Fall from Grace is a candid, personal history of an academic physician and biotechnology executive that reflects on medicine as it was in the mid-twentieth century and chronicles the changes in society and medicine during the second half of that century. The book investigates the social revolution of those times; the scientific and technological advances that occurred; the influence of the computer and the digital revolution; the entry of corporate management into health care; and the effects of the profit motive on the care of patients. All of these have had enormous influence on the role of the physician in health care. The inadequacies, over the years, of the fee-for-service system and the consequent governmental involvement in reimbursement systems are discussed and compared with other health care payment systems around the world. The net effect of these various forces has been to benefit patients through greatly improved technology yet has caused medicine to evolve from an art form focused on personal care to a more technical exercise largely controlled by fiscal considerations. These changes also refashioned the role of the physician from healer and counselor into manager of an impersonal health care team. The book provides a view of the current state of medicine, patients, and physicians and a perspective on the future. "A compact, perceptive diagnosis of the nation's terminally ill health care system." - Kirkus Reviews "Marr has produced a tightly written, forcefully argued indictment of the U.S. health care system that's well-documented and benefits from his insider knowledge of how hospitals and health care professionals work." - Kirkus Reviews J. Joseph Marr, MD, graduated from the Johns Hopkins University School of Medicine. The first half of his career, twenty years, was in academic medicine where he held positions of Professor of Medicine, Microbiology, and Biochemistry. He had an extensive research program in biochemistry as applied to parasitic diseases and was a consultant to the World Health Organization during that time.  Dr. Marr then entered into executive management of pharmaceutical and biotechnology companies for another decade and then was a Partner with an international venture capital firm. Dr. Marr has been a member of Board of Directors of public, private, and nonprofit organizations. He is the author of over two hundred academic publications; authored and edited seven books; and published short stories, essays, and poems. He lives near Denver, CO. Fall From Grace A Physician's Retrospective on the Past Fifty Years of Medicine and the Impact of Social Change By J. Joseph Marr iUniverse Copyright © 2015 J. Joseph Marr, MD. All rights reserved. ISBN: 978-1-4917-5485-6 Contents ACKNOWLEDGMENTS, IX, INTRODUCTION, XI, THE WAY WE WERE, 1, EXPANSION OF THE MEDICAL CARE SYSTEM, 13, THE ADVENT AND DOMINANCE OF TECHNOLOGY, 30, ADMINISTRATION OF MEDICINE, 43, FOR-PROFIT AND NONPROFIT, 52, DEFENSIVE MEDICINE, 71, HUBRIS IN MEDICINE, 80, THE REMAINS OF THE DAY, 89, CODA AND PERSPECTIVE, 102, REFERENCES, 108, CHAPTER 1 THE WAY WE WERE ENTERING AN ERA AT ITS CLOSE The changes in medicine and its practice during the past half century are well beyond anything that would have been imagined at the halfway mark of that century. The situation and the role of the physician have altered considerably. The status then enjoyed by the physician has been eclipsed by technical progress in medicine. In addition, there are many interesting and compelling scientific and technological careers available that did not exist in midcentury. They have served as magnets for younger people with high aspirations. These are the types of people who would have entered into medicine when it was the acme of careers. They have within them varying mixtures of the entrepreneur, the curious, the intellectual, the scientist, the humanist, and a touch of the pragmatist. The science and technology that developed over these past fifty years have made it possible to have careers in information technology, astrophysics, space exploration, undersea exploration, and new sources of energy, among others. The technology of war even played a role, and an important one. Paramount in all this was the computer. It changed society and then the world, and, as it changed the world, it changed medicine. But it changed it for the better. It brought diagnostic power undreamed of and made efficient an inefficient process. It brought the recognition that medicine, unbeknownst to itself, controlled a large segment of the economy. This was a phenomenon that occurred almost by accident: As more people were born—and kept alive by sanitation and vaccination—more medicine was needed to care for them in their adult years. The costs became significant, and many people could not afford them. Physicians engrossed in the practice of a consuming art—the Magnificent Obsession of movie fame and many novels—noted but