Assuring access to care, treating patients with fairness, sustaining our ethical values, and caring for patients with decency and respect are irreproachable standards for American psychiatry. The logo for the Toronto Annual Meeting draws our attention to a standing bear, the bear symbolizes renewal and strength for the Innuit nation. Future historians of medicine will be astonished by a decade of revolutionary scientific advances in psychiatry, illuminated by new findings in the neurosciences, psychopharmacology, and dynamic treatment modalities. These developments reflect our strength and our capacity for renewal. They speak to the creative work of our brilliant research establishment, which has given fresh hope to those in despair. As never before, we have an integrated, sophisticated view of how to help our suffering patients. Paradoxically, excellent patient care has been constrained by most profit-driven payment systems, without social accountability or responsibility to anyone but stockholders. But there is a bright future ahead! A sea change of public opinion has compelled state and federal legislative action. Litigation, APA-sponsored, is beginning to show results. State attorneys general and insurance commissioners are moving with alacrity. And the President's Commission has generated a patient's bill of rights, which by Executive Order, now covers 40 percent of all Americans. Psychiatry, the oldest medical specialty and the fourth largest, has led the counterattack against the inequities imposed upon our patients and our professionalism. We gather new allies, partners, and advocates each day. Despite the changed environment, psychiatry is living and well. Our superb educational base and standard-setting groups are reshaping their missions; research funding over the past 13 years is up 470 percent in medical schools, second only to internal medicine. Resolute and more determined than ever, we look to brighter days ahead, when the proven values of access, fairness, ethics, and decency will be vouchsafed for our patients in need
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