Through the ages, rabies has exemplified the danger of diseases that transfer from wild animals to humans and their domestic stock. In South Africa, rabies has been on the rise since the latter part of the twentieth century despite the availability of postexposure vaccines and regular inoculation campaigns for dogs.
In Mad Dogs and Meerkats: A History of Resurgent Rabies in Southern Africa, Karen Brown links the increase of rabies to the HIV/AIDS epidemic. Her study shows that the most afflicted regions of South Africa have seen a dangerous rise in feral dog populations as people lack the education, means, or will to care for their pets or take them to inoculation centers. Most victims are poor black children. Ineffective disease control, which in part depends on management policies in neighboring states and the diminished medical and veterinary infrastructures in Zimbabwe, has exacerbated the problem.
This highly readable book is the first study of rabies in Africa, tracing its history in South Africa and neighboring states from 1800 to the present and showing how environmental and economic changes brought about by European colonialism and global trade have had long-term effects.
Mad Dogs and Meerkats is recommended for public health policy makers and anyone interested in human-animal relations and how societies and governments have reacted to one of the world’s most feared diseases.
A mother whose child has had a cochlear implant tells Laura Mauldin why enrollment in the sign language program at her daughter’s school is plummeting: “The majority of parents want their kids to talk.” Some parents, however, feel very differently, because “curing” deafness with cochlear implants is uncertain, difficult, and freighted with judgment about what is normal, acceptable, and right. Made to Hear sensitively and thoroughly considers the structure and culture of the systems we have built to make deaf children hear.
Based on accounts of and interviews with families who adopt the cochlear implant for their deaf children, this book describes the experiences of mothers as they navigate the health care system, their interactions with the professionals who work with them, and the influence of neuroscience on the process. Though Mauldin explains the politics surrounding the issue, her focus is not on the controversy of whether to have a cochlear implant but on the long-term, multiyear undertaking of implantation. Her study provides a nuanced view of a social context in which science, technology, and medicine are trusted to vanquish disability—and in which mothers are expected to use these tools. Made to Hear reveals that implantation has the central goal of controlling the development of the deaf child’s brain by boosting synapses for spoken language and inhibiting those for sign language, placing the politics of neuroscience front and center.
Examining the consequences of cochlear implant technology for professionals and parents of deaf children, Made to Hear shows how certain neuroscientific claims about neuroplasticity, deafness, and language are deployed to encourage compliance with medical technology.
Contributors: P. Wenzel Geissler; Murray Last; Rebecca Marsland; Lotte Meinert; Benson A. Mulemi; Ruth J. Prince; and Noemi Tousignant.
Since 1955, moving from early work in psychopharmacology to studies of clinical method and the psychiatric schools, Leston Havens has been working toward a general theory of therapy. It often seems that twentieth-century psychiatry, sect-ridden, is a Tower of Babel, as Havens once characterized it. This book is the distillation of long years of thought and practice, a bold yet modest attempt to delineate an “integrated psychotherapy.”
The boldness of this effort lies in its author’s willingness to recognize the best that each school has to offer, to describe it cogently, and to integrate it into a full response to today’s new kind of patient. Descriptive or medical psychiatry, psychoanalysis, interpersonal or behavioristic psychiatry, empathic or existential therapy-viewed in metaphors, respectively, of perceiving, thinking, managing, feeling-all have useful contributions to make to contemporary methods of treatment. But how? Havens’s modest answer is through appropriate language, and he demonstrates exactly what he means: when to ask questions, when to direct or draw back, when to sympathize.
Practitioners now must deal with less dramatic, but more stubborn, problems of character and situation; lack of purpose, isolation, submissiveness, invasiveness, deep yet vague dissatisfaction. Some kind of human presence must be discovered in the patient, and Havens gives concrete, absorbing examples of ways of “speaking to absence,” of making contact. The emphasis is on verbal technique, but the underlying broad, humane intent is everywhere evident. It is no less than to transform passivity, by means of disciplined therapeutic concern, into a state of being Human.
In the last fifteen years, the field of palliative care has experienced a surge in interest in spirituality as an important aspect of caring for seriously ill and dying patients. While spirituality has been generally recognized as an essential dimension of palliative care, uniformity of spiritual care practice has been lacking across health care settings due to factors like varying understandings and definitions of spirituality, lack of resources and practical tools, and limited professional education and training in spiritual care.
In England in the seventeenth century, childbirth was the province of women. The midwife ran the birth, helped by female "gossips"; men, including the doctors of the day, were excluded both from the delivery and from the subsequent month of lying-in.
But in the eighteenth century there emerged a new practitioner: the "man-midwife" who acted in lieu of a midwife and delivered normal births. By the late eighteenth century, men-midwives had achieved a permanent place in the management of childbirth, especially in the most lucrative spheres of practice.
Why did women desert the traditional midwife? How was it that a domain of female control and collective solidarity became instead a region of male medical practice? What had broken down the barrier that had formerly excluded the male practitioner from the management of birth?
This confident and authoritative work explores and explains a remarkable transformation--a shift not just in medical practices but in gender relations. Exploring the sociocultural dimensions of childbirth, Wilson argues with great skill that it was not the desires of medical men but the choices of mothers that summoned man-midwifery into being.
At the dawn of the twenty-first century, we have become accustomed to medical breakthroughs and conditioned to assume that, regardless of illnesses, doctors almost certainly will be able to help—not just by diagnosing us and alleviating our pain, but by actually treating or even curing diseases, and significantly improving our lives.
For most of human history, however, that was far from the case, as veteran medical historian Michael Bliss explains in The Making of Modern Medicine. Focusing on a few key moments in the transformation of medical care, Bliss reveals the way that new discoveries and new approaches led doctors and patients alike to discard fatalism and their traditional religious acceptance of suffering in favor of a new faith in health care and in the capacity of doctors to treat disease. He takes readers in his account to three turning points—a devastating smallpox outbreak in Montreal in 1885, the founding of the Johns Hopkins Hospital and Medical School, and the discovery of insulin—and recounts the lives of three crucial figures—researcher Frederick Banting, surgeon Harvey Cushing, and physician William Osler—turning medical history into a fascinating story of dedication and discovery.
