Old Medicines, New Hope: The Revolution in Repurposed Drugs

A Board member and advisor to my "Rebuild Medicine" non-profit published an Op-Ed in Real Clear Health, charting ways to unlock safer, faster, and more affordable cures for today’s toughest diseases.

The above Op-Ed was written by my new friend and colleague, Dr. Stephen M. Smith, who is, interestingly, an infectious diseases (ID) specialist, most notably in HIV/AIDS and urban health. Why interestingly? Because, and this is a not-so-fun fact, throughout my ICU career, my least liked consulting specialists were from ID!

With rare exceptions among truly gifted infectious disease specialists (like Stephen I should add), most ID docs tended to order excessive panels of tests looking for every infectious pathogen known to man—an approach I often called the “machine gun” method of diagnosis. As an inside joke, I’d say they were “summoning the vampires in the basement,” a reference to the large volumes of blood drawn for their lab analyses and cultures, as specimens were sent down to the hospital basement, where all the diagnostic testing took place.

Forgive me for I digress, as I should say that Steve is not one of them - I have learned from my conversations with him that he is an astute clinician and a polymath with a diverse set of knowledge areas. He currently serves as president and founder of The Smith Center for Infectious Diseases and Urban Health, a non-profit clinic in New Jersey focused on treating infectious diseases in inner-city populations. Before we turn to the Op-Ed, here is another not-so-fun fact: Steve did his infectious disease fellowship at the NIH… under Anthony Fauci. Yup.

But Fauci was no match for Steve’s brilliance, as can be evidenced in today's Op-Ed, an Op-Ed that Fauci would have never written in a million years. Enjoy:

Most new drugs released in the U.S. are the product of 15-year development projects that cost billions and frequently result in failure. An easier, faster way is hiding in plain sight. Thousands of generic medications sitting in our medical cabinets are a potential goldmine of new applications that could be developed in years, not decades. The Trump administration can revolutionize healthcare by establishing a systematic framework to study and develop repurposed generic drugs.

For millennia, medicine has been practiced by observation. Physicians tried different approaches to treatment, gauged a patient’s response, and shared their findings. Over the past century, that practice gave way to a mechanical approximation of this process, whereby patented medicines are tested through large-scale randomized controlled trials. This approach has yielded incredible breakthroughs, allowing millions to live longer, healthier lives. But these trials are incredibly expensive and carry a great risk of failure. Today the biopharmaceutical industry spends roughly $200 billion per year on R&D, roughly 70% of which—some $60 billion—results in failed projects.

More importantly, our regulatory system relies too heavily on these trials to affirm new drugs, leaving little room for the time-tested practice of observation in medicine. This came to a head during the COVID pandemic, when physicians who treated patients with generic repurposed medicines to observe potential benefit lost their jobs for bucking institutional protocols. These men and women spent their lives in service to others, meticulously practicing medicine for decades, trying new treatment approaches to gauge patient response, and healing the sick. Many lives were destroyed merely for want of practicing medicine as it had always been done, in search of a way to alleviate suffering.

The rest of the Op-ED can be read here, which details some effective ways of furthering the field in terms of policy. With Bobby at the helm, those ideas could definitely become a reality.

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