The same applies in medicine. It is those high on the socioeconomic ladder who are most likely to hear about a medical innovation, to understand its implications, to have a cousin whose friend's sister can get them at the top of the list to receive it, and to be able to afford it (whether thanks to health insurance or deep pockets). During the past few decades, the U.S. has had an unprecedented economic boom, has been at the core of the biotech revolution, and has spent the highest percentage of its GDP on health care of any country on Earth. Despite that, we rank something like 29th in life expectancy, in large part because we're moving in the direction of a dichotomized nation--where our urban poor are elderly by age 60, crippled with heart disease, obesity and diabetes, while our wealthy septuagenarians are wrestling with the decision of whether to go for the knee replacement this close to ski season. The best of our biomedical science doesn't always trickle down very far.