Rare disease clinical trials also require extraordinary customer service—sometimes even including package delivery. In one case, each treatment dose cost more than $3,500, required constant refrigeration within a narrow temperature range, and had to be checked in and out to document protocol compliance and chain of custody—requirements beyond even FedEx’s legendary capabilities. Often, the task fell to the trial’s clinical research associates (CRAs), who went well beyond their job description to ensure the trial succeeded.

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