Tall windows overlook the Patapsco River in the newly renovated 7th floor lobby of MedStar Harbor Hospital in Baltimore’s Cherry Hill.

That view greets patients volunteering to participate in an early phase clinical trial — the very beginning of a long testing process that any medication or therapy must complete before hitting pharmacy shelves or hospitals. Many of the volunteers at Harbor Hospital are taking a medication that, before their study began, had only ever been tested in animals.

The early phase clinical research unit on the 7th floor is one of four around the world run by Parexel, a multibillion dollar research organization. And Parexel just made a major investment in the Harbor Hospital unit.

Last week, Parexel finished a two-year renovation project that cost $10 million and increased the unit’s bed capacity from 60 to 72. Construction on the floor was phased, allowing trials to continue without disruption, said Amy Roach, vice president and unit head of Baltimore’s Parexel site. During an open house Wednesday to celebrate the floor’s facelift, about 40 trial participants were staying on the unit, Roach said.

The renovations added more security measures to the floor and updated its nursing station, pharmacy and other clinical spaces. A television screen in the hallway offers a minute-by-minute schedule for when patients need to have vitals taken, give blood or urine for tests, or receive doses of the medication they’re testing. Advanced freezers keep samples collected from patients at precise — and very cold — temperatures, which are monitored 24/7 to ensure they don’t fall out of the required range.

Many of the floor’s updates were completed to improve patients’ experience during their stay, which typically lasts for up to a week, but could stretch longer. Roach recalled one study that required trial participants to stay for 55 days.

While patients participate in the study, they must remain on the hospital’s 7th floor, where they can be monitored in a highly controlled environment. They’re not allowed to bring outside food or drinks onto the unit and must adhere to a list of rules while participating in their trial.

Before the renovation added a spacious recreation area to the floor — complete with a bookshelf stacked with board games, private phone booths and two televisions — there wasn’t much space for participants to relax or work, Roach said. The rooms also were outdated.

“If you’re staying here for two weeks,” she said, “that’s going to impact your decision to stay.”

The new patient rooms still resemble hospital quarters — there are emergency call buttons beside the beds, which are separated from one another by curtains — but there’s more storage space for personal belongings. Parexel also has more flexibility to house participants in smaller, more private rooms, instead of the traditional 12-bed model, where healthy research volunteers tend to stay.

Besides working toward improving retention in clinical trials, Roach and her team are trying to improve the diversity of trial participants.

Surveys of clinical trials show that white people tend to be overrepresented among participants, even when Black people and other people of color are more likely to be affected by the illness or condition being studied.

That’s part of the reason why Parexel chose South Baltimore as a site for one of its early phase clinical research units, Roach said. Cherry Hill, where MedStar Harbor Hospital is located, is a historically Black neighborhood.

Though every study is different, on average, 60 to 65% of the people participating in research at Parexel’s Baltimore site are Black or African American, Roach said. In a city like Baltimore — where the legacy of medical racism looms large through the story of Henrietta Lacks — it takes a lot of trust building and education to encourage Black residents to participate in studies, Roach said.

“Continuing to remind people that research is a voluntary process,” she said, when asked what that education looks like. “We have to have informed consent before we do something. At any time, if someone’s not comfortable with something, they can stop. They can leave.”

Parexel’s relationship with MedStar helps, Roach said.

MedStar has a huge footprint in the Baltimore area, with more than 400 care sites. That means many city residents have a MedStar hospital or health center nearby, said Dr. Petros Okubagzi, MedStar Health’s vice president of clinical and translational research.

“People don’t randomly get sick and want to be in a clinical trial,” he said. “A key part is being in the community, being a trusted care provider of the community.”

Nearly two decades ago, Parexel made global headlines when a leukemia drug being tested in one of its London clinics triggered life-threatening reactions in six healthy volunteers. While an interim review by the United Kingdom regulators found that Parexel had acted within its protocols, a later report found that TeGenero, the sponsoring drug company, had not properly considered the safe dosage of the drug for humans.

A lot has changed since 2006, Roach said. It’s now industry standard to conduct something called “sentinel paired dosing” in studies testing a drug for the first time in a human. In this practice, one participant receives an active dose of the drug and another receives a placebo. Then, researchers monitor their symptoms before dosing any other participants.

The U.S. Food and Drug Administration doesn’t require early phase clinical trials to be conducted in a hospital, but Parexel’s Baltimore site has been located in Harbor Hospital since 2001, Roach said. In the rare event that something goes wrong, there are crash carts on hand and an emergency department and intensive care unit a few floors away.

“We follow not only what the FDA regulates,” Roach said, “but we go above and beyond that, in terms of safety measures.”