Like other dangerous but pleasurable activities, such as downhill skiing and mountain climbing, engaging in unprotected sex implicitly involves the weighing of costs and benefits. Recognizing that the transmission of the AIDS virus is a consequence of private choices—rational and often informed—to engage in risky conduct, the authors employ tools of economic analysis to reassess the orthodox approach to AIDS by the public health community.

Standard predictions of the spread of AIDS, the authors argue, are questionable because they ignore rational behavioral response to the risk of infection. For the same reason, customary recommended public health measures, such as extensive testing for the AIDS virus, not only may be ineffective in controlling the spread of the disease but may actually cause it to spread more rapidly. The authors examine regulatory measures and proposals such as mandatory testing, criminal punishments, and immigration controls, as well as the subsidization of AIDS education and medical research, the social and fiscal costs of AIDS, the political economy of the government's response, and the interrelation of AIDS and fertility risk.

Neither liberal nor conservative, yet on the whole skeptical about governmental involvement in the epidemic, this book is certain to be controversial, but its injection of hard-headed economic thinking into the AIDS debate is long overdue. Although Private Choices and Public Health is accessible to the interested general reader, it will also capture the attention of economists—especially those involved in health issues—epidemiologists, public health workers, lawyers, and specialists in sexual behavior and drug addiction.

In recent years, issues of infection prevention and control, patient safety, and quality-of-care have become increasingly prominent in healthcare facilities. Practical Healthcare Epidemiology takes a practical, hands-on approach to these issues, addressing all aspects of infection surveillance and prevention in clear, straightforward terms. This fully revised third edition brings together the expertise of more than fifty leaders in healthcare epidemiology who provide clear, sound guidance on infection prevention and control for the full range of patients in all types of healthcare facilities, including those in settings with limited resources. A powerful resource for practitioners in any branch of medicine or public health who are involved in infection prevention and control, whether they are experienced in healthcare epidemiology or new to the field.

“A handy desk reference and an up-to-date primer for trainees and experts alike” —The Journal of the American Medical Association

“An essential for anyone in the field.”—Thomas R. Talbot, Chief Hospital Epidemiologist, Vanderbilt University Medical Center  

A call to reform Catholic health care ethics, inspired by the teachings of Pope Francis

Since its first edition in 1948, the US Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services (ERD) has guided Catholic institutions in the provision of health care that reflects both the healing ministry of Jesus and the Church’s understanding of human dignity. However, while the papacy of Pope Francis and the clerical sex-abuse scandal both profoundly impacted the Catholic Church, the latest edition of the ERD does not address or reflect these transformations.

Now for the first time, Todd A. Salzman and Michael G. Lawler present an extended critical commentary on the 2018 ERD. They argue that it is problematic in a number of ways. First, the revised ERD continues to prioritize a rule-based over a personalist-based ethical method, with an emphasis on absolute norms that proscribe specific medical acts. Further, it does not take into account Pope Francis’s transforming ecclesiological, methodological, and anthropological visions, neither internally in Catholic health care institutions nor externally in collaborations between Catholic and non-Catholic health care institutions. Finally, the revised ERD provides no evidence that the bishops grasp how the clerical sex-abuse scandal and its cover-up have fundamentally undermined episcopal authority and credibility.

Salzman and Lawler propose new ways forward for US Catholic health care ethics that prioritize human dignity as their guiding principle. As there is pluralism in Catholic definitions of human dignity, there must be pluralism in the norms and directives that facilitate realizing human dignity. Pope Francis’s emphasis on the virtues of mercy and care should move the ERD forward from a focus on absolute norms in medical ethics to a focus on virtues and principles to guide both patients and health care professionals in their discerned conscientious health care decisions.

“In this rigorous and beautifully researched volume, Milanich considers the tension between social and biological definitions of fatherhood, and shows how much we still have to learn about what constitutes a father.”
—Andrew Solomon, author of Far from the Tree: Parents, Children, and the Search for Identity

For most of human history, the notion that paternity was uncertain appeared to be an immutable law of nature. The unknown father provided entertaining plotlines from Shakespeare to the Victorian novelists and lay at the heart of inheritance and child support disputes. But in the 1920s new scientific advances promised to solve the mystery of paternity once and for all. The stakes were high: fatherhood has always been a public relationship as well as a private one. It confers not only patrimony and legitimacy but also a name, nationality, and identity.

