Quick comment. Obviously I agree that this is a general problem in small biotech. Nonetheless there is a matter of degree. Flexible designs require greater transparency - especially in the case of companies with a history of wandering in the wilderness and claiming they were 'on track'.
(in contrast, a simple SPA with simple endpoint is relatively hard to obfuscate on. And note that none of this is to say that I disagree with using adaptive trial designs - but from an operational perspective they require rigor that the company may not be able to execute and from an investor perspective they require either great trust in the company or greater transparency. Was it GPCB that actually lied about their SPA endpoint?)
Will comment more thoroughly later. Gotta run right now.