondria." They renamed it atypical cystic fibrosis.
It's a variation on a dread disease with a short life expectancy.
I began getting healthier. My doctor expressed zero curiosity and scheduled me fewer appointments.
Fast forward 18 years, the internet likes to claim I have Munchausen. In other words, I've come full circle from "crazy" to "legitimate medical condition" to another variation of "crazy" for the crime of rudely getting healthier when the world says "You can't do that!"
As we mint more billionaires they are going to do an end-run around the FDA. If I were a billionaire there is no way in hell I'd wait for a standard drug trial to progress on an FDA timeline.
Eventually one or more of the ultra wealthy is going to survive a disease that government sanctioned healthcare says is incurable. This will make its way through the network of the wealthy, and with some luck the whole process of how a drug was developed outside of the system will come out.
The bloat and overhead of the current process is intolerable. We've managed to elevate caution to a crippling set of shackles and at the same time put control of the process into the hands of people who only care about the calculus the OP so carefully describes. We pay unending lipservice to process and safety but drug companies are only act in proportion to potential liability.