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This document is designed to introduce a conversation. Considering that the focus of the summit will be on action plan development, the organizers felt it may be helpful and efficient to summarize commonly known issues and assumptions that will likely underpin the conversation. In this document, we discuss the value of clinical trials to Canada; what other countries are doing to attract them; what the situation looks like in our country; possible issues and explanations for recent trends; an overview of our strengths, and a look at current initiatives at both the national and provincial levels. While the document will not propose any solutions, it will highlight some considerations that may be relevant in action planning. At the end of the paper, we will provide some questions that may be relevant to the more specific discussion items on site.