664. Are Thousands of Medical Cures Hiding in Plain Sight?

What It Covers

Freakonomics Radio examines drug repurposing — using FDA-approved medications for new diseases — through physician-scientist David Fagenbaum's survival story, EveryCure's AI-driven platform scanning 4,000 drugs against 18,000 diseases, and economist Chris Snyder's pull-funding proposal to fix broken financial incentives blocking life-saving discoveries already sitting on pharmacy shelves.

Key Questions Answered

• •The Repurposing Math: Only 25% of the 18,000 known human diseases have FDA-approved treatments, yet repurposing existing drugs costs roughly 1% of developing a new compound from scratch. Generic drugs are already manufactured, safety-tested, and available at pharmacies, making them the highest-ROI path to closing the treatment gap for the remaining 13,500+ untreated diseases.
• •AI Knowledge Graphs: EveryCure's platform maps every drug, disease, gene, and protein into a biomedical knowledge graph, scoring all 4,000 approved drugs against all 18,000 diseases from 0 to 1. Scores near 0.99 flag the strongest repurposing candidates for human medical review, dramatically narrowing where researchers should focus clinical trial resources first.
• •Lidocaine and Breast Cancer: A 1,600-patient randomized trial published in the Journal of Clinical Oncology found that injecting lidocaine — a standard surgical numbing agent already used in nearly every procedure — around breast tumors eight to ten minutes before excision reduced patient mortality by 29%. Despite this result, no widespread adoption has occurred due to absent commercial incentives.
• •Pull Funding Mechanism: The Market Shaping Accelerator proposes a federal pull-funding program where Medicare or Medicaid pays companies a percentage of documented savings per patient after a repurposed generic drug proves effective. Estimated cost runs roughly $1 billion per successful indication, but government pays nothing unless measurable patient outcomes are confirmed first.
• •Advanced Market Commitments Work: The 2009 pneumococcal vaccine advanced market commitment — a $1.5 billion fund backed by the Gates Foundation and five governments — attracted three manufacturers, drove prices down, and has been credited with saving 700,000 children's lives. The same pull-funding model accelerated COVID-19 vaccine development, compressing a multi-year timeline into months.