Dr. Michel van Harten, CEO of myTomorrows, helping patients discover and access treatments.
Picture this: A cancer therapy is in development, with a clinical trial actively enrolling patients who could benefit from it. But often the patients who need it most never hear about it or can’t navigate the system to get to it.
An estimated 70% of Americans say they’re inclined to participate in clinical trials, yet fewer than 5% of adults living with cancer ever do. The gap between willingness and participation has nothing to do with science and everything to do with access.
What does it mean to innovate if the people you built something for can’t reach it? In clinical research, where the cost of inaction runs highest, that question deserves more attention than it gets.
Breakthroughs Versus Access
The dominant narrative around medical progress celebrates the breakthrough, the lab discovery, the Phase III result and the FDA approval. The harder, less examined frontier is access to treatments still under investigation. Science produces breakthroughs. Infrastructure creates access to them. Access is what drives impact.
Certain advances in genomics, precision medicine and AI are increasing the number of investigational therapies reaching clinical development. Yet if patients cannot find, understand and navigate these opportunities, science risks outpacing the systems meant to connect it with the people it intends to serve.
The problem becomes visible at scale when looking at clinical trials. More than 80% of trials worldwide fail to enroll on schedule, with 55% of terminated trials citing low patient accrual as the leading cause of closure. The gap between “a trial exists” and “the right patient can reach it” is where the most consequential but least addressed work lies. Every month an eligible patient fails to reach an investigational treatment represents lost learning for researchers, slower development for sponsors and a missed opportunity for the patient.
Geography is one reason. Research shows 78 major cancer centers are involved in 94% of all U.S. cancer trials. Those centers tend to sit in socioeconomically advantaged areas with higher proportions of white residents. For patients living hours away, an enrolling trial can stay out of reach.
Racial and ethnic disparities compound the gap. In the trials behind the FDA’s 2025 novel drug approvals, Black participants enrolled at lower rates than white or Asian participants. In some drug programs, they made up 0% of those enrolled. These disparities reflect access failures, not scientific ones.
Diagnosing The Access Barriers
Four barriers consistently keep patients from accessing pre-approval treatments.
1. Information Gaps
A trial cannot help anyone who doesn’t know it exists or understand what it involves. The European Health Literacy Survey found that almost half of respondents across Europe, a region with some of the world’s most developed healthcare systems, had limited health literacy.
2. Navigation
This excludes more patients than many would assume. Knowing a trial exists is only the first step. Reaching it means navigating fragmented clinical trial databases, complicated eligibility criteria and referral pathways that vary by institution. That complexity can shut out patients as effectively as cost or geography.
3. Trust
This gap has roots that reach back decades. From 1932 to 1972, the U.S. Public Health Service’s Tuskegee Syphilis Study tracked untreated syphilis in hundreds of Black men, withholding treatment even after penicillin became a standard cure in the 1940s. That history correlates with lasting increases in medical mistrust and mortality within the same community.
Mistrust remains a key barrier to research participation among many Black patients, sustained by ongoing inequities and discriminatory encounters. When an institution with a history of failing a population delivers an innovation without involving that community, the innovation predictably fails to reach the people who may need it most.
4. Systemic Barriers
Even patients who are informed, motivated and trusting still face hurdles relating to geography, cost, insurance, language, transportation and fragmented data systems. The early years of the HIV epidemic show how these barriers can be moved.
Many people with AIDS could not get into clinical trials, which were the main route to investigational drugs. In October 1988, around 1,500 ACT UP activists protested at FDA headquarters to demand faster research and approval of AIDS treatments. The following year, federal health officials accepted a “parallel track” approach, making innovative drugs available to patients who could not join trials without disrupting the trials themselves.
Access: The Real Engine Of Impact
An access problem is a failure of the connective tissue between an innovation and the population it was designed to serve. Building that connective tissue means investing in five areas at once. These are not abstract categories. Each reflects a breakdown many health professionals have seen keep a treatment from the person who needed it.
1. Tools for discovery help people find and reach relevant investigational treatments and trials, instead of just learning they exist.
2. Trusted communication builds credibility early by involving intended users in shaping solutions and reaching them through the community institutions and peers they already rely on.
3. Health literacy support, embedded across schools, clinics, hospitals and community centers, gives patients what they need to make informed decisions about their own care.
4. Reduced system fragmentation cuts the number of platforms, touchpoints and decision points a patient must navigate alone.
5. Dedicated patient navigators do the same, turning a complex system into something a person can find their way through, especially when they speak the patient’s language.
None of these fixes calls for a scientific advance—only a willingness to treat access as seriously as discovery.
Access should be a prerequisite for scientific progress, not an afterthought. Every investigational treatment that reaches the person who needs it is progress made real. That is the work worth measuring.
The next era of medical innovation will be defined less by the therapies we discover and more by how well we connect them with patients who need them. Access is not downstream of innovation. It is what allows innovation to matter.
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