An important problem which is a source of concern for most academicians and clinical investigators is the role of the medical school and of the academician-investigator in developing, refining, and delivering the fruits of biologic research. Doctor Louis Fieser, inventor of Napalm, said, "An inventor cannot be responsible for how other people use his inventions." I would paraphrase this thought by saying that a clinical investigator cannot be irresponsible about the non-use of his discoveries.
I would like to start with a concrete problem—how to accomplish the management of patients with end-stage renal disease when research has developed not one, but two, effective modes of therapy which are capable of adding years to useful life and rehabilitating a substantial fraction—perhaps even a majority— of those who are treated. Although the problem may seem specialized at first glance, it contains all of the ethical and economic conflicts which apply to other