Book excerpt: This book sets out the unique and paradoxical position biomedical science finds itself in, in the early 21st (superscript st) century. Science has never been stronger in shaping the world we live in; progress in medical science during most of the last century has helped to transform health care and prolong our lives; almost daily advances in biological science promise hope for the future and yet medical science has been in serious decline for the past three decades.Biomedical Science in the 21st (superscript st) Century: Sunset or New Dawn? sets out the recent decline in the context of medical science's stunning past successes. Professor Sheridan discusses the failure to translate new discoveries in biological science into medical advances; the dramatic decline in research productivity in the pharmaceutical industry in the context of falling numbers of clinical scientists; the disruption of medical science during prolonged and repeated reforms of health care delivery; changing social and political attitudes towards health care and science; the loss of trust in big pharmaceutical companies and recent revelations of fraud in science. The book deals with the creative nature of original science, how it is driven by curiosity and self-motivation and how these can be stifled by pettifogging managerialism.The book presents a vision of what medical science can deliver during the coming half century and what is needed to overcome the present challenges. It questions the assumptions that big is best in the organisation of science and suggests a new model for drug development based on a restoration of trust and a more constructive relationship between regulators and industry./a