Compact and compelling, this searching history vividly depicts and explains the emergence of modern medicine—and, in a provocative epilogue, outlines the paradoxes and confusions underlying our contemporary understanding of disease, death, and life itself.
Advance directives—such as living wills and health care proxies—are documents intended to declare and preserve the health care choices of patients if they become unable to make their own decisions. This book provides a comprehensive overview of advance directives and clear, practical directions for writing and interpreting them.
Nancy M.P. King provides a legal, philosophical, and historical analysis of the moral and legal force of advance directives. She explains the types and models of advance directives currently in use and offers guidelines for individuals seeking to write, read, and use directives to promote individuals' health care choices within the laws of their own states.
King emphasizes that advance directives are not orders given by patients to their doctors; instead, they are documents that invite conversation between doctors and patients about health care decisions of great importance. The purpose of advance directives is to support patients' health care choices, and the book promotes a thoughtful use of advance directives that is best calculated to achieve that purpose, whatever form individual advance directives may take.
This new edition has been updated to reflect the many changes in advance directive statutes since 1991, including expanded discussions of health care proxy statutes, the impact of the Patient Self-Determination Act and the Supreme Court's Cruzan decision. King also has extended her analysis of the implications for advance directives of managed care, resource allocation, resource scarcity, and the debate over futile treatment at the end of life.
Making Sense of Advance Directives is a valuable handbook for patients, health care providers and administrators, patient counselors, lawyers, policymakers, and any individual interested in advance directives.
Most Americans—even those with significant disability—want to live in their homes and communities. Unpaid family members or friends often work as “informal” caregivers, helping those who need assistance— and many feel they have no option but to serve. In contrast, paid personal assistance services workers (PAS) provide a lifeline to those consumers with complex needs and limited social networks. However, there is a crisis looming in the increasing needs for paid PAS and the limited available PAS workforce.
Making Their Days Happen explores disability, health, and civil rights, along with relevant federal and state labor policies related to personal assistance services. Lisa Iezzoni addresses the legal context of paid PAS as well as financing mechanisms for obtaining home-based personal assistance. She also draws upon interviews she conducted with paid PAS consumers and PAS workers to explore PAS experiences and their perspectives about their work.
Offering recommendations for improving future experiences of PAS consumers and providers, Iezzoni emphasizes that people with disabilities want to be a part of society, and PAS workers who do this low-wage work find satisfaction in helping them achieve their goals.
A sweeping global history that looks beyond European urban centers to show how slavery, colonialism, and war propelled the development of modern medicine.
Most stories of medical progress come with ready-made heroes. John Snow traced the origins of London’s 1854 cholera outbreak to a water pump, leading to the birth of epidemiology. Florence Nightingale’s contributions to the care of soldiers in the Crimean War revolutionized medical hygiene, transforming hospitals from crucibles of infection to sanctuaries of recuperation. Yet histories of individual innovators ignore many key sources of medical knowledge, especially when it comes to the science of infectious disease.
Reexamining the foundations of modern medicine, Jim Downs shows that the study of infectious disease depended crucially on the unrecognized contributions of nonconsenting subjects—conscripted soldiers, enslaved people, and subjects of empire. Plantations, slave ships, and battlefields were the laboratories in which physicians came to understand the spread of disease. Military doctors learned about the importance of air quality by monitoring Africans confined to the bottom of slave ships. Statisticians charted cholera outbreaks by surveilling Muslims in British-dominated territories returning from their annual pilgrimage. The field hospitals of the Crimean War and the US Civil War were carefully observed experiments in disease transmission.
The scientific knowledge derived from discarding and exploiting human life is now the basis of our ability to protect humanity from epidemics. Boldly argued and eye-opening, Maladies of Empire gives a full account of the true price of medical progress.
“Maladies of Empire has a captivating writing style, is exhaustively researched, and is persuasive in argumentation. Jim Downs has written a game-changing book.”—Deirdre Cooper Owens, author of Medical Bondage: Race, Gender, and the Origins of American Gynecology
“An eye-popping study of the history of infectious diseases, how they spread, and especially how they have been thwarted by experimentation on the bodies of soldiers, slaves, and colonial subjects…a timely, brilliant book about some of the brutal ironies in the story of medical progress.”—David W. Blight, author of Frederick Douglass
“Brilliant…Jim Downs uncovers the origins of epidemiology in slavery, colonialism, and war. A most original global history, this book is required reading for historians, medical researchers, and really anyone interested in the origins of modern medicine.”—Sven Beckert, author of Empire of Cotton
“[Sheds] light on the violent foundations of disease control interventions and public health initiatives [and] implores us to address their inequities in the present.”—Ragav Kishore, The Lancet
Most stories of medical progress come with ready-made heroes. John Snow traced the origins of London’s 1854 cholera outbreak to a water pump, leading to the birth of epidemiology. Florence Nightingale’s care of soldiers in the Crimean War revolutionized medical hygiene. Yet focusing on individual innovators ignores many of the darker, unacknowledged sources of medical knowledge.
Reexamining the foundations of modern medicine, Jim Downs shows that the study of infectious disease depended crucially on the unrecognized contributions of conscripted soldiers, enslaved people, and subjects of empire. From Africa and India to the Americas, plantations, slave ships, and battlefields were the laboratories where physicians came to understand the spread of disease. Boldly argued and urgently relevant, Maladies of Empire gives a long overdue account of the true price of medical progress.
Russian psychologist A. R. Luria presents a compelling portrait of a man’s heroic struggle to regain his mental faculties. A soldier named Zasetsky, wounded in the head at the battle of Smolensk in 1943, suddenly found himself in a frightening world: he could recall his childhood but not his recent past; half his field of vision had been destroyed; he had great difficulty speaking, reading, and writing.
