The 0.06% Problem - Who Actually Gets to Try New Treatments
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Here’s a fun fact: humanity spends $83 billion a year on clinical trials, but nobody tracks how many people actually participate.
Not the WHO. Not the FDA. Not ClinicalTrials.gov. Nobody.
We can tell you how many trials exist (515,000 registered globally). We can tell you how much money gets spent ($83B). But ask “how many humans participated last year?” and you get… silence.
It’s like running a restaurant that tracks food costs and table counts but has no idea how many customers showed up.
So We Built a Script and Did the Math
We pulled 100,000 trials from ClinicalTrials.gov and counted actual enrollment numbers:
US Trials (Cumulative)
- Phase 1: 722,619 people (median: 33 per trial)
- Phase 2: 2,181,530 people (median: 60 per trial)
- Phase 3: 6,548,474 people (median: 237 per trial)
- Phase 4: 2,718,541 people (median: 90 per trial)
- Total: 12.2 million people across all active/recruiting/completed US trials
But that’s cumulative - trials running over many years. To get annual enrollment, divide by average trial duration (~2.7 years):
That’s the old estimate based on average trial duration. But we can do better.
The Better Method: Count Completed Trials
We analyzed trials that actually completed each year (not estimates):
US Interventional Trials (Phase 1-4 drug trials only):
- 2024: 1.66M participants (3,038 completed trials)
- 2023: 1.56M participants (3,557 completed trials)
- 2022: 1.52M participants (3,631 completed trials)
- 2021: 842K participants (3,601 trials)
- 2020: 951K participants (3,366 trials)
Average US: ~1.5 million/year (interventional drug trials)
The US represents 54% of the global trials market, so:
Global: ~2.8 million participants/year (strict definition - interventional only)
But this excludes observational studies, device trials, and behavioral interventions. If you count everything:
Global: ~5-8 million participants/year (all clinical research)
England’s data confirms the scale: 1.05 million participants in 2023/24 across all study types.
Industry Standard: IQVIA 2022
The most authoritative source is IQVIA’s 2022 report, showing:
Global: 1.9 million participants annually (2022)
This represents post-COVID normalization from the 4 million peak in 2021 (when COVID trials dominated). IQVIA tracks actual pharmaceutical industry data, making it more reliable than our ClinicalTrials.gov extrapolations.
Why the discrepancy with our 2.8M estimate?
- IQVIA counts actual industry trials (interventional drug studies)
- Our ClinicalTrials.gov analysis includes government/academic trials
- Different completion date definitions
- Our US-to-global scaling may overestimate
For our economic model, we use IQVIA’s 1.9M as the conservative baseline for current global trial capacity.
The Tragedy in Numbers
World population: 8 billion
Clinical trial participants annually: 1.90M (interventional drug trials, IQVIA 2022)
Or ~5 million if counting all clinical research (observational, device, behavioral)
Participation rate: 0.024% (drug trials) or 0.06% (all clinical research)
Using the conservative IQVIA figure (1.9M ÷ 8B = 0.024%), your odds of participating in a drug trial are 1 in 4,211.
Even if you count all clinical research (5M ÷ 8B = 0.06%), your odds are only 1 in 1,600.
Meanwhile, 150k people die every day from diseases we’re studying.
The Access Lottery
2.40B people are living with chronic diseases right now. That’s cardiovascular disease, cancer, diabetes, COPD, mental illness, chronic pain.
They’re alive. They’re suffering. And they could potentially benefit from the treatments we’re studying.
The ratio: 1 person gets access to drug trials for every 1,263 living with disease (using IQVIA’s 1.9M).
Even counting all clinical research (5M), it’s still only 1 in 480.
The Willingness Gap
And here’s what makes it even more infuriating: surveys show 49-51% of people are willing to participate in clinical trials.
Half of humanity would say yes if asked.
But only 0.0792% of disease patients actually get to participate in drug trials (1.90M ÷ 2.40B).
Even counting all clinical research, it’s just 0.2% (5M ÷ 2.40B).
That’s not a recruitment problem. That’s an exclusion problem.
