Perhaps more than any other medical discipline, internal medicine is identified with science [1]. Science is cognitive, involving accurate observation and clear description, hypothesis generation, data gathering and interpretation, and the creation of theory. But science is also a state of mind: skeptical, open, balanced, respectful of evidence, thorough, always on the alert for bias. In this broad sense, good science is good science whatever the subject: biomedical, epidemiological, psychosocial, political-economic. The core value of Annals has rested largely in the quality of its science. Today's scientific knowledge in medicine is good, but there is a great deal of room for deeper understanding; for, as Lewis Thomas has said, "The only solid piece of scientific truth about which I feel totally confident is that we are profoundly ignorant about nature" [2]. (Who, for example, would have imagined even a few years ago that gastric and duodenal ulcers would turn out to be largely infectious diseases?) It will be my first responsibility, therefore, to broaden and improve in every way possible Annals' contributions to the scientific enterprise.

In considering science in relation to medicine, however, it is critical to distinguish between basic medical science and the science of clinical medicine. Basic medical science is largely biological and quantitative; it has provided the infrastructure for medical thinking and many of the tools that have led to medicine's enormous current diagnostic and therapeutic power. In contrast, the science of clinical medicine is largely high-level, semi-quantitative information processing. It is a scientific language and a discipline unto itself; it is much of what internists do all day [3]. In my view, the scientific core of Annals should be the science of clinical medicine, with basic medical science surrounding and supporting that clinical core.

Much of the scientific power of today's clinical medicine is attributable to improvements in clinical reasoning and to a shift away from authoritarian use of anecdotal, case-based information toward the authoritative use of statistical, population-derived, "evidence-based" information [4, 5]. Annals will participate actively in the evolution of evidence-based medicine, particularly the support of international efforts such as the Cochrane Collaboration [6].

Although both statistical and clinical epidemiologic thinking have strongly influenced our most basic concepts of medicine, patients still get sick one at a time. And although science lets us to do a lot more than we could in the past, patients still suffer [7-9]. Caring for patients continues to be at least as important as curing them, and Annals will therefore continue to play a vigorous role in fostering the development of the emerging "science of caring" [10]. Moreover, even at its scientific best, medicine is always a social act. As one of the major general medical journals, Annals therefore also needs to continue to expand its involvement with the complex social, political, and economic context in which medicine exists [11].

As a medical publication, Annals has an obligation to inhabit the same professional universe as its readers and its authors. We intend to develop further our efforts to listen directly to our readers' interests, so ably begun by Suzanne and Robert Fletcher, almost certainly this time with the help of electronic connectivity. The time may also have come to undertake a serious general study of internists' information needs, perhaps in collaboration with other medical publishers.

Edward Huth has provided decades of leadership in matters of style, and style will continue to be very important to Annals. We will work hard for the right balance between variety and consistency; clear, concise language; more and better use of graphics; a journal that is visually attractive and a pleasure to read.

Authors care about fair, efficient review and timely publication of their contributions, and we will continue to do everything we can to make those possible. The process of peer review, at the level of both primary and secondary publication, is being continually refined, and we will support those efforts. The economics and, increasingly, the ecology of print publishing are challenging; we will need all the help we can get in these areas, including help from the revolution in electronic production methods.

More generally, internal medicine is challenged on many fronts. Although it is not the role of any single institution, including Annals, to turn internal medicine's fortunes around, even if it could, Annals can join with other institutions to help re-invigorate internal medicine as a science, a practice, a career, and a profession. Reaching out in many directions, to students, to residents, to internists in other countries; interacting effectively with the media and with our colleagues in health-related industries; dealing head on with certain key education issues; improving our ways of processing, synthesizing, and presenting information—all are part of this institutional agenda.

Not the least challenging, and among the most exciting, prospects for Annals as an institution is its potential role in creating an electronic future. We recognize that despite an abundance of ideas and effort, not to mention plenty of bad jokes about it, the promise of the "information superhighway" is far from realized. What does seem clear, however, is that major changes are taking place in how we receive and perceive information; Annals will be part of these changes one way or another.

One of my most important possessions is the two-volume biography of William Osler given to me by my father, a neurosurgeon; he, in turn, received it from his teacher and mentor, Harvey Cushing, who wrote it. The book reminds me that I was raised on the idea that medicine calls for commitment and excellence above all else. I will look to this heritage as we work to meet and, I hope, increase the high standards for medical editing set by my distinguished predecessors at Annals: Suzanne and Robert Fletcher, Edward Huth, Russell Elkinton, and the others who came before them.

My career has included both subspecialty and general phases and both basic science and clinical practice; I have worked in both academic and community settings and have been deeply involved in research, clinical medicine, and teaching. I will need all this breadth of experience as Annals helps to grapple with the tension between centrifugal and centripetal forces—between the seemingly irresistible fragmentation into ever narrower subspecialties and the integrating pull of our common discipline [1].

I look forward to the task of editing Annals. It will be an adventure.