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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.

 Mark Twain has always been America’s spokesman, and his comments on a wide range of topics continue to be accurate, valid, and frequently amusing. His opinions on the medical field are no exception. While Twain’s works, including his popular novels about Tom Sawyer and Huckleberry Finn, are rich in medical imagery and medical themes derived from his personal experiences, his interactions with the medical profession and his comments about health, illness, and physicians have largely been overlooked.

In Mark Twain and Medicine, K. Patrick Ober remedies this omission. The nineteenth century was a critical time in the development of American medicine, with much competition among the different systems of health care, both traditional and alternative. Not surprisingly, Mark Twain was right in the middle of it all. He experimented with many of the alternative care systems that were available in his day—in part because of his frustration with traditional medicine and in part because he hoped to find the “perfect” system that would bring health to his family.

Twain’s commentary provides a unique perspective on American medicine and the revolution in medical systems that he experienced firsthand. Ober explores Twain’s personal perspective in this area, as he expressed it in fiction, speeches, and letters. As a medical educator, Ober explains in sufficient detail and with clarity all medical and scientific terms, making this volume accessible to the general reader.

Ober demonstrates that many of Twain’s observations are still relevant to today’s health care issues, including the use of alternative or complementary medicine in dealing with illness, the utility of placebo therapies, and the role of hope in the healing process.

Twain’s evaluation of the medical practices of his era provides a fresh, humanistic, and personalized view of the dramatic changes that occurred in medicine through the nineteenth century and into the first decade of the twentieth. Twain scholars, general readers, and medical professionals will all find this unique look at his work appealing.

Are advanced industrialized countries converging on a market response to reform their systems of social protection? By comparing the health care reform experiences of Britain, Germany, and the United States in the 1990s, Susan Giaimo explores how countries pursue diverse policy responses and how such variations reflect distinctive institutions, actors, and reform politics in each country.

In Britain, the Thatcher government's plan to inject a market into the state-administered national health service resulted in a circumscribed experiment orchestrated from above. In Germany, the Kohl government sought to repair defects in the corporatist arrangement with doctors and insurers, thus limiting the market experiment and designing it to enhance the solidarity of the national health insurance system. In the United States, private market actors foiled Clinton's bid to expand the federal government's role in the private health care system through managed competition and national insurance. But market reform continued, albeit led by private employers and with government officials playing a reactive role. Actors and institutions surrounding the existing health care settlement in each country created particular reform politics that either militated against or fostered the deployment of competition.

The finding that major transformations are occurring in private as well as public systems of social protection suggests that studies of social policy change expand their focus beyond statutory welfare state programs. The book will interest political scientists and policymakers concerned with welfare state reform in advanced industrial societies; social scientists interested in the changing balance among state, market, and societal interests in governance; and health policy researchers, health policymakers, and health care professionals.

Susan Giaimo is an independent scholar. She completed her Ph.D. in Political Science at the University of Wisconsin-Madison. She also earned an MSc in Politics from the London School of Economics and Political Science, with the Politics and Government of Western Europe as the branch of study. After completing her doctorate, she was a postdoctoral fellow in the Robert Wood Johnson Foundation Scholars in Health Policy Research Program, University of California at Berkeley, and the Robert Bosch Foundation Scholars Program in Comparative Public Policy and Comparative Institutions, American Institute for Contemporary German Studies, Johns Hopkins University. She taught in the Political Science Department at Massachusetts Institute of Technology for five years. During that period she won the Society for the Advancement of Socio-Economics Founder's Prize for "Adapting the Welfare State: The Case of Health Care Reform in Britain, Germany, and the United States," a paper she coauthored with Philip Manow. She has also worked for health maintenance organizations (HMOs) and medical practices in the United States.

In 1998, health expenditures in the United States accounted for 12.9% of national income-the highest share of income devoted to health in the developed world. The United States also spends more on medical research than any other country-in 2000, the federal government dedicated $18.4 billion to it, compared with only $3.7 billion for the entire European Union. In this book, leading health economists ask whether we are getting our money's worth.

From an economic perspective, they find, the answer is a resounding "yes": in fact, considering the extraordinary value of improvements to health, we may even be spending too little on medical research. The evidence these papers present and the conclusions they reach are both surprising and convincing: that growth in longevity since 1950 has been as valuable as growth in all other forms of consumption combined; that medical advances producing 10% reductions in mortality from cancer and heart disease alone would add roughly $10 trillion-a year's GDP-to the national wealth; or that the average new drug approved by the FDA yields benefits worth many times its cost of development.

The papers in this book are packed with these and many other surprising revelations, their sophisticated analysis persuasively demonstrating the massive economic benefits we can gain from investments in medical research. For anyone concerned about the cost and the value of such research-from policy makers to health care professionals and economists-this will be a landmark book.

The conquest and colonization of the Americas resulted in all kinds of exchanges, including the transmission of diseases and the sharing of medicines to treat them. In this book, Kelly Wisecup examines how European settlers, Native Americans, and New World Africans communicated medical knowledge in early America, and how the colonists represented what they learned in their literatures.

