Everything in a clinical trial should be designed to optimise the success of meeting the trial’s endpoints. This goal starts with developing a flawless protocol, which then dictates all downstream trial activities. Trial Sponsors often in collaboration with Contract Research Organisations (CROs) then painstakingly follow this protocol, which was optimised in every way to meet the trial’s endpoints, yet most clinical products eventually fail to make it to market.1 Failing to meet the trial’s primary endpoint could mean that the treatment does not work as hypothesised, but trial endpoint failure could also stem from several other factors such as not optimising your protocol’s inclusion and exclusion criteria, from treatment non-adherence, or from a highly variable measurement.