I do think that maintaining the budget of a clinical study could lead organizations to conduct the studies in developing countries to save on costs. Balancing funding with results might not be easy since it could be difficult to plan a clinical protocol that will for sure produce a significant evidence without going over budget. By conducting studies in developing countries, maybe the organization can afford 20 surgeons in the study and obtain at least 15 will produce meaningful and supportive data for the product, whereas in the U.S you might only be able to afford 5 surgeons to participate in the study.