Former FDA Commissioner Dr. Robert Califf provides a brutally honest assessment of the current clinical research landscape. He discusses the critical challenges facing medical innovation, from overly complex clinical trials to profit-driven healthcare systems. Dr. Califf offers insights into why clinical research has become increasingly difficult, shares his vision for a more integrated learning health system, and provides hope for researchers and healthcare professionals looking to drive meaningful change. A must-listen for anyone passionate about improving medical research and patient care.