Some Imperatives for Clinical Research

The preeminence of the research university in the United States is based on a policy to support basic science research, research training, and education in the same institution. The success of American medicine, and particularly of its academic health centers, is the result of this combination accompanied by a strong commitment to apply basic research through clinical studies performed during clinical care. America's leadership in health research and health care may be in serious jeopardy because opportunities for clinical research are at significant risk. Between $800 million and $2.5 billion from patient care revenues have been used to underwrite research in our academic health centers.1,2Attempts to control expenditures through managed care and reductions in Medicare and Medicaid place increasing pressure on the budgets of these institutions and threaten this source of research support. Studies by the staff at the Association of American Medical Colleges have shown that "medical