A year ago in these pages ("The Third Millennium and the Consumer: Some Reflections," Hospital Quarterly, Fall 1999, at 30) we wrote about the "empowered consumer" in the context of the facilitative and disruptive effects of the Internet and direct-to-consumer advertising by pharmaceutical companies. Our (very provisional) conclusions were that "the present and future are filled with opportunities for individuals to take greater control over their wellness and their health, as well as their healthcare"; also to mess them up; and that the healthcare system as we know it is almost certainly to be pulled into new shapes. A year later, the situation is evolving so quickly that we can usefully take a step back to gain a broader perspective on the changes underway and their significance for the future. The changes, or most of them, are well known to readers of this journal, but it is useful to look at them as a whole.