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The safety of the drugs we use hinges on the rigorous testing of these compounds in a clinical setting. But now more than ever, testing a new medical therapy requires deep pockets. Global spending on clinical trials is estimated to reach $68.9 billion a year by 2025, according to Grand View Research, a market-research company. There are efforts emerging to rein in growing costs. In September, the US Food and Drug Administration Commissioner Scott Gottlieb said he wanted to reduce the cost of clinical trials through various methods, including the use of seamless trials, which save money by running continuously instead of in three phases. Still, some say that the current system is too dysfunctional to fix and that only a complete overhaul will do.