A systematic approach to US market entry.

Almost every US trial is public. A 2007 law, FDAAA 801, makes registration mandatory, so the record is close to complete. A substantial protocol amendment costs about $450,000 in direct work (Tufts CSDD), before the weeks of delay each one adds. Multiply how often a company amends by how many trials it runs, and the pain sorts into an order. The companies at the top are losing the most. Here is the commercial case and its focus.

pain = mean( rank(amendments), rank(enrollment failure), rank(startup lag) )Each signal is ranked 0 to 100 against every other cell, then the three are averaged with equal weight. No learned weights, no black box. A cell with fewer than two measurable signals reads insufficient, not zero.

Less painMore paininsufficient data


Oncology	82	92	91	79	22,100
Infectious Disease	19	52	42	42	9,765
Healthy Volunteers	1	8	23	12	9,574
Endocrine & Metabolic	9	46	42	45	6,264
Cardiovascular	21	82	72	71	5,646
Neurology	28	81	86	56	5,616
Immunology & Inflammation	33	78	67	56	5,484
Psychiatry	23	61	51	53	3,418
Respiratory	11	57	49	56	3,366
General & cross-cutting	12	70	65	54	2,899
Dermatology	14	32	30	17	2,749
Rare & Genetic	35	96	89	94	2,471
Nephrology & Urology	8	77	67	34	2,222
Hematology	28	95	87	92	2,155
Musculoskeletal	36	60	69	63	1,854
Gastroenterology	10	64	47	52	1,852
Ophthalmology	36	68	50	43	1,624
Pain & Anesthesiology	4	40	38	51	1,190
Women's & Reproductive Health	6	42	61	84	1,007

See who carries the pain

In brief

What this is: An interactive map of 454,031 public trials, every figure carrying the sample it rests on (methodology).
The deliverables: The map with per-cell evidence, the ranked account list, and a one-page board brief (PDF).
How it is built: A deterministic pipeline over the public record. The amendment figure is a disclosed proxy, and contract research organizations are a named blind spot (limits).