We need a great degree of intelligence to judge the “cost effectiveness” of a drug. In lymphoblastic leukemia, every trial in the 1950s and 1960s typically added between six and ten weeks of survival benefit. By the late 1960s, a substantial fraction of patients, about sixty percent, were being cured. If we had judged the cost effectiveness of Aminopterin in Sidney Farber’s trials—which showed a survival benefit of only a few weeks in only some children—we might have abandoned the drug altogether. Judge “cost effectiveness” too early and you might throw out powerful drugs that have not been
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