The new science of paternity, with methods such as blood typing, fingerprinting, and facial analysis, would bring clarity to the conundrum of fatherhood—or so it appeared. Suddenly, it would be possible to establish family relationships, expose adulterous affairs, locate errant fathers, unravel baby mix-ups, and discover one’s true race and ethnicity. Tracing the scientific quest for the father up to the present, with the advent of seemingly foolproof DNA analysis, Nara Milanich shows that the effort to establish biological truth has not ended the quest for the father. Rather, scientific certainty has revealed the fundamentally social, cultural, and political nature of paternity. As Paternity shows, in the age of modern genetics the answer to the question “Who’s your father?” remains as complicated as ever.

Pain is immediate and searing but remains a deep mystery for sufferers, their physicians, and researchers. As neuroscientific research shows, even the immediate sensation of pain is shaped by psychological state and interpretation. At the same time, many individuals and cultures find meaning, particularly religious meaning, even in chronic and inexplicable pain.

This ambitious interdisciplinary book includes not only essays but also discussions among a wide range of specialists. Neuroscientists, psychiatrists, anthropologists, musicologists, and scholars of religion examine the ways that meditation, music, prayer, and ritual can mediate pain, offer a narrative that transcends the sufferer, and give public dignity to private agony. They discuss topics as disparate as the molecular basis of pain, the controversial status of gate control theory, the possible links between the relaxation response and meditative practices in Christianity and Buddhism, and the mediation of pain and intense emotion in music, dance, and ritual. The authors conclude by pondering the place of pain in understanding--or the human failure to understand--good and evil in history.

It was not long ago that scientists proclaimed victory over polio, the dread disease of the 1950s. More recently polio resurfaced, not conquered at all, spreading across the countries of Africa. As we once again face the specter of this disease, along with other killers like AIDS and SARS, this powerful book reminds us of the personal cost, the cultural implications, and the historical significance of one of modern humanity's deadliest biological enemies. In Polio and Its Aftermath Marc Shell, himself a victim of polio, offers an inspired analysis of the disease. Part memoir, part cultural criticism and history, part meditation on the meaning of disease, Shell's work combines the understanding of a medical researcher with the sensitivity of a literary critic. He deftly draws a detailed yet broad picture of the lived experience of a crippling disease as it makes it way into every facet of human existence.

Polio and Its Aftermath conveys the widespread panic that struck as the disease swept the world in the mid-fifties. It captures an atmosphere in which polio vied with the Cold War as the greatest cause of unrest in North America--and in which a strange and often debilitating uncertainty was one of the disease's salient but least treatable symptoms. Polio particularly afflicted the young, and Shell explores what this meant to families and communities. And he reveals why, in spite of the worldwide relief that greeted Jonas Salk's vaccine as a miracle of modern science, we have much more to fear from polio now than we know.

Between 1990 and 1993, breast cancer activism became a significant political movement. The issue began to receive extensive media attention, and federal funding for breast cancer research jumped dramatically. Describing the origins of this surge in interest, Maureen Hogan Casamayou attributes it to the emergence of politically potent activism among breast cancer survivors and their supporters. Exploring the creation and development of the National Breast Cancer Coalition (NBCC), she shows how many of its key leaders were mobilized by their own traumatic experiences with the disease and its treatments.

Casamayou details the NBCC’s meteoric rise and impressive lobbying efforts, explaining how—in contrast to grassroots movements founded by dedicated individuals—the coalition grew from the simultaneous efforts of a network of women who invested their time, energy, money, and professional skills in the fight for increased funding for breast cancer research. This multiple leadership—or collective entrepreneurialism, says Casamayou—was crucial to the NBCC’s success framing the issue in the minds of the public and policymakers alike.

