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The article comments on how the new political economy of medical care is creating an unprecedented demand for epidemiological knowledge in the United States. The article author first summarizes the conventional opinion of historians about the use of epidemiology in clinical medicine. Then he explains why the contemporary revision of the social contract between medicine and American society is creating an intense demand for knowledge based on the study of defined populations. Next, he explores implications of this new social contract for physicians, patients, and purchasers. Finally, he address a paradox that throughout the 20th century, academic physicians and most practitioners of medicine have taken pride in being at the forefront of scientific progress. Yet, medical care may be one of the last sectors of society in industrial countries to embrace fully probabilistic thinking. It explores contemporary history relevant to the controversy about silicone breast implants. This controversy offers practical examples of the conflict between the certitudes of a decaying social contract and the implications of another that is emerging.

The article reviews the article "How Healthy Could a State Be?" by David Kindig, Paul Peppard and Bridget Booske, which appeared in the periodical "Public Health Reports" in March and April, 2009.