Demanding Medical Excellence is a groundbreaking and accessible work that reveals how the information revolution is changing the way doctors make decisions. Michael Millenson, a three-time Pulitzer Prize nominee as a health-care reporter for the Chicago Tribune, illustrates serious flaws in contemporary medical practice and shows ways to improve care and save tens of thousands of lives.

"If you read only one book this year, read Demanding Medical Excellence. It's that good, and the revolution it describes is that important."—Health Affairs

"Millenson has done yeoman's work in amassing and understanding that avalanche of data that lies beneath most of the managed-care headlines. . . . What he finds is both important and well-explained: inconsistency, overlap, and inattention to quality measures in medical treatment cost more and are more dangerous than most cost-cutting measures. . . . [This book] elevates the healthcare debate to a new level and deserves a wide readership."—Library Journal

"An involving, human narrative explaining how we got to where we are today and what lies ahead."—Mark Taylor, Philadelphia Inquirer

"Read this book. It will entertain you, challenge, and strengthen you in your quest for better accountability in health care."—Alex R. Rodriguez, M.D., American Journal of Medical Quality

"Finally, a health-care book that doesn't wring its hands over the decline of medicine at the hands of money-grubbing corporations. . . . This is a readable account of what Millenson calls a 'quiet revolution' in health care, and his optimism makes for a refreshing change."—Publishers Weekly

"With meticulous detail, historical accuracy, and an uncommon understanding of the clinical field, Millenson documents our struggle to reach accountability."—Saty Satya-Murti, M.D., Journal of the American Medical Association

A creature of Jewish mythology, a golem is an animated being made by man from clay and water who knows neither his own strength nor the extent of his ignorance. Like science and technology, the subjects of Harry Collins and Trevor Pinch's previous volumes, medicine is also a golem, and this Dr. Golem should not be blamed for its mistakes—they are, after all, our mistakes. The problem lies in its well-meaning clumsiness.

Dr. Golem explores some of the mysteries and complexities of medicine while untangling the inherent conundrums of scientific research and highlighting its vagaries. Driven by the question of what to do in the face of the fallibility of medicine, Dr. Golem encourages a more inquisitive attitude toward the explanations and accounts offered by medical science. In eight chapters devoted to case studies of modern medicine, Collins and Pinch consider the prevalence of tonsillectomies, the placebo effect and randomized control trials, bogus doctors, CPR, the efficacy of Vitamin C in fighting cancer, chronic fatigue syndrome, AIDS cures, and vaccination. They also examine the tension between the conflicting faces of medicine: medicine as science versus medicine as a source of succor; the interests of an individual versus the interests of a group; and the benefits in the short term versus success rates in the long term. Throughout, Collins and Pinch remind readers that medical science is an economic as well as a social consideration, encapsulated for the authors in the timeless struggle to balance the good health of the many—with vaccinations, for instance—with the good health of a few—those who have adverse reactions to the vaccine.

In an age when the deaths of research subjects, the early termination of clinical trials, and the research guidelines for stem cells are front-page news, Dr. Golem is a timely analysis of the limitations of medicine that never loses sight of its strengths.

In Health Care at Risk Timothy Stoltzfus Jost, a leading expert in health law, weighs in on consumer-driven health care (CDHC), which many policymakers and analysts are promoting as the answer to the severe access, cost, and quality problems afflicting the American health care system. The idea behind CDHC is simple: consumers should be encouraged to save for medical care with health savings accounts, rely on these accounts to cover routine medical expenses, and turn to insurance only to cover catastrophic medical events. Advocates of consumer-driven health care believe that if consumers are spending their own money on medical care, they will purchase only services with real value to them. Jost contends that supporters of CDHC rely on oversimplified ideas about health care, health care systems, economics, and human nature.

In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.

In 1976, a small group of psychologists urged that more research be done on aspects of health and health care outside the domain of mental health. Today, health psychology is one of the fastest growing divisions of the American Psychological Association; journals and textbooks in increasing numbers are another signal of rapid growth in this field.

Listening to the Whispers gives voice to scholars in philosophy, medical anthropology, physical therapy, and nursing, helping readers re-think ethics across the disciplines in the context of today's healthcare system. Diverse voices, often unheard, challenge readers to enlarge the circle of their ethical concerns and look for hidden pathways toward new understandings of ethics. Essays range from a focus on the context of corporatization and managed care environments to a call for questioning the fundamental values of society as these values silently affect many others in healthcare. Each chapter is followed by a brief essay that highlights issues useful for scholarly research and classroom discussion. The conversations of interpretive research in healthcare contained in this volume encourage readers to re-think ethics in ways that will help to create an ethical healthcare system with a future of new possibilities.

Outstanding Academic Title, Choice Magazine

This book examines the major phases in the history of health services in Africa and treats health as an integral aspect of the deepening crisis in Africa’s underdevelopment. One important thesis is that Western delivery systems have made health care less accessible for most people. Contributors direct attention to problems engendered by food shortages, acute cases of infection, the market in fake drugs as well as the inequality of access to facilities, the violation of human rights, and the recent danger of the dumping of toxic wastes in several African countries. One major implication of this volume is that there can be no solution to the health crisis in Africa until the linkage between health and poverty is recognized. The authors consider questions that add to the contemporary discussion of the place that traditional African medicine and philosophy should take alongside modern Western medicine in Africa today.

Since Pinochet's regime assumed power in 1973, the Chilean public medical system has been incrementally disassembled in favor of private enterprise, modeled after U.S. HMOs. Scarpaci assembles data ranging from interviews with patients to income statements and balance sheets from the National Health Service System, National Health Fund, and National Statistics Institute to view the financial and cultural impediments imposed by the Pinochet system that have compromised and effectively limited health care accessibility for Chile's adult population.

Unequal Cures illuminates the connections between public health and political change in Bolivia from the beginning of the twentieth century, when the country was a political oligarchy, until the eve of the 1952 national revolution that ushered in universal suffrage, agrarian reform, and the nationalization of Bolivia’s tin mines. Ann Zulawski examines both how the period’s major ideological and social transformations changed medical thinking and how ideas of public health figured in debates about what kind of country Bolivia should become. Zulawski argues that the emerging populist politics of the 1930s and 1940s helped consolidate Bolivia’s medical profession and that improved public health was essential to the creation of a modern state. Yet she finds that at mid-century, women, indigenous Bolivians, and the poor were still considered inferior and consequently received often inadequate medical treatment and lower levels of medical care.

Drawing on hospital and cemetery records, censuses, diagnoses, newspaper accounts, and interviews, Zulawski describes the major medical problems that Bolivia faced during the first half of the twentieth century, their social and economic causes, and efforts at their amelioration. Her analysis encompasses the Rockefeller Foundation’s campaign against yellow fever, the almost total collapse of Bolivia’s health care system during the disastrous Chaco War with Paraguay (1932–35), an assessment of women’s health in light of their socioeconomic realities, and a look at Manicomio Pacheco, the national mental hospital.