在内布拉斯加州奥马哈的 XCancer——由唯一一名医师 Luke Nordquist 经营的前列腺癌私人诊所——药厂看重的是速度：他说最快约两周就能启动一项试验，而学术中心往往要花上数月。XCancer 在 15 年内参与了 200 多项试验，并在诺华（Novartis）的 Pluvicto 计划中大量纳入病人。这股热潮是结构性的：肿瘤学试验约有 2,400 项正在进行，从 2000 年的约 400 项大增，而药厂估计每年在肿瘤临床试验上花约 800 亿美元。

金钱随著病人流动。大型试验中，赞助商对每名受试者的支付可达 25 万美元以上，不到十年前还不到这个数字的一半。然而在美国，医师可能没有法律义务告诉参与者诊所因为招募而获得报酬，而这些总额可能多年都不透明。彭博的分析发现，自 2000 年以来获批的癌症药物中，少于一半被证明能延长寿命，一些研究则显示平均增益以「几周」计。病人 Dan Odorisio 说他在 Pluvicto 以及两项阿斯利康（AstraZeneca）试验期间 PSA 恶化，觉得自己「失去了一年」；他在 9 月 26 日去世，曾获得约 1,600 美元的差旅补助。

Nordquist 的诊所显示私人试验基础设施的规模：员工从 3 人成长到 60 多人，每月看诊约 450 名前列腺癌病人，另有 25–50 名其他泌尿系癌症病人；约 30% 参与试验，而全国比率为 7.1%。联邦资料显示，他的公司在截至 2024 年的 7 年内至少从药厂取得 2,200 万美元，并收取 30%–35% 的管理间接费。整体上，产业资助上升而公部门停滞：2022 年为止的 5 年间，产业试验收案几乎倍增至约 12 万人，而联邦资助收案维持约 1.5 万人；NIH 之后在 2 月下旬到 8 月间终止了 118 项补助。批评者也指出「稻草人」对照组；一篇论文发现 2013 年至 2018 年年中之间的 96 项核准中有 16 项依赖较差或被排除的治疗选项。

At XCancer, a private prostate-cancer clinic in Omaha run by one physician, Luke Nordquist, drugmakers value speed: he says he can open a trial in about two weeks, versus months at academic centers. XCancer has joined 200+ trials over 15 years and enrolled heavily in Novartis’s Pluvicto program. The boom is structural: about 2,400 oncology trials are underway, up from ~400 in 2000, and drugmakers are estimated to spend roughly $80 billion a year.

Money follows patients. Sponsors can pay $250,000+ per enrollee in major trials, less than half that under a decade ago. Yet US doctors may have no legal duty to tell participants their clinic is paid for enrollment, and totals can stay opaque for years. A Bloomberg analysis found fewer than half of cancer drugs approved since 2000 proved to extend life, and some studies show average gains measured in weeks. Patient Dan Odorisio said his PSA worsened on Pluvicto and two AstraZeneca trials and he “lost a year”; he died Sept. 26 after about $1,600 in travel reimbursements.

Nordquist’s clinic grew from 3 employees to 60+ and sees ~450 prostate-cancer patients plus 25–50 other urologic-cancer patients monthly; about 30% enroll, vs 7.1% nationally. Federal data show his firms received $22M+ from pharma in the 7 years through 2024, with 30%–35% overhead. Industry trial enrollment nearly doubled to ~120,000 patients in the 5 years through 2022 while federal enrollment stayed ~15,000; NIH later terminated 118 grants from late Feb. to Aug. Critics cite “straw man” controls; a paper found 16 of 96 approvals (2013–mid-2018) relied on inferior or excluded options.