Matthew H. Maxwell, DBA, MS · Chief Innovation Officer
Ask a research leader at an academic health system where the institution is strong in industry trials, and the answer usually starts with cancer. The payment record bears that out. Of the industry research dollars paid in 2023 to 2025 to organizations whose type could be coded, academic centers received 77% in oncology, against 11% in psychiatry, 12% in infectious disease and 6% in obesity.
Most of the money in those three areas went to dedicated research organizations, the companies and site networks whose main business is running trials, which received between 77% and 85% of the coded dollars there. I found this while analyzing ClinicalTrials.gov registry records and federal Open Payments data on industry drug trials with US sites (the full report is linked at the end). For a research leader choosing where to grow, it marks out therapeutic areas where academic centers have so far taken a small part of the work.
Where academic centers lead
Academic centers hold their largest shares in immunology and allergy (77% of coded dollars) and non-malignant hematology (74%), followed by respiratory, cardiovascular and nephrology at 55%, 50% and 45%. Neurology, rheumatology and metabolic disease sit near 31%. Dermatology is at 36% and gastroenterology and hepatology at 38%.
These dollars include investigator-initiated studies and other company-funded work, where academic centers take a larger share than they do of industry trials. Counting only dollars that carry the registry number of an industry-sponsored trial, dedicated research organizations received 54% across all areas and academic centers 29%.
Many trials in the areas where academic centers hold the least enroll outpatients with common conditions, often patients seen in primary care. Infectious disease and psychiatry also run inpatient trials, in patients who are hospitalized with an infection or an acute episode of illness.
Where demand is moving
Trial-site pairs, meaning one trial recruiting in one US location during a year, rose 9% from 2019 to 2025. The growth came from sponsors that do not file with Open Payments, most of them companies without a product on the US market. Their trial-site pairs rose by 24% to 61%, depending on how filing is defined, while filing sponsors stayed between a 7% fall and a 2% rise on the same definitions.
The largest of these non-filing sponsors in 2025 were Akero, Neumora, 89bio and Viking, and none of them works in cancer. Akero and 89bio develop drugs for fatty liver disease, Neumora for depression, and Viking for obesity.
The primary care opening
In obesity and infectious disease, the largest group of investigators is physicians in family medicine, internal medicine or pediatrics with no subspecialty. They make up 39% of obesity investigators and 40% in infectious disease. Of those whose main organization could be coded, 79% in obesity and 69% in infectious disease were listed as investigators mainly on payments to dedicated research organizations.
Academic health systems own large primary care networks, yet nationally primary care physicians are among the least likely to do industry research. In 2025, about 1% of primary care physicians and of psychiatrists were named as investigators on industry research payments, against 8% of cardiologists, neurologists and rheumatologists and 18% of oncology specialists. The 2025 shares will rise as delayed payment records come in.
For outpatient trials in obesity, infectious disease and psychiatry, much of the patient base is already in the health system's clinics, and so are many of the physicians who could lead the studies. The inpatient trials in these areas draw on the health system's hospitals, which a free-standing research site does not have. I think a patient with depression or obesity is more likely to consider a trial offered by the clinic that already treats them. A health system that builds this capacity gives its own patients a way into research that today mostly happens elsewhere, and that is worth as much as the revenue.
Enrollment against plan outside oncology
Completed industry trials in dermatology, ophthalmology, metabolic disease and obesity enrolled at a median of 92% to 97% of the speed their sponsors planned. Completed trials in psychiatry, respiratory, rheumatology and cardiovascular disease enrolled at 87% to 88%. Completed oncology trials enrolled at 70%, and about half of oncology's gap with other areas reflects its larger share of early-phase trials.
These figures describe trials in each area wherever they ran. I also compared trials placed mainly at academic centers with trials at other types of site, and the estimates were too imprecise to show a difference in either direction. In these non-cancer areas, the typical completed trial came close to its sponsor's enrollment plan.
Building the program
The public data don't measure how a site runs, so this section draws on our work at Vitalief with research enterprises.
We usually start by asking which trials the program is built for, because inpatient and outpatient studies run on different operations. Outpatient trials in obesity, depression, vaccines or metabolic disease enroll from clinic panels over months, so they depend on referral volume and on visits that fit around patients' work and family. Inpatient trials, such as studies in hospitalized infections, acute heart failure or acute psychiatric illness, enroll during an admission and often within hours of a diagnosis. They depend on daily screening of admissions, consent at the bedside (sometimes from a legally authorized representative), and close work with hospital medicine, emergency and intensive care teams and the investigational pharmacy. Most programs will want both, and I think the inpatient side is where an academic health system has the clearest structural advantage.
Activation comes first for either kind. Budget, contract, coverage analysis and review by the institutional review board can run in parallel, with one person accountable for the activation date. An inpatient trial also needs agreements with the nursing units, the pharmacy and the after-hours staff, and those are best started alongside the contract.
Coordinator capacity comes next, and the two settings need it in different shapes. A new outpatient program often begins with a handful of trials spread across departments, none with enough volume to keep a dedicated coordinator busy; a coordinator pool shared across departments lets the program take on trials before each department can staff its own. Inpatient trials need coverage when patients arrive, which can mean evenings and weekends, and a pool can share that schedule across studies.
Recruitment differs by setting as well. For outpatient trials that means prescreening queries in the electronic health record, referral paths that primary care and specialty clinics will use, and a route for interested physicians to start as sub-investigators and later lead studies. For inpatient trials it means alerts in the health record when an admission meets the trial's criteria, and hospitalists and emergency physicians who are trained as sub-investigators. Feasibility has to be honest in both settings. An inpatient estimate should rest on admission counts that meet the criteria and on whether the team can reach those patients inside the trial's enrollment window. In our experience, sponsors come back to sites whose enrollment estimates held up, so a program does better to decline trials its patient base can't support.
The payment data add one finding here. In the 15% of recent trials whose payments name the investigators, trials whose investigators carried more industry studies ran late less often, with an odds ratio of 0.76 per doubling of studies. Sponsors may give busy investigators easier trials, so this association doesn't show that volume causes speed. It is consistent with building a program around investigators who run industry studies regularly.
How Vitalief helps
Vitalief works with academic health systems on research operations. For a non-cancer program that means sizing the opportunity against the institution's own patients and physicians, redesigning start-up, providing coordinator capacity through a managed pool, and setting up sponsor invoicing so the new revenue is collected. If your institution is weighing where to grow outside oncology, we would be glad to talk it through.
About the data. Trials come from ClinicalTrials.gov and its monthly archives (the Aggregate Analysis of ClinicalTrials.gov database), January 2017 to March 2026. Payments come from the Centers for Medicare & Medicaid Services Open Payments research files for 2019 to 2025 (June 2026 release). Payment years 2022 to 2025 are provisional, because manufacturers may delay reporting payments on unapproved products for up to four years. Organization types were coded by an AI model from each organization's website and have not been audited by people. Coded organizations account for 62% of research dollars paid to organizations. Enrollment speed is measured against each sponsor's own plan, and multinational trials are measured as a whole. All results are associations.