A new study argues that many neurologic and psychiatric clinical trial failures stem less from biology and more from measurement tools that cannot detect meaningful treatment effects. The authors contend that commonly used clinical outcome assessment (COA) instruments lack sensitivity for the specific dimensions that interventions are meant to improve. The paper highlights that developing new treatments requires innovation in outcome decision-making—either tailoring existing instruments or building new COAs to close “validity gaps.” The authors point to broader COA guidance efforts, including frameworks discussed by the European College of Neuropsychopharmacology in 2024. By tying failure rates to measurement limitations, the study sets up a practical mandate for trial designers: match endpoints and instruments to the biology and expected clinical change, rather than relying on legacy scales that may miss signal.