Swiss medical historian Henry Sigerist, describing his visit to the U.S., observes how a "backwater" nation, largely dependent on Europe for ideas and education, is rapidly becoming a dominant force in world medicine. This is an early recognition of the commitment to pharmaceutical and medical research as a central pillar of the U.S. economy. Ramsden (2018) writes: "Sigerist also identified the failure to secure the health and well being of the population in its entirety, noting the significant inequalities in access to quality health care."