Over the last several decades, the Food and Drug Administration has allowed pharma companies to sell hundreds of drugs to patients without adequate evidence that they work and, in many cases, with clear signs that they pose a risk of serious harm.

Nieraj Jain was puzzled by the patient sitting quietly in front of him. The woman, in her sixties, was losing her eyesight; that much was clear. Her vision was blurred, and she was having increasing difficulty seeing at night and in bright sunlight. Less obvious was the cause. A retinal specialist and surgeon at Emory University in Georgia, Jain pored over specialized scans of her eye and saw odd patches of pigment on her retina — patches that didn’t fit with any known diagnosis.

A fleeting memory pulled him up short; hadn’t he seen another pat

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