12Medical Research for Hiretrying to make a pro at the sites�expense rather than from the pharmaceutical companies. A physician I interviewed called these companies ond scum,�and some sites and SMOs explicitly state in their marketing materials that they will not work with study brokers. In fact, only 11 percent of sites use study brokers to d contracts; the majority rely instead on personal contacts, industry publications, and cold calls.34 Clinical trials advertising agencies specialize in creating advertisements that will meet regulation (for example, ads must clearly state that the therapies offered are experimental, and they cannot use the word ew�in describing the drug, therapy, or device), pass IRB review, and be effective. Advertising agencies are often hired not only for their ability to design a good campaign but also for appropriate expertise regarding where to place ads to reach target audiences effectively. These companies recommend types of radio stations, times of the day, and so on for reaching the speci demographics required for studies. Central patient recruitment companies have a similar function to advertising agencies within the clinical trials industry. Although recruitment companies often provide the same services as advertising agencies, many of them specialize in what are called eady-to-recruit�or directly solicitableopulations. In most cases, this service consists of databases of individuals�names and contact information that are cross-referenced by disease state, geographic location, sex, age, and other variables. The recruitment companies can build these databases from scratch, or they create them by cobbling together preexisting databases. One example of the latter is a single database compiled from data on health insurance claims, U.S. census demographics, and marketing data on media exposure. The compilation of such information is designed to answer questions such as hat television programs are favored by middle-class asthmatics in New England�The answer to this type of question is valuable to companies searching for an effective way of recruiting potential subject volunteers. Another simple function that central patient recruitment companies serve is to offer centralized call centers to complete the prescreening of individuals. This service removes from investigative sites the burden and expense of talking with individuals who are not eligible for given protocols. With so many companies and services propagating within the industry, one would expect that they demonstrate considerable efacy in speeding up the pace of clinical trials. Indeed, new drugs were approved on an average of sixteen months faster in 1999�001 (about 5.92 years) than in the period