Much of the book consists of excerpts from Zasetsky’s own diaries. Laboriously, he records his memories in order to reestablish his past and to affirm his existence as an intelligent being. Luria’s comments and interpolations provide a valuable distillation of the theory and techniques that guided all of his research. His “digressions” are excellent brief introductions to the topic of brain structure and its relation to higher mental functions.
Shattering the myths about what’s wrong with managed health care, this penetrating introduction to managed care explains its origins and identifies its real achievements and shortcomings.
Walter A. Zelman and Robert A. Berenson argue that many criticisms of managed care tend to idealize the costly and fragmented insurance system it supplanted, without pinpointing the true inadequacies of today’s managed care. In addition to providing reasoned answers to the most alarmist critiques of managed care, the authors maintain that it has not fulfilled its potential to improve the overall quality of care.
The authors propose thirteen concrete recommendations for raising quality in managed care programs, ranging from enacting additional legal protections and increased disclosure to putting the purchasing power in the hands of those who care most about quality — individuals, rather than employers.
With practical solutions for making managed care better, The Managed Care Blues and How to Cure Them is a bold call for greater consumer protection, knowledge, and power in the health care arena.
In Managing Motherhood, Managing Risk, Denise Roth Allen persuasively argues that development interventions in the Third World often have unintended and unacknowledged consequences. Based on twenty-two months of fieldwork in the Shinyanga Region of west central Tanzania, this rich and engaging ethnography of women's fertility-related experiences highlights the processes by which a set of seemingly well-intentioned international maternal health policy recommendations go awry when implemented at the local level.
An exploration of how threats to maternal health have been defined and addressed at the global, national, and local levels, Managing Motherhood, Managing Risk presents two contrasting, and oftentimes competing, definitions of risk: those that form the basis of international recommendations and national maternal health policies and those that do not. The effect that these contrasting definitions of risk have on women's fertility-related experiences at the local level are explored throughout the book.
This study employs an innovative approach to the analysis of maternal health risk, one that situates rural Tanzanian women's fertility-related experiences within a broader historical and sociocultural context. Beginning with an examination of how maternal health risk was defined and addressed during the early years of British colonial rule in Tanganyika and moving to a discussion of an internationally conceived maternal health initiative that was launched on the world stage in the late 1980s, the author explores the similarities in the language used and solutions proposed by health development experts over time.
This set of "official" maternal health risks is then compared to an alternative set of risks that emerge when attention is focused on women's experiences of pregnancy and childbirth at the local level. Although some of these latter risks are often spoken about as deriving from spiritual or supernatural causes, the case studies presented throughout the second half of the book reveal that the concept of risk in the context of pregnancy and childbirth is much more complex, involving the interplay of spiritual, physical, and economic aspects of everyday life.
Contributors. Ellen Barry, Laurie Beck, Joan Bertin, Janet Calvo, Wendy Chavkin, Kay Dickersin, Abigail English, Elizabeth Fee, Carol Gill, Nancy Krieger, Joyce McConnell, Judy Norsigian, Ann Scales, Susan Stefan, Lauren Schnaper, Catherine Teare
Widely praised as the best available study of its kind, Marriage and Divorce, in a new, revised edition, incorporates recent statistics to bring its treatment up to date. This book is replete with information about factors affecting the stability of marriage, the decision to marry or to divorce, and differences in marriage and divorce patterns among various socioeconomic classes and races. There are, in addition, chapters on people who never marry, on the relationship of marital status and health, on family composition and living arrangements, and on work experience and income of married persons. The new, concluding chapter focuses on developments in the turbulent decade of the sixties and early seventies.
Sociologists, psychologists, marriage counselors, and practitioners in the medical and health fields as well as demographers will find this study invaluable, as will students in these and related areas.
Much like Vladimir Lenin, his onetime rival for the leadership of the Bolshevik party during its formative years, Alexander Bogdanov (1873–1928) was a visionary. In two science fiction novels set on Mars, Bogdanov imagined a future in which the workers of the world, liberated from capitalist exploitation, create a “physiological collective” that rejuvenates and unites its members through regular blood exchanges. But Bogdanov was not merely a dreamer. He worked tirelessly to popularize and realize his vision, founding the first research institute devoted to the science of blood transfusion.
In A Martian Stranded on Earth, the first broad-based book on Bogdanov in English, Nikolai Krementsov examines Bogdanov’s roles as revolutionary, novelist, and scientist, presenting his protagonist as a coherent thinker who pursued his ideas in a wide range of venues. Through the lens of Bogdanov’s involvement with blood studies on one hand, and of his fictional and philosophical writings on the other, Krementsov offers a nuanced analysis of the interactions between scientific ideas and societal values.
Scholarship on Maya healing traditions has focused primarily on the roles of midwives, shamans, herbalists, and diviners. Bonesetters, on the other hand, have been largely excluded from conversations about traditional health practitioners and community health resources. Maya Bonesetters is the first book-length study of bonesetting in Guatemala and situates the manual healing tradition within the current cultural context—one in which a changing medical landscape potentially threatens bonesetters’ work yet presents an opportunity to strengthen its relevance.
Drawing on extensive field research in highland Guatemala, Servando Z. Hinojosa introduces readers to a seldom documented, though nonetheless widespread, variety of healer. This book examines the work of Kaqchikel and Tz’utujiil Maya bonesetters, analyzes how they diagnose and treat injuries, and contrasts the empirical and sacred approaches of various healers. Hinojosa shows how bonesetters are carefully adapting certain biomedical technologies to meet local expectations for care and concludes that, despite pressures and criticisms from the biomedical community, bonesetting remains culturally meaningful and vital to Maya people, even if its future remains uncertain.
