It has been said that scientific revolutions have certain defining characteristics: each of them necessitates the community's rejection of time-honored scientific theory in favor of another incompatible with it; each produces a shift in the problems available for scientific study and in the standards by which the profession determines what is admissible for study; and each transforms the scientific imagination in ways that revise, in turn, the world in which scientific work is done. Thomas S. Kuhn, the great historian of science, first made these observations in his book, The Structure of Scientific Revolutions, published in 1962.

Since 1945 the Lasker Medical Research Awards have recognized individuals whose work has revolutionized the way in which medical research has progressed. The combined scope of this work transformed the last half of the 20th century, marking our time an "epoch of biology". Lasker discoveries have had a major impact on the health and well-being of people around the world, decreasing mortality and significantly reducing morbidity from disease and disability.
Once again this year's Award winners have made unexpected discoveries and have "turned on its head" assumptions about possibilities arising from their work. Through extraordinary insight and skill, their novel investigations have led not only to important new research directions, they have changed how their colleagues think about disease and the approaches that can be taken to understand it.

Mary Lasker also led a revolution that has transformed the world of medical research. She created a "Kuhnian" paradigm shift in expectations about the role of the federal government in providing support for organized medical research. Leading our country toward a deeper commitment to medical research, Mrs. Lasker challenged prevailing attitudes about the potential role of government in the funding of medical research. The result has been the creation of a National Institutes of Health that is the envy of the world. There is nothing like it on the planet in terms of its magnitude and reach. No other country has created such an institution with the power to affect the health and well-being of a nation and directly impact its standard of living.

In the same spirit of adventure and in continuing the tradition of "thinking outside the box", the Mary Woodard Lasker Charitable Trust recently engaged several new initiatives intended to present scientists and policy makers with new methods for framing questions important to medical science.

In 1999 the Trust, through its Funding First program, committed to undertake a study of the economic impact of this country's long term investment in medical research. A team led by the President of the University of Chicago, Hugh Sonnenschein, and nationally prominent economists Robert Topel and Kevin Murphy, approached the issue by introducing a new way of measuring the economic contributions of medical research. Their papers, which have been summarized in a publication, "Exceptional Returns: The Economic Value of America's Investment in Medical Research," offer startling conclusions about the importance of this national investment to the United States. These economists conclude that the magnitude of the cumulative benefit from the investment in medical research has upset conventional thinking about the importance of medical research. Their findings include:

• Increases in life expectancy in just the decades of the 1970's and 1980's were worth $57 trillion to Americans ? a figure six times larger than the entire output of tangible goods and services last year. The gains associated with the prevention and treatment of cardiovascular disease alone totaled $31 trillion.

• Improvements in health account for almost one-half of the actual gain in American living standards in the past 50 years.

• Medical research that reduced deaths from cancer by just one-fifth would be worth $10 trillion to Americans ? double the national debt.

• While it is not always possible to pin down cause and effect, the likely returns from medical research are so extraordinarily high that the payoff from any plausible "portfolio" of investments in research would be enormous.

With support from the Michael E. Debakey Foundation, Bristol-Myers Squibb Foundation and the Robert Wood Johnson Charitable Trust, the Mary Woodard Lasker Charitable Trust is providing for the distribution of the "Exceptional Returns" report through a series of forums in major cities throughout the country. The University of Chicago Press will publish the complete research manuscripts underlying the report early in 2001.

In addition to the economic impact study, the Mary Woodard Lasker Charitable Trust is also supporting an initiative aimed at changing how members of Congress perceive the future opportunities, emerging from recent advances in medical science, for applying new knowledge to the diagnosis and treatment of disease. A new work, "Opportunities of Science in the 21st Century" will inform Congressional decisionmakers how investments in medical research can pay-off over the next twenty five years in terms of progress toward prevention, treatment, and cure in major areas of disease and disability. Co-chaired by Dr. David Nathan, President of the Dana Farber Cancer Institute and Dr. Jean Wilson, Professor of Internal Medicine, UT Southwestern Medical Center, the project gathered experts from across the spectrum of medical research to write of the progress they anticipate in areas ranging from cardiovascular disease and cancer to diabetes, lung disease, and reproductive disorders. The Journal of the American Medical Association (JAMA) will devote its entire January 3, 2001 issue to the report. This work will be presented to Congressional leaders in February 2001.

The recent announcement of the completion of the sequencing of the human genome seems a fitting milestone to the close of the twentieth century. A new and vast horizon of exploration lies before the medical research community as we move into the century ahead; one which, if past be prologue, holds the promise that age-old afflictions finally can be understood and soon eradicated.

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