efficient, large-scale clinical research in the United States, once basic research has led to the development of new therapeutic approaches. The European adeptness is due to many factors.

In some cases, it is because of the centralized government control of medical schools and research institutions. In others, it is because physicians are able to maintain a single life–long comprehensive record of patients, which makes it easier to randomize individual patients or practice. Furthermore, in some countries, such as the United Kingdom, clinical-trial methodology has been a special interest of the medical research council and by a national policy that uses randomized trials as a way to introduce new treatment or diagnostic tests.

Because of the nature of the venture-capital industry in the United States, the greater flexibility of this industry, and its willingness to fund small biotechnology startup firms, particularly those involved in molecular biology and recombinant-DNA technology, there has been a remarkable growth in biotechnology and a gradual shift of those firms into large pharmaceutical firms. In the last 7 years, although the number of biotechnology companies worldwide has been rather static at approximately 1,275, the amount of money spent on research and development by the industry has almost doubled from $4.9 billion to $9.9 billion (Ernst & Young, 1998a). The result of this phenomenal growth has been the creation of a new source of employment for PhD and MD trainees in immunology, which has attracted many