Not sure what you sort of answer you are looking for, but I do understand that the NIH is pushing for more community hospitals to participate in clinical trials in order to increase the "clinical relevance" of their research at a faster pace. On the flip side, doctors and community hospitals often participate in pharmaceutical trials because they are well compensated for enrolling patients and getting them to participate (eg having a nurse on staff meeting with the patient every month or so to discuss side effects and draw the patient's blood to look for side effects and efficacy). My dad has a friend who is a GI doc who has his own private practice, and apparently pulls in close to 500,000 in profit from pharmaceutical clinical trials alone (more then many GI docs make with clinical work alone). Of course most pharmaceutical research is done at academic medical centers where it sometimes serves to advance medical science, but oftentimes it's done purely for the benefit of the drug company and for the financial recompensation of the researchers who recruit patients for their studies (eg finding an indication for every psychiatric disorder for the usage of zoloft in order to make it seem superior to other ssri's).
