The President of our scientific Society is called upon to conclude his brief tenure of office by delivering an address. This rather strange custom is not embedded in the By-Laws of the American Society for Clinical Investigation. Furthermore, casual perusal of the past fails to reveal any firm mandate transmitted from a grateful membership for this form of gratuitous ponti-fication. Nevertheless, like some aging Beefeater at the Tower of London, each president bows to history and clings to these atavistic trappings. He can describe, decry, fret, predict, or praise-and all of these have been done with considerable spirit and effectiveness in the past. More immediately, he is expected to examine some of the issues and problems which face that part of medicine and science in which we hold a common interest, as reflected in our presence here today. More bluntly, it might be considered a" State of the Board-walk Address." In that context this year, marking the beginning of a new decade, does not lend itself to graceful benedictions. Academic medicine is in trouble and we all know it. It is my privilege to dig into this problem briefly during this, my last day of active membership in the ASCI. Almost 8 centuries ago, Alexander Neckam, Abbott of Cirencester, wrote an encyclopedia of current science entitled" The Nature of Things." He stated," Science is acquired at great expense, by frequent vigils, by great expenditure of time, by sedulous diligence of labor, by vehement application of mind." This precis from a 13th century monastery is clearly applicable to the individual; it is equallyapplicable to a society. For approximately 20 yr, the American people have seen fit to furnish that''great expense" on an expanding base as an investment in biomedical science. As you know, this has occurred without any clear statement of national policy. It has grown and diversified steadily, nevertheless, under the leadership of some remarkable men in government. We can single out forparticular note James Shannon, Lister Hill, and the late John Fogarty, although manyothers have made major contributions. This new and largely unenunciated federal policy has furnished the single most important force in the revolution which has occurred in modern biology and scientific medicine during this period, both in this country and indirectly throughout the world. The mechanismsof support which have evolved have allowed for the recruitment and training of many of the nation's best scientific minds in the life sciences and a reasonable, peermonitored program for broad distribution of research funds on considerations of merit. The impact of this biological revolution on medical education has been profound and largely salutary. Its influence on medical care has been impressive, although most of the major diseases remain to be fully elucidated. Into this confident and expansive scientific society, of which we here today are a part, the budgetary restrictions of the past 3 yr have injected an alarming seismic tremor. A number of important questions arise, which can be considered only briefly at this time. Wthy have the cutbacks occurred? What does this mean for the future? What can we do to reverse this trend?

A thorough analysis of thepathogenesis ofour problems would be lengthy, tedious, and largely unconvinc-ing. It will not be attempted here. In biology and medicine we are not alone in our partial public repudiation for there has been amore general national retreat in science and technology. The reductions in support of biomedical science have in fact come relatively late and have been less severe than those in other branches of science, although this is a point withoutany particular potential for comfort …