An introduction to a Forum series on biomedical research policy issues, this paper provides background on the organization and structure of both public and private research entities. It outlines the federal components, from the National Institutes of Health (NIH) to the Department of Veterans Affairs. It also looks at the rapid growth in pharmaceutical, biotechnology, and medical device research and development and the varying responses from managed care plans, practice-based research networks, and contract research organizations. After laying out various tensions in the field, such as competition among disease-oriented advocates, alignment of different priorities, allocation of dollars between basic and clinical research, charges of conflict of interest among researchers, politicization of research issues, and relationship to the rising costs of health care, the paper reviews some suggestions for reform. Among those summarized are the recommendations of an NIH panel, an Institute of Medicine committee, a Commonwealth Fund task force, and a clinical research summit sponsored by the Association of American Medical Colleges, the American Medical Association, and Wake Forest University School of Medicine.