A Measure of Malpractice tells the story and presents the results of the Harvard Medical Practice Study, the largest and most comprehensive investigation ever undertaken of the performance of the medical malpractice system. The Harvard study was commissioned by the government of New York in 1986, in the midst of a malpractice crisis that had driven insurance premiums for surgeons and obstetricians in New York City to nearly $200,000 a year.
The Harvard-based team of doctors, lawyers, economists, and statisticians set out to investigate what was actually happening to patients in hospitals and to doctors in courtrooms, launching a far more informed debate about the future of medical liability in the 1990s. Careful analysis of the medical records of 30,000 patients hospitalized in 1984 showed that approximately one in twenty-five patients suffered a disabling medical injury, one quarter of these as a result of the negligence of a doctor or other provider. After assembling all the malpractice claims filed in New York State since 1975, the authors found that just one in eight patients who had been victims of negligence actually filed a malpractice claim, and more than two-thirds of these claims were filed by the wrong patients.
The study team then interviewed injured patients in the sample to discover the actual financial loss they had experienced: the key finding was that for roughly the same dollar amount now being spent on a tort system that compensates only a handful of victims, it would be possible to fund comprehensive disability insurance for all patients significantly disabled by a medical accident. The authors, who came to the project from very different perspectives about the present malpractice system, are now in agreement about the value of a new model of medical liability. Rather than merely tinker with the current system which fixes primary legal responsibility on individual doctors who can be proved medically negligent, legislatures should encourage health care organizations to take responsibility for the financial losses of all patients injured in their care.
An exploration of the representational culture of Alzheimer’s disease and how media technologies shape our ideas of cognition and aging
With no known cause or cure despite a century of research, Alzheimer’s disease is a true medical mystery. In Mediating Alzheimer’s, Scott Selberg examines the nature of this enduring national health crisis by looking at the disease’s relationship to media and representation. He shows how collective investments in different kinds of media have historically shaped how we understand, treat, and live with this disease.
Selberg demonstrates how the cognitive abilities that Alzheimer’s threatens—memory, for example—are integrated into the operations of representational technologies, from Polaroid photographs to Post-its to digital artificial intelligence. Focusing on a wide variety of media technologies, such as neuroimaging, art therapy, virtual reality, and social media, he shows how these cognitively oriented media ultimately help define personhood for people with Alzheimer’s. Media have changed the practices of successful aging in the United States, and Selberg takes us deep into how technologies like digital brain-training and online care networks shape ideas of cognition and healthy aging.
Packed with startlingly fresh insights, Mediating Alzheimer’s contributes to debates around bioethics, the labor of caregiving, and a national economy increasingly invested in communication and digital media. Probing the very technologies that promise to save and understand our brains, it gives us new ways of understanding Alzheimer’s disease and aging in America.
With the defeat of national health reform, many liberals have looked to the states as the source of health policy innovation. At the same time, many in the new Republican majority and several governors also support increased state control. In contrast, Michael S. Sparer convincingly argues that states by themselves can neither satisfy the liberal hope for universal coverage nor the conservative hope for cost containment. He also points to two critical drawbacks to a state-dominated health care system: the variation in coverage among states and the intergovernmental tension that would inevitably accompany such a change.
Supporting his arguments, Sparer analyzes the contradictions in operations and policies between the New York and California Medicaid programs. For instance, why does New York spend an average of $7,286 on its Medicaid beneficiaries and California an average of $2,801? The answer, the author suggests, is rooted in bureaucratic politics. California officials enjoy significant bureaucratic autonomy, while the system in New York is fragmented, decentralized, and interest-group dominated. The book supports this conclusion by exploring nursing home and home care policy, hospital care policy, and managed care policy in the two states. Sparer's dissection of the consequences of state-based reform make a persuasive case for national health insurance.
Medicaid, one of the largest federal programs in the United States, gives grants to states to provide health insurance for over 60 million low-income Americans. As private health insurance benefits have relentlessly eroded, the program has played an increasingly important role. Yet Medicaid’s prominence in the health care arena has come as a surprise.
Many astute observers of the Medicaid debate have long claimed that “a program for the poor is a poor program” prone to erosion because it serves a stigmatized, politically weak clientele. Means-tested programs for the poor are often politically unpopular, and there is pressure from fiscally conservative lawmakers to scale back the $350-billion-per-year program even as more and more Americans have come to rely on it. For their part, health reformers had long assumed that Medicaid would fade away as the country moved toward universal health insurance. Instead, Medicaid has proved remarkably durable, expanding and becoming a major pillar of America’s health insurance system.
In Medicaid Politics, political scientist Frank J. Thompson examines the program’s profound evolution during the presidential administrations of Bill Clinton, George W. Bush, and Barack Obama and its pivotal role in the epic health reform law of 2010. This clear and accessible book details the specific forces embedded in American federalism that contributed so much to Medicaid’s growth and durability during this period. It also looks to the future outlining the political dynamics that could yield major program retrenchment.
For over thirty years, David F. Kelly has worked with medical practitioners, students, families, and the sick and dying to confront the difficult and often painful issues that concern medical treatment at the end of life. In this short and practical book, Kelly shares his vast experience, providing a rich resource for thinking about life's most painful decisions.
Kelly outlines eight major issues regarding end-of-life care as seen through the lens of the Catholic medical ethics tradition. He looks at the distinction between ordinary and extraordinary means; the difference between killing and allowing to die; criteria of patient competence; what to do in the case of incompetent patients; the meaning and use of advance directives; the morality of hydration and nutrition; physician-assisted suicide and euthanasia; and medical futility. Kelly's analysis is sprinkled with significant legal decisions and, throughout, elaborations on how the Catholic medical ethics tradition—as well as teachings of bishops and popes—understands each issue. He provides a helpful glossary to supplement his introduction to the terminology used by philosophical health care ethics. Included in Kelly's discussion is his lucid description of why the Catholic tradition supports the discontinuation of medical care in the Terry Schiavo case. He also explores John Paul II's controversial papal allocution concerning hydration and nutrition for unconscious patients, arguing that the Catholic tradition does not require feeding the permanently unconscious.
