Table 1 Summary of related work.

¹⁹

providing services ensuring security and maintaining the privacy of patients

Practical Byzantine Fault Tolerance (PBFT) consensus algorithm

Increased bias, manipulation risks, low reliability

²⁴

Traceability of consent in clinical trials

Proof of concept with time stamp

Unsure whether the person signed the consent is the right one or not

²⁵

Tracking, securing, and management of clinical trials

Permissioned Ethereum, blockchain

Lack of network scalability

²⁶

Monitoring and management of clinical data in multisite trials

Permissioned Hyperledger Fabric, blockchain

The cost of network setup is high

²⁷

Monitoring and detecting falsified, spurious and counterfeit drugs

Ethereum Hyperledger Fabric, and Delegated PoS (DPoS) and practical Byzantine fault tolerance (PBFT

It requires implementation plans and policies

²⁸

Inspection and tracking the data flow of drugs to prevent counterfeit drugs

Consortium PoW

Consultation with key investors to perform a cost–benefit evaluation

²⁹

Analyze, trace, manage and verify medical data for clinical trial and precision medicine

General blockchain platform

Lack of consistency

²¹

Identification of malicious nodes and the selection of the primary node

PBFT consensus mechanism

Nodes with a lower value cannot participate in the consensus at all and it causes bias

³⁰

Improve the scalability and throughput

MBFT consensus mechanism

Using the two-layer consensus algorithm increases complexity, requires more resources

³¹

Reducing the overhead for validating and recording transactions

Geographic-PBFT

Inequality of resources, increasing complexity

²²

Improve clinical monitoring, ensure secure communication, and enhance data privacy in a decentralized manner

–

Complexity, Scalability, Security Risks