The other trouble is that these excellent trials will only be able to observe relatively immediate side effects. If there's other long-term side effects, they won't be detected for years or more.
See my edit. You're trying to use the definition of long term side effect to show that we need long term studies before we can deem things safe. But that doesn't follow. If the prevalence of some potentially chronic condition is low enough after a month to be safe, that it might be even safer doesn't really matter.
Right like to recap but remove the word "long term" entirely, you said that there might be issues that develop after years without warning. I said that no that's not possible, stuff can't develop suddenly after even just a month or so, because the mechanisms don't exist. You then cited an example of something that developed in under a month or two as a counterexample. When I put it that way, it's clear that it isn't actually a counterexample.
> Side effects don't have to happen in the next 6 months.
If this is a molecule with a short half-life that is broken down and expelled by the body, it isn't going to have random side effects that show up months in the future.
The "whatever reason" is that the level of long-term side effects that can be tolerated depends on the disease being cured. A drug that cures a previously fatal cancer should be approved, even if there are some long-term side-effects, because it's better than death. A drug that treats hair loss or heartburn needs studies to make sure that serious long-term side effects are extremely rare.
Testing for rare long-term effects requires a huge sample size, and billion dollar clinical trial budgets.
Teams do decide, early on, to try to discover drugs for serious diseases or common diseases, depending on how much money they think they can raise. Usually only proven teams can raise the huge amounts, so most pharma startups target serious niche diseases hoping for approval under the orphan drug program.
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