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At no time in human history has the potential been greater for translating biological knowledge and technological capability into powerful tools for preventing and treating disease and caring for our communities' health. At the same time, a new set of challenges threatens our ability to make the most of these scientific opportunities. Today's cost-conscious and competitive health care marketplace has had a major impact on funding streams that have long been available to support biomedical and health research and the training of scientists.

Clinical research is the "neck of the scientific bottle," through which all scientific developments in biomedicine must flow before they can be of real-world benefit to the public. Without a robust national program of clinical research that enjoys the participation and harnesses the full strength of all components of the health sector, the impact of revolutionary advances in the biomedical and health sciences on the health of the public will be largely diminished.