Critical Issues in Health and Medicine – Serie

In our rapidly advancing scientific and technological world, many take great pride and comfort in believing that we are on the threshold of new ways of thinking, living, and understanding ourselves. But despite dramatic discoveries that appear in every way to herald the future, legacies still carry great weight. Even in swiftly developing fields such as health and medicine, most systems and policies embody a sequence of earlier ideas and preexisting patterns.In History and Health Policy in the United States, seventeen leading scholars of history, the history of medicine, bioethics, law, health policy, sociology, and organizational theory make the case for the usefulness of history in evaluating and formulating health policy today. In looking at issues as varied as the consumer economy, risk, and the plight of the uninsured, the contributors uncover the often unstated assumptions that shape the way we think about technology, the role of government, and contemporary medicine. They show how historical perspectives can help policymakers avoid the pitfalls of partisan, outdated, or merely fashionable approaches, as well as how knowledge of previous systems can offer alternatives when policy directions seem unclear.Together, the essays argue that it is only by knowing where we have been that we can begin to understand health services today or speculate on policies for tomorrow.

In the first decade of the AIDS epidemic, New York City was struck like no other. By the early nineties, it was struggling with more known cases than the next forty most infected cities, including San Francisco, combined. Fighting for Our Lives is the first comprehensive social history of New York's AIDS community-a diverse array of people that included not only gay men, but also African Americans, Haitians, Latinos, intravenous drug users, substance abuse professionals, elite supporters, and researchers. Looking back over twenty-five years, Susan ChambrÉ focuses on the ways that these disparate groups formed networks of people and organizations that-both together and separately-supported persons with AIDS, reduced transmission, funded research, and in the process, gave a face to an epidemic that for many years, whether because of indifference, homophobia, or inefficiency, received little attention from government or health care professionals. Beyond the limits of New York City, and even AIDS, this case study also shows how any epidemic provides a context for observing how societies respond to events that expose the inadequacies of their existing social and institutional arrangements. By drawing attention to the major faults of New York's (and America's) response to a major social and health crisis at the end of the twentieth century, the book urges more effective and sensitive actions-both governmental and civil-in the future.

The history of medicine is much more than the story of doctors, nurses, and hospitals. Seeking to understand the patient’s perspective, historians scour the archives, searching for rare personal accounts. Bringing together a trove of more than 400 family letters by Charles Dwight Willard, Suffering in the Land of Sunshine provides a unique window into the experience of sickness.A Los Angeles civic leader at the turn of the twentieth century, Willard is well known to historians of the West, but exclusively for his public life as a booster and reformer. Willard’s evocative story offers fresh insights into several critical issues, including how concepts of gender, class, and race shape patients’ representations of their illness, how expectations of cure affect the illness experience, how different cultures constrain the coping strategies of the sick, and why robust health is such an exalted value in certain societies.

The aftermath of Hurricane Katrina has placed a national spotlight on the shameful state of healthcare for America's poor. In the face of this highly publicized disaster, public health experts are more concerned than ever about persistent disparities that result from income and race. This book tells the story of one groundbreaking approach to medicine that attacks the problem by focusing on the wellness of whole neighborhoods. Since their creation during the 1960s, community health centers have served the needs of the poor in the tenements of New York, the colonias of Texas, the working class neighborhoods of Boston, and the dirt farms of the South. As products of the civil rights movement, the early centers provided not only primary and preventive care, but also social and environmental services, economic development, and empowerment. Bonnie Lefkowitz-herself a veteran of community health administration-explores the program's unlikely transformation from a small and beleaguered demonstration effort to a network of close to a thousand modern health care organizations serving nearly 15 million people. In a series of personal accounts and interviews with national leaders and dozens of health care workers, patients, and activists in five communities across the United States, she shows how health centers have endured despite cynicism and inertia, the vagaries of politics, and ongoing discrimination.

Severe and persistent mental illnesses are among the most pressing health and social problems in contemporary America. Recent estimates suggest that more than three million people in the U.S. have disabling mental disorders. The direct and indirect costs of their care exceed 180 billion dollars nationwide each year. Effective treatments and services exist, but many such individuals do not have access to these services because of limitations in mental health and social policies. For nearly two centuries Americans have grappled with the question of how to serve individuals with severe disorders. During the second half of the twentieth century, mental health policy advocates reacted against institutional care, claiming that community care and treatment would improve the lives of people with mental disorders. Once the exclusive province of state governments, the federal government moved into this policy arena after World War II. Policies ranged from those focused on mental disorders, to those that focused more broadly on health and social welfare. In this book, Gerald N. Grob and Howard H. Goldman trace how an ever-changing coalition of mental health experts, patients' rights activists, and politicians envisioned this community-based system of psychiatric services. The authors show how policies shifted emphasis from radical reform to incremental change. Many have benefited from this shift, but many are left without the care they require.

