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Looking into the future is a past time that has prevailed for centuries. There has always been a place for the soothsayer, the astrologer and the prophet. Futurology assumes that the future is an extrapolation of the present and the past. This of course, is a very simplistic and native concept. More changes have occurred in this decade, aptly called “The decade of the brain” than has ever occurred since the dawn of civilization. In spite of this, there are several among us who refuse to think of the future, but cling desperately to the present, not realizing that we are already the past!

Let us spend a moment fantasizing how the world will be in 2025 AD. Today’s population of 5.75 billion (and every sixth of them an Indian). Giant space stations would be in permanent orbit. Colonization of neighboring planets may have started. The average age of the population would have increased. Geriatric neurosurgery would be a subspecialty. Congenital malformations would be a distinct rarity Privatization of health care would be the rule. Postgraduate medical training will be common place in corporate hospitals and private medical universities.

Choice of a treatment option would be dictated by the payer. Health care delivery would primarily aim at cost containment. Health Maintenance Organizations would only be interested in resource management within a fixed annual budget. In 1965 health expenditure in the USA was 6% of the gross domestic product. In 1992 it was 13.6% and is expected to be 18% in 2000 and 29% in 2020 unless major changes are effected. At the beginning of this millennium physicians in China were paid only if their clients were in good health. They were not compensated, for diagnosing and treating diseases. In the next millennium this policy may well be reintroduces.

The neuroscientist of today can be compared to a blind folded individual walking across the Grand Canyon. He is expected to maintain, service and repair the most intricate computer that has ever been produced. Though the original prototype was launched almost 7 million years ago we still do not have the complete circuit diagrams. In such a situation is it reasonable to expect the health care provider, dealing with the brain to guarantee an uptime of even 95% ? Though the warranty period is steadily increasing, spares are not yet available!

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