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Freakonomics Radio

664. Are Thousands of Medical Cures Hiding in Plain Sight?

Freakonomics Radio

Freakonomics Radio + Stitcher

Documentary, Society & Culture

4.532.8K Ratings

🗓️ 20 February 2026

⏱️ 52 minutes

🧾️ Download transcript

Summary

Existing drugs can sometimes be repurposed to treat rare diseases. But making that match can be hard — and the financial incentives are weak. Guest host Steve Levitt tries to solve the puzzle.

Transcript

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0:00.0

There is a horrible infectious disease that you have probably never heard of.

0:09.0

It's called balaumuthia.

0:10.6

It's basically your brain-eating amoeba.

0:13.3

They don't really know how it's transmitted probably through some sort of soil exposure.

0:17.7

It causes encephalitis, which is swelling in parts of the brain. It can kill you in

0:24.3

relatively short order. It's extremely rare, and so there's been very little study of it.

0:30.0

That is Heather Stone. She's a health science policy analyst in the Food and Drug Administration.

0:34.9

The FDA has not approved any treatments for balamuthia,

0:38.6

but that doesn't necessarily mean there aren't any treatments.

0:43.1

Three or four years ago, a clinician in San Francisco at University of California

0:49.0

treated the first patient with a drug called nitroxylene,

0:53.0

which had been approved in Europe for 50 years

0:55.7

for urinary tract infections. One pre-clinical study had shown off-the-chart amoebicidal activity

1:02.0

that nobody had ever known about. You might not think that a UTI drug could treat a brain-eating

1:07.4

amoeba, but biochemistry can surprise you.

1:11.6

A couple of years later, I got a call from a mother of a young girl who had been infected

1:18.1

with Balamuthia and was not expected to survive. And she was desperately trying to get a hold

1:23.1

of nitroxylene. I was able to help get what's called an emergency I&D, an investigational new drug

1:30.5

application, because the drug is not approved in the U.S., but it's approved in Europe. You have to

1:36.3

get special permission from the FDA to use the drug. They sent the drug, and Elena had a pretty

1:41.5

remarkable recovery. Now, I mean, it's not a miracle cure. There have been

1:46.9

other patients who have received the treatment who have not survived. But for a disease that had a 90%

...

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