The system isn’t failing because people don’t want to help find cures. It’s failing because:
- Trials only exist at major academic medical centers
- Most people live too far away
- Eligibility criteria exclude 90% of patients
- Enrollment caps fill up instantly
We have 1.2 billion people with chronic disease who are willing and able to participate. We’re enrolling 1.90M in drug trials (or ~5M counting all clinical research).
We’re turning away 99.84% of willing participants (using drug trials), or 99.6% if counting all clinical research.
The Cost Per Patient
Using IQVIA’s 1.90M drug trial participants:
$83B ÷ 1.90M = $43,684 per participant annually
Even if we count all clinical research (5M participants):
$83B ÷ 5 million participants = $16,600 per participant annually
That’s not per treatment. That’s the overhead cost per human enrolled, covering:
- Regulatory paperwork
- Compliance monitoring
- Data collection
- Insurance against lawsuits
- Committees reviewing committees
- The salaries of people whose job is writing protocols
Phase 3 trials (median 237 participants) cost $20M each. That’s $84,388 per patient. Not for the drug. For the trial.
You could buy each participant a new Honda Civic and still have money left over.
Why This Matters
If you get cancer, your odds of getting into a clinical trial are about 5%. If you’re unlucky enough to get a rare disease, your odds of a trial existing are basically zero.
The system isn’t designed to help sick people try treatments. It’s designed to generate data clean enough to satisfy regulators. The fact that some people get treatment is a side effect.
Humans spend $83B a year to help 0.0792% of the 2.40B people suffering from chronic disease (using IQVIA’s 1.90M drug trial participants).
Even counting all clinical research, it’s just 0.2% (5M participants).
The other 99.92% (or 99.8% counting all research) get to wait. And suffer. And while they wait, 150k die every day.
The Data We Have
Here’s what we pulled from ClinicalTrials.gov:
| Phase | Trials | Total Enrollment | Median/Trial | Cost/Patient |
|---|---|---|---|---|
| Phase 1 | 11,833 | 722,619 | 33 | $15,909 |
| Phase 2 | 14,852 | 2,181,530 | 60 | $9,174 |
| Phase 3 | 8,989 | 6,548,474 | 237 | $5,650 |
| Phase 4 | 5,790 | 2,718,541 | 90 | $6,437 |
(Cost per patient calculated from phase spending estimates divided by participant counts)
The absurd part: These are the best numbers available, and they’re educated guesses based on trial durations we estimated from other research.
What a 1% Treaty Could Do
The math is straightforward:
Today’s Capacity
- Global military spending: $2.72T
- Clinical trials spending: $83B
- Participants: 1.90M/year at $43,684 each (drug trials, IQVIA 2022)
With 1% of Military Spending Redirected
- 1% of $2.72T = $27 billion additional
- New total: $110 billion (32% increase in funding)
With Your Decentralized Framework for Drug Assessment
- Enrollment isn’t limited by proximity to trial sites
- Patients report outcomes via smartphone
- Trials run continuously instead of in isolated batches
- Cost per participant drops to ~$1K (from $43,684)
The Result
- $110B ÷ $1K = 110 million participants/year
- Current: 1.90M/year (IQVIA 2022)
- Medical progress accelerates 58x
A cure that would take 58 years could take 1 year.
And we’d only be using 9% of available capacity (1.2 billion willing participants).
The data would be better too. More diverse. More representative. Collected from people living their actual lives instead of visiting clinics every week.
The Bottom Line
Nobody knows how many people participate in clinical trials because nobody bothers to track it.
We had to build a script to count.
The answer: 1.90M people a year (drug trials, IQVIA 2022), at a cost of $43,684 each.
Or ~5 million if you count all clinical research (observational, device, behavioral) at $16,600 each.
2.40B people are living with chronic disease.
The ratio: 1 in 1,263 (drug trials) or 1 in 480 (all clinical research).
The 99.92% who don’t get access to drug trials (or 99.8% for all research)? They suffer. And 150k die every day.
Methodology: Primary source: IQVIA 2022 report showing 1.9M global participants (post-COVID normalization). Supporting data from ClinicalTrials.gov API v2 (November 2025), analyzing 100,000 active/recruiting/completed trials. Annual estimates based on phase-specific trial durations from ASPE. See spending breakdown.