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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20 episodes
Updated July 22

Episodes20

Newest first

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.
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.
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.
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.
May 21 · 13 min
Ep 2.23: Jill Fikowski on Why Participants Drop Out and What to Do About It (3/3)
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 that pressure produces. We also look at what happens after the last visit particularly in psychedelic trials and whether researchers have a responsibility that doesn't end when the database closes. Retention problems, Jill argues, are almost always inception problems. And solving them starts with a question most teams never ask. Part 3 of 3.
May 20 · 21 min
Ep 2.22: Jill Fikowski on Designing Trials That Communities Actually Want to Join (2/3)
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, but in protocol design, recruitment strategy, and how findings are shared. Jill walks us through a Quebec youth cannabis and psychosis study that surpassed both its enrollment and retention targets simply by asking participants what they needed before the protocol was finalised. We also get into the tension between industry-sponsored research and genuine community care. Part 2 or 3
May 19 · 13 min
Ep 2.21: Jill Fikowski on on Substance Use, Stigma, and the Research That Actually Changed Policy (1/3)
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 design community engagement and knowledge translation into your trial from day one 2. The gap between saying participants matter and actually building research around their humanity 3. What happens when you ask participants at the end: "What could we have done better?" 4. The difference between checking the box on community input and genuinely centering stakeholder voices She challenges us to confront how our biases shape every decision: who we enroll, what data we collect, what we do with findings, and whether we ever ask participants what they actually needed. Part 1 of 3.
May 14 · 12 min
ICT Ep 2.20: What Monty Python Can Teach Us About Clinical Trials
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 how this impacts sites in particular, increasing workload, creating friction, and ultimately making studies harder to execute. The discussion also highlights how relying on historical processes and “what’s worked before” can prevent teams from adapting to today’s reality. Most importantly, they challenge listeners to rethink how processes are designed, not just by optimising what exists, but by asking whether it should exist at all. A practical and thought-provoking conversation on reducing complexity and improving trial execution.
May 6 · 12 min
ICT Ep 2.19: Everyone Has a Plan Until the Trial Starts
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 the site level, long trainings, broken systems, and unclear processes, gradually drains momentum. From pre-mortems to escalation paths, this conversation focuses on how to prepare for what will go wrong, even before it does.
April 29 · 13 min
ICT Ep 2.18 What Recruitment Is Missing: Time, Trust, and a Cup of Tea
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 recruitment, retention, and patient experience. A thoughtful conversation on why clinical research needs to see the person behind the data.
April 16 · 14 min
ICT Ep 2.17 Borrowing the F1 Playbook: What Formula One Gets Right That Clinical Trials Don't
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 continuous improvement. Liam draws on his experience in professional sport to reflect on why teams that truly operate at that level are rarer than we think, and why clinical trials are no exception. The episode leaves listeners with one question: what if we did the debrief before the problem existed?
April 13 · 13 min
ICT Ep. 2.16 Leading Teams That Take Risks and Deliver Results With Frank Watanabe (3/3)
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. Finally, he outlines his vision for Arcutis and what “meaningful innovation” really means focusing on solving real problems that matter to patients and clinicians.
April 9 · 11 min
ICT Ep. 2.15 Innovation, Risk and Building Great Teams With Frank Watanabe (2/3)
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 culture where people feel comfortable taking risks and learning from failure. From encouraging teams to challenge the status quo to fostering psychological safety through leadership, Frank outlines what it takes to build organizations that continuously improve. They also dive into aligning incentives, building a mission-driven culture, and ensuring that when a company succeeds, its people succeed too.
April 7 · 15 min
ICT Ep. 2.14 From Navy Officer to CEO: The DNA of Leadership with Frank Watanabe (1/3)
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 defines his philosophy: leadership isn’t about authority, it’s about earning trust and loyalty. They discuss how operating principles can become the “DNA” of a company, not just words on a wall, and what it takes to embed culture into everyday decision-making.
April 1 · 20 min
ICT Ep 2.13: The Hidden Complexity of Trial Feasibility
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 Pete, who chases the sexiest percentage instead of the biggest addressable population. And Motivation Mabel, the patient who technically qualifies but simply isn't interested. Together in this episode, Liam and Ted make the case that real feasibility isn't about being right it's about being useful. Understanding the conversion funnel, knowing how confident you actually are in your data, and recognizing that patients are humans driven by trust.
March 18 · 13 min
ICT Ep: 2.12: Dropping the Baton: Why Clinical Trial Handoffs Keep Failing
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 before they're actually ready, the gaps are rarely dramatic, but the cost adds up. The culprit, more often than not, is assumption over communication. Tune in to find out why fixing the handoff might be the simplest, and most overlooked way to run better trials.
March 11 · 10 min
ICT Ep 2.11: The Top 10 Signs Your Site Feasibility Process Is Off Track
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 site feasibility by simplifying processes, questioning legacy requirements, and focusing on identifying and supporting sites with the highest potential for success. Ted and Liam also examine how better feasibility strategy can improve enrollment outcomes, reduce operational burden, and ultimately lead to more efficient clinical trials. This episode is for professionals involved in site feasibility, trial startup, enrollment strategy, and clinical operations, and for those who want to move beyond broken processes and drive better trial performance.
March 4 · 18 min
ICT Ep 2.10 Where Clinical Trials Break Down, Even With Good Teams
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, not randomly. The discussion reframes “execution issues” as predictable outcomes of how trials are designed and governed, offering a clearer lens for understanding why good teams can still produce fragile results.
February 18 · 18 min
ICT EP 2.9: Designing Eligibility Criteria That Work in the Real World
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 - How “gray areas” force sites into interpretation rather than execution - The disconnect between healthcare documentation and research expectations - Why enrollment challenges often originate long before the first patient is screened - What sponsors can do to design criteria that work in the real world- not just on paper This conversation is a practical reflection on how better protocol design can remove friction, protect sites, and keep trials moving.
February 11 · 17 min
ICT EP 2.8: The Cost of Fragmented Enrollment Ownership And Why Leadership Must Step In
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 criteria and healthcare documentation to behavioral science, site motivation, patient experience, and operational execution, highlighting why small decisions made early can have outsized effects later. Tune in to explore why improving enrollment starts with rethinking how the system is built.