All notes in this topic
Two-Sided Investigator Opacity: Sites Can't See Sponsors, Sponsors Can't See Sites
80% of active US physician-investigators run just 1 to 5 trials in three years, on razor-thin margins, while sponsor payment timelines and site solvency stay invisible to each other until after the contract is signed. Nobody discloses first, so both sides discover the truth only after it is too late to matter.
Helicopter Research Is a Partner-Discovery Failure
Only 6.5% of general medical journal papers have a coauthor from the study population's country, and one in five African COVID papers had no African author at all. The verified local co-investigator exists everywhere. Nobody can find her.
The Invisible Negative Result
47% of clinical trial results are never made public, and an estimated 85% of research spending is avoidably wasted. Nobody indexes who already tried an idea and quietly abandoned it, so the same failed study gets repeated in hospital after hospital.
The K-to-R Cliff: Losing Independence for Lack of a Team, Not Ideas
About 43% of NCI K awardees ever obtain an R01-equivalent, at a median of 5.5 years. Physician-scientists are 1.3% of US physicians, and 49% of those surveyed had considered leaving. First R01s now arrive in investigators' forties rather than their thirties. The transition is won by assembling a team and lost by inheriting one.
Serendipity-Only Pathways: The Clinician Who Has the Patients and the Foundation That Cannot Find Them
More than 80% of rare conditions received no research investment over a five-year period despite more than a billion pounds spent. Patient organizations report that only serendipitous pathways exist to reach an interested researcher. Meanwhile the clinician quietly following nine patients with the condition has no idea anyone is looking.
Nobody Will Review Your Paper: The Reviewer Shortage That Is Actually a Discovery Failure
Editors now invite six or seven reviewers per manuscript, up from two or three a decade ago, and sometimes twenty or more to secure two. At one journal, 58% of invitees simply ignored the request and 14% who accepted never delivered. The scarce resource is not reviewers. It is knowing which qualified reviewer is free this month.
"Who Has a Cohort of X?" Data Does Not Move Through Repositories. It Moves Through People.
Of 1,792 manuscripts stating data were available on reasonable request, 93% of authors did not share when asked. Yet among researchers who shared privately, 74% said it produced authorship or a future collaboration. A decade of data-sharing policy has been solving the wrong problem.
Trained But Idle: The Investigators Nobody Ever Calls Again
Roughly half of physicians who file an FDA Form 1572 conduct exactly one trial. The industry calls them one-and-done and blames regulatory burden. But 44.4% of them said they wanted to run another trial and no opportunity ever came. The US principal investigator pool shrank from 28,292 to 26,115 while trial volume rose.
The Zero-Enrolling Site Is a Search Failure, Not a Recruitment Failure
Roughly one in nine activated trial sites never enrolls a single patient while Phase III burns about $55,716 a day. Half of investigators who run one trial never run another, and 44% of them wanted to. Ninety percent of patients want their own doctor to tell them about trials; under 1% are referred by one. This is a discovery problem wearing a recruitment costume.