First, note that the reason for the existence of the placebo arm is to determine if the drug is more effective than placebo, so in some cases the drug will not be, and nothing will have been lost!  Second, for this point to stand, it has to be shown why the present generation should be prioritised above all future ones: the consequences of giving the present patients a slightly increased chance of survival is to negatively impact patients in the future in a myriad ways (see opposition arguments).  Third, there are a number of reasons to doubt that this is, in fact in the present patient’s best interest: it is not the case that terminally ill people have ‘nothing to lose’ and can therefore be used as human guinea pigs (providing there is an, as yet unspecified, probability of survival). The large-scale provision of un-trialled drugs may well result in side-effects denigrating the quality of the patient’s remaining years.  Finally, the practical consequence considered can be sidestepped through a) better supervision of trials and b) improved doctor-patient relationships (a particular problem during the AIDS crisis). Further, note that the case of AIDS is something of an anomalous one: AIDS patients were more numerous and politicised than any other group before or since, thus enabling this sort of trial-breaking behaviour.