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The past, present and future
International Journal of Gynecology & Obstetrics 67 Ž1999. S153᎐S157
The past, present and future E. Diczfalusy U Karolinska Institutet, Stockholm, Sweden
Abstract My generation has seen more progress in science and technology than all preceding generations together. We have also witnessed several intellectual, technological, medical and social revolutions spearheaded by the contraceptive revolution and followed by those in reproductive health, gender equity, information, communication, globalization, international assistance, etc. The results of the first contraceptive revolution were spectacular, by 1990 some 900 million couples used contraception, which became a global lifestyle. When this revolution lost momentum, a new departure took place: the Rockefeller Foundation’s Contraception-21 initiative. The major achievements of this initiative are presented in this volume. All papers represent a significant contribution also to the ultimate objective: the achievement of human dignity for every woman. The revolutions mentioned above profoundly changed the world and our perception of it. They will also assist humankind in deconstructing the deterministic worldview of past centuries and replacing it with a science-driven anthropocentric philosophy. 䊚 1999 International Federation of Gynecology and Obstetrics. Keywords: Contraceptive revolution; Deterministic philosophy; Anthropocentric worldview
1. The 20th century As the 20th century rapidly approaches its end, it provides an excellent opportunity for some reflection over its most characteristic features, in general, and the almost incredible scientific and technological achievements in particular. In fact, our generation belongs to the most privileged ones among the scientists of all epochs, since we have seen more progress in science and technology than all scientists of all preceding generaU
Tel.: q46-8532-51035; fax: q46-8532-50751.
tions together since the dawn of history. Also, our generation belongs to the most privileged ones, because we have witnessed a number of powerful intellectual, technological, medical and social revolutions that profoundly changed the world and our perception of it. Just a few examples: the revolutions in information and communication; in globalization; international assistance; contraception; reproductive health; and gender equity w1x. All of these revolutions took place with an unprecedented speed in the second half of the 20th century and were spearheaded by the contraceptive revolution w2x. When and how did the contraceptive revolution
0020-7292r99r$20.00 䊚 1999 International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 9 9 . 0 0 1 5 8 - 7
S154
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
start? In retrospect, the year 1952 appears to be particularly important in this respect, the first national family planning program is established by the Government of India and the International Planned Parenthood Federation ŽIPPF. is formed in Bombay, its statutes were established in Stockholm in 1953. The next ᎏ perhaps even more important ᎏ year is 1955; the fifth International Planned Parenthood conference takes place in Tokyo and in her presidential address, Mrs Margaret Sanger remarked ‘during the last 300 years the global population had shot up from 500 million to 2 billion 500 million. In spite of our great technical progress at least two-thirds of the world’s people at the present time cannot obtain enough calories to maintain normal standards of health and efficiency’ w3x. One should perhaps reflect a moment on the above statement, since we have just reached a world population of 6 billion people but not even our most acclaimed prophets of gloom and doom, would be willing to claim today, that two-thirds of this population ᎏ or 4 billion people ᎏ are severely undernourished. Hence, it cannot be denied that considerable progress has been achieved as far as the nutritional status of humankind is concerned, even though we still have a long way to go. Like at every international conference, a large number of technical papers were presented in Tokyo, however, one of them, a seemingly very dry, almost dull paper presented by Gregory ŽGoody. Pincus w4x is today a major historical milestone, demonstrating for the first time that ovulation in women can be inhibited by the oral administration of progestins. It is also of historical significance that it was Margaret Sanger and Mrs S. McCormick who persuaded Dr Pincus a few years before, in 1950, to start a screening program of potential ovulation inhibitors in rabbits and that the Planned Parenthood Research Fund provided an initial grant of US$2100 for these studies in 1951 w5x. The first progestins ᎏ norethynodrel and norethisterone ᎏ were approved by the US Food and Drug Administration for ‘menstrual regulation’ in 1957 and the first combined estrogen᎐ progestin oral contraceptives ᎏ Enovid ŽSearle.
