community defends the idea that scientists alone should decide how much money should be spent and on what projects. Ideally, all projects that have scientific merit should be funded. Despite its many defenders, this view is a lost cause. Earmarking and mandates have already transformed funding decisions into political ones. In the areas of both medical and science policy, influential proposals are on the table that would require judgments to be made not just about what is effective science or medicine, but also about how much to spend and how to allocate resources across specialties and disciplines. The most profound institutional question that we face is not whether there will be bodies that make these decisions, but how they will be constituted. For it is not clear that there is anyone currently who is competent to make these decisions. New kinds of science policy specialists will emerge who have tools that will help in these decision-making processes. But we must resist the temptation to take these decisions away from scientists and give them to some other elite. These are societal decisions, and everyone in the United States who is affected by science should be represented in the decision process.

As I have suggested, we are a diverse society with different interests and values; yet we all want to be heard. As individuals many of us have contradictory desires. There are different ways of trying to encompass multiple perspectives in a fair decision-making process. One of the great challenges of the future will be to construct such inclusionary processes. At best the result will be wild and wooly; at worst it will be chaos and anarchy. However, I believe that we have little choice but to try to construct such processes. My guess is that, in the future, society will demand nothing less.