Companion to Scott's FDA-and-Paxlovid post. A short but worthwhile companion that materially updated his position. Commenters supply the strongest counter to his 'inexcusable delay' claim: FDA approval also requires validating commercial-scale manufacturing (Zutano's clear explanation of why scale-up isn't trivial — heat transfer scales with surface area but reaction heat with volume) and completing drug-interaction/organ-impairment safety tests the efficacy trial deliberately excluded. Scott concedes gracefully (Mistakes-page entry: 'I was wrong to say this was literally inexcusable') but holds the core point via his preferred fix — tiered approval (an immediate 'medium-level, not technically illegal' status, upgraded later), so the 99% without contraindications aren't held hostage to 'a PR campaign to sway the stupidest 10%.' Closes with the sharp 'deal with the devil' framing: banning all drugs until one agency approves them ties Medicine's whole reputation to that agency.

Quality 67 · Strong. Strong-floor (67). The honest self-correction plus the tiered-approval proposal and the reputation-hostage framing give it standalone value above a bare companion, but it is short and mostly built on commenters' manufacturing/safety points.

Claude’s paradigm shift 46 · Moderate. Moderate (46). The tiered-approval idea is a sharpening of Scott's standing FDA-reform position, not a new frame.

Real-world impact 1 · Negligible. 1 — a companion commentary; negligible independent real-world effect.

Highlights From The Comments On The FDA And Paxlovid