Every year, billions of dollars flow into clinical trials that produce little usable knowledge — trials that ask the wrong questions, enroll too few participants, or report results so incompletely that physicians cannot act on them. Understanding why this systemic failure persists requires going beyond data and asking the people who design, fund, and regulate trials what they actually see on the ground.
A qualitative study published in JAMA Network Open gathered perspectives from 55 professionals spanning 16 countries across five continents, interviewed individually via video platform between October 2024 and March 2025. Participants included funders, trial designers, sponsors, and regulatory and ethics professionals. Using a five-point framework — covering trial importance, design, feasibility, integrity, and reporting — researchers conducted thematic analysis combining deductive coding drawn from a prior global rapid review with inductive coding to surface new patterns. The core findings centered on why uninformative trials persist despite decades of methodological guidance, and what structural or procedural changes might reduce design and conduct failures at scale.
This work sits within a long-running conversation in evidence-based medicine about research waste — a concept formalized by Iain Chalmers and colleagues over a decade ago, estimating that roughly 85% of biomedical research investment is squandered. What distinguishes this study is its qualitative, insider-perspective approach rather than bibliometric or methodological auditing. For health-conscious adults, the downstream implication is real: the clinical guidelines shaping their care are only as trustworthy as the trials behind them. Limitations here include the inherent subjectivity of qualitative interviews, potential selection bias toward reform-minded participants willing to engage, and the descriptive rather than prescriptive nature of the outputs. Still, as an effort to diagnose institutional and cultural barriers to trial quality from within the system itself, this is a meaningful — if incremental — contribution to a problem that directly affects the reliability of health recommendations reaching the public.