William C. Hahn It truly has been an honor and a privilege to have served as the President of the ASCI for the last year, and as has been the tradition since the founding of the Society in 1909, I stand here with more than a little trepidation to deliver an address where the expectation is that I will have something profound, witty, and maybe even important to say. Indeed, although my tenure as the President of the ASCI has been entirely enjoyable, I have lived under the terrible knowledge that I would be standing here today giving this address. In thinking about this task, I did what all of my predecessors have done. I sat down and read the history of the ASCI and the prior orations from Presidents past. And, as most of my predecessors, I realized with horror that anything that I had thought that I might say or have any credible value had already been said in a much more eloquent way than I could ever imagine doing myself. After reflecting upon what I had read, I first realized that I am not a historian and therefore will not recite the history of the ASCI (1), since I know I would be corrected by those of you who know the history far better than I do. However, it was clear to me that reading the history of the ASCI since 1909 amounts to following the history of academic medicine in the United States. Moreover, the presidential addresses represent an oral history of academic medicine, as each President focused on either something very personal to them or a pressing issue of the day. If you have the time, I would urge you to read these lectures, as one will get a good sense of the history and the broad outlines of what has happened in our field over the past 100 years. One thing that becomes clear is that there are certain themes that recur in these orations, and the theme that I want to address today is really probably one of the more common recurring themes. In fact, this theme emerged immediately after the founding of this Society—the existential threat to the existence of a physician-scientist. I have chosen to dwell on this theme because in any gathering of scientists or physicians of more than one person over the last several years, the conversation quickly focuses around this question. Indeed, we daily hear chilling pronouncements, including statements such as “The health care system is going to put all of us out of business. The NIH budget is terrible. Research is doomed. The physicianscientist, scientist, or academic hospital is dead, dying, threatened.” All of this is quite depressing, except that I borrowed this slide from my boss, Dr. Edward Benz, from his ASCI presidential address in 1992 (2). Thus, it is quite clear that this is not a new problem. Indeed one might believe that we have cried wolf too many times when facing perceived threats. However, there are some new challenges to our existence that require careful consideration. Specifically, we face increasing skepticism from health care payers, Congress, and the public about the values and motivations of those of us who are engaged as physicians and scientists at a time when our government has seemingly lost the will to find the consensus to govern. Thus, it is not an exaggeration to say that these considerations when put together create what some have called the “perfect storm,” an alignment of issues that individually could be surmounted but when combined is disastrous. The irony of this situation, as Dr. Francis Collins described yesterday in his lecture, is that this comes at a time when the opportunities to make a difference in medicine and the health of people have never been more promising. Our knowledge of disease mechanisms eloquently recounted by many speakers at this meeting is expanding at an …