and Anovlar ŽSchering AG. ᎏ were approved in 1959 and 1961, respectively w6x. This was rapidly followed, from the 1960s on, by the development of greatly improved medicated intrauterine devices w7x and as a consequence of the contraceptive revolution and in spite of the considerable efforts of the opponents of contraception, by 1990, some 900 million couples around the world were using contraception w8x Žsee also paper by Fathalla.. As we are entering the 21st century, approximately 90% of the governments of the world provide support to family planning w9x. In a speech on 19 May 1856, Abraham Lincoln remarked, ‘be not deceived, revolutions don’t go backward’. ŽPerhaps something for opponents of contraception to reflect upon?. No, revolutions don’t go backward, however, they can result in a major evolution. As the turn of the century comes close, we are witnessing a major social metamorphosis worldwide, the transformation of the first contraceptive revolution into a generally accepted global lifestyle, the normal way of life. ‘In my beginning is my end’, says T.S. Eliot w10x and perhaps predictably, as Dr Fathalla describes in his paper in this Supplement, ‘the first contraceptive revolution lost its momentum after the first wave of significant achievements; the mission lost its clarity, science has temporarily dried up and industry has retrenched’. By the late 1980s, there was a clear need for a new departure, for a second contraceptive revolution, in order to reinvigorate the field and promote further progress. This new departure took place in 1993 with the Contraception-21 initiative of the Rockefeller Foundation. As also discussed by Dr Fathalla in detail in his paper, ‘the central theme of the strategy is that it should be driven by unmet needs of women and not by a demographic imperative or by the scientific opportunity alone’. If I ruled the world, I would make it compulsory for each of the some 200 Member States of the UN to adopt and fully implement the very first sentence of the Constitution of the Federal Republic of Germany: ‘Die Wurde des Menschen ¨ ist unantastbar;’ human dignity is inviolable w11x. As I see it, the most important contribution of the Contraception-21 initiative is to significantly
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
broaden and deepen the global impact of the first contraceptive revolution and to further contribute to its ultimate goal, the achievement of human dignity by all of the women of the world. In fact, each and every component of the Contraception21 initiative is permeated by and aiming at this ultimate objective. ‘Thinking is one of the greatest joys of humankind’, says Bertold Brecht in his Galileo Žcf. 14.. However, the joy of thinking can be accentuated greatly when it becomes the concentrated effort of a group of dedicated scientists who are guided by a common ambition: to seek ways and means to further improve the human condition, in general, and that of underprivileged populations, in particular. Many of us felt and still feel that collaborating on an endeavor like the Contraception-21 initiative is both a privilege and a scientific challenge; however, it also provides a unique intellectual atmosphere for trying to realize our common dream. Indeed, where is the borderline between individual dreaming and collective thinking? When several scientists have the same dream, it becomes a common idea based on shared values. Indeed, modern history is the history of such ideas. However, scientists sometimes take too much for granted when collaborative relationships are established. At the Bellagio II Conference, Professor Stock characterized very well the human condition in this respect by quoting Henry Ford: Coming together is a beginning; keeping together is progress; working together is success.
After working closely together for several years, it would seem justifiable to consider our joint endeavor a real success. In a recent address, Dr Gro Harlem Brundtland w12x, the Director-General of the World Health Organization ŽWHO. said, ‘We can combat ill health. We can do our part to combat poverty and suffering. Nothing in life as I see it has more meaning’. She said this in an address to WHO staff but it is also relevant to the activities conducted within the Contraception-21 initiative.
