The emphasis on sub-group analysis to establish which patients would benefit most from Qnexa -- with an emphasis on collecting data from everyday patients -- reflects both a shift in the Vivus strategy and a change in FDA's outlook. I think going forward a Steve Nissen will not be able to trash drugs of companies that he doesn't work for to the advantage of products from firms that he does with a sloppy meta-analysis. (As as aside, Nissen's use of a meta-analysis to attack Eric Topol's research on the value of using gene tests to select drugs for stenting procedures was recently laughed off and ridiculed.) And companies that want to move a new product to market would do well to seek approval based on those sub-groups where the benefits exceed the risk. And to be able to monitor disease progression and treatment response after market with simple blood tests would advance approval even more. The more risk can be defined and measured at the subgroup or individual level, the less chance anti-innovation forces will have to block new devices and drugs that have clinical utility.
That's what The Critical Path was supposed to do. It sounds like the Qnexa decision was made consistent with that mission.