** We’ve paused the Works in Progress podcast feed, so head over to our dedicated Hard Drugs podcast feed to listen to future episodes, if you hadn’t subscribed there already! https://harddrugs.worksinprogress.co/ ** GLP-1 drugs like Ozempic and Mounjaro have transformed the treatment of obesity as well as diabetes, can help treat heart disease, kidney disease, sleep apnea, and maybe even Alzheimer’s. But they are far from the only medicine with more than one use. Aspirin, colchicine, minoxidil, and Viagra were all found to treat more conditions than expected, and about a third of drugs end up with a second approved use. In this episode, Jacob and Saloni explore the idea of drug repurposing: taking a medicine made for one disease and finding it works against others. They trace how GLP-1 drugs emerged from an adorable Gila monster, why some drugs have multiple uses, why so many of those uses go untested, and how patents, competition, prizes, and platform trials shape whether we ever find them. Hard Drugs is a podcast from Works in Progress about medical innovation presented by Saloni Dattani and Jacob Trefethen. You can watch or listen on YouTube, Spotify, or Apple Podcasts. Saloni’s substack newsletter: https://www.scientificdiscovery.dev/Jacob’s blog: https://blog.jacobtrefethen.com/  Acknowledgements:Aria Babu, editor at Works in ProgressGraham Bessellieu, video editorAbhishaike Mahajan, cover artAtalanta Arden-Miller, art directionDavid Hackett, composerBlogsJulia Rohrer (2018). The uncanny mountain: p-values between .01 and .10 are still a problem https://www.the100.ci/2018/02/15/the-uncanny-mountain-p-values-between-01-and-10-are-still-a-problem/ Abhishaike Mahajan (2025). Mapping the off-target effects of every FDA-approved drug in existence (EvE Bio) https://www.owlposting.com/p/mapping-the-off-target-effects-of VideosGeorge Davey Smith (2026). Does the shingles vaccine prevent dementia? https://www.youtube.com/watch?v=qlTnnQytOJ0 Articles & reportRadwan Darwish et al. (2025). History of glucagon-like peptide-1 receptor agonists. https://doi.org/10.1016/j.phrs.2025.108045 Brian L. Furman (2012). The development of Byetta (exenatide) from the venom of the Gila monster as an anti-diabetic agent. https://doi.org/10.1016/j.toxicon.2010.12.016 Eric Budish, Maya M. Durvasula, Benjamin N. Roin, Heidi L. Williams (2026). Missing markets for innovation: evidence from new uses for existing drugs. NBER Working paper. https://www.nber.org/system/files/working_papers/w34222/w34222.pdf Babak Sahragardjoonegani, Reed F Beall, Aaron S Kesselheim, Aidan Hollis (2021). Repurposing existing drugs for new uses: a cohort study of the frequency of FDA-granted new indication exclusivities since 1997. https://pmc.ncbi.nlm.nih.gov/articles/PMC7780607/ BMJ (2020). Covid-19: The inside story of the RECOVERY trial https://www.bmj.com/content/370/bmj.m2670 Stephan Guyenet (2021). The future of weight loss https://worksinprogress.co/issue/the-future-of-weight-loss/ Kevin Hickey, Erin Ward (2024). The Role of Patents and Regulatory Exclusivities in Drug Pricing https://www.congress.gov/crs-product/R46679 Alex Kesin (2025). The three-thousand-year journey of colchicine https://worksinprogress.co/issue/the-three-thousand-year-journey-of-colchicine/ Samy Suissa, Laurent Azoulay (2012). Metformin and the risk of cancer: time-related biases in observational studies https://doi.org/10.2337/dc12-0788 Nicholas Reville (2026). Proposing an NIH High-Leverage Trials (HILT) Program. Center for Addiction Science, Policy, and Research (CASPR) https://caspr.org/policy/papers/HILT/ WebSmithsonian’s National Zoo. Gila monster. https://nationalzoo.si.edu/animals/gila-monster 

GLP-1 drugs like Ozempic and Mounjaro have transformed the treatment of obesity as well as diabetes, help treat heart disease, kidney disease, sleep apnea, and maybe even Alzheimer’s. But they are far from the only medicine with more than one use. Aspirin, colchicine, minoxidil, and Viagra were all found to treat more conditions than expected, and about a third of drugs end up with a second approved use. In this episode, Jacob and Saloni explore the idea of drug repurposing: taking a medicine made for one disease and finding it works against others. They trace how GLP-1 drugs emerged from an adorable Gila monster, why some drugs have multiple uses, why so many of those uses go untested, and how patents, competition, prizes, and platform trials shape whether we ever find them. Hard Drugs is a podcast from