Latin american critical ('social') epidemiology new settings for an old dreamJim Bloyd, DrPH, MPH
Breilh, J. (2008). Latin american critical ('social') epidemiology: New settings for an old dream. International Journal of Epidemiology, 37(4), 745-50. doi:10.1093/ije/dyn135
postneoliberal public health care reforms neoliberalism, social medicine, an...Jim Bloyd, DrPH, MPH
Several Latin American countries are implementing a suite of so-called "postneoliberal" social and political economic policies to counter neoliberal models that emerged in the 1980s. This article considers the influence of postneoliberalism on public health discourses, policies, institutions, and practices in Bolivia, Ecuador, and Venezuela. Social medicine and neoliberal public health models are antecedents of postneoliberal public health care models. Postneoliberal public health governance models neither fully incorporate social medicine nor completely reject neoliberal models. Postneoliberal reforms may provide an alternative means of reducing health inequalities and improving population health.
Human rights in developing countries and its relationship with country’s econ...AI Publications
The purpose of this study is to examine the relationship of human rights and economic development in the developing countries. A quantitative method used in order to analyze data gathered by the researcher. The researcher used questionnaire in order to be able to analyze the current study. A random sampling method used, where almost all participants will have equal chances of being selected for the sample. The researcher gathered 161 questionnaires, however 12 questionnaires were invalid and 149 questionnaires were properly completed. The questionnaire structured in the form of multiple choice questions. The finding of this study showed that there is a strong and positive relationship between human right and economic development in developing countries, according the research hypothesis was found to be supported which stated that a developed economic in developing country will have a positive relationship with the protection of human rights.
Latin american critical ('social') epidemiology new settings for an old dreamJim Bloyd, DrPH, MPH
Breilh, J. (2008). Latin american critical ('social') epidemiology: New settings for an old dream. International Journal of Epidemiology, 37(4), 745-50. doi:10.1093/ije/dyn135
postneoliberal public health care reforms neoliberalism, social medicine, an...Jim Bloyd, DrPH, MPH
Several Latin American countries are implementing a suite of so-called "postneoliberal" social and political economic policies to counter neoliberal models that emerged in the 1980s. This article considers the influence of postneoliberalism on public health discourses, policies, institutions, and practices in Bolivia, Ecuador, and Venezuela. Social medicine and neoliberal public health models are antecedents of postneoliberal public health care models. Postneoliberal public health governance models neither fully incorporate social medicine nor completely reject neoliberal models. Postneoliberal reforms may provide an alternative means of reducing health inequalities and improving population health.
Human rights in developing countries and its relationship with country’s econ...AI Publications
The purpose of this study is to examine the relationship of human rights and economic development in the developing countries. A quantitative method used in order to analyze data gathered by the researcher. The researcher used questionnaire in order to be able to analyze the current study. A random sampling method used, where almost all participants will have equal chances of being selected for the sample. The researcher gathered 161 questionnaires, however 12 questionnaires were invalid and 149 questionnaires were properly completed. The questionnaire structured in the form of multiple choice questions. The finding of this study showed that there is a strong and positive relationship between human right and economic development in developing countries, according the research hypothesis was found to be supported which stated that a developed economic in developing country will have a positive relationship with the protection of human rights.
Welfare state retrenchment is widely seen as a highly unpopular endeavor and, therefore, as politically difficult to pursue. This assumption has underpinned most of the political science research on this issue, notably Paul Pierson‘s seminal contributions about the ‗new politics of the welfare state‘. Yet, the question remains why and under what circumstances cutbacks take place in highly developed welfare states despite these formidable political obstacles. This article reviews the literature on the politics of retrenchment, namely on the impact of socioeconomic problem pressure, political parties, political institutions, welfare state structures and ideas. Most authors agree that socio-economic problems – particularly domestic problems – contribute to an atmosphere of ‗permanent austerity‘ which inspires cutbacks. Moreover, according to most scholars, the extent of retrenchment possible depends on the specific institutional configuration of a political system and the path dependence of existing welfare state structures. The debate on the relevance of political parties and ideas, by contrast, is still far from settled. Further unresolved issues include the nature of the dependent variable in retrenchment studies. Also, the exact motives for cutbacks are theoretically still little understood, as are the political mechanisms through which they are realized. I argue that, because of the nature of these persisting issues, the pluralistic dialogue between different methods and approaches – as well as their combination – remains the most promising way forward in the study of welfare state politics.
A New Ethical Model for Examining Emergency MedicineOmar Ha-Redeye
Talk by Omar Ha-Redeye at the 16th World Congress on Disaster and Emergency Medicine on Thursday May 14, 2009.
For more details see Ha-Redeye, O (2009). Assessing the Needs of Health Professionals and Stakeholders. Chapter 6 in Population Health, Communities & Health Promotion (Eds. Sansnee Jirojwong, Pranee Liamputtong). Oxford University Press. ISBN: 9780195560558
International Journal of Engineering Research and Applications (IJERA) is an open access online peer reviewed international journal that publishes research and review articles in the fields of Computer Science, Neural Networks, Electrical Engineering, Software Engineering, Information Technology, Mechanical Engineering, Chemical Engineering, Plastic Engineering, Food Technology, Textile Engineering, Nano Technology & science, Power Electronics, Electronics & Communication Engineering, Computational mathematics, Image processing, Civil Engineering, Structural Engineering, Environmental Engineering, VLSI Testing & Low Power VLSI Design etc.
Liberal Democracy in America and Socialism in Vietnam Impact on Health Insura...LongHienLe
This article compares two political theories, namely liberal democracy, and socialism, on health insurance and services in America and Vietnam. More specifically, it dives deeper into the relationship between the different types of economy in each social formation and the quality of the health care system development as expressed in specific policies.
