Translating from the rivers of Babylon to the coronary bloodstream.

I was attracted to medicine because it affords the opportunity to integrate science and humanism in service to others. And I became attracted to a career in research when I realized that the application of the scientific method to alleviate suffering from disease is one of our species’ proudest achievements. I feel privileged to be able to participate in this process and recognize that it carries with it enormous responsibilities (1). The evidence of the power of the scientific method to improve human health is compelling. In fact, since approximately 1840, people in the scientifically most advanced countries have enjoyed an amazing linear increase in life expectancy at birth, with the life expectancy at birth for women increasing nearly 40 years, from approximately 45 to 85 years (Figure 1A and ref. 2). During the first approximately 100 years, from 1840 to 1940, increases in life expectancy were primarily due to improvements in sanitation, access to clean water, early attempts at vaccination, and the introduction of medical microbiology, epitomized by the research of Dr. George M. Kober, who improved the safety of the milk supply in Washington, DC, as a model for the country. During this period, children were the major beneficiaries of these scientific advances, since they were especially vulnerable to contagious illnesses. During the last 70 years, fueled in large part by the growth in funding by the NIH in the US and on a smaller scale by similar governmental agencies in other countries as well as the investments by pharmaceutical and, later, biotechnology companies, the increase in life expectancy has reflected medical innovations — new drugs, vaccines, devices, diagnostic and imaging technologies, surgical procedures and nonsurgical interventions, and disease prevention strategies that build on a solid base of evidence (3–5). Increasingly, the benefits have been enjoyed by the elderly, with the majority of benefit now going to those over 65 years of age and with the fastest growth in benefit going to those over 80 years of age (2). As dramatic as these statistics are in their own right, they take on much more profound import when considered against humans’ estimated 200,000 years on earth (6). Assuming a life expectancy at birth of 25 years at the very beginning of the prescientific era, it took approximately 200,000 years to gain approximately 20 years of life expectancy at birth or approximately 10,000 years to gain a single year of life expectancy. In contrast, throughout the 170 years of the scientific era, it has required less than five years to gain a year of life expectancy at birth (Figure 1B). If the current trend continues, approximately half of the children born in the United States in the year 2000 will live to 100 years of age. The challenges before us are, therefore, clear: to sustain the improvements in life expectancy, reduce the burden of disability, and ensure that people the world over share equally in the benefits of better health.