Innovating Clinical Trials

Every trial starts with a number on a slide,  patients needed, months allotted, a clean straight line on a chart.  Liam and Ted pull that line apart in this episode, starting with Lasagna's Law: the 1970s observation that eligible patients seem to vanish the moment a trial opens and reappear the moment it closes. They dig into why recruitment forecasts go wrong not because the math is bad, bu...

In this episode, Ted  opens with a poem that captures the persistent, compounding burden on clinical trial sites: 50-page consents, non-functional tech, poached CRCs, financial holdbacks, and study designs that ask far too much from participants for far too little payoff. What follows is a candid conversation between Ted and Liam about why these problems haven't gone away and in many cases, h...

In this episode, Liam and Ted explore one of the most underexamined problems in clinical trial recruitment: patient motivation is not static.  Drawing on real-world experience from a late-night participant funnel audit to an insomnia study no-show Liam introduces two interconnected frameworks: the Decision Threshold Matrix and the Trial Value Equation. The matrix maps patient motivation across fou...

In the final episode of our three-part series with Jill Fikowski, founder and CEO of Changemark Research + Evaluation, we get into one of the most persistent problems in clinical research: retention. Jill unpacks why participants drop out and it's rarely what sponsors assume.  From there, we get into the pressure that lands on research coordinators when enrollment is behind, the practices tha...

In Part 2 of our conversation with Jill Fikowski, founder and CEO of Changemark Research + Evaluation, we get into what good community engagement actually looks like in practice not as a checkbox, but as a core design principle. Jill opens with a clear answer to what good looks like: involve community from the very beginning and not just at the consent stage, not just in an advisory board email, b...

Jill Fikowski, founder and CEO of Changemark Research + Evaluation, brings 25+ years of lived and professional experience in substance use and mental health research. In this episode we cover her work on the SALOME trial, one of the rare studies that directly changed policy. But it wasn't just the science. It was how they centered participants from the beginning. We also explore: 1. How to de...

Clinical trials don’t become complex overnight, they get there one added process at a time. In this episode, Ted and Liam break down why the industry is so effective at adding new layers, but rarely takes the time to remove what’s no longer needed. Whether it’s protocols, systems, or workflows, each addition is often made with good intent, but the cumulative effect can be significant. They explore...

A 5 AM wake-up call. A perfectly planned setup. And a moment that never delivered. In this episode, Liam and Ted use a story about a missed “blood moon” to explore a deeper truth in clinical trials: expectations don’t always match reality. They discuss how similar frustrations show up at clinical trial sites, where small issues stack up and slowly erode motivation. They break down how friction at...

What does it actually mean to put the patient first? In this episode, Liam and Ted explore the role of empathy and human connection in clinical trials. From rushed pre-screening calls to a powerful story of pausing a consent conversation just to connect, they highlight how small moments build lasting trust. They also discuss why trust is rarely factored into budgets, despite being critical to recr...

What makes a truly high-performing team? Inspired by the precision of Formula One pit crews, where the difference between winning and losing is measured in milliseconds, Ted and Liam explore what clinical trial teams can learn from elite performance environments. Ted outlines six principles that drive high-performing teams: clear objectives, defined roles, mapped processes, and a culture of contin...

In Part 3 of 3, Liam and Ted continue their conversation with Frank Watanabe, CEO of Arcutis Biotherapeutics discussing work-life balance, building social capital, and management vs. leadership. The conversation explores leadership at a practical level, from building trust across remote teams to creating flexibility that allows individuals to balance work and life in a way that works for them. Fin...

In Part 2 of 3, Liam and Ted continue their conversation with Frank Watanabe, CEO of Arcutis Biotherapeutics, focusing on what it takes to hire and build high-performing teams in high-risk environments. Frank shares how he approaches hiring beyond technical skills placing strong emphasis on cultural fit, risk tolerance, and the ability to innovate.  The discussion also explores how to create a cul...