S155
2. The 21st century Just a few months more and we will enter a new epoch in the history of humankind, the 21st century, and many of us wonder what kind of epoch will that be? Tartarus or Elysion? Perhaps, as so often is the case, something in between? Chi vivra, ` verra` . . . those who will be around will see. However, I am convinced that to each epoch in history belongs a new spiritual, philosophical and ethical content. I am also firmly convinced that the new philosophical content of the 21st century will be anthropocentric, with a major philanthropic dimension. This new philosophy will deconstruct the deterministic worldview of many centuries and replace it with a science-driven approach to the world and to us. The deterministic worldview of our past is characterized in a classical manner in the book of Hugo Grotius w13x, Rights of War and Peace, published in 1625, translated into some 30 languages and reprinted Žin Latin. some 50 times: ‘The law of nature is so unalterable that it cannot be changed by God Himself’, wrote Grotius, but it could have been written also by Isaac Newton, if not Albert Einstein. The quintessence of the anthropocentric philosophy of our future is equally straightforward, ‘we are taking our own evolution into our own scientific hands in a consistent manner unthought of by earlier societies’ w14x. During hundreds of thousands of years, nature was shaping homo sapiens, setting the boundaries between the biologically possible and impossible. Today it is human creativity and inventiveness that defines the limits of the conditio humana ᎏ contraception, in vitro fertilization, and genetic manipulation represent just a few examples of these new biological realities. ‘We are witnessing the birth of a new science that reflects the complexity of the real world’, says Ilya Prigogine, ‘a new science which considers us and our creativity as part of a fundamental movement at all levels of nature’ w15x. During many centuries, science was considered to be ancilla theologiae, the instrument of theology. Many people believe that today it is chiefly ancilla pecuniae, the instrument of money-mak-
S156
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
ing, but I hope that few would deny that it is already, and will increasingly be, ancilla humanitatis, humankind’s instrument to be used for the improvement of the human condition. Dr Fathalla, in his introductory remarks to the third Bellagio Conference w16x, alluded to the fact that philanthropic organizations wish to do good and industry wishes both to do good and to do well. Perhaps not only industry . . . what about governments? ‘Government expenditure on science and technology is targeted to make the maximum contribution to national economic performance and quality of life’, says the UK Government White Paper from 1993, ‘and national policies for science and technology put increasing emphasis on strengthening the economy and gaining market advantages’ w17x. If so, a strong case can be made for more and more collaboration between philanthropic organizations and industry to single out specific areas that are particularly suitable for joint efforts to improve the human condition. I feel that governments should also consider joining such future enterprises, given the fact that during the 20th century the nation state became too small to do the big things but too big to do well the small things . . . Irrespective of the composition of such sponsor consortia of the future, there can be little, if any, doubt as to the fundamental direction of their support. The target will be scientific research, the most powerful ancilla humanitatis. ‘Science began with the Promethean affirmation of the power of reason, but it seemed to end in alienation ᎏ a negation of everything that gives meaning to human life. Our belief is that our own age can be seen as one of a quest for a new type of unity in our vision of the world, and that science must play an important role in defining this new coherence’, says Prigogine w18x. But is science really so powerful? Is it omnipotent? Certainly not! Human knowledge is imperfect and will remain so forever. However, it is indefinitely perfectible! What research can do and does well, is to indefinitely perfect knowledge and, thus, constantly improve the human condition. As I see it, there is no end to it ᎏ not even the shortness of human life ᎏ since scientific
knowledge is self-correcting, truly cumulative and progressive. As Lucius Apuleius, who lived in the second century, characterized our condition: ‘Singillatim mortales, cunctim perpetui’. As individuals, we are mortal beings, but together we represent continuity. Future generations of scientists will expand and further improve the work our generation tried to achieve. In his opening remarks to the last panel discussion of the third Bellagio Conference, Dr Steven Sinding mentioned ‘the fresh breeze of new realities heralding the arrival of the 21st century’. In my perception, it is a strong wind, rather than a breeze. The wind of new realities is blowing with increasing strength. It is up to us to decide whether we prefer protective windscreens or new types of windmills. I am convinced that new mechanisms of collaboration between the public and private sectors to develop greatly needed new types of contraceptives for men and women and to eliminate the scourge of sexually transmitted diseases ᎏ like the Contraception-21 initiative ᎏ belong to this new category of windmills. I am also convinced that without some knowledge of the past, one cannot have a vision of the future and that President Franklin Delano Roosevelt was right in his assessment that ‘without vision the people perish’. Viewed against this background, it is most gratifying to see the achievements of a new vision collected in this volume. References w1x Diczfalusy E. In search of human dignity: gender equity, reproductive health and healthy aging. Int J Gynecol Obstet 1997;59:195᎐206. w2x Diczfalusy E. The contraceptive revolution; an era of scientific and social development. London: The Parthenon Publishing Group, 1997. w3x Sanger M. Presidential Address, the 5th International Planned Parenthood Conference, Tokyo 1955. Quoted by Westman A: Acta Endocrinol ŽCopenhagen. 1956; ŽSuppl 28.:5. w4x Pincus G. Some effects of progesterone and related compounds upon reproduction and early development in mammals. Acta Endocrinol ŽCopenhagen . Suppl 1956;28:18᎐36. w5x Pincus G. The control of fertility. New York: Academic Press, 1965. w6x Diczfalusy E. Keynote address. The history of steroidal
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
w7x
w8x
w9 x w10x
contraception: what is past and what is present. In: Michal F, editor. Safety requirements for contraceptive steroids. Cambridge: Cambridge University Press, 1989: 1᎐18. Rowe JP. Intrauterine contraception: advances and future prospects. In: Matsumoto S, editor. Recent advances in fertility control. Amsterdam: Excerpta Medica Current Clinical Practice Series No 45, 1987:22᎐55. United Nations. World contraceptive use 1994. United Nations Department for Economic and Social Information and Policy Analysis, STrESArSER.Ar143. New York: United Nations, 1994. United Nations. National Population Policies. STrESArSER.Ar171. United Nations Publication Sales No. E.99.XIII.3. New York: United Nations, 1998. Eliot TS. Four quartets. East Coker. The complete poems and plays of T.S. Eliot. London: Guild Publishing, 1987:177.
