Have you ever taken an organic chemistry class? If you had, you'll have had a laboratory component where you're asking to synthesize various things and learn other basic laboratory techniques like fractional distillation, recrystallization, various separations, etc. Having gone through such classes, what you read in the textbook isn't exactly how it works. It's not exactly A + B --> C + D. The reactions don't run to 100%. You'll get less, and you get various minor products which end up being impurities that you want to remove. Imperfections in your techinque can cost you part of your yield as well.
The point here is that to get maximum value out of a reaction, you need a fair amount of experience, ultra pure reagents, ultra clean equipment, and optimized technique. And if your synthesis pathway is 15-20 steps from A to X, it becomes a fairly precise business to do it correctly and avoid contamination through each reaction in the synthesis. There's a barrier to entry into the market caused by simply having to meet what we all would consider basic standards of cleanliness and purity of the products.
And then, there's the batch testing to prove what that you have what you think you have so you don't end up with meningitis-causing bacterial contamination in your product that ends up killing 200 kids (well, young adults) before people figure out where it came from.
To answer your question:
Your mom & pop apothecary probably can do it on a small scale, especially if the pharmacist is old school trained or has experience compounding
Doing it on a large scale is going to require a fairly steep barrier to entry (ie it's very expensive, 7-8 figures) in terms of building a facility and obtaining the equipment to do it, getting someone competent to optimize it all and keep it running at a high standard. And after all of that, then you have to deal with the FDA
Even if you did set up such an operation, you still need medicinal grade chemical products to start with that you'll have to purchase from laboratory suppliers or similar.
You really can't get out of the "system" without compromising on scale, quality, or cost.
Have you ever taken an organic chemistry class? If you had, you'll have had a laboratory component where you're asking to synthesize various things and learn other basic laboratory techniques like fractional distillation, recrystallization, various separations, etc. Having gone through such classes, what you read in the textbook isn't exactly how it works. It's not exactly A + B --> C + D. The reactions don't run to 100%. You'll get less, and you get various minor products which end up being impurities that you want to remove. Imperfections in your techinque can cost you part of your yield as well.
The point here is that to get maximum value out of a reaction, you need a fair amount of experience, ultra pure reagents, ultra clean equipment, and optimized technique. And if your synthesis pathway is 15-20 steps from A to X, it becomes a fairly precise business to do it correctly and avoid contamination through each reaction in the synthesis. There's a barrier to entry into the market caused by simply having to meet what we all would consider basic standards of cleanliness and purity of the products.
And then, there's the batch testing to prove what that you have what you think you have so you don't end up with meningitis-causing bacterial contamination in your product that ends up killing 200 kids (well, young adults) before people figure out where it came from.
To answer your question:
You really can't get out of the "system" without compromising on scale, quality, or cost.
Well shoot. There goes my new business plan of creating my own boutique "Small Pharma" chain of Ye Olde Cognitive Dissonance Apothecaries. 😮💨