The ability to obtain health care is fundamental to the security, stability, and well-being of poor families. Government-sponsored programs provide temporary support, but as families leave welfare for work, they find themselves without access to coverage or care. The low-wage jobs that individuals in transition are typically able to secure provide few benefits yet often disqualify employees from receiving federal aid.Drawing upon statistical data and in-depth interviews with over five hundred families in Oregon, Karen Seccombe and Kim Hoffman assess the ways in which welfare reform affects the well-being of adults and children who leave the program for work. We hear of asthmatic children whose uninsured but working mothers cannot obtain the preventive medicines to keep them well, and stories of pregnant women receiving little or no prenatal care who end up in emergency rooms with life-threatening conditions.Representative of poor communities nationwide, the vivid stories recounted here illuminate the critical relationship between health insurance coverage and the ability to transition from welfare to work.

Winner of the 2008 Arthur J. Viseltear Prize from the American Public Health Association and Nominated for the 2008 William H. Welch Medal, AAHMThough notorious for its polluted air today, the city of Los Angeles once touted itself as a health resort. After the arrival of the transcontinental railroad in 1876, publicists launched a campaign to portray the city as the promised land, circulating countless stories of miraculous cures for the sick and debilitated. As more and more migrants poured in, however, a gap emerged between the city’s glittering image and its dark reality.Emily K. Abel shows how the association of the disease with “tramps” during the 1880s and 1890s and Dust Bowl refugees during the 1930s provoked exclusionary measures against both groups. In addition, public health officials sought not only to restrict the entry of Mexicans (the majority of immigrants) during the 1920s but also to expel them during the 1930s. Abel’s revealing account provides a critical lens through which to view both the contemporary debate about immigration and the U.S. response to the emergent global tuberculosis epidemic.

Today's physicians are medical scientists, drilled in the basics of physiology, anatomy, genetics, and chemistry. They learn how to crunch data, interpret scans, and see the human form as a set of separate organs and systems in some stage of disease. Missing from their training is a holistic portrait of the patient as a person and as a member of a community. Yet a humanistic passion and desire to help people often are the attributes that compel a student toward a career in medicine. So what happens along the way to tarnish that idealism? Can a new approach to medical education make a difference?Doctors Serving People is just such a prescriptive. While a professor at Rush Medical College in Chicago, Edward J. Eckenfels helped initiate and direct a student-driven program in which student doctors worked in the poor, urban communities during medical school, voluntarily and without academic credit. In addition to their core curriculum and clinical rotations, students served the social and health needs of diverse and disadvantaged populations. Now more than ten years old, the program serves as an example for other medical schools throughout the country. Its story provides a working model of how to reform medical education in America.

The United States spends greatly more per person on health care than any other country but the evidence shows that care is often poor and inappropriate. Despite expenditures of 1.7 trillion dollars in 2003, and growing substantially each year, services remain fragmented and poorly coordinated, and more than 46 million people are uninsured. Why can't America, with its vast array of resources, sophisticated technologies, superior medical research and educational institutions, and talented health care professionals, produce higher quality care and better outcomes?In The Truth about Health Care, David Mechanic explains how health care in America has evolved in ways that favor a myriad of economic, professional, and political interests over those of patients. While money has always had a place in medical care, "big money" and the quest for profits has become dominant, making meaningful reforms difficult to achieve. Mechanic acknowledges that railing against these influences, which are here to stay, can achieve only so much. Instead, he asks whether it is possible to convert what is best about health care in America into a well functioning system that better serves the entire population.Bringing decades of experience as an active health policy participant, researcher, teacher, and consultant to the public and private sectors, Mechanic examines the strengths and weaknesses of our system and how it has evolved. He pays special attention to areas often neglected in policy discussions, such as the loss of public trust in medicine, the tragic state of long-term care, and the relationship of mental health to health care.For anyone who has been frustrated by uncoordinated health networks, insurance denials, and other obstacles to obtaining appropriate care, this book will provide a refreshing and frank look at the system's current and future dilemmas. Mechanic's thoughtful roadmap describes how health plans, healthcare professionals, policymakers, and consumer groups can work together to improve access, quality, fairness, and health outcomes in America.