S157
w11x Constitution of the German Federal Republic: 1. Grundgesetz, Artikel 1., Satz 1. w12x Brundtland GH. Address to WHO staff, 21 July 1998. w13x Grotius H. ŽHuig de Groot.. De Jure Belli ac Pacis Libris, 1625. w14x Mittelstrass J. Science and culture. Eur Rev 1996; 4:293᎐300. w15x Prigogine I. The end of certainty-time, chaos and the new laws of nature. New York: The Free Press, 1997:7. w16x Report of the Bellagio III Conference, Rockefeller Foundation, New York, NY, 30 March᎐2 April 1999. w17x Llewellyn Smith C. International collaboration in science and technology; lessons from CERN. Eur Rev 1999;7:77᎐92. w18x Prigogine I. The end of certainty-time, chaos and the new laws of nature. New York: The Free Press, 1997:185᎐186.
The past, present and future E. Diczfalusy U Karolinska Institutet, Stockholm, Sweden
Abstract My generation has seen more progress in science and technology than all preceding generations together. We have also witnessed several intellectual, technological, medical and social revolutions spearheaded by the contraceptive revolution and followed by those in reproductive health, gender equity, information, communication, globalization, international assistance, etc. The results of the first contraceptive revolution were spectacular, by 1990 some 900 million couples used contraception, which became a global lifestyle. When this revolution lost momentum, a new departure took place: the Rockefeller Foundation’s Contraception-21 initiative. The major achievements of this initiative are presented in this volume. All papers represent a significant contribution also to the ultimate objective: the achievement of human dignity for every woman. The revolutions mentioned above profoundly changed the world and our perception of it. They will also assist humankind in deconstructing the deterministic worldview of past centuries and replacing it with a science-driven anthropocentric philosophy. 䊚 1999 International Federation of Gynecology and Obstetrics. Keywords: Contraceptive revolution; Deterministic philosophy; Anthropocentric worldview
1. The 20th century As the 20th century rapidly approaches its end, it provides an excellent opportunity for some reflection over its most characteristic features, in general, and the almost incredible scientific and technological achievements in particular. In fact, our generation belongs to the most privileged ones among the scientists of all epochs, since we have seen more progress in science and technology than all scientists of all preceding generaU
Tel.: q46-8532-51035; fax: q46-8532-50751.
