Billions in R&D goes to getting molecular entities approved by FDA that are clinically meaningless. The medical R&D is done just to get a product that provides already existing functionality or already existing treatment with a slightly modified molecule that can be patented.

It's like the joke about man who goes to patent office and says that he invented gunpowder. Patent clerk says that unfortunately gunpowder has already been invented. The man says: "But I invented more of it." Approval process is not looking if the new drug is meaningful improvement over existing drugs. "Inventing more of the same" is approved if it can be tweaked a little to be unique.

Alternative is also true. There are potentially clinical treatments and medicines that receive no approvals because there is no profit motive to push them trough the expensive process of approval.