These findings provide evidence of an inverse relationship between growth in NIH awards during the past decade and managed care penetration among US medical schools. Whether this association is causal remains to be determined.

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An inspiring leader. A modest man of oversized accomplishments. A visionary with the passion, intellect, and character to move conversation into action. Those are among the encomiums voiced by the colleagues and friends of Harrison Spencer upon his untimely death last August at the age of 71, as they recalled an exceptional life of dedication and a career that stretched from Atlanta to Africa, Geneva to London, San Salvador to New Orleans, and ultimately to Washington, DC. ''Harrison is best described as a problem solver,'' said Georges Benjamin, MD, executive director of the American Public Health Association. ''Fifteen minutes with him on a curbside was in many ways worth hours of discussion with other people.'' Stellar educational credentials helped shape Spencer's thinking: undergraduate work at Haverford College; a medical degree from the Johns Hopkins University School of Medicine; a master's degree in public health from the University of California, Berkeley, School of Public Health; and a diploma in tropical medicine and health from the London School of Hygiene & Tropical Medicine. Two years of training at the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (CDC) reinforced his lifelong commitment to building a healthier planet. The depth of Spencer's talent was further honed in leadership positions of increasing responsibility. He held impressive titles at some of the world's finest institutions, served on numerous committees and boards, and earned membership in many prestigious professional societies. But ultimately, it was his personal style that gave him so much influence. He knew that to build an organization or transform a field, he had to bring the right people along. ''It was never about Harrison. It was always about what he was doing in collaboration with others,'' said William Roper, MD, MPH, dean of the School of Medicine and vice chancellor for medical affairs at the University of North Carolina at Chapel Hill. ''He was the model of a servant leader,