KAFKAS ÜNİVERSİTESİ/KAFKAS UNIVERSITY
SOCIOLOGY
Course
LECTURE NOTES AND POWER POINT PRESENTATIONS
Prof.Dr. Halit Hami ÖZ
Kars, TURKEY
hamioz@yahoo.com
Mey Akashah and Stephen P. Marks, "Accountability for the Health Consequences...Mey Akashah
Mey Akashah and Stephen P. Marks (2006), "Accountability for the Health Consequences of Human Rights Violations: Methodological Issues in Determining Compensation," Health and Human Rights, Vol. 9(2), pp. 256-279.
Abstract:
The issue of compensation is an under-studied dimension of a rights-based approach to health. The emerging normative framework that allows for compensation of human rights abuses lacks a consistent and transparent methodology for valuing health losses. While methods for assigning monetary values to decreases in health have evolved through health economics, these techniques have developed outside of a human rights framework and do not adequately account for such concerns as fairness and nondiscrimination. These methods may in fact underestimate damages for poor individuals and communities, as well as for those subjected to prolonged abuses. This article will examine the normative foundations for compensation, evaluate methodological shortcomings, and propose a methodology for the valuation of health damages in group settings.
Gilead Sciences' Novel Antiviral Drugs Morgan Stanley Report 1993 StreetReports
Analyst report on Gilead Sciences, 1993, describing Gilead`s development of a novel class of antiviral drugs to treat AIDS, cytomegalovirus, and other viruses.
"State of the Gilead" presentation by Dr. Michael L. Riordan, the founder and...presentationselect
"Just one word-- Nucleotides" is the opening slide in the "State of the Gilead" talk by the company's founder and CEO Michael L. Riordan in July 1992, shortly after Gilead's IPO. Nucleotides have proven to be an important advance against viral infections, including HIV/AIDS, hepatitis B, and hepatitis C. Excerpts from the presentation:
"Gilead's business is science."
"We are only as good as our principles,"
"We're in this boat together."
"We learn from each other."
"We are receptive to the ideas of others."
"Diverse personalities are accepted."
Riordan (Gilead Sciences) Schmergel (Genetics Institute) Vincent (Biogen) Bio...ArrowDyn
Michael L Riordan, the founder & CEO of Gilead, Gabriel Schmergel, the CEO of Genetics Institute, and James L Vincent, the CEO of Biogen, are interviewed by G Steven Burrill regarding the state of the Biotech industry. 1991.
Gilead Sciences Initial Public Offering Prospectus January 1992LucasBillings
IPO prospectus for Gilead Sciences, Inc., January 1992.
Gilead Executive Management:
Michael L. Riordan, the company's founder and CEO;
John C. Martin, Vice President for Research and Development;
Michael F. Bigham, Vice President for Corporate Development and CFO.
Founded by Dr. Michael L. Riordan in 1987, the biopharmaceutical company Gilead Sciences raised more than $400 million from the equity markets in the 1990s.
Gilead Sciences Name Filed by Company Founder Michael L Riordancalstatehistories
Filings with the California Secretary of State by Dr. Michael L Riordan, Gilead founder and CEO, establishing the company name as Gilead Sciences, Inc.
Welfare state retrenchment is widely seen as a highly unpopular endeavor and, therefore, as politically difficult to pursue. This assumption has underpinned most of the political science research on this issue, notably Paul Pierson‘s seminal contributions about the ‗new politics of the welfare state‘. Yet, the question remains why and under what circumstances cutbacks take place in highly developed welfare states despite these formidable political obstacles. This article reviews the literature on the politics of retrenchment, namely on the impact of socioeconomic problem pressure, political parties, political institutions, welfare state structures and ideas. Most authors agree that socio-economic problems – particularly domestic problems – contribute to an atmosphere of ‗permanent austerity‘ which inspires cutbacks. Moreover, according to most scholars, the extent of retrenchment possible depends on the specific institutional configuration of a political system and the path dependence of existing welfare state structures. The debate on the relevance of political parties and ideas, by contrast, is still far from settled. Further unresolved issues include the nature of the dependent variable in retrenchment studies. Also, the exact motives for cutbacks are theoretically still little understood, as are the political mechanisms through which they are realized. I argue that, because of the nature of these persisting issues, the pluralistic dialogue between different methods and approaches – as well as their combination – remains the most promising way forward in the study of welfare state politics.
A New Ethical Model for Examining Emergency MedicineOmar Ha-Redeye
Talk by Omar Ha-Redeye at the 16th World Congress on Disaster and Emergency Medicine on Thursday May 14, 2009.
For more details see Ha-Redeye, O (2009). Assessing the Needs of Health Professionals and Stakeholders. Chapter 6 in Population Health, Communities & Health Promotion (Eds. Sansnee Jirojwong, Pranee Liamputtong). Oxford University Press. ISBN: 9780195560558
International Journal of Engineering Research and Applications (IJERA) is an open access online peer reviewed international journal that publishes research and review articles in the fields of Computer Science, Neural Networks, Electrical Engineering, Software Engineering, Information Technology, Mechanical Engineering, Chemical Engineering, Plastic Engineering, Food Technology, Textile Engineering, Nano Technology & science, Power Electronics, Electronics & Communication Engineering, Computational mathematics, Image processing, Civil Engineering, Structural Engineering, Environmental Engineering, VLSI Testing & Low Power VLSI Design etc.
Liberal Democracy in America and Socialism in Vietnam Impact on Health Insura...LongHienLe
This article compares two political theories, namely liberal democracy, and socialism, on health insurance and services in America and Vietnam. More specifically, it dives deeper into the relationship between the different types of economy in each social formation and the quality of the health care system development as expressed in specific policies.
