Abstract
The five areas outlined in this discussion represent a large proportion of the current environment for clinical trials. They identify significant obstacles to the advancement of knowledge in clinical oncology. There is no single or overriding solution to the health care system and its problems with funding and access or to the antiintellectual mood of our times. Continuous efforts to improve science are needed now more than ever. Adequate accession to trials is an ongoing issue. These problems are compounded by the ethical issues created by today's opportunities. The etiquette of territoriality is no less daunting. Each of these affects the environment in which trials are conducted, and each deserves the serious attention of all of us. Some suggestions for action have been made. The need for resolution is obvious.