Define a patient as being "in" a clinical trial as late in the process as possible. This is done both by randomizing as late as possible and by saying that at least one dose must be given, and possibly add that one set of measures must be made after the first treatment. Then the ITT analysis is more fair than if you randomize long before treatment is started.

Creating a recruitment strategy is like the step therapy model in treating hypertension. One starts with one or two elements and adds others as needed to achieve the desired enrollment goals. In the recruitment strategy one can initially plan to add additional elements at pre-determined times, and to stop or use periodic pulsed elements (e.g., radio advertisements once every week).

Good ethics and high scientific and medical standards can and should be used as a means to beat the competition. Regulatory agencies may raise the bar for others to meet in developing similar products if you have raised the bar yourself.