Medical Care at the End of Life addresses the major issues that inform this last stage of caregiving. It offers a critical guide to understanding the medical ethics and relevant legal cases needed for clear thinking when individuals are faced with those crucial decisions.
Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine.
In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical and technological procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to accelerate labor with oxytocin to augment their productivity. Despite the achievements of the childbirth and women’s health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year.
The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. While Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their strategies will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be fundamentally "re-formed," and the reforms must be based on democracy, caring, and social justice as well as economics.
In this book Paul Carrick charts the ancient Greek and Roman foundations of Western medical ethics. Surveying 1500 years of pre-Christian medical moral history, Carrick applies insights from ancient medical ethics to developments in contemporary medicine such as advance directives, gene therapy, physician-assisted suicide, abortion, and surrogate motherhood. He discusses such timeless issues as the social status of the physician; attitudes toward dying and death; and the relationship of medicine to philosophy, religion, and popular morality. Opinions of a wide range of ancient thinkers are consulted, including physicians, poets, philosophers, and patients. He also explores the puzzling question of Hippocrates' identity, analyzing not only the Hippocratic Oath but also the Father of Medicine's lesser-known works.
Complete with chapter discussion questions, illustrations, a map, and appendices of ethical codes, Medical Ethics in the Ancient World will be useful in courses on the medical humanities, ancient philosophy, bioethics, comparative cultures, and the history of medicine. Accessible to both professionals and to those with little background in medical philosophy or ancient science, Carrick's book demonstrates that in the ancient world, as in our own postmodern age, physicians, philosophers, and patients embraced a diverse array of perspectives on the most fundamental questions of life and death.
This book is the first comprehensive examination of medical ethics in the Renaissance. It investigates the ethical considerations, evaluations of procedures, and techniques of problem-solving in the writings of European physicians and surgeons from the mid-sixteenth through the mid-seventeenth centuries.
While much of the medical practice and literature of the Renaissance remained a continuation or reinterpretation of ancient medicine, Winfried Schleiner reveals an emerging self-conscious field of medical ethics that should be considered modern, as it increasingly separates medicine from theology, the cure of the body from that of the soul. The exceptions to this trend appear in the discussions of certain sexual topics, such as masturbation, by physicians close to the Counter-Reformation. Analyzing the writings of Protestant, Catholic, and Jewish physicians—the latter developed the most secular medical ethics of the era—he probes the dominant and emerging philosophical ideas together with conceptions of the role of physicians and of physical well-being.
Schleiner selects several topics to explore the development of ethical ideas in depth: placebos and the broader issue of lying to patients; the treatment of hysteria; masturbation; and the prevention of sexually transmitted diseases—subjects that are still highly charged moral as well as medical topics today.
This pioneering study will be of value to ethicists and to historians of science, medicine, and Renaissance and gender studies.
In a single convenient resource, this revised and updated edition of a classic text organizes and presents clearly the documents of the Catholic Church pertaining to medical ethics. Introductory chapters provide the context for interpreting the Church's teachings and theological values, guiding the reader in how to apply the teachings to particular ethical dilemmas and helping the reader to understand the role of conscience within the Catholic tradition.
The teaching of the Church in regard to health care ethics is pertinent not only for health care professionals and students, but for all who are concerned about the common good of society. Medical Ethics examines specific teachings of the Church on over seventy issues in clinical and research ethics, including abortion, AIDS, artificial insemination, assisted suicide, cloning, contraception, euthanasia, gene therapy, health care reform, organ donation and transplantation, organizational ethics, stem cells, surrogate motherhood, and withholding and withdrawing life support.
O'Rourke and Boyle bring this fourth edition up to the present day by incorporating recent papal documents regarding the social aspects of health care, assent to Church teaching, and the 2008 papal instruction Dignitas personae, an extremely influential document that illuminates such controversial dilemmas as prenatal adoption, frozen embryos, and genetic diagnosis.
In a single convenient resource, this book organizes and presents clearly the documents of the Catholic church pertaining to medical ethics. Introductory chapters provide the context for interpreting the Church's teachings and guide the reader in applying the teachings to particular ethical quandaries.
This third edition has been updated to incorporate the statements issued since the preparation of the second edition. The authors have revised the introductory chapters to include ideas from the papal encyclical Splendor Veritatis and "Instruction of the Ecclesial Vocation of the Theologian," published by the Vatican Congregation for the Doctrine of the Faith, concerning the various levels of the teachings of the Church. Other new statements included in this edition are relevant topics from the papal encyclical Evangelium Vitae (abortion, euthanasia, amniocentesis, suicide and withdrawing life support); the Vatican Congregation of Doctrine and Faith on uterine isolation; the U.S. bishops on the care of anencephalic infants, genetic testing, and cloning; and the Pennsylvania Catholic Conference on the treatment for rape in Catholic hospitals.
Governments throughout the industrialized world make decisions that fundamentally affect the quality and accessibility of medical care. In the United States, despite the absence of universal health insurance, these decisions have great influence on the practice of medicine.
In Medical Governance, David Weimer explores an alternative regulatory approach to medical care based on the delegation of decisions about the allocation of scarce medical resources to private nonprofit organizations. He investigates the specific development of rules for the U.S. organ transplant system and details the conversion of a voluntary network of transplant centers to one private rulemaker: the Organ Procurement and Transplantation Network (OPTN).
As the case unfolds, Weimer demonstrates that the OPTN is more efficient, nimble, and better at making evidence-based decisions than a public agency; and the OPTN also protects accountability and the public interest more than private for-profit organizations. Weimer addresses similar governance arrangements as they could apply to other areas of medicine, including medical records and the control of Medicare expenditures, making this timely and useful case study a valuable resource for debates over restructuring the U.S. health care system.
