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Published online by Cambridge University Press: 26 March 2001
If we want things to stay as they are, thing will have to change
Guiseppe di Lampedusa, The Leopard
Medical and technical knowledge in medicine has increased more in the last 50 years than in the previous five centuries. Many factors have contributed to this dramatic change, including developments in pathophysiology, genetics, molecular biology and basic science. There is no reason to fear that this daunting progress will be halted in the third millennium. The practice of medicine in the present and next decades will also change rapidly because of new perceptions and demands of the patients, and evolution in society. In this article, some factors affecting medicine and the drivers of change in health are discussed. Expenditure for health cure and care is increasing faster than the financial income. On which criteria should one re-allocate resources and decide between difficult choices? Medical doctors, sociologists, philosophers, economists, politicians all have different views of needs in a world of uncontrolled rather than controlled liberalism. Some issues are identified here, but no solutions or recommendations are offered.