KAFKAS ÜNİVERSİTESİ/KAFKAS UNIVERSITY
SOCIOLOGY
Course
LECTURE NOTES AND POWER POINT PRESENTATIONS
Prof.Dr. Halit Hami ÖZ
Kars, TURKEY
hamioz@yahoo.com
Mey Akashah and Stephen P. Marks, "Accountability for the Health Consequences...Mey Akashah
Mey Akashah and Stephen P. Marks (2006), "Accountability for the Health Consequences of Human Rights Violations: Methodological Issues in Determining Compensation," Health and Human Rights, Vol. 9(2), pp. 256-279.
Abstract:
The issue of compensation is an under-studied dimension of a rights-based approach to health. The emerging normative framework that allows for compensation of human rights abuses lacks a consistent and transparent methodology for valuing health losses. While methods for assigning monetary values to decreases in health have evolved through health economics, these techniques have developed outside of a human rights framework and do not adequately account for such concerns as fairness and nondiscrimination. These methods may in fact underestimate damages for poor individuals and communities, as well as for those subjected to prolonged abuses. This article will examine the normative foundations for compensation, evaluate methodological shortcomings, and propose a methodology for the valuation of health damages in group settings.
Gilead Sciences' Novel Antiviral Drugs Morgan Stanley Report 1993 StreetReports
Analyst report on Gilead Sciences, 1993, describing Gilead`s development of a novel class of antiviral drugs to treat AIDS, cytomegalovirus, and other viruses.
"State of the Gilead" presentation by Dr. Michael L. Riordan, the founder and...presentationselect
"Just one word-- Nucleotides" is the opening slide in the "State of the Gilead" talk by the company's founder and CEO Michael L. Riordan in July 1992, shortly after Gilead's IPO. Nucleotides have proven to be an important advance against viral infections, including HIV/AIDS, hepatitis B, and hepatitis C. Excerpts from the presentation:
"Gilead's business is science."
"We are only as good as our principles,"
"We're in this boat together."
"We learn from each other."
"We are receptive to the ideas of others."
"Diverse personalities are accepted."
Riordan (Gilead Sciences) Schmergel (Genetics Institute) Vincent (Biogen) Bio...ArrowDyn
Michael L Riordan, the founder & CEO of Gilead, Gabriel Schmergel, the CEO of Genetics Institute, and James L Vincent, the CEO of Biogen, are interviewed by G Steven Burrill regarding the state of the Biotech industry. 1991.
Gilead Sciences Initial Public Offering Prospectus January 1992LucasBillings
IPO prospectus for Gilead Sciences, Inc., January 1992.
Gilead Executive Management:
Michael L. Riordan, the company's founder and CEO;
John C. Martin, Vice President for Research and Development;
Michael F. Bigham, Vice President for Corporate Development and CFO.
Founded by Dr. Michael L. Riordan in 1987, the biopharmaceutical company Gilead Sciences raised more than $400 million from the equity markets in the 1990s.
Gilead Sciences Name Filed by Company Founder Michael L Riordancalstatehistories
Filings with the California Secretary of State by Dr. Michael L Riordan, Gilead founder and CEO, establishing the company name as Gilead Sciences, Inc.
Science of Synthesis: The only full-text resource for evaluated methods in sy...greeninsel
Science of Synthesis is a truly unique resource and it is the first and foremost focal point for critically evaluated information on chemical transformations for those individuals involved in the design and construction of organic molecules. The online product combines full-text browsing functionality together with modern structure and reaction search capabilities.
Review pages 109–110 of Essentials of Health Policy and Law as wel.docxjoellemurphey
Review pages 109–110 of Essentials of Health Policy and Law as well as the following legislation:
Examination and Treatment for Emergency Medical Conditions and Women in Labor
You are a consultant specializing in policy analysis. Based on theExamination and Treatment for Emergency Medical Conditions and Women in Labor legislation, as well as the situation that follows, you will complete a policy analysis with 3–5 options for your client, Congresswoman Moody, to consider.
Congresswoman Moody represents a state that borders Mexico. She is up for re election next year, and she will seek another term in office.
There are many undocumented workers that reside in her district. Congresswoman Moody is vocal about the need to provide health care to all that need it, but she also believes in fiscal restraint and does not support bail-outs for private facilities. She is well aware that her state’s Medicaid budget is almost exhausted for this year, and the state’s unemployment rate remains stubbornly high.
Apart from the voters, other affected constituents include three private regional medical centers trauma units that receive referrals from five or more small facilities that have emergency departments with lesser trauma status. Also, the largest health care corporation that owns two of the three medical centers in her catchment area, and which supported her in her last bid for election with campaign funds at the allowable limit, is threatening to refuse Medicare and Medicaid patients to ensure survival in the bad economy. An increase in unfunded mandates for urgent care may push this corporation into private payer only, and Congresswoman Moody is aware that there are enough affluent families in the area to support two facilities providing only designer medicine and concierge services.
All options must:
· Be within the power of Congresswoman Moody to do
· Be consistent with Congresswoman Moody’s values, and
· Address the issue identified in the problem statement
You will:
1. Identify 3–5 options for Congresswoman Moody’s consideration
2. Identify criteria that will be used to evaluate the options
3. Identify pros and cons for each option
4. Use a side-by-side table (MS® Excel® would be appropriate for this) to assist in analyzing the options.
Submitting Your Assignment
Prepare your written Assignment in a Word and/or Excel document and save it in a location and with a name you will remember, using the following naming convention: username-assignment-unit#.doc.
Page number 109
In terms of national constitutions, a 2004 survey reported that some two-thirds of constitutions worldwide address health or health care, and that almost all of these do so in universal terms, rather than being limited to certain populations.13 For example, consider the health-related constitutional aspects of four politically and culturally diverse countries—Italy, the Netherlands, South Africa, and Poland—that have some type of “right to health”: Italy’s Constitution guarantees a ...