In this wide-ranging book, one of the boldest thinkers in modern neuroscience confronts an ancient philosophical problem: can we know the world as it really is?

Drawing on provocative new findings about the psychophysiology of perception and judgment in both human and nonhuman primates, and also on the cultural history of science, Jean-Pierre Changeux makes a powerful case for the reality of scientific progress and argues that it forms the basis for a coherent and universal theory of human rights. On this view, belief in objective knowledge is not a mere ideological slogan or a naïve confusion; it is a characteristic feature of human cognition throughout evolution, and the scientific method its most sophisticated embodiment. Seeking to reconcile science and humanism, Changeux holds that the capacity to recognize truths that are independent of subjective personal experience constitutes the foundation of a human civil society.

Most neurology is done by general physicians rather than by neurologists. Still, neurology is perceived by doctors to be one of the most troublesome and difficult medical specialties. Neurologic symptoms are often vague and uncertain, and seemingly insignificant symptoms can reflect frightening disorders.

Thomas Glick, a superb teacher as well as an experienced clinician, has written this book in the belief that errors in handling neurologic cases stem not so much from a failure to command a daunting body of knowledge as from inadequate clinical reasoning. Dr. Glick shows how the skills of the primary-care physician can be applied to the special problems of neurologic history-taking and physical examination. He emphasizes time-saving ways to focus the exam and avoid diagnostic error. The book describes clear procedures for cases that the generalist can handle comfortably and offers guidelines on when (and how) to seek the advice of the consultant neurologist. Case histories, scattered liberally throughout the text, highlight the discussions and give the reader a rich sampling of specific methods of problem solving.

Clinicians who feel skeptical about the effectiveness of neurologic therapy or frustrated by its application will find here a commonsense approach to therapeutic planning. Chapters on ambulatory and chronic neurologic care also convey a positive sense of the broader therapeutic possibilities that exist in neurologic practice. Neurologic residents, senior medical students, psychiatrists, and allied health professionals, as well as primary caregivers, will benefit from the insights contained in this sensitive and articulate book.

Parkinson’s disease is a movement disorder characterized by tremor, stiffness, and slow gait. It affects 500,000 people in the United States, with approximately 50,000 new cases diagnosed annually. But its impact is much wider. Family members with little understanding of the disease often find themselves struggling to help their loved one navigate the complexities of the health care system. Patients wonder, Which treatments are best for me? Will I be able to live on my own? Should I join a drug trial?

In this straightforward, compassionate guide, Nutan Sharma and Elaine Richman address these concerns and more. They provide a thorough review of the etiology, diagnosis, and current treatment of Parkinson’s, with special consideration given to the effect on family dynamics and routines—including the often neglected topics of long-term care and sexual function. The authors also review the pros and cons of various alternative therapies, including nutritional supplements, massage therapy, and traditional Chinese medicine.

The second edition of Psychotherapy with Deaf Clients from Diverse Groups features the introduction of six new chapters that complement full revisions of original chapters with advances in the field since its initial publication. The first part begins with a new chapter on the current ethical issues relevant to working with deaf clients. In subsequent chapters it provides updated information on the diversity of consumer knowledge, attitudes, beliefs, and experiences. Deaf therapists and their involvement in the Deaf community also are scrutinized in this context.

       The revised second part examines psychotherapy for various constituencies, including deaf women; lesbian, gay, and bisexual deaf populations; children of deaf parents; and people with Usher syndrome. Part Three chapters consider interventions with African American deaf clients, American Indians who are deaf, and Asians who are American and deaf. A new chapter expands information on therapy for Latino deaf clients.

       The final section incorporates three new chapters on other deaf populations — deaf college students, recipients of cochlear implants, and deaf elderly clients. Also, new information has been added to chapters on the treatment of deaf survivors of sexual abuse and deaf clients with chemical dependency. The last addition to the second edition outlines dialectical behavior therapy for deaf clients, a valuable option for clinicians.

