Randomized controlled trials lasting more than four to five years become prohibitively expensive, and early-stage drug trials rely on biomarkers to yield answers within a shorter timeframe.

“you need to be able to get the answer in a short period of time what do I mean by short period of time well I would say that if you truly look at an RCT lasting more than than four or five years you're looking at a very long RCT um it's not that it's not possible but boy it becomes cost prohibitive um so the longest randomized control trials have to be able to answer a question within a few years and in an Ideal World a lot less so if you look at early stage drug trials they basically have to have biomarkers because you at least have to get your answer in Phase One and phase two using biomark workers and not necessarily hard outcomes”