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Innovating Clinical Trials

Liam Eves and Ted Trafford

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.

Ted Trafford - https://probitymedical.com/
With 30 years of experience in clinical research, Ted serves as the Director of Business Development, driving business growth and leading Feasibility and Site Relationship teams at Probity Medical Research, a clinical trial site administrative support company with a consortium of 75+ sites across four countries. As a writer and speaker, Ted contributes to thought leadership and strategic initiatives in the clinical trials industry, leveraging his extensive experience and creative approach to drive meaningful discussion and progress for Sponsors, CROs, Sites and Technology Vendors.

Liam Eves - https://www.theendpointpodcast.com/
Liam's held executive roles in SMOs and CROs, and led all major functions of trial delivery. His journey into the field began unexpectedly after an injury ended his career as a professional footballer. Over the years Liam has optimized trial delivery methods / systems for effective enrollment and trial delivery. Currently, he focuses on building and advising companies in the clinical trial space.

Opinions expressed are those of the participants and not their employers.

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S2 · E43
Yesterday · 14 min
ICT Ep 2.43: Robert Goldman on AI in Clinical Operations: Innovation or Marketing? (Part 3/3)
In Part 3 of this three-part conversation, Liam and Ted wrap up their discussion with Robert Goldman, Vice President and Global Head of Clinical Operations at Contraline, on a question that lands in every ClinOps inbox: is “AI-powered” innovation or marketing? Robert explains why a dashboard from eight years ago isn’t new just because it has an AI label, how to test a vendor’s pitch, and why AI should support clinical judgment, not replace it. He also asks the question he puts to every AI vendor: if the hours saved are real, why aren’t drugs reaching patients faster? It’s the same demand for evidence Robert brings to feasibility estimates and site selection in Parts 1 and 2 of the series. Listen to all parts of the conversation to see how it runs from the first plan to the latest technology.
S2 · E42
Thursday · 22 min
ICT Ep 2.42: Robert Goldman on Rethinking Feasibility (Part 2/3)
In Part 2 of this three-part conversation, Liam and Ted continue their discussion with Robert Goldman, Vice President and Global Head of Clinical Operations at Contraline, to talk about why feasibility so often fails to predict what happens next. Robert explains why historical benchmarks mean little for a study that has never been done, and what he would use instead: measurable assumptions, early performance indicators, and intervention points agreed in advance. Ted raises the feasibility question he has never seen on a questionnaire, and Robert explains why sites are afraid to answer it honestly. They discuss why sponsors budget for backup sites, why the fastest responders aren’t always the best, and how sponsors can build real relationships with sites before the selection process begins. Join us in Part 3 of the conversation as Robert gives his take on AI in clinical operations.
S2 · E41
Wednesday · 18 min
ICT Ep 2.41: Robert Goldman on "Optimism Is Not an Enrollment Plan" (Part 1/3)
In Part 1 of this three-part conversation, Liam and Ted sit down with Robert Goldman, Vice President and Global Head of Clinical Operations at Contraline, who brings nearly 20 years of clinical research experience spanning CRO roles and sponsor-side clinical operations, to talk about why the industry rewards optimism in planning and demands realism in execution. Robert shares how a detour through Caribbean medical school led him into clinical research by accident, and what he has learned about how lean biotech teams succeed: knowing what to build, what to outsource, and what good looks like. Together they look at why feasibility estimates stay unrealistic when everyone is incentivized to present the best case, and why optimism is not an enrollment plan. Robert leaves listeners with the question he would ask instead of “how many patients can you enroll?”: show me the evidence for your estimate, and tell me what happens when you’re wrong.
