I totally understand the frustrations experienced by the author of this post. I am a nurse and my exposure to the Clinical Trial Industry came from a more bottoms up entry point. Its mind boggling to the the total costs CRO's charge for the services compared to the eventual experience for the staff and patients taking part in these studies. CRO's are in dire need of disruption. I also agree about the incestuous industry hence the very slow progress being observed. It's hard to show any progress when it's the same people moving around the same companies and implementing ideas that are somewhat outdated. Also, from a cost perspective, i think the future is also coming to a place where Clinical trials get outsourced outside the US. Sites and PI's outside the US should be empowered to run this clinical trials as they provide a more cost effective solution with regards to operational costs and also access to an ever growing number of patients, reducing clinical trials timelines that lead to increased costs. I understand the need for CRO's to maintain quality, and they can do this by building out the right relationships and partnerships with overseas contractors, but i believe in the long run, this is the solution. I believe this so much that i launched my own CRO company. Infiuss Health. The goal of this company is to unlock the potential for studies to the run by CROs and smaller life science companies outside the US. We are starting with Africa. As soon as we can unlock this population that has traditionally just been taboo to life science companies, imagine the lengths we could go with with access other geographies.