tions together since the dawn of history. Also, our generation belongs to the most privileged ones, because we have witnessed a number of powerful intellectual, technological, medical and social revolutions that profoundly changed the world and our perception of it. Just a few examples: the revolutions in information and communication; in globalization; international assistance; contraception; reproductive health; and gender equity w1x. All of these revolutions took place with an unprecedented speed in the second half of the 20th century and were spearheaded by the contraceptive revolution w2x. When and how did the contraceptive revolution
0020-7292r99r$20.00 䊚 1999 International Federation of Gynecology and Obstetrics. PII: S 0 0 2 0 - 7 2 9 2 Ž 9 9 . 0 0 1 5 8 - 7
S154
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
start? In retrospect, the year 1952 appears to be particularly important in this respect, the first national family planning program is established by the Government of India and the International Planned Parenthood Federation ŽIPPF. is formed in Bombay, its statutes were established in Stockholm in 1953. The next ᎏ perhaps even more important ᎏ year is 1955; the fifth International Planned Parenthood conference takes place in Tokyo and in her presidential address, Mrs Margaret Sanger remarked ‘during the last 300 years the global population had shot up from 500 million to 2 billion 500 million. In spite of our great technical progress at least two-thirds of the world’s people at the present time cannot obtain enough calories to maintain normal standards of health and efficiency’ w3x. One should perhaps reflect a moment on the above statement, since we have just reached a world population of 6 billion people but not even our most acclaimed prophets of gloom and doom, would be willing to claim today, that two-thirds of this population ᎏ or 4 billion people ᎏ are severely undernourished. Hence, it cannot be denied that considerable progress has been achieved as far as the nutritional status of humankind is concerned, even though we still have a long way to go. Like at every international conference, a large number of technical papers were presented in Tokyo, however, one of them, a seemingly very dry, almost dull paper presented by Gregory ŽGoody. Pincus w4x is today a major historical milestone, demonstrating for the first time that ovulation in women can be inhibited by the oral administration of progestins. It is also of historical significance that it was Margaret Sanger and Mrs S. McCormick who persuaded Dr Pincus a few years before, in 1950, to start a screening program of potential ovulation inhibitors in rabbits and that the Planned Parenthood Research Fund provided an initial grant of US$2100 for these studies in 1951 w5x. The first progestins ᎏ norethynodrel and norethisterone ᎏ were approved by the US Food and Drug Administration for ‘menstrual regulation’ in 1957 and the first combined estrogen᎐ progestin oral contraceptives ᎏ Enovid ŽSearle.
and Anovlar ŽSchering AG. ᎏ were approved in 1959 and 1961, respectively w6x. This was rapidly followed, from the 1960s on, by the development of greatly improved medicated intrauterine devices w7x and as a consequence of the contraceptive revolution and in spite of the considerable efforts of the opponents of contraception, by 1990, some 900 million couples around the world were using contraception w8x Žsee also paper by Fathalla.. As we are entering the 21st century, approximately 90% of the governments of the world provide support to family planning w9x. In a speech on 19 May 1856, Abraham Lincoln remarked, ‘be not deceived, revolutions don’t go backward’. ŽPerhaps something for opponents of contraception to reflect upon?. No, revolutions don’t go backward, however, they can result in a major evolution. As the turn of the century comes close, we are witnessing a major social metamorphosis worldwide, the transformation of the first contraceptive revolution into a generally accepted global lifestyle, the normal way of life. ‘In my beginning is my end’, says T.S. Eliot w10x and perhaps predictably, as Dr Fathalla describes in his paper in this Supplement, ‘the first contraceptive revolution lost its momentum after the first wave of significant achievements; the mission lost its clarity, science has temporarily dried up and industry has retrenched’. By the late 1980s, there was a clear need for a new departure, for a second contraceptive revolution, in order to reinvigorate the field and promote further progress. This new departure took place in 1993 with the Contraception-21 initiative of the Rockefeller Foundation. As also discussed by Dr Fathalla in detail in his paper, ‘the central theme of the strategy is that it should be driven by unmet needs of women and not by a demographic imperative or by the scientific opportunity alone’. If I ruled the world, I would make it compulsory for each of the some 200 Member States of the UN to adopt and fully implement the very first sentence of the Constitution of the Federal Republic of Germany: ‘Die Wurde des Menschen ¨ ist unantastbar;’ human dignity is inviolable w11x. As I see it, the most important contribution of the Contraception-21 initiative is to significantly
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
broaden and deepen the global impact of the first contraceptive revolution and to further contribute to its ultimate goal, the achievement of human dignity by all of the women of the world. In fact, each and every component of the Contraception21 initiative is permeated by and aiming at this ultimate objective. ‘Thinking is one of the greatest joys of humankind’, says Bertold Brecht in his Galileo Žcf. 14.. However, the joy of thinking can be accentuated greatly when it becomes the concentrated effort of a group of dedicated scientists who are guided by a common ambition: to seek ways and means to further improve the human condition, in general, and that of underprivileged populations, in particular. Many of us felt and still feel that collaborating on an endeavor like the Contraception-21 initiative is both a privilege and a scientific challenge; however, it also provides a unique intellectual atmosphere for trying to realize our common dream. Indeed, where is the borderline between individual dreaming and collective thinking? When several scientists have the same dream, it becomes a common idea based on shared values. Indeed, modern history is the history of such ideas. However, scientists sometimes take too much for granted when collaborative relationships are established. At the Bellagio II Conference, Professor Stock characterized very well the human condition in this respect by quoting Henry Ford: Coming together is a beginning; keeping together is progress; working together is success.