This is the compelling story of an experiment begun in 1961 that eventually affected the lives of almost all of the residents of the island of Martha's Vineyard. The author writes engagingly of the island and its year-round inhabitants, a community of some seven thousand persons of diverse ethnic and social backgrounds.

With sympathy and insight Milton Mazer analyzes the stresses that are peculiar to the conditions of life on the island, and he describes the kinds of psychological disorders that are precipitated by those stresses. He reports, without technical jargon, the results of a five-year study of a great variety of psychosocial predicaments experienced by the people of the island. Finally he examines the catalytic effect the mental health center and its research findings have had on the development of other supportive agencies and how the community established a network of human services to meet its needs.

The work clearly demonstrates that striking advances can be made by a mental health program that is informed by an understanding of the community served. The book will stand as a model for future studies in this area.

This volume heralds the appearance, for the first time in many years, of a totally new document by Sigmund Freud. It is the draft of a lost metapsychological paper, one of twelve essays written during World War I at the peak of the master's powers. Freud intended to publish all twelve in book form, under the title Preliminaries to a Metapsychology, and thereby set out the theoretical foundations of psychoanalysis. Scholars have long lamented the disappearance without a trace of seven of these important essays.

Only in 1983 did Ilse Grubrich-Simitis happen upon this draft, in Freud's handwriting, in an old trunk containing papers and documents of his Hungarian collaborator Sándor Ferenczi. With the help of a brief letter Freud had written on the back of the last page, she soon realized that the manuscript she had found was the draft of the final paper in the series. That draft is published here in facsimile, together with a transcription in German of the facsimile and the English translation.

In the first part of the draft, which is written in a kind of shorthand, Freud contrasts the three classic transference neuroses: anxiety hysteria, conversion hysteria, and obsessional neurosis. In the second part, which is written in complete sentences, Freud undertakes a daringly speculative "phylogenetic fantasy" He explores whether the debilitating illnesses of the neurotic and the psychotic today might have originated long ago as adaptive responses of the entire species to threatening environmental changes or to traumatic events in the prehistory of mankind.

In the draft "Fantasy" Freud modifies and expands the line of reasoning he began in Totem and Taboo (1912-13) after an intensely productive exchange with Ferenczi about Lamarckian concepts, making this recovered draft of major significance to students not only of psychoanalysis but also of the social sciences, humanities, and natural sciences.

Ilse Grubrich-Simitis has contributed a detailed essay, setting the overview in the context of Freud's life, his work, and his historical and scientific prominence. She quotes from relevant letters of Freud and Ferenczi, some published here for the first time.

Salvador Minuchin is widely recognized as one of the preeminent family therapists in the world. He has been described, in the American Journal of Psychotherapy, as “a most original innovator, a superb clinician, and an outstanding teacher.” Now, in this pioneering work, he and his co-authors apply the effectiveness of family therapy techniques to an illness that has long resisted treatment—anorexia nervosa.

The purpose of their book is threefold: to develop a new theory of psychosomatic disease, to confirm it with scientific data, and to show it unfolding in actual therapeutic situations with anorectic patients. Drawing upon their own clinical experience and illustrating their views with case studies, they advance a new approach that places the locus of the illness not in the individual but in the family. Their method, which has been highly successful, requires the active involvement of the therapist as an agent of change within the family, stimulating crises that are severe enough to shake up the system and allow it to reform in new and healthier patterns.

This book has revolutionary implications, not just for anorectic patients but for those suffering from all other psychosomatic disease. Whereas such illnesses to date have often eluded treatment, the approach through family therapy holds out the promise of future successes.

Plants seldom figure in the grand narratives of war, peace, or even everyday life yet they are often at the center of high intrigue. In the eighteenth century, epic scientific voyages were sponsored by European imperial powers to explore the natural riches of the New World, and uncover the botanical secrets of its people. Bioprospectors brought back medicines, luxuries, and staples for their king and country. Risking their lives to discover exotic plants, these daredevil explorers joined with their sponsors to create a global culture of botany.

