Clinical trials are a massive industry with brutal economics, long timelines, and failure rates that would be unacceptable in almost any other sector. In this episode, Dr. Andree Bates is joined by Dr. Joseph Geraci of NetraMark to break down why trials fail so often, how patient heterogeneity drives cost and uncertainty, and where AI can realistically shift the economics.

Topics discussed in this episode:

• Why clinical trial economics are becoming unsustainable
• Patient heterogeneity and why disease definitions break trials
• Finding “pockets” of responders within small datasets
• Trial enrichment and substudies that reveal a drug’s advantage
• Why pharma adoption can be slow, even when failures are constant
• Regulatory interest, guidelines, and sponsor risk aversion
• Large language models vs mathematically augmented AI approaches
• Speed as the biggest economic lever in trials
• Practical examples across depression, schizophrenia, oncology, and beyond
• What clinical trials could look like in five years with AI-driven insight

Dr. Joseph Geraci shares his unusual path from mathematics and mathematical physics into oncology and medical science including a decision to move into hospital research. That shift shaped his focus: not just discovering more molecules, but understanding why the same drug can work brilliantly for some patients and fail for others.