All clinical studies are not equal so some nuance on the objective of the studies is probably important. My impression is that grant funded clinical studies tend to be earlier in development and more exploratory if interventional, or observational if larger (eg framingham study). This isn’t absolute, but the funding required to cover large definitive pivotal studies, and all pharm/tox and manufacturing needed for a drug approval is large and I believe is very unlikely to be covered by grants. I agree NIH is essential and Pharma has some large issues, but I don’t believe NIH is teeing up loads of approvable drugs for industry to exploit.