Rosemary Stevens – författare

The reissue of Rosemary Stevens's groundbreaking book on the growth of medical specialties offers a new opportunity to consider the state of the American health care system. Updated with an extensive new introduction and a new bibliography, Stevens's book chronicles the development of the medical profession and shows how increasing emphasis on specialization has influenced medical education and public policy. She details specialization's effects on health care costs and on health care providers, and her concerns are especially timely: the implications of technology and the resulting ethical dilemmas, the issues of insurance, many people's limited access to care. As a long-time observer of American medicine, Stevens makes a valuable contribution to the current debate on how best to provide--and pay for--a high level of medical care in this country.

Before World War II, the great majority of practicing doctors in England and Wales were general practitioners. They performed their own surgery, and were accustomed to treating a wide variety of illnesses and symptoms. Specialists were few in number, tended to practice in large towns, and were often associated with major hospitals. But rapidly changing medical institutions and services in the twentieth century have compelled specialization even among more modest doctors and hospitals.

American hospitals are unique: a combination of public and private institutions that are at once charities and businesses, social welfare institutions and icons of U.S. science, wealth, and technical achievement. In Sickness and in Wealth helps us understand this huge and often contradictory "industry" and shows that throughout this century the voluntary not-for-profit hospitals have been profit-maximizing enterprises, even though they have viewed themselves as charities serving the community. Although our hospitals have provided the most advanced medical care for acutely sick and curable patients, they have been much less successful in meeting the needs of the chronically ill and the socially disadvantaged. That, Stevens concludes, is the next urgent task of social policy.

Before World War II, the great majority of practicing doctors in England and Wales were general practitioners. They performed their own surgery, and were accustomed to treating a wide variety of illnesses and symptoms. Specialists were few in number, tended to practice in large towns, and were often associated with major hospitals. But rapidly changing medical institutions and services in the twentieth century have compelled specialization even among more modest doctors and hospitals.

In the early 1920s, with the nation still recovering from World War I, President Warren G. Harding founded a huge new organization to treat disabled veterans: the US Veterans Bureau, now known as the Department of Veterans Affairs. He appointed his friend, decorated veteran Colonel Charles R. Forbes, as founding director. Forbes lasted in the position for only eighteen months before stepping down under a cloud of criticism and suspicion. In 1926-after being convicted of conspiracy to defraud the federal government by rigging government contracts-he was sent to Leavenworth Penitentiary. Although he was known in his day as a drunken womanizer, and as a corrupt, betraying toady of a weak, blind-sided president, the question persists: was Forbes a criminal or a scapegoat? Historian Rosemary Stevens tells Forbes's story anew, drawing on previously untapped records to reveal his role in America's initial and ongoing commitment to veterans. She explores how Forbes's rise and fall in Washington illuminates President Harding's efforts to bring business efficiency to government.She also examines the Veterans Bureau scandal in the context of class, professionalism, ethics, and etiquette in a rapidly changing world. Most significantly, Stevens proposes a fascinating revisionist view of both Forbes and Harding-and raises questions about not only the validity but the source of their respective reputations. They did not defraud the government of billions of dollars, Stevens convincingly documents, and do not deserve the reputation they have carried for a hundred years. Packed with vibrant characters-conniving friends, FBI agents, and rival politicians split by sectional and ideological interests as well as gamblers, revelers, and wronged wives- A Time of Scandal will appeal to anyone interested in political gossip, presidential politics, the "Ohio Gang," and the 1920s.

A traumatic brain injury (TBI)-a brain injury caused by a sudden jolt, blow, or penetrating head trauma that disrupts the function of the brain-can happen to anyone. The effects of a TBI vary from person to person, depending on the force dynamics of injury and the patient's anatomy and physiology. People with TBI-related disabilities and their family members and caregivers need comprehensive, coordinated, person-centered systems of care that attend to their changing needs long after their acute injury has been treated medically. At least 5.3 million Americans are estimated to have a TBI-related disability. The Health Resources and Services Administration's (HRSA) TBI Program, initially authorized by the Traumatic Brain Injury Act of 1996 (P.L. 104-106) and reauthorized by the Children's Health Act of 2000 is a modest federal program with broad ambitions: a $9 million grants program aimed at motivating states to create systems improvement on behalf of persons with TBI with disabilities and their families.In 2004, the federal Office of Management and Budget (OMB) questioned the effectiveness of the HRSA TBI Program, noting that there had been no regular independent evaluations of the program's effects on TBI patients and their families. To address these concerns, HRSA contracted with the Institute of Medicine (IOM) in the spring of 2005 to conduct a study: (1) to assess the impact of the HRSA Program on how state systems are working or failing to work in support of individuals with TBI; and (2) to advise HRSA on how it could improve the program to best serve individuals with TBI and their families. The IOM appointed an 11-member Committee on Traumatic Brain Injury to perform the study. This report presents the IOM Committee on Traumatic Brain Injury's assessment of the HRSA TBI Program's impact and recommendations for improving the program.