After working closely together for several years, it would seem justifiable to consider our joint endeavor a real success. In a recent address, Dr Gro Harlem Brundtland w12x, the Director-General of the World Health Organization ŽWHO. said, ‘We can combat ill health. We can do our part to combat poverty and suffering. Nothing in life as I see it has more meaning’. She said this in an address to WHO staff but it is also relevant to the activities conducted within the Contraception-21 initiative.
S155
2. The 21st century Just a few months more and we will enter a new epoch in the history of humankind, the 21st century, and many of us wonder what kind of epoch will that be? Tartarus or Elysion? Perhaps, as so often is the case, something in between? Chi vivra, ` verra` . . . those who will be around will see. However, I am convinced that to each epoch in history belongs a new spiritual, philosophical and ethical content. I am also firmly convinced that the new philosophical content of the 21st century will be anthropocentric, with a major philanthropic dimension. This new philosophy will deconstruct the deterministic worldview of many centuries and replace it with a science-driven approach to the world and to us. The deterministic worldview of our past is characterized in a classical manner in the book of Hugo Grotius w13x, Rights of War and Peace, published in 1625, translated into some 30 languages and reprinted Žin Latin. some 50 times: ‘The law of nature is so unalterable that it cannot be changed by God Himself’, wrote Grotius, but it could have been written also by Isaac Newton, if not Albert Einstein. The quintessence of the anthropocentric philosophy of our future is equally straightforward, ‘we are taking our own evolution into our own scientific hands in a consistent manner unthought of by earlier societies’ w14x. During hundreds of thousands of years, nature was shaping homo sapiens, setting the boundaries between the biologically possible and impossible. Today it is human creativity and inventiveness that defines the limits of the conditio humana ᎏ contraception, in vitro fertilization, and genetic manipulation represent just a few examples of these new biological realities. ‘We are witnessing the birth of a new science that reflects the complexity of the real world’, says Ilya Prigogine, ‘a new science which considers us and our creativity as part of a fundamental movement at all levels of nature’ w15x. During many centuries, science was considered to be ancilla theologiae, the instrument of theology. Many people believe that today it is chiefly ancilla pecuniae, the instrument of money-mak-
S156
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
ing, but I hope that few would deny that it is already, and will increasingly be, ancilla humanitatis, humankind’s instrument to be used for the improvement of the human condition. Dr Fathalla, in his introductory remarks to the third Bellagio Conference w16x, alluded to the fact that philanthropic organizations wish to do good and industry wishes both to do good and to do well. Perhaps not only industry . . . what about governments? ‘Government expenditure on science and technology is targeted to make the maximum contribution to national economic performance and quality of life’, says the UK Government White Paper from 1993, ‘and national policies for science and technology put increasing emphasis on strengthening the economy and gaining market advantages’ w17x. If so, a strong case can be made for more and more collaboration between philanthropic organizations and industry to single out specific areas that are particularly suitable for joint efforts to improve the human condition. I feel that governments should also consider joining such future enterprises, given the fact that during the 20th century the nation state became too small to do the big things but too big to do well the small things . . . Irrespective of the composition of such sponsor consortia of the future, there can be little, if any, doubt as to the fundamental direction of their support. The target will be scientific research, the most powerful ancilla humanitatis. ‘Science began with the Promethean affirmation of the power of reason, but it seemed to end in alienation ᎏ a negation of everything that gives meaning to human life. Our belief is that our own age can be seen as one of a quest for a new type of unity in our vision of the world, and that science must play an important role in defining this new coherence’, says Prigogine w18x. But is science really so powerful? Is it omnipotent? Certainly not! Human knowledge is imperfect and will remain so forever. However, it is indefinitely perfectible! What research can do and does well, is to indefinitely perfect knowledge and, thus, constantly improve the human condition. As I see it, there is no end to it ᎏ not even the shortness of human life ᎏ since scientific