LEARNING OBJECTIVES By the end of this chapter, you will b.docxsmile790243
LEARNING OBJECTIVES
By the end of this chapter, you will be able to:
Describe the meaning and importance of the "no-duty"
principle
o Explain generally how the U.S. approach to health rights
differs from that of other high-income countries
o Describe the types and limitations of individual legal rights
associated with health care
Describe the balancing approach taken when weighing
individual rights against the public's health
Atthe turn of the 20th century, an Indiana physician named
George Eddingfield repeatedly refused to come to the aid
of Charlotte Burk, who was in labor, even though he was
Mrs. Burk's family physician. Doctor Eddingfield conceded
at trial that he made this decision for no particular reason,
and desplte the facts that he had been ~ffered monetary ~
compensation in advance of his performing any medical
services and that he was a·ware that no Other physician
was available to provide care to Mrs .. Burk.. Unattehded by
any medical providers, Mrs. Burk eventually fell gravely ill,
and both she and her unborn child died. After a trial and
subsequent appeals, Dr. Eddingfield was found to not have
wrongfully caused either death.
in Health
Health
A~a:urid_{h~ ..·sa toe;' _tim_~:-~,i t,he:·.hc~h.~t_Jo;~a*i:P~:~-f;U~~d~:-r~_: ~\
the.. Cambrid.ge, M~ssachus~tt~,··s.<>a(d•otH~alth•ofl!er~.d :.!.
ev€ryo n~. wi-thi~ ·Ci_tY :Ji :ffiit_~- --~9 ·:b:~-:Y,~~C~lh~-~~-~~:-_a:g·~J!i~}~_ti:~~:,::::_
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hea_L~h -~he- pow~r; --~~ ae_r __~e_ftaiq: :sirC:~~SJ~:n--~~-~;~_f~:-:f~j\Pif~_i;~c\ -.i
the vacdnatioil nf,_in·d_i_vtd~·als:. ~ft~r\¥f_u~Si~;S-~f9:A~1,~-~W_y~ ~~;~<l
the cambridge ~o~~d'_s-·o.rd_~f~H~5n:i__~--9:9~~¢o_bici_~:W:~~1f~g~:* -~
victedby a .~tate t;,ialcourt11nasenf~n.5~a tgR~X<i~~pn~:; ~·}
R~nia~kab ly, _t•fr:: _J~a ~q)J_~:o_n~~: --~~-5-~ ~-~ -~-f~~:? ~¥; ~,:~-9~~~~~~~~:,~6\ ·>-1
.. the United Stat~s s.uPtern~[o"crJ,itres.\llt~\tjpf9e~;o#b~ }J
co~.rt's •.~pstit11P9rrantp~blis·~~~lt9t~lin,;Qi~i~~i\'lg~~,· •.•
ing statement•eP~Vtljmitrti~nstgf.undarpe.n~~~in~jvidtiak··· i
rights in.the .fat~.·ofthr~ati toj:~¢ pt1~lic'~ .tJe~lf~\ / .··.. ·
INTRODUCTION
The real-life scenarios in the vignette touch upon the key
issues you will confront in this chapter: namely, the ways in
which the law creates, protects, and restricts individual rights
in the contexts of health care and public health. Individuals
in society are deeply impacted by law on a daily basis, and
this fact is no less true when individuals navigate the health
care system, or when an individual's actions are measured
against the broader interests ofthe public's health. Over many
decades, legal principles have been rejected, developed, and
refined as the law continually struggles to define the appropri
ate relationship between individuals and the physicians, hos
pitals, managed care companies, and others they encounter in
the healthcare delivery sys ...
1Identifying the VulnerableLearning ObjectivesAfteEttaBenton28
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxaulasnilda
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxfelicidaddinwoodie
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
CHAPTER 7The policy processEileen T. O’GradyThere are tJinElias52
CHAPTER 7
The policy process
Eileen T. O’Grady
“There are three critical ingredients to democratic renewal and progressive change in America: good public policy, grassroots organizing and electoral politics.”
Paul Wellstone
Nurses can more strategically and effectively influence policy if they have a clear understanding of the policymaking process. Conceptual models can help to organize and interpret information by depicting complex ideas in a simplified form; to this end, political scientists have developed a number of conceptual models to explain the highly dynamic process of policymaking. This chapter reviews two of these conceptual models.
Health policy and politics
Health policy encompasses the political, economic, social, cultural, and social determinants of individuals and populations and attempts to address the broader issues in health and health care (see Box 7.1 for policy definitions). A clear understanding of the points of influence to shape policy is essential and includes framing the problem itself. For example, if nurses working in a nurse-managed clinic are troubled by staff shortages or long patient waits, they may be inclined to see themselves as the solution by working longer hours and seeing more patients. Defining and framing the problem is the first step in the policy process and involves assessing its history, patterns of impact, resource allocation, and community needs. Broadening and framing the problem to influence or educate stakeholders at the local, state, or federal level could include advocating for better access or funding for nursing workforce development (see Box 7.1).
BOX 7.1
Policy Definitions
Policy is authoritative decision making related to choices about goals and priorities of the policymaking body. In general, policies are constructed as a set of regulations (public policy), practice standards (workplace), governance mandates (organizations), ethical behavior (research), and ordinances (communities) that direct individuals, groups, organizations, and systems toward the desired behaviors and goals.
Health policy is the authoritative decisions made in the legislative, judicial, and executive branches of government that are intended to direct or influence the actions, behaviors, and decisions of others (Longest, 2016).
Policy analysis is the investigation of an issue including the background, purpose, content, and effects of various options within a policy context and their relevant social, economic, and political factors (Dye, 2016).
The next step is to bring the problem to the attention of those who have the power to implement a solution. Other key factors to consider include generating public interest, the availability of viable policy solutions, the likelihood that the policy will serve most of the people at risk in a fair and equitable fashion, and consideration of the organizational, community, societal, and political viability of the policy solution.