But some secrets were unearthed only to be lost again. In this moving account of the abuses of indigenous Caribbean people and African slaves, Schiebinger describes how slave women brewed the "peacock flower" into an abortifacient, to ensure that they would bear no children into oppression. Yet, impeded by trade winds of prevailing opinion, knowledge of West Indian abortifacients never flowed into Europe. A rich history of discovery and loss, Plants and Empire explores the movement, triumph, and extinction of knowledge in the course of encounters between Europeans and the Caribbean populations.

As Puerto Rico rapidly industrialized from the late 1940s until the 1970s, the social, political, and economic landscape changed profoundly. In the realm of heath care, the development of medical education, new medical technologies, and a new faith in science radically redefined childbirth and its practice. What had traditionally been a home-based, family-oriented process, assisted by women and midwives and “accomplished” by mothers, became a medicalized, hospital-based procedure, “accomplished” and directed by biomedical, predominantly male, practitioners, and, ultimately reconfigured, after the 1980s, into a technocratic model of childbirth, driven by doctors’ fears of malpractice suits and hospitals’ corporate concerns.

Pushing in Silence charts the medicalization of childbirth in Puerto Rico and demonstrates how biomedicine is culturally constructed within regional and historical contexts. Prior to 1950, registered midwives on the island outnumbered registered doctors by two to one, and they attended well over half of all deliveries. Isabel M. Córdova traces how, over the next quarter-century, midwifery almost completely disappeared as state programs led by scientifically trained experts and organized by bureaucratic institutions restructured and formalized birthing practices. Only after cesarean rates skyrocketed in the 1980s and 1990s did midwifery make a modest return through the practices of five newly trained midwives. This history, which mirrors similar patterns in the United States and elsewhere, adds an important new chapter to the development of medicine and technology in Latin America.

A searing study of how modern reproductive politics shapes women's bodily agency

Pregnancy indisputably takes place within a woman's body. But as reproductive power finds its way into the hands of medical professionals, lobbyists, and policymakers, the geographies of pregnancy are shifting, and the boundaries need to be redrawn, argues Laura R. Woliver. The Political Geographies of Pregnancy is a vigorous analysis of the ways modern reproductive politics are shaped by long-standing debates on abortion and adoption, surrogacy arrangements, new reproductive technologies, medical surveillance, and the mapping of the human genome.

Across a politically charged backdrop of reproductive issues, Woliver exposes strategies that claim to uphold the best interests of children, families, and women but in reality complicate women's struggles to have control over their own bodies. Utilizing feminist standpoint theory and promoting a feminist ethic of care, Woliver looks at abortion politics, modern adoption laws that cater to male-headed families, regulations that allow the state to monitor pregnant women but not always provide care for them, and the power structures behind the seemingly benign world of egg-selling and surrogate parenting. She also considers the potentially staggering political implications of mapping the human genome, and the exclusion of women's perspectives in discussions about legislation and advancements in reproductive technologies.

The ability to identify and abort fetuses with certain genetic abnormalities is among the most recent and most important of medical advances. In this book, one of the world's leading medical geneticists, Harry Harris, discusses the promise and the perils of the new techniques. Dr. Harris writes with great clarity; he explains technical concepts and terms so well that a layman can follow his account with little effort. This book will serve as an excellent introduction to a large and growing literature.

Dr. Harris begins by explaining methods of prenatal diagnosis and the kinds of disease that can, at present, be identified in utero. He identifies technological limitations of the procedure and also discusses certain theoretical factors that limit its future applicability. The book concludes with a long and balanced examination of ethical issues entailed by the practice of selective abortion. The author limits discussion of his own opinions in favor of evaluating the main contemporary positions and exploring the basis of controversy. He makes clear, however, his own view that there are clear advantages to the technique and clear limitations and that there will always be gray areas in which decision must be painful and individual—unaided by pat moralizing.

As prenatal tests proliferate, the medical and broader communities perceive that such testing is a logical extension of good prenatal care—it helps parents have healthy babies. But prenatal tests have been criticized by the disability rights community, which contends that advances in science should be directed at improving their lives, not preventing them. Used primarily to decide to abort a fetus that would have been born with mental or physical impairments, prenatal tests arguably reinforce discrimination against and misconceptions about people with disabilities.

