Not Enrolling Patients? The One Explanation You Haven’t Considered Yet

Recently, I had a chat with a friend of mine who works at a top 10 CRO and was telling me about one of the last clinical trials he was managing. It was for an indication that is quite “popular” in clinical trials nowadays. He was a part of the site selection and knew they made sure to get the most experienced investigators on board.

His team also made sure to check the availability of patients at the site before the start of the study. The investigator meeting was really fancy and everyone was happy.

The study started and almost no patients were enrolled.

The sponsor was curious and wanted to take any possible action to change that. My friend was surprised as well. He started going through the possible scenarios one by one:

Are the investigators engaged with us?
Do they believe in the new treatment?
Do they really have patients?

Surprisingly, none of the above was key to understanding the issue with enrollment. In the end, he decided to have The Talk. He invited some of the investigators for a friendly chat. Instead of asking them “how many patients did you recruit this week”, he asked them:

What stops you from enrolling patients?

Then came the moment of truth:

The fee per Patient.

It turned out that the investigators were working on multiple trials for the same indication. As usual, they were getting paid per patient. The fee per patient for my friend’s trial was lower than the rest and so every time they had to make the decision which trial to enroll the patient in, they were opting for the better-paying ones.

My friend was transparent with the sponsor and this was a game-changer.

I am sharing this story as I am quite disappointed by the way clinical trials work. Without placing any blame, I have to say, I believe there are better ways to run research. This whole story kind of begs the question:

What if we raced to help patients and not investigators?

First published on LinkedIn

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