At the end of the Second World War, a diagnosis of cancer was a death sentence. Sixty years later, it is considered a chronic disease rather than one that is invariably fatal. Although survival rates have improved, the very word continues to evoke a special terror and guilt, inspiring scientists and politicians to wage war against it.In Under the Radar, Ellen Leopold shows how nearly every aspect of our understanding and discussion of cancer bears the imprint of its Cold War entanglement. The current biases toward individual rather than corporate responsibility for rising incidence rates, research that promotes treatment rather than prevention, and therapies that can be patented and marketed all reflect a largely hidden history shaped by the Cold War. Even the language we use to describe the disease, such as the guiding metaphor for treatment, "fight fire with fire," can be traced back to the middle of the twentieth century.Writing in a lucid style, Leopold documents the military, governmental, industrial, and medical views of radiation and atomic energy to examine the postwar response to cancer through the prism of the Cold War. She explores the role of radiation in cancer therapies today, using case studies and mammogram screening, in particular, to highlight the surprising parallels. Taking into account a wide array of disciplines, this book challenges our understanding of cancer and how we approach its treatment.Examines the postwar response to cancer through the prism of the Cold WarGoes beyond medical science to look at the influence of Cold War policies on the way we think about cancer todayLinks the experience of postwar cancer patients with the broader evolution of what have become cancer industriesTraces the history of human-made radiation as a state-sponsored environmental toxin

Today, more than 75 percent of pharmaceutical drug trials in the United States are being conducted in the private sector. Once the sole province of academic researchers, these important studies are now being outsourced to non-academic physicians.According to Jill A. Fisher, this major change in the way medical research is performed is the outcome of two problems in U.S. health care: decreasing revenue for physicians and decreasing access to treatment for patients. As physicians report diminishing income due to restrictive relationships with insurers, increasing malpractice insurance premiums, and inflated overhead costs to operate private practices, they are attracted to pharmaceutical contract research for its lucrative return. Clinical trials also provide limited medical access to individuals who have no or inadequate health insurance because they offer "free" doctors' visits, diagnostic tests, and medications to participants. Focusing on the professional roles of those involved, as well as key research practices, Fisher assesses the risks and advantages for physicians and patients alike when pharmaceutical drug studies are used as an alternative to standard medical care.A volume in the Critical Issues in Health and Medicine series, edited by Rima D. Apple and Janet Golden

In Making Room in the Clinic, Julie Fairman examines the context in which the nurse practitioner movement emerged, how large political and social movements influenced it, and how it contributed to the changing definition of medical care. Drawing on primary source material, including interviews with key figures in the movement, Fairman describes how this evolution helped create an influential foundation for health policies that emerged at the end of the twentieth century, including health maintenance organizations, a renewed interest in health awareness and disease prevention, and consumer-based services.

At the dawn of the Progressive Era, when America was experiencing an industrial boom, many working families often ate contaminated food, lived in decaying urban tenements, and had little access to medical care. In a city that demanded change, Los Angeles women, rather than city officials, championed the call to action.Cultivating Health, an interdisciplinary chronicle, details women's impact on remaking health policy, despite the absence of government support. Combining primary source and municipal archival research with comfortable prose, Jennifer Lisa Koslow explores community nursing, housing reform, milk sanitation, childbirth, and the campaign against venereal disease in late nineteenth and early twentieth century Los Angeles. She demonstrates how women implemented health care reform and civic programs while laying the groundwork for a successful transition of responsibility back to government.Koslow highlights women's home health care and urban policy-changing accomplishments and pays tribute to what would become the model for similar service-based systems in other American centers.

From the early 1980s, the U.S. environmental breast cancer movement has championed the goal of eradicating the disease by emphasizing the importance of reducing-even eliminating exposure to chemicals and toxins. From Pink to Green chronicles the movement's disease prevention philosophy from the beginning.Challenging the broader cultural milieu of pink ribbon symbolism and breast cancer "awareness" campaigns, this movement has grown from a handful of community-based organizations into a national entity, shaping the cultural, political, and public health landscape. Much of the activists' everyday work revolves around describing how the so called "cancer industry" downplays possible environmental links to protect their political and economic interests and they demand that the public play a role in scientific, policy, and public health decision-making to build a new framework of breast cancer prevention.From Pink to Green successfully explores the intersection between breast cancer activism and the environmental health sciences, incorporating public and scientific debates as well as policy implications to public health and environmental agendas.

