It is a little more than three years since the American Society of Nephrology was organized at the time of the Third International Congress of Nephrology. During that time there have been major changes in the intellectual climate of this country and changes that affect very heavily the medical research and educational community of which we are a part. Some of our most basic assumptions have come under challenge; some of our most cherished ideals turn out not to be universally shared; seemingly solid support has been found more shaky than we would have believed possible. What has gone wrong? How could we have failed to realize we were getting into such a position? And what can we do, now and for the future, to strengthen the base from which we operate?
There are many simple, or rather simplistic, answers to what has gone wrong, and they are all too