"The chassis is broken, and the wheels are coming off." This is a sad but accurate view of the American health care system that is shared by many physicians, nurses, hospital administrators, insurers, and payors and, most importantly, by the public. Even the prestigious Institute of Medicine has recently recognized serious dysfunctions in health care delivery.1 Ironically, just when decades of biomedical research are beginning to pay miraculous dividends, public confidence in the medical establishment is eroding. The fundamental relationship between patient and physician is in danger of disintegrating as a rapidly widening gap grows between what many conventional health care providers deliver and what the public wants and needs.