Are you suggesting when a new drug hits the market doctors should just try it out on a few patients to see if actually does what it says it does? If only there was some way this sort of trial and error could be performed before a drug was widely available, in a controlled environment...

" If only there was some way this sort of trial and error could be performed before a drug was widely available, in a controlled environment..."

This is exactly how doctors determine what works, with or without the government. See the off-label discussion in the link above.

I'm familiar with the off-label discussion, but what number of these off-label uses were discovered by treating coinciding conditions in patients? How many were last ditch attempts when other treatment options either don't exist or failed?

I'm not suggesting that current regulation by the FDA isn't flawed, or that it doesn't need an overhaul, but I think it's clear that there should be some proof that efficacy studies were done before a drug becomes widely available, especially when the potential damage done by a failed treatment is so high. The current opioid crisis has completely eroded any faith that the pharmaceutical industry is capable or willing to regulate itself.