U.S. health care has changed dramatically during the past century. A new breed of physicians use new machines, vaccines, and ideas in ways that have touched the lives of virtually everyone. How and why did these changes occur?
The biographical essays comprising this volume address this question through the stories of six scientific innovators at the University of Michigan Medical School. Michigan was the first major U.S. medical school to admit women, to run its own university hospital, and, by the turn of the century, was recognized as one of the finest medical schools in the country. The people whose stories unfold here played a central part in defining the place of medical science at the University of Michigan and in the larger world of U.S. health care.
Introductory sections are followed by biographical profiles of George Dock, Thomas Francis, Albion Hewlett, Louise Newburgh, Cyrus Strurgis, and Frank Wilson. Drawing on extensive archival research, the authors provide a richly textured portrait of academic medical life and reveal how the internal content of science and medicine interacted with the social context of each subject's life. Also explored is the relationship between the environment (the hospital, the university, and the city) and the search for knowledge.
These narratives expand our perspective on twentieth-century medical history by presenting these individuals' experiences as extended biopsies of the period and place, focal points illuminating the personal nature of medicine and locating the discipline within a social and institutional setting.
Joel D. Howell is Associate Professor, Department of Internal Medicine, Department of History, and Department of Health Services Management and Policy, University of Michigan.
Medical malpractice has been at the center of recurring tort crises for the last quarter-century. In 1960, expenditures on medical liability insurance in the United States amounted to about $60 million. In 1988, the figure topped $7 billion. Physicians have responded not simply with expensive methods of "defensive medicine" but also with successful pressure upon state legislatures to cut back on the tort rights of seriously injured patients. Various reforms have been proposed to deal with the successive crises, but so far none have proved to be effective and fair.
In this landmark book, Paul Weiler argues for a two-part approach to the medical malpractice crisis. First, he proposes a thorough revision of the current tort liability regime, which would concentrate available resources on meeting actual financial losses of seriously injured victims. It would also shift the focus of tort liability from the individual doctor to the hospital or other health care organization. This would elicit more effective quality assurance programs from the institutions that are in the best position to reduce our current unacceptable rate of physician-induced injuries.
But in states such as New York, Florida, and Illinois, where the current situation seems to have gone beyond the help of even drastic tort reform, the preferred solution is a no-fault system. Weiler shows how such a system would provide more equitable compensation, more effective prevention, and more economical administration than any practical alternative.
How often are patients seriously injured through faulty medical care? And what proportion of these people receive compensation for their injuries and suffering? This is the first book that tries to answer these questions in a careful, scholarly way. Among its important findings is that at most one in ten patients injured through medical negligence receives compensation through the malpractice system.
The focus of public attention has been on the rising cost to physicians of malpractice insurance. Although Patricia Danzon analyzes this question thoroughly, her view is much broader, encompassing the malpractice system itself--the legal process, the liability insurance markets, and the feedback to health care. As an economist, she is concerned with the efficiency or cost-effectiveness of the system from the point of view of its three social purposes: deterrence of medical negligence, compensation of injured patients, and the spreading of risk. To provide evidence of the operation of the system in practice, to distinguish fact from allegation, and to evaluate proposals for reform, she has undertaken a detailed empirical analysis of malpractice claims and insurance markets. It is a major contribution to our understanding of how the system works in practice and how it might be improved.
How the politics of “medical necessity” complicates American health care
The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In this book, Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives.
From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity.
Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.
Competent physicians make accurate diagnoses. How are accurate diagnoses made? This readable book gives some important answers to that question. Experienced physicians were presented with diagnostic problems and asked to solve them. Through the use of trained actors serving as “patients” and with a variety of supplementary techniques, the investigators were able to dissect the process by which diagnoses, right and wrong, are made.
Reporting on the most comprehensive investigation of clinical reasoning yet conducted, the authors present data and conclusions of importance not just to medical educators but to anyone interested in the psychology of problem solving. Rigorous attention to methods, thorough grounding in contemporary theories of problem solving, and a healthy respect for the complexity of real-life situations characterize this remarkable study.
A sampling of its salient findings only suggests the richness of this book. Successful diagnosticians begin to form hypotheses almost as soon as they encounter a patient. They entertain a limited number of hypotheses, but these are tested repeatedly during a workup. New findings are treated as confirming, refuting, or not contributing to the solution contemplated; more elaborate schemes based on a knowledge of probabilities are not used. A common error is to relate new information to a working hypothesis, although the information is, in fact, non-contributory. The performance of even an experienced physician varies markedly from case to case. Two of the most important determinants of competence are information and experience; problem-solving skills without a rich supply of facts are insufficient for diagnostic acumen.
John S. Haller,Jr., provides the first modern history of the Eclectic school of American sectarian medicine.
The Eclectic school (sometimes called the "American School") flourished in the mid-nineteenth century when the art and science of medicine was undergoing a profound crisis of faith. At the heart of the crisis was a disillusionment with the traditional therapeutics of the day and an intense questioning of the principles and philosophy upon which medicine had been built. Many American physicians and their patients felt that medicine had lost the ability to cure. The Eclectics surmounted the crisis by forging a therapeutics based on herbal remedies and an empirical approach to disease, a system independent of the influence of European practices.
Although rejected by the Regulars (adherents of mainstream medicine), the Eclectics imitated their magisterial manner, establishing two dozen colleges and more than sixty-five journals to proclaim the wisdom of their theory. Central to the story of Eclecticism is that of the Eclectic Medical Institute of Cincinnati, the "mother institute" of reform medical colleges. Organized in 1845, the school was to exist for ninety-four years before closing in 1939.
Throughout much of their history, the Eclectic medical schools provided an avenue into the medical profession for men and women who lacked the financial and educational opportunities the Regular schools required, siding with Professor Martyn Paine of the Medical Department of New York University, who, in 1846, had accused the newly formed American Medical Association of playing aristocratic politics behind a masquerade of curriculum reform. Eventually, though, they grudgingly followed the lead of the Regulars by changing their curriculum and tightening admission standards.
