The trial he did on autism, which was exactly as you describe, cost $1,2 million, which is apparently cheap as far as trials go. What exactly costs that money and why it cant be cheaper - that's a question I never quite found an answer to.
I have worked a lot on budgeting and I continue to find it fascinating. Humans often tend to underestimate costs because we imagine that our task is a slight extra burden for organisations that we imagine are already flush with funding.
If you think about the trial's marginal costs: 10 injections of suramin - it must seem cheap. But if you're paying your share of the salary costs of everyone involved, and your share of the fixed costs of all the organisations involved (they bill you enough to cover their rent, elecrticity, pensions, etc.) then it obviously adds up.
Something like a clinical trial has a lot of admin involved and admin is expensive. For example, getting human research ethics committee approval includes not only a lot of work by people inside your organisation ,who must be paid and provided an office to work in , etc., but also an application fee that can be
worth several thousand dollars, to help fund the decision making process.
Once you think about all the organisations involved and imagine that you have to fund them for all their costs, not just rely on them doing just a tiny bit of extra work for you gratis, it adds up.
I found this explanation helpful:
"Once approved, we need to recruit physicians to run the trials, patients to participate, nurses to perform care and administrators to do all the documenting and reporting to various oversight bodies. A company usually pays a research organization to set this up, which adds additional cost.
Once the skeleton of the trial is in place, you have to train researchers, physicians and nurses to administer the trial and accumulate all the necessary resources (drugs, hospital space, medical equipment, medical supplies, etc.). There is also a large cost associated with monitoring compliance with the study protocol and various regulations governing clinical trials. Similar costs associated with monitoring clinical outcomes (known as pharmacovigilance). Constant reporting and documentation during this whole thing. And you need people to analyze the data and make decisions on how to proceed. The sponsoring company also needs people on the business end making sure things are going to be budgeted appropriately when inevitable delays, trial drop outs, etc. happen.
On top of all this, you have the medical costs of the enrolled patients. Medical technology is improving all the time and more and more procedures are being used to evaluate patient response. Think routine exams, blood work but also MRIs and speciality tests. This ups the cost per patient significantly. Clinical staff to handle all that is expensive."
