The Rise of For-Profit Experimental Medicine

55 Pages Posted: 30 Mar 2020 Last revised: 25 Jun 2023

See all articles by Pierre Azoulay

Pierre Azoulay

Massachusetts Institute of Technology (MIT) - Sloan School of Management; National Bureau of Economic Research (NBER)

Ariel Fishman

Yeshiva University

Date Written: March 2020


Beginning around 1990, academic medical centers have ceased to be the primary locus of industry-sponsored clinical trial activity. Instead, clinical trials have increasingly been conducted in private practices and for-profit, dedicated study sites. We examine the underlying causes of this startling evolution. On the demand side, the greater availability of non-academic investigators has enabled pharmaceutical firms to better match physicians' skills with specific projects. On the supply side, we argue that the growth of managed care health insurance has contributed to a rise in the number of non-academic physicians performing clinical research. We find evidence consistent with these claims using a unique data set containing information about 85,919 site contracts for 7,735 clinical trials between 1991 and 2003. Furthermore, we examine the gap in prevailing prices for comparable procedures conducted for clinical trials versus conventional medical care, and conclude that the effect of managed care on entry is consistent with non-academic physicians “inducing demand” so as to resist downward pressures on their income.

Suggested Citation

Azoulay, Pierre and Fishman, Ariel, The Rise of For-Profit Experimental Medicine (March 2020). NBER Working Paper No. w26892, Available at SSRN:

Pierre Azoulay (Contact Author)

Massachusetts Institute of Technology (MIT) - Sloan School of Management ( email )

100 Main Street
Cambridge, MA 02142
United States


National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Ariel Fishman

Yeshiva University ( email )

500 West 185th Street
New York, NY 10033
United States

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