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There are many new sorts of trials coming online that are closer to the model he's proposing here. (Which, BTW, is more like A/B testing than like a classical RCT.) See esp. adaptive trials, point-of-care trials, and global cumulative trails. Some of these new models are really being run by real clinical researchers.

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This is a great point and I think many doctors are pushing for new ways to perform clinical trials but adaptive trials generally only change a single parameter during the course of a trial (dosage for example). And POC trials open up the number of patients that may be willing to participate by administering tests at local sites but the state of clinical trials still has a long way to go. Once it's firmly in drug companies' and insurance agencies' best interest to open things up then we may see more rapid change.

"opening things up" is definitely going to help, and is a huge part of the philosophy of my nonprofit science research org (our first project will be taking an anticancer through preclinical). There are, however, a ton ton ton of biological issues that still are, open or not, difficult to surmount, sometimes not even having to do with the cancer itself (bioavailability, side effects, etc).

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