Clinical trials today are highly bureaucratic, expensive, and time-consuming. Most trials fail to recruit enough participants to answer their questions at all.

This great post by Adam Kroetsch explains how things got this way.

What's most interesting to me is that rigour doesn't have to mean bureaucracy.

For decades, some researchers have been pushing for larger, simpler, more efficient trials that are arguably more rigorous than their bureaucratic counterparts.

The RECOVERY trial is probably the best example. It identified dexamethasone as a life-saving COVID-19 treatment within months of the pandemic, and enrolled over 40,000 patients using a two-page consent form. In a single trial, it tested over a dozen treatments within two years.

I'm a fan of this model. While there are sometimes trade-offs between rigorous practices and speed, there are also many win-win ideas that mean we don't need to compromise at all, and we can improve both at once.