It is estimated that more than 50 million Latinos live in the United States. This is projected to more than double by 2050. In Health Issues in Latino Males experts from public health, medicine, and sociology examine the issues affecting Latino men's health and recommend policies to overcome inequities and better serve this population. The book addresses sexual and reproductive health; alcohol, tobacco, and drug use; mental and physical health among those in the juvenile justice or prison systems; chronic diseases; HIV/AIDS; Alzheimer's and dementia; and health issues among war veterans. It discusses utilization, insurance coverage, and research programs, and includes an extensive appendix charting epidemiological data on Latino health.

In Diagnosis, Therapy, and Evidence, Gerald N. Grob and Allan V. Horwitz employ historical and contemporary data and case studies, combining into one book a variety of medical and psychiatric conditions. They utilize case studies and examine tonsillectomy, cancer, heart disease, PTSD, anxiety, and depression, and identify differences between rhetoric and reality and the weaknesses in diagnosis and treatment

Through ninety-five in-depth interviews with primary care physicians (PCPs) working in different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first centuryÙtheir work, stresses, hopes, expectations, and values. Timothy Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicineÙlarger numbers of younger, female, and foreign-born physicians.

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

The 1960s revolutionized American contraceptive practice. Diaphragms, jellies, and condoms with high failure rates gave way to newer choices of the Pill, IUD, and sterilization. Fit to Be Tied provides a history of sterilization and what would prove to become, at once, socially divisive and a popular form of birth control.During the first half of the twentieth century, sterilization (tubal ligation and vasectomy) was a tool of eugenics. Individuals who endorsed crude notions of biological determinism sought to control the reproductive decisions of women they considered "unfit" by nature of race or class, and used surgery to do so. Incorporating first-person narratives, court cases, and official records, Rebecca M. Kluchin examines the evolution of forced sterilization of poor women, especially women of color, in the second half of the century and contrasts it with demands for contraceptive sterilization made by white women and men. She chronicles public acceptance during an era of reproductive and sexual freedom, and the subsequent replacement of the eugenics movement with "neo-eugenic" standards that continued to influence American medical practice, family planning, public policy, and popular sentiment.

In 1973, San Francisco allergist Ben Feingold created an uproar by claiming that synthetic food additives triggered hyperactivity, then the most commonly diagnosed childhood disorder in the United States. He contended that the epidemic should not be treated with drugs such as Ritalin but, instead, with a food additive-free diet. Parents and the media considered his treatment, the Feingold diet, a compelling alternative. Physicians, however, were skeptical and designed dozens of trials to challenge the idea. The resulting medical opinion was that the diet did not work and it was rejected. Matthew Smith asserts that those scientific conclusions were, in fact, flawed. An Alternative History of Hyperactivity explores the origins of the Feingold diet, revealing why it became so popular, and the ways in which physicians, parents, and the public made decisions about whether it was a valid treatment for hyperactivity. Arguing that the fate of Feingold's therapy depended more on cultural, economic, and political factors than on the scientific protocols designed to test it, Smith suggests the lessons learned can help resolve medical controversies more effectively.

Patients as Policy Actors offers groundbreaking accounts of one of the health field's most important developments of the last fifty years--the rise of more consciously patient-centered care and policymaking. The authors in this volume illustrate, from multiple disciplinary perspectives, the unexpected ways that patients can matter as both agents and objects of health care policy yet nonetheless too often remain silent, silenced, misrepresented, or ignored. The volume concludes with a unique epilogue outlining principles for more effectively integrating patient perspectives into a pluralistic conception of policy-making. With the recent enactment of the Patient Protection and Affordable Care Act, patients' and consumers' roles in American health care require more than ever the careful analysis and attention exemplified by this innovative volume.

Patients as Policy Actors offers groundbreaking accounts of one of the health field's most important developments of the last fifty years--the rise of more consciously patient-centered care and policymaking. The authors in this volume illustrate, from multiple disciplinary perspectives, the unexpected ways that patients can matter as both agents and objects of health care policy yet nonetheless too often remain silent, silenced, misrepresented, or ignored. The volume concludes with a unique epilogue outlining principles for more effectively integrating patient perspectives into a pluralistic conception of policy-making. With the recent enactment of the Patient Protection and Affordable Care Act, patients' and consumers' roles in American health care require more than ever the careful analysis and attention exemplified by this innovative volume.