S2 · E40
October 29 · 17 min
ICT Ep 2.40: Duncan Shaw on the AI Translation Trap: Why the Human “Last Mile” Still Matters When the Stakes Are High (Part 3/3)
In Part 3 of this three-part conversation, Liam and Ted wrap up their discussion with Duncan, President at DTS Language Services about AI, risk mitigation, and the human factors that are hard to capture in clinical trial translation. Duncan calls translation the “last mile” of clinical trials, where small details can decide whether a site activates or a patient stays in a study. He explains why AI has a place when millions of words are on tight timelines, but argues that low-volume, high-risk clinical content is a very different proposition. He compares AI translation to an autopilot where the human is only brought in after something goes wrong, and describes how translators are spending 80% to 90% of the usual effort correcting AI output while being asked to accept much lower prices. And just when it gets serious, Duncan closes with a story about what happened when he translated a stack of Chinese tattoos. Spoiler: most of it was gibberish!
S2 · E39
October 28 · 16 min
ICT Ep 2.39: Duncan Shaw on the Translation “Quilt Factor”: How Inconsistency Can Erode Patient Trust and Derail Trial Operations (Part 2/3)
In Part 2 of this three-part conversation, Liam and Ted continue their discussion with Duncan, President at DTS Language Services about patient trust, consistency, and the operational realities of translating clinical trial content. Duncan explains how small issues, from inconsistent terminology to differences in date formats, can undermine a patient’s confidence in a study and even lead to missed visits. Trust comes from consistency, fewer handoffs, and an approach that fits the purpose of the content, and describes the “quilt factor” that builds up when previous translations, multiple CROs, and competing terminology databases pile on top of each other. The conversation ends on a question every sponsor should ask before translation begins: what does success actually look like?
S2 · E38
October 27 · 15 min
ICT Ep 2.38: Duncan Shaw on the Hidden Risks of Clinical Trial Translation: What Happens With One Wrong Word (Part 1/3)
In Part 1 of this three-part conversation, Liam and Ted sit down with Duncan, President at DTS Language Services, to talk about the good, the bad, and the ugly of clinical trial translation. Drawing on experience in both pharmaceutical and language services, Duncan explains why translation is far more than converting words from one language to another, and why a mistranslation in a clinical study isn’t just a typo but a potential risk to a patient, a trial, or a regulatory submission. Duncan explains why the real work of translation starts before the translation itself: understanding who is reading the content, their language, reading level, context, fears, and emotions, and making sure the final version is both linguistically trusted and faithful to the approved source. He argues that translators have to resist the temptation to “improve” content. Liam connects this to a problem he's seen: the constant addition of complexity, particularly in consent forms. This episode is a candid look at the hidden complexity behind clinical trial translation and the role it plays in patient trust, compliance, and study execution.
S2 · E37
October 26 · 18 min
ICT Ep 2.37: "You Lose a Patient You Didn't Even Know You Lost" Why No One Owns Recruitment
In this episode, Ted introduces the “ENROLL Corporation” (Everyone Needed for Recruitment Optimization Leadership and Logistics) an imaginary joint venture owned by the sponsor, the CRO, every site, and every vendor. He explains why most recruitment providers solve one small piece of the problem, much like a wildlife photographer so focused through a 500mm lens that an animal wanders past unnoticed. Liam adds a river analogy about who “eats their own cooking,” and together they look at the 80-plus factors that affect recruitment, the holes in the enrollment funnel that nobody measures, and how adding complexity to a protocol can quietly cost months.
S2 · E36
October 23 · 16 min
ICT Ep 2.36: Robin Piazza on ICH E6 R3 and the New Rules for Safety Oversight (Part 2/2)
In Part 2, Robin Piazza, Liam and Ted get specific about what good safety oversight actually looks like in practice, and what sponsors are getting wrong under the shift from FDA 2024 guidance to the stricter ICH E6 R3 standard. We explore: - FDA 2024 guidance vs. ICH E6 R3: why global studies need one uniform plan - Why a DMC charter is a “how the DMC will operate," not evidence, and is what inspectors actually want to see, and whether the charter was followed. - The hidden conflict when the same experienced DMC member sits on multiple competing trials What a safety oversight committee looks like when it’s “firing on all cylinders." Robin also digs into a problem many sponsors don’t see coming: experienced DMC members who sit on multiple competing trials and intelligence bias the conflicts this creates. This is the practical half of the conversation, moving from why to how, with guidance on getting your safety oversight set up and ready before an inspector asks to see it.
