Episode Details

12 articles including 4 podcasts

EA/LW Intro: I believe clinical trial abundance could be an EA cause area - there's still a lot of disability/disease burden in the world, even in developed countries, and increasing the pace of progress is very tractable. And it's not just a matter of speed/quantity of innovation: the current system selects against ambitious risky bets. It deserves an EA-specific post, but for now here's a curated reading list.

Since the 1950s, the cost of developing a new drug has increased by ~80x. It now costs on the order of a billion dollars to get one drug approved (including the cost of failures). Consequently, fewer drugs get invented, ambitious but risky areas are avoided, and patients pay the price.

Why have clinical trials gotten so expensive, and what can we do about it? Why isn't Big Pharma interested in diseases like ME/CFS and Long COVID? Why won't advanced AI automatically lead to biomedical breakthroughs?

There's a growing movement of researchers, policy wonks, and patient advocates trying to answer these questions and fix what's broken. It's loosely organized under the banner "Clinical Trial Abundance." Here's what to read to understand it.

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Outline:

(01:34) 1. The pharma industry from Paul Janssen to today: why drugs got harder to develop and what we can do about it - by Alex Telford, 2023

(02:16) 2. Diagnosing the decline in pharmaceutical R&D efficiency - by Jack Scannell et al., 2012

(03:56) 3. To Get More Effective Drugs, We Need More Human Trials - by Ruxandra Teslo and Jack Scannell, 2025

(04:38) 4. Why clinical trials are inefficient. And why it matters - by Adam Kroetsch, 2025

(05:22) 5. Clinic-in-the-Loop - by Ruxandra Teslo in Asimov Press, 2025

(05:52) 5. Interview with the CEO of Eli Lilly, Dave Ricks - by Patrick and John Collison

(06:39) 6. Clinical trial reforms that once seemed radical - by Saloni Dattani

(07:38) 7. Biotechs Lost Archive - by Ruxandra Teslo, 2025

(08:30) 8. Why More Biotechs Are Starting Trials In Australia - by Dan Schell, 2025

(09:10) 9. The Case for Clinical Trial Abundance - by many authors, 2024

(09:40) 10. Some questions about biotech that I find interesting - by Alex Telford, 2024

(10:19) 11. Clinical Trial Abundance (policy framework) - by 1DaySooner

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First published:
April 20th, 2026

Source:
https://forum.effectivealtruism.org/posts/wsMxedeaGTiNBmi7f/why-clinical-trials-are-broken-and-how-to-fix-them-a-reading

Linkpost URL:
https://open.substack.com/pub/viralpersistence/p/why-clinical-trials-are-broken-and

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Narrated by TYPE III AUDIO.

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