I read Myrna E. Watanabe's article on sponsored clinical research in the managed care setting (The Scientist, June 24, 1996, page 1) with great interest. It is clear that clinical research of all sorts eventually will need to be conducted by and in managed care organizations (MCOs). After all, traditional settings for such research are disappearing as managed care is becoming a major, if not the dominant, modality of health care delivery. Moreover, assurance of research validity will require that a representative amount of clinical research be adapted to MCO requirements and conducted in the managed care environment.

p It seems to me that the societal covenant that has supported clinical research and improved health care over the years has eroded as the structure, settings, and players of our health care system have changed. A new system of research resources, capabilities, obligations, and involvements must emerge. Hopefully, it...

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