From here.
I looked through some charities and tried to assess their efforts. I ended up looking at what activities they were carrying out, how much detail they provided about their activities, the quality of any financial reporting/quality reporting processes they seemed to have and how easy it seemed to be to access financial breakdowns. The exercise became more of a "gut feel" analysis than I would have liked but was still tremendously useful - I'm open to suggested edits/additions, and will touch on some of the further research I would have liked to have done at the end.
Great suggestion, particularly as you say for trials with a super expensive treatment relative to control.
In defense of current practice, I'd like to add that a major difficulty when running medical trials for new therapeutics is simply recruiting patients to the trial. Many patients enroll on the trial with the aim of getting the experimental treatment, so it's a lot easier to recruit people when your trial has a 50% or 75% chance of assignment to therapeutic arm.
Some other important strategies that are currently hot right now:
Platform trials: One giant trial that has one control arm and maybe three to four treatment arms. Hard to do as it requires a lot of people to work together but amazing when you pull them off (e.g. we did many of these for COVID)
Use of historical or shared control data: Why recruit as many controls if you can integrate existing data in a statistically principled, unbiased way (easier said than done of course).