Dr Andras Fehervary offers the industry perspective on the barriers that are preventing patients joining clinical trials and explains how they are working to remove these barriers. The barriers include regulatory issues, industry economics, geographical infrastructure and educational issues. Dr Fehervary questions whether the balance between risk aversion and access to new medicine should be reevaluated, especially in the case of rare diseases, speaks about the drawbacks of the industry’s traditional tendency to concentrate trials in well established cancer centres for the economic benefits and established infrastructure, and suggests how clinical trial design can be improved through innovative partnerships between industry, patient groups, investigators and other stake holders. Dr Fehervary concludes by suggesting 'systems for temporary use' as a way of increasing patient access to new drugs, discusses the role patient advocate groups have to play raising awareness of clinical trials, speaks about the value of registries for gathering data and cites need for greater patient involvement in clinical trial design.