Works in Progress about medical innovation presented by Saloni Dattani and Jacob Trefethen. You can watch or listen on YouTube, Spotify, or Apple Podcasts. Chapters: Saloni’s substack newsletter: https://www.scientificdiscovery.dev/Jacob’s blog: https://blog.jacobtrefethen.com/  Acknowledgements:Aria Babu, editor at Works in ProgressGraham Bessellieu, video editorAbhishaike Mahajan, cover artAtalanta Arden-Miller, art directionDavid Hackett, composerCorrection: Saloni misdescribed the mechanism of immortal time bias - it comes from the pre-prescription time being counted in the treatment group, not the control group. BlogsJulia Rohrer (2018). The uncanny mountain: p-values between .01 and .10 are still a problem https://www.the100.ci/2018/02/15/the-uncanny-mountain-p-values-between-01-and-10-are-still-a-problem/ Abhishaike Mahajan (2025). Mapping the off-target effects of every FDA-approved drug in existence (EvE Bio) https://www.owlposting.com/p/mapping-the-off-target-effects-of VideosGeorge Davey Smith (2026). Does the shingles vaccine prevent dementia? https://www.youtube.com/watch?v=qlTnnQytOJ0 Articles & reportsRadwan Darwish et al. (2025). History of glucagon-like peptide-1 receptor agonists. https://doi.org/10.1016/j.phrs.2025.108045 Brian L. Furman (2012). The development of Byetta (exenatide) from the venom of the Gila monster as an anti-diabetic agent. https://doi.org/10.1016/j.toxicon.2010.12.016 Eric Budish, Maya M. Durvasula, Benjamin N. Roin, Heidi L. Williams (2026). Missing markets for innovation: evidence from new uses for existing drugs. NBER Working paper. https://www.nber.org/system/files/working_papers/w34222/w34222.pdf Babak Sahragardjoonegani, Reed F Beall, Aaron S Kesselheim, Aidan Hollis (2021). Repurposing existing drugs for new uses: a cohort study of the frequency of FDA-granted new indication exclusivities since 1997. https://pmc.ncbi.nlm.nih.gov/articles/PMC7780607/ BMJ (2020). Covid-19: The inside story of the RECOVERY trial https://www.bmj.com/content/370/bmj.m2670 Stephan Guyenet (2021). The future of weight loss https://worksinprogress.co/issue/the-future-of-weight-loss/ Kevin Hickey, Erin Ward (2024). The Role of Patents and Regulatory Exclusivities in Drug Pricing https://www.congress.gov/crs-product/R46679 Alex Kesin (2025). The three-thousand-year journey of colchicine https://worksinprogress.co/issue/the-three-thousand-year-journey-of-colchicine/ Natália Coelho Mendonça (2024). The promise of SGLT2 inhibitors https://worksinprogress.co/issue/the-future-of-kidney-treatment/Samy Suissa, Laurent Azoulay (2012). Metformin and the risk of cancer: time-related biases in observational studies https://doi.org/10.2337/dc12-0788 Nicholas Reville (2026). Proposing an NIH High-Leverage Trials (HILT) Program. Center for Addiction Science, Policy, and Research (CASPR) https://caspr.org/policy/papers/HILT/ WebSmithsonian’s National Zoo. Gila monster. https://nationalzoo.si.edu/animals/gila-monster 

Alberta is the only part of the world that has people but not rats. Rats came to the new world on ships to New York, Boston and Philadelphia during the Industrial Revolution. From there they spread west at a rate of 24 kilometers a year and by 1950 they were on Alberta's border. But Albertans stopped them coming any further. In the US there is a culture that lives in dense cities, the women usually work, and yet they still have an average of six children each. The ultra-Orthodox have a number of pro-fertility norms, most of which wouldn't work for the secular world but some we could learn from. Sam, Pieter, and Aria discuss a handful of pieces in Issue 24 of Works in Progress. They talk land reclamation, vaccinating wild animals, the Squamish Nation's housing development in Vancouver and how The Glorious Revolution caused the Industrial Revolution. Buy your copy here: https://worksinprogress.co/print/

In the nineteenth century, cities often grew a thousandfold while increasing wages, the size of homes, and delivering great public goods like electricity and plumbing to their people. What made them so extraordinary? They had a hybrid of laissez-faire and top-down control. Landowners could build almost anything they liked but street networks were laid out with near-Soviet thoroughness decades in advance. Transport and utilities, meanwhile, ran as regulated monopolies. They were funded by users, turned a profit, but prices were controlled. Samuel, Ben and Aria discuss what made this system work and why it was dismantled. 

