tl;dr: Hospitals and universities are running late-stage clinical trials to repurpose generic drugs at less than 10% of pharma industry costs, operating outside the patent system with lower expertise, risk, and capital barriers. Examples include using a cancer drug to treat blindness and an old anti-inflammatory for Covid. Pharma companies lose interest in repurposing once drugs go generic due to competition, but academic researchers step in, motivated by patient outcomes and publication rather than profit.