Public interest is a fascinating dynamic ...
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Breast Cancer Information Essay Free Essay Example. Skin cancer research paper conclusion / custom essay paper writing. Breast cancer college essays. Top Cancer Essay ~ Thatsnotus. How the American Cancer Society Might Provide Education and Support .... Essay on Cancer | Cancer Essay for Students and Children in English - A .... Environmental Factors that Could Cause Cancer Essay Example | Topics .... essay examples: Breast Cancer Essay. Cancer Writing Assignment | PDF | Cancer | Clinical Medicine.
Medicalization, Markets and ConsumersAuthor(s) Peter .docxaryan532920
Medicalization, Markets and Consumers
Author(s): Peter Conrad and Valerie Leiter
Source: Journal of Health and Social Behavior, Vol. 45, Extra Issue: Health and Health Care
in the United States: Origins and Dynamics (2004), pp. 158-176
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/3653830
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Medicalization, Markets and Consumers*
PETER CONRAD
Brandeis University
VALERIE LEITER
Simmons College
Journal of Health and Social Behavior 2004, Vol 45 (Extra Issue): 158-176
This paper examines the impact of changes in the medical marketplace on med-
icalization in U S. society. Using four cases (Viagra, Paxil, human growth hor-
mone and in vitro fertilization), we focus on two aspects of the changing med-
ical marketplace: the role of direct-to-consumer advertising of prescription
drugs and the emergence ofprivate medical markets. We demonstrate how con-
sumers and pharmaceutical corporations contribute to medicalization, with
physicians, insurance coverage, and changes in regulatory practices playing
facilitating roles. In some cases, insurers attempt to counteract medicalization
by restricting access. We distinguish mediated and private medical markets,
each characterized by differing relationships with corporations, insurers, con-
sumers, and physicians. In the changing medical environment, with medical
markets as intervening factors, corporations and insurers are becoming more
significant determinants in the medicalization process.
Over the past three decades there has been a
marked increase in the medicalization of soci-
ety (Zola 1972; Conrad and Schneider 1992;
Barsky and Boros 1995; Riska 2003).
Medicalization occurs when previously non-
medical problems are defined and treated as
medical problems, usually in terms of illnesses
or disorders. While medicalization can be bi-
directional, there is strong evidence for
increases in medicalization. This growth of
medical jurisdiction is "one of the most potent
transformations of the last half of the twentieth
century in the West" (Clarke et al. 2003:161).
In this same period, the institution of medicine
has undergone major changes in its social
orga ...
A HISTORICAL AND CONCEPTUAL OVERVIEW: Using Knowledge and Technology to Impr...IJMSIRJOURNAL
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with disabilities requires understanding the many meanings of disability and quality of life. It
also requires exploring whether rehabilitation services and knowledge utilization can make a
difference in life quality. Understanding the disability constructs helps increase understanding of
the relevance of the prosumer concept for people with disabilities. The knowledge utilization
literature traditionally has focused on scientific knowledge and not intuitive, meditative, or
experiential knowledge. Its emphasis has been on getting research results into practice and only
more recently expanded to include getting exemplary practices more widely known and used.
Because the literature on knowledge utilization is often intermixed with Research on the
scientific knowledge cycle, it is essential to understand what is meant by the scientific knowledge cycle. The discussion that follows leans heavily on the editorial work of Dr. Robert
Rich, past editor of the Knowledge journal, past president of the Society on Knowledge
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The Path to Public Office: Medicine versus Law, by Michael L. Riordan
1. THE PATH TO PUBLIC OFFICE: MEDICINE VERSUS LAW
by
MICHAEL L. RIORDAN
Reprinted From: Perspectives in Biology and Medicine
Volume 29 Number 2 Winter 1986
3. political power of lawyers" [3, 1:285], and indeed he was correct. The
farmers, physicians, soldiers, and businessmen of the infant nation's
governing institutions gave way to a marked preponderance of lawyers.
Their ascendency was ungraciously forecast by the Frenchman Crevecoeur, who, not long after independence, described American lawyers as
weeds "that will grow in any soil that is cultivated by the hands of others;
and when once they have taken root, they will extinguish every other
vegetable that grows around them" [4, p. 40].
Grow they did. The majority of congressmen are lawyers. Nearly twothirds of presidents have been lawyers. Despite the fact that there are no
statutory qualifications for serving on the Supreme Court-appointees
need not even have a legal background-all the Supreme Court justices
are lawyers (although notably it was not until 1957 that the Court comprised only law school graduates) [5]. There is also a markedly disproportionate representation of lawyers in other high-level positions of the
executive branch: a near majority of President Carter's cabinet were
lawyers, and within the present administration's cabinet, there are five
lawyers. 1
A law degree is commonly considered a legitimate entree to virtually
any public policy position-it is the union card for those who wish to
govern. On top of being an uncontestable qualification for political adventurism, it is becoming, more and more, a prerequisite-so much so
that one exasperated author exclaims that the "absence of a law degree is
almost as effective a disqualifier for high office as being nonwhite or
female" [4, p. 43].
It is easy to speculate why lawyers have achieved their status as the
"high priests of American politics" [7]. They are willing to devote time
and energy to politics because such service readily enhances their private
law careers. 2 They have immediate access to and a monopoly of an entire
branch of government, the judicial system, which can be an important
route of advancement into other government sectors. Since legislative
bodies make laws, an undiscerning public presumes that lawyers are
automatically best suited for being legislators.
It is easy, as well, to note probable reasons for the paucity of physicians
in government. The demands of medical school, residency training, and
practice often preclude outside commitments, and political prominence
1Lawyers' long-standing domination of public offices was concisely stated by David R.
