Not all that long ago, many first-in-class drugs approved in the U.S. could face competition within five years as more drugs in that class poured from the pipeline. Not so much these days. FDA Commissioner Scott Gottlieb chalks the difference up to the growing complexity and cost of clinical trials, for both drugs and devices. The cause and effect of the cost of trials and the lack of ready competition is contributing to high prices for therapies and cures, he said.