'Bureaucracy' is commonly used as a trigger word. When I see it, I'm alerted to manipulation and, in some contexts, a certain partisan dogma. After all, who likes bureaucracy? By the same token, who like stop lights or authentication or other structures in life? But every large organization functions using bureaucracy - every highly successful one, every median one, every poor one.

> A system originally conceived to safeguard patients has gradually produced a strange and troubling outcome: the mere chance of survival is effectively reserved for the very few who possess the means to assemble an army of experts capable of navigating its labyrinthine procedures.

The survival of who? The three people who are trying to experiment on themselves (with questionable results, especially when their experiment has N=1)? That's a crisis? What about the 99.9..% of sick people?

> I will focus on the former: small, exploratory trials, which will be called early-stage small n trials for the purpose of this essay.

'early-stage' - it's just like a startup! Except the human experimentation part.

> In recent years, China has been advancing rapidly in biotechnology, in part because it is easier to run early-stage clinical studies there.

> “The US can’t afford to lose the biotech race with China.”

With the 'bureaucracy', it's right out of central casting, including the scare tactic: The same arguments have been used for labor standards, property rights, democracy itself.