Tuberculosis (TB) kills approximately 4,500 people worldwide every day. While most cases of TB can be treated with antibiotics, some strains have developed drug resistance that makes their treatment more expensive, more toxic and less effective for the patient. The IOM Forum on Drug Discovery, Development, and Translation and the Academy of Science of South Africa held a workshop to discuss ways to fight the growing threat of drug-resistant TB. Table of Contents Front Matter 1 Introduction 2 The Incidence of Drug-Resistant TB in Southern Africa 3 Surveillance and Tracking of Drug-Resistant TB 4 Transmission and Infection Control 5 Diagnosis of Drug-Resistant TB 6 Treatment of Drug-Resistant TB 7 Drug-Resistant TB in Children 8 Convergence of Science and Policy to Create a Blueprint for Action References Appendix A: Agenda Appendix B: Report from the National Institute of Allergy and Infectious Diseases (NIAID) Workshop Appendix C: Participant Biographies

An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise. Table of Contents Front Matter 1 Introduction 2 The State of Clinical Research in the United States: An Overview 3 Challenges in Clinical Research 4 Clinical Trials in Cardiovascular Disease 5 Clinical Trials in Depression 6 Clinical Trials in Cancer 7 Clinical Trials in Diabetes 8 Building a Robust Clinical Trials Infrastructure References Appendix A Agenda Appendix B Participant Biographies

The Food and Drug Administration (FDA) is tasked with ensuring the safety and effectiveness of medicine. FDA's science base must be strong enough to make certain that regulatory decisions are based on the best scientific evidence. The IOM held a public workshop on February 26, 2010, to examine the state of regulatory science and to consider approaches for enhancing it.