"Even the most optimistic advocate of innovation in medicine cannot ignore ever-increasing , costs associated in some measure with that we so much admire. And, as we are equally well aware, access to clinical services is far from universal or equitable. As I write this introduction, more than forty million Americans lack and medical expenses remain a major cause of bankruptcy. Still another paradox complicates the relationship between society and medicine. Though expectations of therapeutic efficacy have never been more euphoric and patients appear to trust their own physicians, respect for the medical profession has declined ... The is trusted even less."