There are mechanisms to provide drugs earlier patients while it is still in clinical development. Companies don't offer expanded access because they worry that it will disncentivize people from entering a trial. In oncology, when i was at the agency, we stood up and said, we're not going to do placiba trials any more. But why even have a stage three or stage four like, just let me choose, and then the data will show from population data? It's unethical in the setting of a disease that we know is terminal to radomize patients to a placebo pill.

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