The author doesn't really understand the details of the operations of clinical trials, though this is a good overview of the kinds of outcomes that show up. I

The author doesn't really understand the details of the operations of clinical trials, though this is a good overview of the kinds of outcomes that show up. I worked on operations software for clinical trials for about a decade, and there are (mostly necessary) regulatory drivers a large fraction of the complexity he complains about. The first order effects of the regulations are pretty straightforward, but when you get into second, third, and fourth order impacts, you start seeing some of the outcomes he's describing.