S2 · E35
October 22 · 20 min
ICT Ep 2.35: Robin Piazza on the Safety Oversight Gap No One's Training For (Part 1/2)
Robin Piazza reached out to us directly with this topic suggestion, and we’re glad she did. In Part 1 of this two-part conversation, Liam and Ted sit down with Robin, Founder of Sapiens GC, who spent over 20 years building and running the industry’s first commercial data monitoring committee service before going independent. She breaks down what a data safety monitoring committee actually does, where sponsors, CROs, and vendors each fall short, and why having one independent, unblinded party in the room can make or break a study’s compliance. We explore: - Why safety oversight responsibility has shifted onto sponsors and why there’s still no playbook for it - What Robin learned from years of “rescue projects” where another vendor’s DMC setup had already gone wrong - Why an independent, unblinded party in the room changes what a sponsor can actually prove during an inspection If you’ve ever wondered who’s really accountable when something goes wrong in a trial, this episode starts answering that.
S2 · E34
October 21 · 15 min
ICT Ep 2.34: Study Startup Delays Are a Symptom: What Happens When You Stop and Listen
In this episode, Liam and Ted ask a simple “what if”, what if the industry took the time to really listen? Ted starts with a study startup delay that looks like a tooling problem but turns out to be a relationship problem. While Liam shares what happened when he pulled a frontline team member into a leadership meeting and found a patient-flow blocker that had backed up a 120-patient-a-day site for days. They talk about why most trial meetings leave no room for problem-solving or relationship-building, why no one truly owns enrollment, and why the simplest rule for building connections is to be helpful, be nice, and go first. The takeaway is a short one: call somebody today.
S2 · E33
October 8 · 19 min
ICT Ep 2.33: Steve Wimmer on the Button That Almost Killed a Recruitment Campaign (Part 3/3)
Each episode in this series has built toward this one: what does all of this look like from the other side of the table? In the final part of this series, the Steve Wimmer shares his experince participating in several clinical trials himself, including one he screen-failed out of, and shares what that experience actually taught him about consent, communication, and being left in the dark. Liam and Ted add their own stories of trying to get into a trial as ordinary, motivated patients and being met with silence from both the sponsor and the site. The conversation closes with one of the most useful stories in the whole series: a call-to-action button on a campaign targeting patients 85 and older that tanked conversion until someone pointed out there was, quite literally, no visible button. Steve leaves listeners with a challenge to the industry's call-and-give-up mentality: with the automation available today, there's no reason to give up on an interested patient just because they didn't pick up the phone the first, second, or fifth time.
S2 · E32
October 7 · 19 min
ICT Ep 2.32: Steve Wimmer on Why Recruitment Campaigns Fall Apart at the Site (Part 2/3)
Part 1 was about why storytelling matters, part 2 is about how to actually operationalize it and Steve Wimmer brings a framework that reframes the entire recruitment funnel. Every interaction a patient has, from the first ad to the first phone call, is either a trust deposit or a trust withdrawal. Miss that, and the best story in the world won't save a campaign that confuses people the moment they land on a website. Steve Wimmer, Liam Eves, and Ted Trafford move from why storytelling matters to how to actually build a recruitment engine around it. Steve introduces a framework that's worth stealing. He explains why building hundreds of interchangeable creative assets beats chasing one "perfect" ad, and why the hardest part of recruitment isn't generating interest, it's what happens after a lead lands at a site with no clear owner. The episode also includes one of the most concrete stories in the series: an eligibility question that should have disqualified around 20% of a patient population but was disqualifying far more and how Steve's team tackled it and watched the numbers snap back to where they should have been. It's a small story with a big point, most recruitment problems aren't unsolvable, they're just approached differently.
