Quo vadis cardiologia? Or: An nescis, mi fili, quantilla prudentia mundus regatur? (Pope Julius III)

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In order to recognize and to solve problems, a look in the future is essential despite many uncertainties. Besides sound bed side-teaching, the main aim in the education of the students should be to acquire self-responsiveness and an attitude of permanent learning. It is more than doubtful whether the high expectations of health politicians will be met to limit the cost of in-patient treatment by introducing diagnosis-related groups in combination with evidence-based medicine, as this method has several severe limitations in order to fulfill this duty. The new financial system based on diagnosis-related groups will be in favor of private investors compared to the government-dependent university hospitals. The changing population pyramid implies not only higher costs but in addition severe medical problems. Within the changing society, alterations in the patient's behavior are to be expected. Several factors will contribute to make the doctor's profession less attractive. In the developing countries a rapid increase in the non-communicative diseases, i.e., in coronary heart disease, has to be expected. Apart from the prolongation of life - especially during its terminal phase - it is mainly the allocation of resources between industrialized and developing countries which will determine the ethical discussion. Germany has lost its leading position of the 19th and beginning of the 20th century in medical sciences. This was based on the liberal university system introduced by Wilhelm von Humboldt. Several pioneering innovations of German cardiologists during the 20th century have not strengthened German industry - in contrast to the situation in the 19th century. The general conditions in Germany, which are not research oriented, have prompted the majority of the pharmaceutical firms to transfer their research activities into foreign countries. In addition Germany's cardiological research has lost basic sciences partners for clinically orientated basic research, as many institutes which formerly worked in the cardiovascular field, are now devoted to other specialties. Restrictive legal regulations--such as the law regulating working hours, anti-corruption laws and the new legal university framework--are not conducive to internationally competitive research. Creative and innovative research requires liberal general conditions and cannot be planed.