In this episode, Liam and Ted sit down with Frank Watanabe, President and CEO of Arcutis Biotherapeutics, to explore his journey from a Navy officer to a biotech executive and the leadership principles established along the way.  Frank shares how his early experiences in the military and his transition into pharma and biotech influenced his approach to leadership, highlighting a key idea that defi...

A patient in a database is not a patient in a trial. So why do we keep treating feasibility like a headcount? Fresh from a week deep in feasibility work, Liam introduces four characters who show up and cause chaos in almost every feasibility process.  There's Spreadsheet Larry, who confuses a number with a truth. The EMR Oracle, who offers psychological safety dressed up as data.  Prevalence...

In elite sports, races are often won or lost in the transition, and Liam and Ted argue that the same is true in clinical trials. Drawing on the precision of Olympic relay racing, they make the case that the handoff points between sponsors, CROs, and sites are where trials quietly succeed or silently fall apart. From recruitment referrals that never get followed up, to sites given the green light b...

Using a David Letterman-inspired “Top 10” format, the conversation highlights common feasibility pitfalls faced by sponsors, CROs, and clinical trial sites, including overly complex questionnaires, unrealistic enrollment expectations, delayed communication, and last-minute fire drills.  The discussion goes beyond surface-level frustration to explore how sponsors and CROs can rethink clinical trial...

Why do clinical trials struggle even when teams are experienced and well-intentioned? In this episode, Liam and Ted explore why these outcomes are rarely about individual performance and far more often about system-level misalignments. They unpack how incentives, information flow, and decision rights across sponsors, CROs, and sites shape behaviour and why execution tends to break down logically,...

Eligibility criteria are meant to bring clarity to clinical trials, but in practice, they often do the opposite. In this episode of Innovating Clinical Trials, Liam and Ted unpack how poorly worded, ambiguous, or misaligned eligibility criteria quietly slow enrollment, frustrate sites, and introduce risk later in development. They explore: - Why small wording choices create big downstream problems...

In this episode, Liam and Ted unpack why enrollment behaves more like an operating system rather than a standalone process. They explore the question of ownership, the role sponsors play through protocol design, and how operational practices, healthcare realities, and human behavior all influence who ultimately makes it into a study. The conversation moves through multiple lenses from eligibility...

In this episode of Innovating Clinical Trials, Liam and Ted explore why building strong relationships with clinical trial sites requires more than dedicated relationship teams, it requires fixing problems at their source. They discuss how many site challenges stem from outdated processes, one-sided agreements, and preventable operational friction that relationship teams are left to manage after th...

In this episode of Innovating Clinical Trials, Liam and Ted explore what determines the trajectory of a clinical trial and why success often depends on preparation, collaboration, and the ability to adapt when things don’t go as planned. They discuss how factors outside a site’s control, such as vendor selection and monitoring approaches, can significantly influence trial momentum. Through real-wo...

In this episode of Innovating Clinical Trials, Liam and Ted challenge a familiar question in clinical research: “How do we increase enrollment?” Instead, they argue that progress starts by asking a better one- “What makes enrollment challenging in the first place?” They explore how study design, existing therapies, operational factors, and most importantly, the lived experience of participants and...

In this episode of Innovating Clinical Trials, Liam and Ted explore why clinical research is, at its core, a people-driven business. Drawing on real-world experiences from both patient and site perspectives, they discuss how trust, communication, and human connection directly influence recruitment, retention, and study success. From participant consent conversations to site selection and prioritiz...

Welcome to Innovating Clinical Trials , the podcast designed for clinical research professionals eager to deepen their understanding of clinical trials through concise, insightful segments. Join your hosts, Liam Eves and Ted Trafford, as they uncover the core issues in clinical research, reflect on the industry, and challenge conventional wisdom. In this episode, Liam and Ted reveal how minor, une...

Welcome to Innovating Clinical Trials , the podcast designed for clinical research professionals eager to deepen their understanding of clinical trials through concise, insightful segments. Join your hosts, Liam Eves and Ted Trafford, as they uncover the core issues in clinical research, reflect on the industry, and challenge conventional wisdom. In this episode, Liam and Ted explore what it truly...