THE REPUBLIC OF TRANSLATIONAL MEDICINE

Abstract Established pharmaceutical innovation theory holds that companies and patents are essential for developing new treatments. Yet, it does not adequately explain numerous clinical trials conducted by hospitals and universities. This paper introduces a new, complementary theory that describes a parallel system of innovation, focused on new uses of already authorised drugs, particularly once generics are available. These trials are driven by incentives previously associated with “open science” and “user innovation” rather than by patents and cost 90 per cent less than commercial equivalents. This “hidden” research system could regularly provide society with affordable treatments.