By the late nineteenth century, the Eclectics found themselves in the backwaters of modern medicine. Unable to break away from their botanic bias and ill-equipped to support the implications of germ theory, the financial costs of salaried faculty and staff, and the research implications of laboratory science, the Eclectics were pushed aside by the rush of modern academic medicine.
According to Jill A. Fisher, this major change in the way medical research is performed is the outcome of two problems in U.S. health care: decreasing revenue for physicians and decreasing access to treatment for patients. As physicians report diminishing income due to restrictive relationships with insurers, increasing malpractice insurance premiums, and inflated overhead costs to operate private practices, they are attracted to pharmaceutical contract research for its lucrative return. Clinical trials also provide limited medical access to individuals who have no or inadequate health insurance because they offer "free" doctors' visits, diagnostic tests, and medications to participants. Focusing on the professional roles of those involved, as well as key research practices, Fisher assesses the risks and advantages for physicians and patients alike when pharmaceutical drug studies are used as an alternative to standard medical care.
A volume in the Critical Issues in Health and Medicine series, edited by Rima D. Apple and Janet Golden
A personal account of the aging body and advanced technologies by a preeminent philosopher of technology
Medical Technics is a rigorous examination of how medical progress has modified our worlds and contributed to a virtual revolution in longevity. Don Ihde offers a unique autobiographical tour of medical events experienced in a decade, beginning in his 70s. Ihde offers experiential and postphenomenological analyses of technologies such as sonography and microsurgery, and ultimately asks what it means to increasingly become a cyborg.
Forerunners: Ideas FirstRunaway medical costs, long-term care, market competition, for-profit medicine, nursing shortages—these are but a few of the issues that swirl around in the late twentieth century’s volatile health care scene. How much of the system do we want to change, and how much do we want to keep? Health policy expert Eli Ginzberg examines such crucial questions in his characteristically broad-gauged perspective. Framing the issues in their historical, political, and professional contexts, the author analyzes how we have arrived at the current crisis.
The book focuses on the three sides of the medical triangle that have separate and sometimes conflicting goals: the physicians want to provide the most health care for the most money; the government, which furnishes 40 percent of the system's funding, wants to limit the money it pays out for health care; and the public, with over a billion annual visits to doctors, wants the most health care for the least money.
Ginzberg explains how the core components of our health care system—the community hospital and physicians who have long practiced in a fee-for-service mode—are under attack, and he indicates the factors that make it uncertain whether the destabilization will slow down or accelerate. Moreover, can key health care centers maintain their leadership in a time when new dollars for health are scarce? How will the floundering state of foundations affect medical care in local communities?
In his final chapters the author zeroes in on the special concerns of the public: high-need patients (including those suffering from cancer, catastrophic illness, and the infirmities of old age, or those who are mentally ill or chronically poor), nursing shortages, unsuccessful cost containment, and lack of consensus within the medical triangle about the major issues on our nation's health agenda.
The first comprehensive edition and translation of Old English writings on health and healing in more than 150 years.
Unlike elsewhere in Europe, vernacular writings on health and healing had a major place in early medieval England. These texts—unique local remedies and translations of late antique Latin treatises—offer insights into the history of science and medicine, social history, scribal practices, and culture. Some cures resemble ones still used today; others are linguistically extravagant, prescribing ambitious healing practices. Alongside recipes for everyday ailments such as headaches are unparalleled procedures for preventing infant mortality, restoring lost cattle, warding off elf-shot, or remedying the effects of flying venom.
Medical Writings from Early Medieval England presents the first comprehensive edition and translation from Old English of these works in more than 150 years. Volume I includes The Old English Herbal, Remedies from Animals, Lacnunga, the Peri Didaxeon, and a compendium of miscellaneous texts.
Contributors. Michael Gusmano, Jacob Hacker, Nancy M. Kane, Stephen A. Magnus, Theodore Marmor, Jonathan Oberlander, Eric M. Patashnik, Mark A. Peterson, Mark J. Schlesinger, Carolyn Tuohy, Bruce Vladeck, Julian Zelizer
“A work of great breadth, originality, and distinction. Rarely do we see such a successful marriage between historical demography and the history of medicine. The interconnections between population increase, migration and immigration on the one hand, and disease and the development of medicine on the other in antebellum America are brilliantly presented.”—Irvine Loudon, Bulletin of the History of Medicine
By the end of the eighteenth century, Peru had witnessed the decline of its once-thriving silver industry, and it had barely begun to recover from massive population losses due to smallpox and other diseases. At the time, it was widely believed that economic salvation was contingent upon increasing the labor force and maintaining as many healthy workers as possible. In Medicine and Politics in Colonial Peru,Adam Warrenpresents a groundbreaking study of the primacy placed on medical care to generate population growth during this era.
The Bourbon reforms of the eighteenth century shaped many of the political, economic, and social interests of Spain and its colonies. In Peru, local elites saw the reforms as an opportunity to positively transform society and its conceptions of medicine and medical institutions in the name of the Crown. Creole physicians in particular, took advantage of Bourbon reforms to wrest control of medical treatment away from the Catholic Church, establish their own medical expertise, and create a new, secular medical culture. They asserted their new influence by treating smallpox and leprosy, by reforming medical education, and by introducing hygienic routines into local funeral rites, among other practices.
Later, during the early years of independence, government officials began to usurp the power of physicians and shifted control of medical care back to the church. Creole doctors, without the support of the empire, lost much of their influence, and medical reforms ground to a halt. As Warren’s study reveals, despite falling in and out of political favor, Bourbon reforms and creole physicians were instrumental to the founding of modern medicine in Peru, and their influence can still be felt today.