S2 · E31
October 6 · 19 min
ICT Ep 2.31: Steve Wimmer on Why Storytelling Is What Sponsors Keep Getting Wrong (Part 1/3)
Liam and Ted sit down with Steve Wimmer, who brings seven years of direct-to-patient recruitment advertising experience. They discuss why storytelling in clinical trial recruitment isn't about writing something clever, it's about connecting an ad, a landing page, and a first site visit to something a real person can recognize as their own life The conversation also tackles a myth sponsors carry into every IRB submission: that regulators are the ones saying no. Steve's experience says otherwise and the story of the "silly dinosaur image" that outperformed every carefully considered alternative in the portfolio makes the case better than any deck could.
S2 · E30
August 14 · 13 min
Ep 2.30: Scott Burgher on Where AI Actually Helps Patient Recruitment (Part 3/3)
In the final part of this three-part conversation, Liam and Ted close things out with Scott Burgher, Director of Patient Operations at Quest Diagnostics, looking ahead at where AI genuinely moves the needle in recruitment, and where the industry still gets feasibility wrong. Scott breaks AI's near-term impact into two practical buckets. The first is administrative: compressing study startup from six to twelve months down to weeks by automating document collection, regulatory submissions, IRB correspondence, and budget negotiations, work that's repetitive by nature and ripe for automation. The second is data-driven: using EHR and lab data to flag genuinely qualified patients rather than relying on broad disease prevalence, cutting down what used to take a coordinator six weeks of manual review. They Explore: 1. Where AI can realistically compress study startup timelines, and where it can't 2. Why mining EHR and lab data beats broad disease-prevalence estimates for site and patient feasibility 3. Why the human element becomes the differentiator as software gets commoditized 4. Why most feasibility processes are still solving the wrong problem Scott's closing thoughts on data, predictive medicine, and the road to digital twins. The conversation closes on feasibility, which Scott calls broken at its core, working backward from protocol specifics to find the real "needle in the haystack" instead of the whole haystack. A thoughtful close to the series.
S2 · E29
August 13 · 16 min
Ep 2.29: "That's Not a Performance Problem, It's a Structural One" Scott Burgher on Why Sites Stop Recruiting (Part 2/3)
In Part 2 of this three-part conversation, Liam and Ted continue with Scott Burgher, Director of Patient Operations at Quest Diagnostics, going deeper into why recruitment keeps falling short. Liam reframes the problem from the ground up: the industry treats recruitment as a marketing function obsessed with filling the top of the funnel, when the real work is moving patients all the way through it. Scott connects this to his experience running end-to-end mock trials years ago, testing the full patient journey, not just whether an ad worked, but whether someone could realistically sit through a four-hour infusion or navigate a handoff between site staff who'd never met them. The conversation turns to site economics, which Scott calls structurally broken: sites invest in staff and training months before seeing payment, and when that investment doesn't pay off, they quietly stop prioritizing the study. As Scott puts it, that's not a performance problem, it's a structural one, though it shows up in the data looking exactly like one. Ted pushes the conversation toward what actually closes that gap: a real feedback loop between sponsors and sites, where issues get surfaced, acted on, and communicated back, not just logged and forgotten. A grounded look at what it actually takes to fix recruitment from the inside.
