been recognition that india is an attractive place to grow an industry of drug research. a 2008 report described the entry of multinational companies into india for clinical trials research as a frenzy. at the time there was a perception that the industry was going to grow fast for the foreseeable future in a way that favored the research investor. most investors wished into enter india through contract research organizations. foreign investment in india has resulted in a concentration of international research centers in india. larger research companies are growing faster than small ones, and larger ones are capturing the influence to propose government regulations more quickly than other stakeholder groups. the investment from foreign companies has resulted in more education, professional training, and jobs in the clinical research sector. however, there has been an obvious sudden increase of influence by both foreign and domestic large companies as this research field has developed. the establishment of the pharmacovigilance program made india a more attractive international destination for foreign companies to bring clinical trials research. history until 1995 the united states, europe, and japan conducted most clinical trials. the first evaluation of good clinical practices for research in india was done in 1995. a 2004 paper advised that india lacked the research environment which most clinical researchers require. because of the risks, that paper advised that foreign countries would not gain benefit from outsourcing clinical trials to india. 2005 to 2013 india agreed to comply with the trips agreement in 2005. the agreement changed the way india recognizes intellectual property and changed the research environment in way that enabled foreign companies to conduct clinical trials in india. foreign contract research organizations were able to conduct clinical trials in india from this point. an estimate in 2007 predicted that india would be conducting about 20% of the world's clinical trials by 2010. further speculation of the time was that india would be the preferred global destination for many sorts of clinical trials. among all that growth, a major concern was establishing regulation to improve the ethics and integrity of clinical research in india. the indian council of medical research established the clinical trials registry - india in july 2007 with the intent to improve india's clinical trials research environment. in 2008 a representative for the indian council of medical research remarked that increased government regulation would be necessary to ensure research integrity and public safety in clinical trials. in 2008 a group of indian medical journals made a pledge that from 2010 onward, they would only publish research on clinical trials if that trial was appropriately registered. prior to this, there were essays considering whether the time was right to do this. in 2009 there was a significant expansion in clinical trials done in india. beginning in 2013 there were many regulatory changes which had the effect of reducing the number of clinical trials while also drawing attention to ethical challenges of clinical research in india. in may 2012 the 59th report of the indian parliamentary standing committee on health and family welfare issued a report criticized the central drugs standard control organization. the report complained that the organization was underfunded and understaffed. because of lack of staff, the organization would never be able to perform its duties. the staff who were there were working under a misguided mandate to "meet the aspirations … demands and requirements of the pharmaceutical industry", which was an error and a conflict of interest against protecting the health of the public. another problem that the report identified was that although india requires drug companies to conduct at least phase iii trials in india if other countries have already approved the drug, for some undocumented reason, the drugs controller was granting approvals without this research. also, in 3 cases, drugs which neither had approval in other countries nor trials in india got approval for undocumented reasons. 2013 to 2019 by 2013 the problems with clinical trials had become troublesome to the point of media and public attention. when the media criticized trials, those reports tended to say that the researchers were exploiting the research participants by treating them as experimental guinea pigs. the media attention and public discussion resulted in researchers conducting fewer trails. the number of trials went from 529 in 2010, to about 250 in 2012, to about 100 in 2013. the response to this was that various government agencies organized regulatory changes to resolve many problems at once. researchers reflected on the causes of the problems, and the necessary changes to prevent future problems, and the regulatory reform which would support the changes in science and industry. one change was that the government named a list of responsibilities and divided among the ethics committee, the investigator, and the sponsor. this way, each of those agents in a clinical trial take responsibility for their parts. from this point the researchers must register all clinical trials into the clinical trials registry - india. another change was that ethics committees associated with clinical trials had to themselves register with the drugs controller general of india. the informed consent process had to include all information both in the text document and a verbal description. no principal investigator can oversee more than three trials at once. anyone funding a principal investigator has to disclose to the government how much they are paying. the government regulator set up audit process for ethics committees. the researchers must report serious adverse events quickly to the study sponsor, the ethics committee, and the government regulator. all trials will comply with publicly available payment formulas for calculating how much money to give in case of someone dying or experiencing any other serious adverse effect. in the informed consent process there were was consensus for addressing some communication issues. one was explaining that the control group in a placebo-controlled study will get no treatment. another was explaining that the drug candidate is experimental, and not necessarily an effective therapy. there was also recognition that many administrative, procedural, and reporting functions needed national standardization. in 2018 the government established a process for approving drugs in india, without clinical trials, in exceptional circumstances such as an epidemic. 2019—present in 2019 the government enacted the new drugs and clinical trials rules 2019. these rules provided more guidance for how the ethics committee of a clinical trial should oversee it. critics of the rules said that the government compromised public safety in favor of industry and financial interests. special populations when indian people consider volunteering for clinical trials they frequently have the same reasons for either joining or declining. motivations for joining include intent to gain health benefit, altruism, in respect of the request of their physician, to get money for participating, and to get an opportunity to learn more about health and research. reasons for not wanting to participate in a trial include mistrust of the organizations managing the research, fear of trial risks, stress, the obligation of participating, fear that the trial will not respect their personal information, creating a burden on their friends and families to support them in the trial, and the lack of available information about the research in their own local language. people with schizophrenia require specific cultural support to participate in clinical trials. a 2009 report described how innovation in phase 1 cancer research trials could have a big impact on indian health. various studies in the united kingdom have described how british researchers can make trial participation easier for south asian people living in the uk. a 2011 report encouraged teaching clinical research in the curriculum of medical students to prepare them to conduct trials. a 2019 survey found that respondents in india were cautious in saying that they would approve of clinical trials related to the sexual health of adolescent girls.