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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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