knowledge is self-correcting, truly cumulative and progressive. As Lucius Apuleius, who lived in the second century, characterized our condition: ‘Singillatim mortales, cunctim perpetui’. As individuals, we are mortal beings, but together we represent continuity. Future generations of scientists will expand and further improve the work our generation tried to achieve. In his opening remarks to the last panel discussion of the third Bellagio Conference, Dr Steven Sinding mentioned ‘the fresh breeze of new realities heralding the arrival of the 21st century’. In my perception, it is a strong wind, rather than a breeze. The wind of new realities is blowing with increasing strength. It is up to us to decide whether we prefer protective windscreens or new types of windmills. I am convinced that new mechanisms of collaboration between the public and private sectors to develop greatly needed new types of contraceptives for men and women and to eliminate the scourge of sexually transmitted diseases ᎏ like the Contraception-21 initiative ᎏ belong to this new category of windmills. I am also convinced that without some knowledge of the past, one cannot have a vision of the future and that President Franklin Delano Roosevelt was right in his assessment that ‘without vision the people perish’. Viewed against this background, it is most gratifying to see the achievements of a new vision collected in this volume. References w1x Diczfalusy E. In search of human dignity: gender equity, reproductive health and healthy aging. Int J Gynecol Obstet 1997;59:195᎐206. w2x Diczfalusy E. The contraceptive revolution; an era of scientific and social development. London: The Parthenon Publishing Group, 1997. w3x Sanger M. Presidential Address, the 5th International Planned Parenthood Conference, Tokyo 1955. Quoted by Westman A: Acta Endocrinol ŽCopenhagen. 1956; ŽSuppl 28.:5. w4x Pincus G. Some effects of progesterone and related compounds upon reproduction and early development in mammals. Acta Endocrinol ŽCopenhagen . Suppl 1956;28:18᎐36. w5x Pincus G. The control of fertility. New York: Academic Press, 1965. w6x Diczfalusy E. Keynote address. The history of steroidal
E. Diczfalusy r International Journal of Gynecology & Obstetrics 67 (1999) S153᎐S157
w7x
w8x
w9 x w10x
contraception: what is past and what is present. In: Michal F, editor. Safety requirements for contraceptive steroids. Cambridge: Cambridge University Press, 1989: 1᎐18. Rowe JP. Intrauterine contraception: advances and future prospects. In: Matsumoto S, editor. Recent advances in fertility control. Amsterdam: Excerpta Medica Current Clinical Practice Series No 45, 1987:22᎐55. United Nations. World contraceptive use 1994. United Nations Department for Economic and Social Information and Policy Analysis, STrESArSER.Ar143. New York: United Nations, 1994. United Nations. National Population Policies. STrESArSER.Ar171. United Nations Publication Sales No. E.99.XIII.3. New York: United Nations, 1998. Eliot TS. Four quartets. East Coker. The complete poems and plays of T.S. Eliot. London: Guild Publishing, 1987:177.
S157
w11x Constitution of the German Federal Republic: 1. Grundgesetz, Artikel 1., Satz 1. w12x Brundtland GH. Address to WHO staff, 21 July 1998. w13x Grotius H. ŽHuig de Groot.. De Jure Belli ac Pacis Libris, 1625. w14x Mittelstrass J. Science and culture. Eur Rev 1996; 4:293᎐300. w15x Prigogine I. The end of certainty-time, chaos and the new laws of nature. New York: The Free Press, 1997:7. w16x Report of the Bellagio III Conference, Rockefeller Foundation, New York, NY, 30 March᎐2 April 1999. w17x Llewellyn Smith C. International collaboration in science and technology; lessons from CERN. Eur Rev 1999;7:77᎐92. w18x Prigogine I. The end of certainty-time, chaos and the new laws of nature. New York: The Free Press, 1997:185᎐186.