What's wrong with more safety?

"The natural progress of things is for liberty to yield and government to gain ground," wrote Thomas Jefferson. It is a natural trend even in functional constitutional democracies where the vast majority claims to value liberty. The explanation of this phenomenon is quite simple: economophobia. Most people go though their lives in blissful ignorance or stubborn denial of the fact that we live in a world of trade-offs. An example of this is the unqualified support that most of us give to the Food and Drug Administration. We simply refuse to acknowledge the fact that choosing more safety means killing more people.

In the vastly influential Free to Choose, Milton Friedman asks that we put ourselves in the position of the decision-makers at the FDA. We have the terrible job of controlling one of the largest American markets and deciding who should live and who should die. What incentives shape our behavior? We evaluate the probability of allowing a bad drug to reach the market versus the probability of delaying or banning a good drug. Which mistake would we rather make?

Now it becomes obvious that the FDA's legal mandate to decide which drugs should be made available to patients in the United States has created a skewed structure of incentives where concerns for safety vastly outweigh concerns for efficacy. Since we don't want to enter history as those approving the next "thalidomide," we would be extra careful with all new drugs. What's wrong with that? Nothing, unless we count the lives that could be saved by all efficient drugs whose approval we delay for extra testing. We would do anything to increase the chances that some Elixir Sulfanilamide will not kill a handful of people under our watch since their tragedy will be observed by all through the media. We may be very decent fellows yet we would gladly sacrifice any number of unseen fellow Americans for the safety of a few and our own comforts.