It has been a distinct honor to be the President of the American Pediatric Society (APS), for the year 2002–2003, the 115th year of our society. This new century appears to be an interesting period for academic medicine; especially since the past decade has seen the industrialization of American medicine. As eloquently stated in a recent Commonwealth Fund Task Force on Academic Health Centers: “As a society, we are experiencing a period of revolutionary change in the science and practice of medicine. The pace of advances in medical knowledge is unprecedented, as is the pace of change in the organization and financing of health care services. In the space of a decade, the human genome was mapped, managed care fundamentally altered the delivery of care, and the information revolution fueled the empowerment of health care consumers as never before. Everything in health care seems different” (1). An obvious question arises: how can we adapt to these changes by thought and action? This adaptive response is of critical importance for the future of academic pediatrics and for all members of the APS.

At times, and often in reaction to change, each of us engages in simplistic thought processes in which we seek simple answers to our problems. In doing so we fail to adequately analyze a situation and to realize the complex, interlinking relationships that are inherent in all phases of modern medicine. For example, when asked to justify a given therapy, we cite enthusiastically the results of a study. No matter how large or how well powered, we may fail to appreciate the limitations of the study. Design, patient population, impact of diet, environment, appropriate controls, health habits of the subjects, and a myriad of other factors are all variables to be considered. This simplification of thought reverts to a late medieval school of philosophy initially called nominalism, which represents the economy or parsimony of thought known as “Ockham's razor.”

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