When the president invited me to give the Harveian Oration she asked me to range widely. This comes with many hazards, including making complex issues simplistic. It is, however, in the spirit of William Harvey. Harvey took employment in St Bartholomew's Hospital explicitly to serve the poor, as well as being physician to two kings. His greatest work on circulation underpins treatment of circulatory diseases in adults and children. It combined anatomy, physiology, mathematical modelling and enlightened speculation.1 He was also a pioneer in embryology. Harvey instructed those giving the Oration to exhort the fellows and members of this College ‘to search and study out the secret of nature by way of experiment’ but also to recognise they are part of a wider medical community. Medicine is a timeless art as well as an evolving science. Many of the essential qualities of a current physician would be recognisable to Harvey and his contemporaries. Empathy, logic, dedication to the public good, diagnosis by listening and examination, and courage in the face of personal risk have not changed over time. A good example is the West African Ebola crisis 3 years ago. The initial risk of medical staff contracting Ebola was calculated at around 10% per person year, 79% of whom died. When we invited volunteers from the NHS to travel to Africa and tackle it we can be proud that there was a massive response from NHS staff, including many members and fellows of the Royal College of Physicians (RCP) going to support their Sierra Leonean colleagues.2 Turning that epidemic around required medical and nursing staff, African and international, to combine absolute discipline, courage, basic clinical skills and innovation that would have been admired by any generation of physicians. Along with these timeless elements every generation of physicians since Harvey has, through science, also changed medicine for all subsequent generations. This Oration will address two questions: what major changes in health has our generation of physicians contributed to the future? And where are we falling short? In answering these questions four issues stand out. The first is the remarkable impact of medical science on health in children globally. The second is the transformational demographic implications of these advances; medicine will in this generation leave the world a completely and permanently different shape demographically, with profound social implications. The third is the rapid advance of medical science on diseases of the middle years, especially cardiovascular disease and, increasingly, cancer. Alongside these advances however are the fourth issue: areas and challenges that we are not tackling as effectively, especially in addressing the health needs of older people with multiple conditions.