Derge: "We know . .. that lawyers have accounted for 70% of the Presidents, VicePresidents, and cabinet members of the United States between 1877 and 1934, a majority
of the members of the United States Senate and the United States House of Representatives, nearly half of the state governors between 1870 and 1950, and about 25% of the
American state legislators since 1900. Yet lawyers have never constituted more than .2% of
the U.S. labor force" [6].
2 For further discussion of how political visibility promotes the lawyer's private practice,
see]. Alter, "With Friends like These," Washington Monthly, pp. 12-22, January 1983.
Perspectives in Biology and M edicine, 29, 2
Winter 1986
31 7
4. hardly attracts patients to physicians in the same way that it attracts
clients to lawyers. Not uncommonly, doctors and doctors-to-be, absorbed in critical issues of biomedical sciences, patient care, and life and
death on the wards, understandably are uninterested in the governing
process and are ready with the retort: "If I had wanted to go into politics
I would've gone to law school!"
This essay does not attempt to explain why so many lawyers and so few
physicians are in government. Rather, this essay examines the relative
merits of hiw school and of medical school as preparations for public
office. It seeks to set aside, for the moment, all the varied postgraduate
career paths in order to focus on the schooling itself, to see whether
indeed there are features of law school that make it intrinsically the best
preparation for a role in public policy, or whether, in fact, medical
school provides an equally apt foundation.
Each school inculcates a different method of thinking. Studies show
that "the ability to think like a lawyer" is overwhelmingly regarded by
law students as the most important skill taught in law school [8]. What
does it mean to think like a lawyer? One of the purported strengths of
the legal mind is the "ability to come to an unfamiliar area, quickly grasp
the essentials, then to organize a solution and finally to translate all this
to others" [9, p. 107]. Presumably this ability is engendered by the keystone of law school-the case study method: the facts of a specific legal
case are presented in sequence, the pertinent segment of the law and
appropriate precedents are identified, and the arguments of the two
sides in the litigation are examined in light of those precedents and laws.
This is a linear process and focuses on single cases, each with unique
circumstances.
That linearity, so deductive in nature, can hardly be considered preparatory to the more inductive, integrative reasoning required of, say, a
governor deciding on a proposed restructuring of his state's agricultural
loan program; the governor must assess the interrelated effects of such a
decision upon farmers' lives and livelihoods, rural communities, agriculture-related businesses, state revenues, future productivity, and a multitude of other consequences. The lawyer is trained instead to argue for
a single party, for instance, a grain elevator owner whose business would
be affected by the new loan program.
The same linearity of reasoning, accompanied by a heavy reliance
upon precedent-that which has already been decided-would also not
engender the innovative, forward-looking mind required of the public
official planning for the future.
In medical school the integrative process, so vital to the public official,
is emphasized instead of the linear, deductive method characteristic of
law. When presented with a patient, the student must obtain and analyze
318
Michael L. Riordan
The Path to Public Office
5. several types of information: the patient's history and symptoms, the
physical exam, and a host of laboratory data-chemistries, radiologic
studies, microscopy, etc. Within the diagnostic process the student does
perform linear, deductive steps similar to those of the lawyer (e.g., the
patient has impaired hearing on the left, on Weber test there is lateralization to the left, therefore, the left ear has a conduction defect), but
these short linear steps merely contribute to a larger aggregate of
findings, some of which may be conflicting, that must be evaluated to
arrive at a likely diagnosis.
That evaluation relies on an understanding of the sensitivity and
specificity of various tests, which are derived from studies of populations. Thus, although the patient is an individual case with unique circumstances, he must be considered within the context of a population.
Likewise for therapeutics: the physician is guided in his choice of treatment by epidemiologic studies of the propensities of populations to respond to that treatment.
In determining the proper therapy for a patient, the physician must
carefully weigh many considerations. What is the likelihood of actually
curing or helping the patient? What discomfort, risks, or inconvenience
accompanies the therapy, and how do they compare to the treatment
benefits? What net change in "quality of life" will result? What is the cost
of therapy to the patient and to social support systems? What are the
psychologic and social consequences of treating or not treating?
After all these questions are taken into account, the physician chooses
the mode of therapy he thinks best. This is the converse of the method
of the attorney, who assumes a stance and then argues that it is best,
constructing his argument ex post facto.
Throughout the patient's course, the physician revises his diagnostic
and therapeutic judgments in light of new information, attempting at all
times to integrate medical knowledge and the changing circumstances of
the patient: "The astute clinician never loses sight of the totality of this
tapestry of illness, even while seeking to repair the threads that disease
mars or destroys" [10, p . 43].
The physician must be attuned not only to the changing conditions of
his patients but also to the rapid changes in his profession. In the basic
sciences, professors repeatedly emphasize to the students that most of
the facts they are learning today were unknown a few years ago and will
be refined and supplanted in the near future. Fundamental understanding of such fields as immunology, neurophysiology, and microbiology is
growing so fast that the student must necessarily look to the future. This
dynamism of medical training is reinforced as the student enters the
wards and rapidly sees new procedures, new imaging techniques, and
new pharmacologic agents. Far from being saddled with the past-with
Perspectives in Biology and M edicine, 29, 2
Winter 1986
319
6. precedent-the physician is always looking for new diagnostic or therapeutic approaches, either from his own research, from other physicians,
or from the ever-sprouting medical literature.
Treating the body, therefore, is much like treating the body politic.
The congressman or governor must also diagnose the problems of the
people he serves and carefully weigh many variables and conflicting
interests in deciding upon a course of action appropriate to, and
efficacious for, that population, continually reassessing his decisions as
their consequences become apparent, and always looking to make improvements in the future. This is a far cry from the legal system, described by one New York City lawyer as "a very mischievous system
designed not to achieve but to frustrate the truth. Each side pulls out the
facts that help and ignores those that don't. Out of that come confusion
and distortion, and the cleverer guy wins" [11, pp. 58-59].
