Beyond inclusion: are clinical trials solving the right problem?

Abstract

In 2024, Denmark led the European Union in clinical trials per capita. This is celebrated as a marker of innovation, signalling Denmark’s research capacity and attractiveness to the global industry. Yet, trial volume alone provides a limited account of clinical research value and hides a more troubling reality: research is concentrated in commercially lucrative areas such as oncology and Alzheimer’s, while children, pregnant individuals, older adults, those with chronic pain, multimorbidity, or less profitable conditions are often overlooked. This mismatch is not merely a policy oversight. It reflects structural and epistemic injustices that determine whose bodies, experiences, and health outcomes are considered research-worthy. Drawing on Denmark as a national case example situated within broader European and international debates, this commentary highlights how inclusion strategies risk focusing on numeric representation rather than justice in knowledge production while also pointing to promising opportunities for inclusive innovation within the clinical research ecosystem in Europe. By moving beyond mere checklist inclusion, there is potential to foster a more equitable, reflective, and justice-oriented approach to participation and knowledge generation, one that benefits patients, researchers, and the broader society.