Academic medicine and the public.
Each year at this time the President is privileged to address the Society on a subject that he hopes will be of interest to members and guests. After giving much thought to the matter, I have decided that the most important problem facing academic medicine today is the question of our relationship to government and to the public that it represents. Stated in the briefest of terms, the issue is how we ought to respond to the pressures being generated by a changing social climate, in which federal support for research seems to be threatened, and demands for more services and community involvement are coming from all sides. This I believe is the problem that is causing us the greatest anguish these days, and this is the problem that I want to discuss with you this morning. Let me confess at the outset that I have no claim to any special wisdom in this area, no solutions to propound , and, in fact, no confidence that there are satisfactory answers to the problems we face. Nevertheless I believe we must examine the current situation as closely as we can. Unless we do we may lose by default any opportunities to influence the future direction of affairs. This Society was born 61 yr ago at another time of great ferment in American medicine. Its early members spearheaded the transformation of the medical educational system that followed the Flexner report, and they contributed in large measure to the revolution that joined together the natural sciences and medicine in the new discipline of clinical investigation. The thesis I would like to put before you is that we have now entered a new era which is going to produce changes in medical education, research, and practice at least as profound as those witnessed by the original Young Turks. Two major developments have contributed to the present state of affairs. There is, first of all, the extraordinary recent history of federal support for medical research, mainly through the National Institutes of Health. Beginning in 1947, with a congressional appropriation of 4 million dollars, the total of funds expended by NIH for extramural support of research rose rapidly until 1966, when it reached approximately 1.2 billion dollars annually. As James Shannon has said, "Never in the nation's history had public funds in such amounts been placed at the disposal of individuals working outside the framework of …