Since its formation 20 years ago, the International Society for Study of the Lumbar Spine has stimulated basic and clinical research. Because few disorders of the lumbar spine are lethal, our usual goal is to improve the quality of life of our patients by relieving pain and improving function. To do so, we must continuously improve the quality of the preventive, diagnostic, and treatment methods we employ. If quality is our goal, we need to be precise in our definition, understand how we measure it, and most importantly, be explicit in how we will improve it. Also, we must understand that our work is being conducted in a shrinking world, where all industrialized nations are profoundly concerned about the costs of health care.