In these essays, a diverse group of ethicists draw insights from both religious and feminist scholarship in order to propose creative new approaches to the ethics of medical care. While traditional ethics emphasizes rules, justice, and fairness, the contributors to this volume embrace an "ethics of care," which regards emotional engagement in the lives of others as basic to discerning what we ought to do on their behalf.
The essays reflect on the three related themes: community, narrative, and emotion. They argue for the need to understand patients and caregivers alike as moral agents who are embedded in multiple communities, who seek to attain or promote healing partly through the medium of storytelling, and who do so by cultivating good emotional habits. A thought-provoking contribution to a field that has long been dominated by an ethics of principle, Medicine and the Ethics of Care will appeal to scholars and students who want to move beyond the constraints of that traditional approach.
The colonial encounter between France and Morocco took place not only in the political realm but also in the realm of medicine. Because the body politic and the physical body are intimately linked, French efforts to colonize Morocco took place in and through the body. Starting from this original premise, Medicine and the Saints traces a history of colonial embodiment in Morocco through a series of medical encounters between the Islamic sultanate of Morocco and the Republic of France from 1877 to 1956.
Drawing on a wealth of primary sources in both French and Arabic, Ellen Amster investigates the positivist ambitions of French colonial doctors, sociologists, philologists, and historians; the social history of the encounters and transformations occasioned by French medical interventions; and the ways in which Moroccan nationalists ultimately appropriated a French model of modernity to invent the independent nation-state. Each chapter of the book addresses a different problem in the history of medicine: international espionage and a doctor’s murder; disease and revolt in Moroccan cities; a battle for authority between doctors and Muslim midwives; and the search for national identity in the welfare state. This research reveals how Moroccans ingested and digested French science and used it to create a nationalist movement and Islamist politics, and to understand disease and health. In the colonial encounter, the Muslim body became a seat of subjectivity, the place from which individuals contested and redefined the political.
In the history of medicine, hospitals are usually seen as passive reflections of advances in medical knowledge and technology. In Medicine by Design, Annmarie Adams challenges these assumptions, examining how hospital design influenced the development of twentieth-century medicine and demonstrating the importance of these specialized buildings in the history of architecture.
At the center of this work is Montreal’s landmark Royal Victoria Hospital, built in 1893. Drawing on a wide range of visual and textual sources, Adams uses the “Royal Vic”—along with other hospitals built or modified over the next fifty years—to explore critical issues in architecture and medicine: the role of gender and class in both fields, the transformation of patients into consumers, the introduction of new medical concepts and technologies, and the use of domestic architecture and regionally inspired imagery to soften the jarring impact of high-tech medicine.
Identifying the roles played by architects in medical history and those played by patients, doctors, nurses, and other medical professionals in the design of hospitals, Adams also links architectural spaces to everyday hospital activities, from meal preparation to the ways in which patients entered the hospital and awaited treatment.
Methodologically and conceptually innovative, Medicine by Design makes a significant contribution to the histories of both architectural and medical practices in the twentieth century.
Annmarie Adams is William C. Macdonald Professor of Architecture at McGill University and the author of Architecture in the Family Way: Doctors, Houses, and Women, 1870–1900 and coauthor of Designing Women: Gender and the Architectural Profession.
A witch doctor casting an evil spell in a steaming jungle village; a young medical-school graduate cleaning a machete wound in a rat-infested thatched hut; a world-renowned scientist doing research in Mexico City—all were part of the mid-twentieth century medical scene in Mexico, a country of great cultural, socioeconomic, and geographical contrasts.
Gordon Schendel, in collaboration with Dr. José Alvarez Amézquita and Dr. Miguel E. Bustamante, relates the history of medicine and public health and welfare in Mexico. This absorbing story begins with a great indigenous culture; continues with Spanish Colonial rule, the unproductive first century of independence from Spain, and the years of revolution; then concentrates on the modern nation.
The Aztec civilization evidenced a knowledge of pharmacology and the fundamentals of health far in advance of contemporary European societies. And almost one hundred years before the Pilgrims landed on Plymouth Rock, New Spain boasted a comprehensive "Public Health Administration" and a hospital system that served all classes. However, throughout Mexico's three centuries as a Spanish colony and its first century of independence, millions of its citizens suffered abysmal poverty. Thus when the Republic of Mexico entered its post-Revolutionary era, the majority of its citizens were plagued by superstition, illiteracy, malnutrition, and the other "diseases of the poor."
The principal part of this story tells how Mexico attacked these problems, and how in a few short years it became a leader and a model for all Latin America in the fields of medicine and public health and welfare. The book is based on Mr. Schendel's research and observations and on his many interviews with doctors and govemment officials. It will be of interest to the medical profession and to concerned laymen of all nationalities, for it illustrates how a dynamic nation met challenges that all countries of the world, developed and underdeveloped, must face.
At the temple of Kom Ombo near Aswan, an enigmatic frieze depicts the deified pharaoh Imhotep receiving a set of elaborate implements, some of which strikingly resemble modern surgical instruments: side by side with eye-of-Horus amulets one finds what surely must be forceps. Evidence of the medical practice of ancient Egypt has come down to us not only in pictorial art but also in papyrus scrolls, in funerary inscriptions, and in the mummified bodies of ancient Egyptians themselves.
Bruno Halioua and Bernard Ziskind provide a comprehensive account of pharaonic medicine that is illuminated by what modern science has discovered about the lives (and deaths) of people from all walks of life--farmers, fishermen, miners, soldiers, scribes and priests, embalmers, construction workers, bakers, prostitutes. From mummies and medical papyri we are able to recognize the aches of osteoarthritis, imagine the occupational hazards faced by press-ganged stonemasons, and learn of the gynecological complaints of courtesans. In presenting these stories Halioua and Ziskind throw light on some of the most enduring questions about life and death in antiquity: about physicians whose skills predate Hippocrates by twenty-five centuries and were first made famous by Homer; about the remedies and techniques they employed, at once strange and strangely familiar; about the men, women, and children they treated; and about the diseases and injuries they were called upon to heal.
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