On the road to "thinking like a lawyer," the student must adopt the
adversarial mode of the U.S. legal system and learn advocacy: to pick or
be assigned a stance and argue for it as zealously as possible, expounding
those points that support that stance and discarding points or evidence
that assails it. The most favorable result of this instruction is that it
"renders men acute, inquisitive, dexterous, prompt in attack, ready in
defense, full of resources ... " [9, p. 107]. More explicitly, however, this
advocacy posture requires the suspension of any concerns other than the
client's best interests. Truth, distinctions between right and wrong, and
the larger values of society must be subordinated to the client's interests;
in arguing a court case, the lawyer must remove himself from the ethical
norms of the society and follow any and all legally prescribed avenues
toward winning the case.
In The Bramble Bush, a collection of lectures to law students, Karl
Llewellyn depicts the first-year student's harsh introduction to this lawyer's posture:
The hardest job of the first year is to lop off your common sense, to knock your
ethics into temporary anesthesia. Your view of social policy, your sense of justice-to knock these out of you along with woozy thinking, along with ideas all
fuzzed along their edges. You are to acquire ability to think precisely, to analyze
coldly, to work within a body of materials that is given, to see, and see only, and
manipulate, the machinery of the law. [12, p. 101]
This unsavory suspension of societal values for the sake of undeterred
advocacy is not an attitude inadvertently acquired by lawyers; it is a
prerequisite of the adversariallegal system. Necessary it may be, but it
has led to many a lawyer's disillusionment. Says one criminal defense
lawyer: "I believe people who commit crimes ought to go to prison and
here I was, trying to keep them out" [ 13, p. 31 ].
How contrary this adversarial disposition seems to the function of the
public officeholder! Granted, mentalities such as "The best way to solve
320 Michael L. Riordan
The Path to Public Office
7. problems is to collide with your opponent.... You demolish your opponent in order to win" [13) may expedite getting into public office, but
must not the policymaker-president, legislator, or cabinet memberconsider reasoned arguments from constituents on many sides of an
issue, directing and arbitrating at the same time, all within the moral and
ethical framework of the society? 3
During medical training one is elbow-to-elbow with ethical issues, and
physicians' decisions are often colored by moral and ethical concerns.
Medical ethics is a common feature of the medical school curriculum,
either as a distinct course or incorporated into other courses. Students
are asked to contemplate and discuss critical ethical problems: What
should be the limits to extraordinary means of life support? How should
scarce or expensive resources like transplant kidneys and renal dialysis
be allocated? To what extremes should we go in sustaining the grossly
premature infant? Who should or should not receive pneumococcal vaccine? What new reproductive techniques are permissible? The student
then faces these issues on the wards; it is not uncommon for a student in
the intensive care unit to participate in an attending's delicate discussion
of Do Not Resuscitate orders with a patient's family .
Not only does medicine deal daily with ethical questions-it is
medicine itself which has stimulated renewed philosophical investigation
of ethics. The author of a recent article in this journal concludes that the
real-life dilemmas posed by medicine prompted practical reasoning in
ethics. "During the last 20 years medicine has 'saved the life of ethics,' "
the article states, and "it has given back to ethics a seriousness and
human relevance which it had seemed .. . to have lost for good" [14, p.
750].
One measure of a society's progress is the condition of its poorest
members, and government policy is often directed toward ameliorating
the plight of socioeconomically depressed segments of the population.
Thus the policymaker should be well acquainted with the impoverished
among his constituency.
Is contact with the economically disadvantaged a feature of law
school? To a limited extent, yes. Many law schools have small, free clinics
for the poor, in which students can participate voluntarily. A handful of
schools have very active legal assistance programs, and in some of these
schools the clinics are a required part of the curriculum. Overall, however, only a small minority of law students have significant contact with
the poor in the course of their schooling. Summers are typically not
spent volunteering at Legal Aid but working for a generous salary
3 0ne must wonder, in fact, how lawyers make the sharp turn from advocates to judgeship. The lack of emphasis on arbitration in law school has been noted , and there is
sentiment that this should be changed [8].
P erspectives in Biology and M edicine. 29. 2
Winter / 986 1 321
8. (sometimes imperative to the indebted student) at a large firm , serving
corporate clients. Rather than instilling concern for those at the lower
end of society, some studies of legal education indicate that law school
moves students away from the conception of the lawyer as a facilitator of
societal interests, remedying societal ills [15].
In most medical schools, however, there is mandatory contact with the
destitute. A large part of the patient population at most teaching hospitals is indigent, and in fact many of the older teaching hospitals were first
established to treat the sick poor. More than a quarter of the university
medical centers in the United States "sit squarely in the midst of the
largest, most troubled decaying inner cities" [ 16, p. 940].
The great majority of medical students have extensive contact with
poor patients on the "public floors" during medicine, surgery, or ob/gyn
rotations, in walk-in clinics, or in the emergency room. Some of the
students may in the end be repelled by the clinical manifestations of
poverty, but at least they see and deal with the chronic alcoholic from the
surrounding slum; they take care of the demented grandmother abandoned on the street; they help treat, in the emergency room, the attempted suicides, the heroin addict's gunshot wounds, and the laid-off
warehouseman scalded by a hysterical spouse. Poverty is in many ways
directly reflected by the types of diseases the student encounters in this
economically depressed patient population. In the recent recession, for
example, greater numbers of tuberculosis cases, more poisonings with
lead-based paints, and an increase in infant mortality have been noted in
urban areas [17]. Thus the medical student is in a unique position to
observe social ills and the consequences of poverty. It is a position that
responsible presidents, senators, and congressmen should envy.