S2 · E28
August 12 · 19 min
Ep 2.28 Scott Burgher on Why 86% of Trials Miss Their Enrollment Deadline (Part 1/3)
In Part 1 of this three-part conversation, Liam and Ted sit down with Scott Burgher, Director of Patient Operations at Quest Diagnostics, who brings over 20 years of patient recruitment experience spanning healthcare marketing, clinical trial agencies, large consulting, and big tech, to talk about the good, the bad, and the ugly of patient recruitment. In this episode, Scott breaks down why recruitment keeps missing the mark. He argues that sponsor decision-making cycles are a massively underestimated blocker, a recruitment strategy can be fully approved by the study team and still sit untouched in legal or procurement for months while the clinical timeline keeps ticking, often defaulting back to digital and social media ads as a last resort. Liam connects this to a separate problem he's seen across budgets: an "iceberg" of recruitment costs sitting below the surface, the centralized strategy and patient-processing work that rarely gets line-itemed alongside site costs. They Explore: 1. Why the 86% missed-enrollment-deadline statistic hasn't moved in over a decade, even as industry awareness has grown 2. How sponsor decision-making cycles quietly stall recruitment strategy for months before outreach even begins 3. The "iceberg" problem: recruitment costs that never make it into the visible budget 4. Why most patients never hear their doctor recommend a clinical trial, and what that gap costs 5. Where AI is genuinely useful in patient identification, and where it's being oversold as a fix 6. The role of primary care physicians in patient recruitment A candid look at the structural issues behind patient recruitment.
S2 · E30
July 22 · 15 min
Ep 2.27: 31 Years of Clinical Trials, Here's What Ted Trafford Knows for Sure
In this special episode, we mark Ted Trafford's 31st year in clinical trials with a candid reflection on what three decades in this industry actually teaches you. It started with a LinkedIn post Ted wrote where is says that after 31 years, he said he'd learned nothing. Listen in to hear what he meant by this. Liam and Ted go on to discuss the more experience you accumulate, the more you realise how much you still don't know. Liam frames this through the circle of competence: as your knowledge grows, so does your awareness of everything sitting outside it. Thirty-one years in, Ted feels that more than ever, and both hosts agree that the willingness to say "I don't know, can you explain that to me" is what separates people who keep growing from people who stop. The conversation also turns to recruitment, where Ted has been quietly building a list of every factor that affects clinical trial enrollment. One item on that list stands out: story. Most sponsors, Ted argues, don't have a compelling narrative around their molecule or their trial, and that gap costs them more than they realise. Liam connects this to something much older than clinical research. Humans have always been moved by story before they're moved by data. This episode is a grounded, honest conversation about what it means to spend a career in this industry, and still be learning.
S2 · E29
July 10 · 18 min
Ep 2.26: Lasagna's Law and Building Recruitment Forecasts You Can Actually Trust
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, but because the assumptions underneath the math are never tested, tracked, or even written down. Liam reframes recruitment forecasting using a sat-nav analogy: the plan is your estimated arrival time, the forecast is what updates as you actually drive. Ted brings a wildlife photographer's lens, literally, arguing most sponsors are zoomed in on the wrong details and missing the bigger picture entirely. A grounded, practical conversation for anyone responsible for building a forecast around best-case, worst-case, and base-case scenarios instead of one optimistic line.
S2 · E25
June 17 · 15 min
Ep. 2.25 The Burdens Still Breaking Clinical Trials: 50-Page Consents, Broken Tech, and Stolen CRCs
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, have gotten worse. Study visits in 2026 take twice as long as a decade ago. One in three procedures collected don't support a primary or key secondary endpoint. Endpoints, procedures, and planned visits have each grown by roughly 40% over 15 years. But this episode isn't only a critique. Conversations with small biotech, mid-size sponsors, and a large pharma groups, all reached out to ask what sites actually need and what's getting in the way. Thirty years ago, that didn't happen. There is a shift and that's worth paying attention to.
S2 · E24
June 10 · 21 min
Ep 2.24 The Decision Threshold Matrix: Why Patient Motivation Isn't Fixed and What It Means for Trial Recruitment
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 four quadrants defined by disease severity and perceived treatment adequacy. It breaks down how patients unconsciously calculate whether participation is worth it and why trial teams consistently inflate the denominator (burden) without strengthening the numerator (benefit). Together, these tools offer a behavioral science-grounded lens for understanding when, why, and how patients engage with research and what teams can do about it. This episode is for anyone working in patient recruitment, site management, or protocol design.

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