In these essays, people on both sides of the issue engage in an honest and occasionally painful debate about prenatal testing and selective abortion. The contributors include both people who live with and people who theorize about disabilities, scholars from the social sciences and humanities, medical geneticists, genetic counselors, physicians, and lawyers. Although the essayists don't arrive at a consensus over the disability community's objections to prenatal testing and its consequences, they do offer recommendations for ameliorating some of the problems associated with the practice.

Arguing that the state must meet strict conditions to justify interfering in at-risk pregnancies, Deborah Mathieu examines the legal and ethical concerns that arise when governments mandate the behavior of pregnant women. She explores both the pregnant woman's right to decide what happens to her body and the future child's right to be protected from avoidable damage. Mathieu addresses such topics as reproductive hazards in the workplace, mandated fetal therapy, forced lifestyle changes for pregnant women, and the future child's right to sue for lack of prenatal care. The controversy raises key issues of rights, duties, and the scope of legitimate state action, thus posing fundamental challenges to the fields of medicine, biomedical ethics, law, and public policy.

This edition has been completely updated and expanded. Mathieu presents new arguments for acceptable types of state intervention and provides specific examples. This edition also incorporates recent court decisions, especially cases involving substance abuse. The book includes both an updated bibliography and an updated reference list of relevant court cases.

Since the publication seven years ago of the third edition of this classic work, there have been rapid changes in the field of dental public health. A sharp drop in childhood tooth decay in developed countries has resulted from the fluoridation of drinking water. Budget cuts in governmental dental care programs have brought increased emphasis to the need for auxiliaries as responsible members of the dental team.

This new edition presents a complete and up-to-date treatment of the tools of dental public health, including biostatistics, epidemiology, and the social sciences. James Morse Dunning provides a concise discussion of survey and evaluation methods and of techniques for the design of delivery programs for dental care. He evaluates the impact of the increasing demand for adult and geriatric dentistry. In response to the critical need for cost-efficient dental care, Dunning goes beyond most dental organizations of the day to advocate the use of well-trained paradental personnel under the general supervision of dentists.

A mere "symbol" of medicine--the sugar pill, saline injection, doctor in a white lab coat--the placebo nonetheless sometimes produces "real" results. Medical science has largely managed its discomfort with this phenomenon by discounting the placebo effect, subtracting it as an impurity in its data through double-blind tests of new treatments and drugs. This book is committed to a different perspective--namely, that the placebo effect is a "real" entity in its own right, one that has much to teach us about how symbols, settings, and human relationships literally get under our skin.

Anne Harrington's introduction and a historical overview by Elaine Shapiro and the late Arthur Shapiro, which open the book, review the place of placebos in the history of medicine, investigate the current surge in interest in them, and probe the methodological difficulties of saying scientifically just what placebos can and cannot do. Combining individual essays with a dialogue among writers from fields as far-flung as cultural anthropology and religion, pharmacology and molecular biology, the book aims to expand our ideas about what the placebo effect is and how it should be seen and studied. At the same time, the book uses the challenges and questions raised by placebo phenomena to initiate a broader interdisciplinary discussion about our nature as cultural animals: animals with minds, brains, and bodies that somehow manage to integrate "biology" and "culture," "mechanism" and "meaning," into a seamless whole.

When workmen excavating the ruins of Pompeii eagerly gathered the native medicinal plants growing there, Wilhelmina Jashemski discovered that this was another example of the continuity of life in the shadow of Vesuvius. Many of the plants used for herbal medicine around Pompeii today are the same ones that ancient authorities such as Pliny the Elder and Dioscorides recommended for treating the same types of disorders.

In this book, Jashemski presents an herbal of thirty-six medicinal plants, most of them known to the ancients and still employed today. She describes each plant's contemporary medicinal uses and compares them to ancient practices as recorded in literary sources. Scientific, English, and Italian names and the plant's mythological associations complete the entries, while elegant, full-page portraits depict each plant visually.