Even if it is acknowledged that a medical education exposes one to the
economic shortcomings of society, many people would argue that the
long hours spent in the hospital sequester the student from the rest of
the "real world"; they would argue that the medical student is ill prepared for a role in public policy because his immersion in medical studies blinds him to the activities of business and government and prevents
him from acquiring a practical knowledge of the world at large. These
people would presume that the law student, studying cases of "real
world" disputes, learning the laws that govern business, and working for
a corporation in the summer, is better versed in the operations of some
of the nation's businesses and industries, and therefore is a more capable
policymaker in America, since "America's business is business."
For better or for worse, medicine is big business. The industry of
medicine and health care now accounts for 10 percent of the nation's
gross national product. Medical school teaches the student, in detail, the
fundamentals on which that entire "medical-industrial complex" is built,
and around which it continues to grow. Can other paths of preparation
322 M icooel L. Riordan
The Path to Public Office
9. for public office-law school included-claim an intimate acquaintance
with such a large chunk of the nation's economy?
Also, much of the material the medical student spends so many
months studying in basic sciences will soon impinge on the "real world"
with stunning magnitude: recombinant DNA techniques and new cellculturing methods will open the door not only to new sources of pharmacologic agents and vaccines but also to the genetic manipulation of
plants for increased crop yields, to the mass production of valuable
nutrients and industrial enzymes, and even to bacterial production of
fuels. These new biotechnologies have their roots in the same biochemistry, microbiology, immunology, virology, and cellular biology the medical student has been so thoroughly immersed in, and indeed much of
the research on which these biotechnologies are founded was, and is,
being done at academic medical centers. Thus the medical student has a
firm grasp of innovations that are emerging as .potent economic factors-factors which are beginning to interest the businessman, and
which soon will be of great significance to those who govern.
The argument that medical education sequesters the student away
from the "real world" is further mitigated when one considers that more
and more of the problems of the "real world" are being placed by society
under the purview of medicine. Many issues formerly regarded as
purely social problems are being "medicalized": drug addiction, alcoholism, certain criminal and violent behaviors, marital difficulties, child
abuse, sexual identity problems, mental and physical disabilities, and
gambling [18]. Even lawyers are marching to the medical center (and not
just with medical malpractice suits}, as occupational health litigation on,
for example, asbestosis or black lung continues to burgeon, and the fates
of sued corporations hang on the radiologist's viewing panel.
Thus far in this essay, several aspects of medical education have been
pointed out that would be valuable to a governing official: the integrative thought process, the study of populations through epidemiology,
the constant regard for ethical contexts, the active pursuit of future
improvements, the personal acquaintance with the ills of poverty, the
knowledge of the foundations of large sectors of the economy, and the
extensive contact with the many societal issues that have now been
"medicalized." Two other advantages should be noted, particularly since
they do not have direct counterparts in law school.
One is that medical school provides an unparalleled view of human
behavior, its frailties and its astounding potentials. The physician and
medical student are brought into the confidence of their patients and are
granted insights into the emotional travails of the unfortunate banker
stricken by a neurodegenerative disease or into the steadfastness of the
mother confronting chemotherapy for cancer. Not only does the student
formally study psychiatry and behavior, he also has, in each patient he
Perspectives in Biology and M edicine, 2 9, 2
Winter 19861
323
10. cares for, a personality case study, and each one of them enriches his
understanding of human thoughts and actions. Sir Arthur Conan Doyle,
the physician who created Sherlock Holmes, had this in mind when he
stated that "a medical training was a most valuable possession for a man,
even if he did not afterwards engage in practice. After a medical education all work in life, if done in the right spirit, became far more easy" [ 19,
p. 1066]. The human insights abounding in medical education also
prompted the author William Somerset Maugham, who studied medicine, to assert, "I do not know a better training for a writer than to spend
some years in the medical profession" [20, p. 45].
Some authors have decried the deficiencies of many public leaders in
understanding the "human factors" inherent to governing. Those authors emphasize how unfortunate it is that "Statesmen are rarely trained
in psychiatry, psychology or anthropology and have no special claims to
any acquired skill in evaluating individual behavior and personality" [21,
p . 185]. Such training is an integral part of medical education.
The second of these two advantages of medical school is that, throughout many of the clinical clerkships, the medical student must work in the
hospital for long hours, often under stress and without sleep. While on
call the student must maintain composure in the face of demanding
patients, bloods to be drawn, IVs to be started, and an impending case
presentation to the chief of medicine the next morning. He must also be
level-headed in an emergency (even though it may have abruptly roused
him from sleep) and carefully, deliberately assist the resident in, say,
performing cardiac compressions and defibrillation during a cardiac
arrest.
There is an obvious analogy between this experience and the performance demanded of a government leader in a time of crisis, in which
instead of one life, many lives may be at stake: he must think clearly and
act decisively, under stress, perhaps without sleep. Indeed, the public
leader in a crisis can take direction from Osler's admonition to medical
students: they must maintain imperturbability, a "coolness and presence of
mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril ... " [22]. There are, on the other hand,
no night calls or cardiac arrests in law school.
In conclusion, there are many reasons to regard medical school as
equal to if not better than law school as a preparation for public office
and the responsibilities of governing. Based on schooling alone, it is
difficult to justify the popular consensus that "the attorney is the accepted agent of all politically effective groups of the American people"
[23, p. 557].
It is also difficult to accept the fact that there are so few medically
trained people leading our political and governmental institutions, when
their schooling is so appropriate for these roles. In history we find sev-
324
Michael L. Riordan
The Path to Public Office
11. eral examples of medical men who served eminently as leaders and
statesmen: Jean-Paul Marat, one of the four leaders of the French Revolution; Sun Yat-sen, the father of modern China; Prime Minister
Georges Clemenceau, the "Tiger of France," who led his country to
victory in World War I and was the chief architect of the Treaty of
Versailles. Today in America, to the society's detriment, there are but
few who apply their enormously valuable medical education to the intensely challenging and important tasks of political and governmental
leadership.
There should be more physicians who aspire to elected or appointed
roles in public office.
REFERENCES
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