The concerns you outline are true, however much of these complaints may ultimately be explained by a less traditional approach to the clinical trials design and execution process.
Over a number of years, for me since early 2015, Anavex have run only small trials with good spacing between them. Not the P1, one or more P2s and finally one or more P3 trials in one indication hoping something sticks all while wearing an Aduhelm for protection.
Armed with all possible knowledge then initiate and run a clinical trials programme taking the time it takes, all the while combined with the latest tools and techniques e.g Ariana KEM Analysis, full genome sequencing, gut microbiome sequencing etc. Then along the way stuffing ever more data with more parameters into the sausage machine and ponder the output.
This approach if done right should be smarter than a shotgun approach when the situation in fact calls for a sniper.
Lol, hopefully that analogy works well for my friends in the land of much freedom and fraud.
We may have this!
Sunday greetings from a Covid restriction and mandated vaccine free Candyland.