As the United States rushed toward industrial and technological modernization in the late nineteenth century, people worried that the workplace had become too competitive, the economy too turbulent, domestic chores too taxing, while new machines had created a fast-paced environment that sickened the nation. Physicians testified that, without a doubt, modern civilization was causing a host of ills-everything from irritability to insomnia, lethargy to weight loss, anxiety to lack of ambition, and indigestion to impotence. They called this condition neurasthenia.Neurasthenic Nation investigates how the concept of neurasthenia helped doctors and patients, men and women, and advertisers and consumers negotiate changes commonly associated with “modernity.” Combining a survey of medical and popular literature on neurasthenia with original research into rare archives of personal letters, patient records, and corporate files, David Schuster charts the emergence of a “neurasthenic nation”-a place where people saw their personal health as inextricably tied to the pitfalls and possibilities of a changing world.

Within forty-eight hours after birth, the heel of every baby in the United States has been pricked and the blood sent for compulsory screening to detect or rule out a large number of disorders. Newborn screening is expanding rapidly, fueled by the prospect of saving lives. Yet many lives are also changed by it in ways not yet recognized.Testing Baby is the first book to draw on parents’ experiences with newborn screening in order to examine its far-reaching sociological consequences. Rachel Grob’s cautionary tale also explores the powerful ways that parents’ narratives have shaped this emotionally charged policy arena. Newborn screening occurs almost always without parents’ consent and often without their knowledge or understanding, yet it has the power to alter such things as family dynamics at the household level, the context of parenting, the way we manage disease identity, and how parents’ interests are understood and solicited in policy debates.

Within forty-eight hours after birth, the heel of every baby in the United States has been pricked and the blood sent for compulsory screening to detect or rule out a large number of disorders. Newborn screening is expanding rapidly, fueled by the prospect of saving lives. Yet many lives are also changed by it in ways not yet recognized.Testing Baby is the first book to draw on parents’ experiences with newborn screening in order to examine its far-reaching sociological consequences. Rachel Grob’s cautionary tale also explores the powerful ways that parents’ narratives have shaped this emotionally charged policy arena. Newborn screening occurs almost always without parents’ consent and often without their knowledge or understanding, yet it has the power to alter such things as family dynamics at the household level, the context of parenting, the way we manage disease identity, and how parents’ interests are understood and solicited in policy debates.

According to the Latina health paradox, Mexican immigrant women have less complicated pregnancies and more favorable birth outcomes than many other groups, in spite of socioeconomic disadvantage. Alyshia GÁlvez provides an ethnographic examination of this paradox. What are the ways that Mexican immigrant women care for themselves during their pregnancies? How do they decide to leave behind some of the practices they bring with them on their pathways of migration in favor of biomedical approaches to pregnancy and childbirth?This book takes us from inside the halls of a busy metropolitan hospital’s public prenatal clinic to the Oaxaca and Puebla states in Mexico to look at the ways Mexican women manage their pregnancies. The mystery of the paradox lies perhaps not in the recipes Mexican-born women have for good perinatal health, but in the prenatal encounter in the United States. Patient Citizens, Immigrant Mothers is a migration story and a look at the ways that immigrants are received by our medical institutions and by our society

According to the Latina health paradox, Mexican immigrant women have less complicated pregnancies and more favorable birth outcomes than many other groups, in spite of socioeconomic disadvantage. Alyshia GÁlvez provides an ethnographic examination of this paradox. What are the ways that Mexican immigrant women care for themselves during their pregnancies? How do they decide to leave behind some of the practices they bring with them on their pathways of migration in favor of biomedical approaches to pregnancy and childbirth?This book takes us from inside the halls of a busy metropolitan hospital’s public prenatal clinic to the Oaxaca and Puebla states in Mexico to look at the ways Mexican women manage their pregnancies. The mystery of the paradox lies perhaps not in the recipes Mexican-born women have for good perinatal health, but in the prenatal encounter in the United States. Patient Citizens, Immigrant Mothers is a migration story and a look at the ways that immigrants are received by our medical institutions and by our society

Since 2006, when the “morning-after pill” Plan B was first sold over the counter, sales of emergency contraceptives have soared, becoming an $80-million industry in the United States and throughout the Western world. But emergency contraception is nothing new. It has a long and often contentious history as the subject of clashes not only between medical researchers and religious groups, but also between different factions of feminist health advocates.The Morning After tells the story of emergency contraception in America from the 1960s to the present day and, more importantly, it tells the story of the women who have used it. Side-stepping simplistic readings of these women as either radical feminist trailblazers or guinea pigs for the pharmaceutical industry, medical historian Heather Munro Prescott offers a portrait of how ordinary women participated in the development and popularization of emergency contraception, bringing a groundbreaking technology into the mainstream with the potential to alter radically reproductive health practices.