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Translational medicine has excited expectations of the drug development process seeing better days. Hope is much needed, as the process in its current form is ‘unsustainable’1 and its yield unimpressive. Only a small percentage of highly promising molecular discoveries find their way into a clinical trial and even a smaller percentage ends up in a pharmaceutical product marketed for clinical indications. Various reasons contribute to this problem ranging from purely biomedical, safety and efficacy ones, to merely commercial calculations. Large numbers of compounds are shelved because pursuing them is simply not a good business idea. Such decisions result in lost drugs from which patients could have benefited. This issue is unresolved but has not gone unnoticed and some initiatives have attempted to offer remedies by incentivising the pharmaceutical industry to open their libraries of unused compounds.2 Provided that companies or academic institutions are able to make an unused compound available, funds must be secured to support clinical trials and the process to keep it advancing in the pipeline.
Masters and Nutt respond to this very issue of funding with a controversial suggestion.3 According to their ‘plutocratic proposal’ rich people who suffer from a disease, for which such an untested shelved compound is a good candidate, …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.