Abstract
A millennium, a century, even a decade is a long time-frame for speculation about anything. Advances in biomedical research in the last few decades have been so extraordinary and escalating at an ever-accelerating pace that any prophecy is a risky proposition. However, it is possible to divine the big, unanswered questions and envisage ways in which they might reasonably be approached in the next few decades, a task which I will try to essay. So many drugs treat so many different medical conditions that a detailed and comprehensive coverage would probably be tiresome. Instead, I will address certain broad themes and diseases that offer both immense challenges and great potential for advances. Rather than review detailed experimental issues, I will confine myself to the 'big picture' issues, providing examples of specific research only in a few instances drawing largely from areas I know best.