Presidential address to the American Society for Clinical Investigation, San Diego, California, 6 May, 1995. Values and value: the survival of biomedical research.

For almost 50 yr the federal government has been committed to building and maintaining the capacity of the university-based biomedical research system. The system of peer-reviewed research grant funding to universities has produced the most successful health research enterprise in the world. The philosophy and vision of this enterprise was articulated by Vanevar Bush in his classic prescription for the federal role in science called Science: The Endless Frontier. In this document, he provided not only recommendations for structures but more importantly, a vision of the proper role of government in what was accepted as a noble and valued societal effort. Over the past 15 yr we have come to expect an annual struggle for funds; we've become used to the arguments that pit limited resources against expanding opportunities and used to fights over how much the NIH budget should increase and how many grants will be funded. Today, we face the same issues but the context has changed. The political discourse that underlies our enterprise has undergone a transformation in Washington. Whether it represents a temporary aberration in a 50-yr experience or a real sea change, we cannot tell. The issues raised by this political transformation, however, are so fundamental, I felt I could not ignore them in addressing these clinical research societies. Even though many individuals responsible for funding this system remain committed to it, we find ourselves in an environment where some of the most fundamental assumptions about federal research funding and of the very value of biomedical research are being questioned. We are confronted with three challenges about underlying values and that is what I want to address: 1. How noble is the scientific effort-are researchers "just another interest group" drinking at the public trough? 2. Just what is the value of innovation in medicine? Innovation is now being challenged as one of the culprits in escalating health costs. 3. Is the role of the federal government in carrying out research appropriate? Should the federal government be responsible for maintaining the physical and human infrastructure of our academic health centers and our public and private biomedical research centers? The first challenge we face is a climate in which antiscience