Is the original thinker encouraged in medicine any more? How do young and excited potential clinical scientists get going? We have no reason to think that there is any paucity of original ideas, and many young medical students and doctors will still be thinking about unresolved medical and scientific problems.

But now the odds are stacked against them. Fifty and more years ago it was possible to embark on a research project with advice from one’s seniors and without much, if any, peer review interference, bureaucratic resistance, or obligatory referral to various ethics committees. There are many other reasons now why opportunities for initiating new ideas are limited. Perhaps the chief is cost, although the initial cost of many of the key discoveries (sympathin (adrenaline), insulin, penicillin, fibrates, lipoprotein receptors) in the last century was not high. Now universities cannot afford to initiate a new project unless funded by a charity or government, and most research developments are undertaken by the big pharmaceutical consortiums. Without the infusion of …