AS COST-CONSCIOUS managed care organizations become the predominant force in the US health care system, the future of clinical research is in jeopardy. The academic medical centers that, since the 1960s, have provided the facilities for such research are coming under increased pressure to reduce costs. Clinical research, usually more expensive than patient care, is on the firing line. Deeply concerned about this situation, Harold Varmus, MD, director of the National Institutes of Health (NIH), convened an advisory panel of 14 experts to review the problems facing clinical research in the current cost-cutting environment and make recommendations for dealing with them. Chaired by David Nathan, MD, professor of pediatrics, Harvard Medical School, Boston, Mass, the panel met on the NIH campus in Bethesda, Md, last month. As might be expected from an NIH-appointed group, the benefits of clinical research were taken as given. Members agreed with, or at least voiced