Most of that distrust is due to bureaucratic misconduct and is well-deserved:
The Tuskegee Syphilis Study was a infamous clinical study conducted in Macon County, Alabama, from 1932 to 1972, by the U.S. Public Health Service. It involved 600 African American men, 399 with syphilis and a control group of 201, who were deceived into participating under the false promise of free medical care. The study aimed to observe the natural progression of untreated syphilis in Black men, even after penicillin became an effective treatment. Researchers deliberately withheld information about the men's diagnosis and treatment options, including the availability of penicillin, leading to severe health consequences for the participants and their families. The study was eventually halted after public outcry and media exposure.
Any private company trying to pull that crap would be sued into oblivion. But of course the govt is often immune from lawsuit, and even grants that to companies to push products of unproven safety long-term safety, like untested RNA covid vaccines.
That said, I seriously doubt patient recruitment explains the difference in costs, as there is virtually no cost to asking a patient if he wants to be part of a clinical trial, which is the initial decision node. They arent paying people to say yes.
The cost starts if the patient agrees to the trial, in terms of processing, data collection, monitoring and doctor visits.
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