Actually, I prefer to say that as our knowledge and our capabilities become more powerful, our professionalism must become more profound. That is one reason why at Johns Hopkins we have introduced a four-year required course of study about the role of physicians in society, in which our students study the implications of new knowledge and evolving technologies. Future generations of physicians and scientists are going to have a more profound understanding of the knowledge and capabilities they possess and an ability to play a leading role in defining and controlling the application of this knowledge. Otherwise, medicine will be reduced to the level of a craft, physicians will lose their status as professionals, and society will lose a great deal more.

I have jotted down a few of the implications of this new knowledge for our academic health centers, and they are all in the form of questions relating to this new science and the potential that we see coming from it and its applications. Fundamentally, we need to ask ourselves what kind of students we will select. What kind of faculty will we recruit for this new era? How do we organize for the future in terms of departmental structure? Some of that has been discussed for the clinical side. We must ask the same questions about the scientific side. What kind of facilities do we need? Will we need any? Will there be virtual universities, and will everybody work at home? How do we integrate where we are going into the larger university? How does this new information become part of our daily lives? Will anybody be there in line to pay for it?

There are many strong forces acting in the medical profession at the moment that would happily see us become more like employees and line workers, technicians, or skilled crafts people. The nationwide skirmish going on right now about who makes the call in the application of health care knowledge may presage larger battles to come. There is only one way we can address this, and that is not individually, but as a profession.

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