OK, not much of a science poster, but I'll bite.

Docs can prescribe off-label, but whether insurance companies will cover such prescriptions is another question.

Read usually won't.

Also, a doc working for an HMO or through a health center or hospital may be obligated (or at least more prone) to stck to the HMO/health center/hospital formulary. 

Finally, for each condition and or phatmaceutical, there is standard guidance. So...there can be a perceived or actual increase in liability risk for a doc to step outside standard guidance, even when there is some evidence to support doing so.

My take is that docs may differ in their willingness to do this, depending upon the level of evidence. BUT that it does happen simetimes when there is eniugh credible research to make them feel justified

I gather that sometimess part of what pushes the formal guidance to change, and insurance companies to add something to formulary, is a preponderance of evidence and docs supporting the use and the sentiment that guidance should be updated in a given situation.

Not a doc though, so one of y'all correct me where i am off.

I think hypothetically your scenario should be possible, and goodness knows i would love to see it 

That said, in terms of practical likelihood, whether enough data would be generated fast enough and sample sizes large enough and responses clearly attributable and robust enough vs. competitor compounds for that to happen vs. waiting for BOM III... not sure.

Any docs out there?