> Compounds are approved for use or not based on empirical evidence, thus the need for clinical trials.

But off-label use is legal, so it's ok to use a drug that's safe but not proven effective (to the FDA's high standards) for that ailment... but only if it's been proven effective for some other random ailment. That makes no sense.

> What's your level of exposure to the pharma industry?

Just an interested outsider who read e.g. the Omegaven story on https://www.astralcodexten.com/p/adumbrations-of-aducanumab .