Let’s talk about “repurposing” drugs. It’s a term that is used a lot in pharma - often with a kind of romantic glow, like we’re treasure hunters stumbling across a forgotten gem in the medicine cabinet. A drug developed for one disease suddenly shows promise for another, and we begin to exclaim that we’ve saved time, money, and maybe even lives. It’s a great story. But here’s an inconvenient truth: the need to repurpose drugs in the first place often signals a failure to understand what a drug could really do from the outset. At IDEA, we’ve been banging this drum for a while now: the industry needs to stop guessing and start purposing drugs properly during early development. Repurposing assumes we got the initial purpose right - or at least close enough to pivot later. But too often, that initial purpose is a rushed, best-guess stab at an indication, a market, or a probability of success. And that’s where things go wrong.
The Problem with Guessing
Picture this: a pharma company has a shiny new molecule. It’s exciting, it’s promising, and the team is eager to get it into the clinic. So, they do what they’ve always done: pick an indication based on a mix of preclinical data, market forecasts, and a dash of gut instinct. They estimate the market size (usually optimistically), ballpark the probability of success (often generously), and charge into Phase 1 with a plan that’s more hope than strategy. Sound familiar? It should. This is how much of the industry operates. But those early decisions - where to aim the drug, who it’s for, and how it might fit into the market - are often made with incomplete information. We’re not saying it’s easy. Drug development is messy, complex, and inherently uncertain. But leaning on quick guesses instead of rigorous exploration is like building a house on a foundation of sand. It might hold up for a while, but don’t be surprised when it starts to wobble. This is where the whole “repurposing” narrative comes from. When a drug fails in its original indication or underperforms commercially, we go back to the drawing board, scouring for new uses. Sometimes, we get lucky - think aspirin or sildenafil. But relying on serendipity isn’t a strategy. (Planned serendipity, perhaps…) It’s a lottery we wouldn’t need to play if we spent more time purposing drugs properly from the start.
We don’t call it ‘guessing’ of course. Almost everywhere, Discovery into Development makes choices based on their own metrics - hastily grabbed signals of efficacy, clear enough signs of safety. And then, poorly calculated forecasts and eNPVs.
Purposing: A Better Way Forward
So, what does “purposing” mean? It’s not about finding the perfect indication on the first try - nobody expects that. It’s about taking the time to explore a drug’s full potential before committing to a single path. It’s about asking tougher questions earlier: What diseases might this molecule address? What patient populations could benefit most? What does the biology tell us, and how can we pressure-test that against real-world data? It’s about being curious, methodical, and maybe even a little skeptical of our own assumptions. At IDEA, we’ve long advocated for a more deliberate, a more deliberately option-based, approach to early-stage development. Instead of rushing to pick an indication and sprinting toward clinical trials, we need to slow down and map out the range of possibilities. This might mean broader preclinical studies, leveraging real-world evidence to identify unmet needs, or even using AI and computational tools to model a drug’s potential across multiple indications. It’s not about delaying progress; it’s about making progress smarter. The payoff? A drug that’s better aligned with its true potential from the start. Fewer late-stage failures. Less need to “repurpose” because we got the purpose right - or at least closer to right - the first time around. And, crucially, a better chance of delivering real value to patients and the healthcare system.
There are lots of quotes that suggest this thinking is not new - it’s just something that we’ve forgotten to remember in drug development
Sun Tzu, The Art of War:
“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.”John Wooden:
“If you don’t have time to do it right, when will you have time to do it over?”Abraham Lincoln:
“Give me six hours to chop down a tree, and I will spend the first four sharpening the axe.”Peter Drucker:
“There is nothing so useless as doing efficiently that which should not be done at all.”
Why This Matters Now
The pressure to move fast in drug development isn’t going away. If anything, it’s intensifying. Investors want quick wins, regulators want clear data, and patients want treatments faster. But speed without strategy is a recipe for waste - wasted time, wasted money, and wasted opportunities to help patients. The good news is that we have tools and approaches today that make proper purposing more feasible than ever. Advances in data science, biomarker discovery, and patient stratification mean we can explore a drug’s potential with unprecedented precision. But tools alone aren’t enough. It takes a mindset shift—a willingness to challenge the status quo and invest in understanding a drug’s possibilities before locking in a development path.
A Call to Action
So, let’s stop romanticizing repurposing. It’s not a sign of ingenuity; it’s often a symptom of a process that’s too hasty, too narrow, too focused on the short term. Instead, let’s commit to purposing drugs thoughtfully from the beginning. Let’s explore the full range of a molecule’s potential before we bet the farm on a single indication. Let’s build a development process that’s as curious and dynamic as the science we’re working with.
Speed without strategy in drug development is just a race to nowhere.
So spot on!