Particularly noteworthy is that these concerns are found at all types of centres, including teaching and non-teaching hospitals, academic medical centres, and office-based practices. Large, sophisticated sites, and smaller, less experienced sites are all tested by the financial management of clinical trials. According to one Midwestern investigator: "Internal billing and collection processes are difficult and payment from sponsors is not always timely". Similarly, a Pacific Coast physician wrote that: "Based on current industry practices, it is almost impossible to track milestone payments to ensure that all study visits/procedures are being reimbursed" Clinical Trial.
Drug Safety Reporting Is A Worry The uneasiness among investigators about the reporting systems associated with serious adverse events (SAE) is especially noteworthy. More than one-quarter of the clinical investigators are troubled by the SAE reporting systems in clinical trials, although far fewer have an issue with the follow-up activities of reported SAEs. The issue of drug safety has most certainly been the focus of great attention in the last few years, possibly highlighted by the Vioxx controversy. Investigators may be more sensitive to the general drug safety issue because medical professionals, public officials, and the general public have given the topic such attention. For example, the FDA has recently reorganised to provide more safety surveillance of marketed drugs, and a widely read Institute of Medicine report highlights the difficulty of anticipating possible drug safety issues with marketed drugs based upon the relatively small number of patients taking part in clinical research studies Clinical Trials.