Reaching for Utopia and slouching toward Gomorrah.

It is a unique privilege to address the 50th annual meeting of the CNS during this first year of a new century and a new millennium. I owe recognition and thanks to many people for their overwhelming support. I thank my parents, Dr. and Mrs. Warren Barrow, and my grandmother, Mrs. Emma Pessina, for providing me with a nurturing environment, an education, and encouragement to pursue my career and life goals. I owe a great debt to my many mentors, particularly Drs. George T. Tindall, John A. Jane, Thoralf M. Sundt, Jr., David G. Piepgras, and Robert F. Spetzler, all of whom have offered me sound advice and numerous opportunities during my career. I thank all the members of the dozen executive committees with whom I have had the privilege to work and CNS Past Presidents J. Michael McWhorter, Michael Salcman, and William F. Chandler for entrusting me with the most important jobs in the CNS. I thank my partners in the Department of Neurosurgery at Emory University School of Medicine for their collegial support and tolerance during this past year. Most important, I express my heartfelt thanks, admiration, and love for my wife and best friend, Mollie, and our three children, Emily, Jack, and Tom. Their patience and support have been uncompromising and greatly appreciated. A golden anniversary, the end of a century, or the beginning of a new millennium are tricks of the calendar, arbitrary calls to reflect on past accomplishments and failures and to predict the course of the future. Fifty years is a short interval in the context of recorded history. Consider that there have been only 85 generations since the time of Jesus, only 18 since Gutenberg invented the printing press, a mere 7 since the American Revolution, and fewer than 3 from Kitty Hawk to the first space walk. Centuries of change now occur in the span of one lifetime. The past 50 years have witnessed some of the most astounding advances in science of any historical period of similar length. Neurosurgery has benefited immensely from this scientific renaissance and has been transformed from a fledgling subspecialty of general surgery into a complex and rewarding discipline that neurosurgeons of 1951 would have difficulty recognizing. One of the primary endeavors of humankind has been the pursuit of Utopia, an impossible ideal (2). Plato was the first to systematically analyze the concept of Utopia in The Republic (30) and greatly influenced Sir Thomas More, who published Utopia (22) and coined the term in 1516. Utopia introduced the notion of science as liberator and universal benefactor, a view championed again in 1627 by Francis Bacon in New Atlantis (3). In envisioning landmark scientific advances, Bacon postulated that through skillful research and subsequent discoveries, society would have the means to harness nature to achieve both panacea and ultimate liberation. The staggering scientific progress achieved during the past half-century has supported the idea that everything can be accomplished in the current era, particularly if the proper technology is applied. Indeed, medical research and discoveries during the past 50 years have made the age-old dream of a disease-free world no longer seem foolish and unattainable (34). Within the next 50 years, aging itself may prove to be simply another disease to be treated. Some experts theorize that the human lifespan should not encounter any natural limits before 120 years, and with continuing advances in molecular biology and further understanding of the aging process, that limit could lengthen to 130 years or more (37). The population of centenarians has exploded, with the result that survival to the age of 100 is no longer the newsworthy feat it was when my great-grandmother turned 100 (Fig. 1). There were approximately 40,000 centenarians in the United States when she died in 1997 at age 110. Unfortunately, the marvelous accomplishments in science during the past half-century that have provided a surge toward a medical Utopia are in contrast to the simultaneous decline in America’s national character and a crisis of cultural values. The past 50 years in the United States have been characterized by the collapse of popular culture, the weakening of the intellect, the growth of an intrusive government guided by irrational incentives, and the transformation of the federal courts into cultural institutions that promote a politically correct agenda. Robert H. Bork described America’s culture in decline in his book Slouching towards Gomorrah (7), with its title referring to the biblical city burned to the ground for the sinfulness of its people. He attributes America’s cultural decline to the “rise of modern liberalism, which stresses the dual forces of radical egalitarianism (the equality of outcome rather than the equality of opportunity) and radical individualism (the drastic reduction of limits to personal gratification)” (7). Let us explore the changes that have occurred in American society during the past half-century and compare and contrast those changes with the transfiguration of medicine during the same period. In doing so, I submit that while American sci-