Malaria is caused not by a virus or bacterium, but by a complex, shape-shifting parasite that has evolved alongside us for millennia. This has made vaccine development a brutal challenge. In this episode, Jacob and Saloni are joined by Katharine Collins, who co-invented the second malaria vaccine, called R21, during her PhD. They discuss the gruelling process of reverse-engineering a vaccine and eureka moments along the way. They ask whether the biggest barriers to new vaccines are scientific or financial, and what it will take to finally eradicate one of natureʼs most vicious killers. Hard Drugs is a podcast from Works in Progress about medical innovation presented by Saloni Dattani and Jacob Trefethen. Timestamps: 00:00 Introduction 05:08 Our favourite parasites 10:12 How to invent a vaccine during your PhD 34:18 Why is it called the R21 vaccine? 37:32 Moving from the bench to billions of doses 41:43 The vicious life cycle of malaria parasites 46:15 Malaria research IN MICE 53:03 The murderer in malaria research 55:51 Would you volunteer to get infected by malaria? 1:08:21 Why did the first malaria vaccine take so long? 1:18:26 Could we have had the vaccine sooner? 1:40:48 Vaccine versus vaccine: which one’s better? 1:46:53 If we did this again today, could we make better vaccines? 2:04:55 Conclusion and our reasons for pessimism and optimism You can watch or listen on YouTube, Spotify, or Apple Podcasts. Saloni’s substack newsletter: https://www.scientificdiscovery.dev/ Jacob’s blog: https://blog.jacobtrefethen.com/  Acknowledgements:Aria Babu, editor at Works in ProgressGraham Bessellieu, video editorAlice Edwards, captionsAbhishaike Mahajan, cover artAtalanta Arden-Miller, art directionDavid Hackett, composer Works in Progress ThesisKatharine Collins (2014). R21, a novel particle based vaccine for a multi-component approach to malaria vaccination. BooksR. Killick-Kendrick (2012). Rodent Malaria.Michael Kremer and Rachel Glennerster (2004). Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases. Articles and reportsSaloni Dattani (2023). Why we didn’t get a malaria vaccine sooner. https://worksinprogress.co/issue/why-we-didnt-get-a-malaria-vaccine-sooner/ Jerome P Vanderberg (2010). Reflections on Early Malaria Vaccine Studies, the First Successful Human Malaria Vaccination, and Beyond https://pmc.ncbi.nlm.nih.gov/articles/PMC2637529/Pratik Pawar (2022). It Took 35 years to Get a Malaria Vaccine. Why? https://undark.org/2022/05/25/it-took-35-years-to-get-a-malaria-vaccine-why/ Ernst R. Berndt, Rachel Glennerster, Michael R. Kremer, Jean Lee, Ruth Levine, Georg Weizsacker & Heidi Williams (2005) Advanced Purchase Commitments for a Malaria Vaccine: Estimating Costs and Effectiveness. https://www.nber.org/papers/w11288 Ryan Duncombe, Karam Elabd and Justin Sandefur (2024). Avoiding Another Lost Decade on Malaria Vaccines https://www.cgdev.org/publication/avoiding-another-lost-decade-malaria-vaccines