Against the prevailing view that colonial texts provide insight only into their writers' perspectives, Wisecup demonstrates that Europeans, Natives, and Africans held certain medical ideas in common, including a conception of disease as both a spiritual and a physical entity, and a belief in the power of special rituals or prayers to restore health. As a consequence, medical knowledge and practices operated as a shared form of communication on which everyone drew in order to adapt to a world of devastating new maladies and unfamiliar cures.

By signaling one's relation to supernatural forces, to the natural world, and to other people, medicine became an effective means of communicating a variety of messages about power and identity as well as bodies and minds. Native Americans in Virginia and New England, for example, responded to the nearly simultaneous arrival of mysterious epidemics and peoples by incorporating colonists into explanations of disease, while British American colonists emphasized to their audiences back home the value of medical knowledge drawn from cross-cultural encounters in the New World.

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

Contrary to the fictional account of James Fenimore Cooper, the Mohegan/Mohican nation did not vanish with the death of Chief Uncas more than three hundred years ago. In the remarkable life story of one of its most beloved matriarchs—100-year-old medicine woman Gladys Tantaquidgeon—Medicine Trail tells of the Mohegans' survival into this century.

Blending autobiography and history, with traditional knowledge and ways of life, Medicine Trail presents a collage of events in Tantaquidgeon's life. We see her childhood spent learning Mohegan ceremonies and healing methods at the hands of her tribal grandmothers, and her Ivy League education and career in the white male-dominated field of anthropology. We also witness her travels to other Indian communities, acting as both an ambassador of her own tribe and an employee of the federal government's Bureau of Indian Affairs. Finally we see Tantaquidgeon's return to her beloved Mohegan Hill, where she cofounded America's oldest Indian-run museum, carrying on her life's commitment to good medicine and the cultural continuance and renewal of all Indian nations.

Written in the Mohegan oral tradition, this book offers a unique insider's understanding of Mohegan and other Native American cultures while discussing the major policies and trends that have affected people throughout Indian Country in the twentieth century. A significant departure from traditional anthropological "as told to" American Indian autobiography, Medicine Trail represents a major contribution to anthropology, history, theology, women's studies, and Native American studies.

“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
 

Over the last two decades, the implosion of economies under the burden of debt, the negative repercussions of structural adjustment programs, the crisis of legitimacy, civil wars, and the collapse of some states have resulted in serious health issues across the African continent. Newly emerging diseases, such as Ebola virus and HIV/AIDS have killed and disabled millions. Some “old diseases,” such as yellow fever, tuberculosis, and polio have reappeared. Malaria, cholera, and meningitis continue to kill thousands. In many countries, the medical infrastructure has collapsed, while an increasing number of physicians and nurses have migrated to more hospitable places. Stigmatization of the affected people has exacerbated social and racial discrimination and has affected the implementation of national and international public health programs. The complexity of the situation requires an interdisciplinary approach. This collection, including contributions by historians, sociologists, anthropologists, and biologists, emphasizes the social and cultural contexts of African health, paying particular attention to the history of the colonial public health system and its legacy.

Widely regarded as the most comprehensive study of its kind, this volume offers valuable insight into the alleged medical differences between whites and blacks that translated as racial inferiority and were used to justify slavery and discrimination.

In Medicine and Slavery, Todd L. Savitt evaluates the diet, hygiene, clothing, and living and working conditions of antebellum African Americans, slave and free, and analyzes the diseases and health conditions that afflicted them in urban areas, at industrial sites, and on plantations.
 

In recent years, relations between patients and physicians in America have undergone a dramatic change. The growing acceptance of natural childbirth, support groups for patients with serious illnesses, health maintenance organizations, and hospices for a "happy death" among family and friends is part of a redefinition of medical practice and reformulation of the field of medical power. No longer is medical practice confined to "taming the beast" of death and fighting the diseases observable in the human body. The modern practitioner is now a manager of the living, taking an ecological view of the patient as a "whole person" in a network of relationships.

Medicine and the Management of Living questions how it has been possible for the patient to change from a silenced specimen observed in the clinic to a person whose subjective experience of illness is important to medical practice and discourse. Arney and Bergen ask, What incited the demand that medicine take the whole person, including the patient's presentation of his or her illness, into consideration? And in whose terms are patients speaking about themselves? The authors argue that the inclusion of patients' experiences in medical discourse that has come about since the 1950s is not so much a result of a "patient rebellion" as an activity preciptated by the medical establishment itself. Drawing inspiration from the work of Michel Foucault, Arney and Bergen examine the structure of medical power, contending that new social technologies like support groups make the patient's subjectivity available for medical evaluation, judgment, and manipulation.

 Throughout this sensitively written discussion, the authors vivify the issues they raise with excerpts from many sources—the writings of a poet dying of cancer, the comments of doctors pondering their own fatal illnesses, and excerpts from popular magazines, medical journals, and sociological studies. They examine the changing role of the medical profession through history, using a modern advertising image and woodcuts from Vesalius's Renaissance anatomy text to show the symbolic portrayal of health and medicine. Their wide-ranging concerns lead the reader through such topics as teenage pregnancy; the historical treatment of medical anomalies like hermaphrodites and the "elephant man" (John Merrick); and literary representations of illness in Sartre, Chekhov, and Brian Clark's recent Broadway drama, "Whose Life Is It Anyway?"

In a provocative yet thoughtful way, Medicine and the Management of Living points the way for a radical reassessment of medical power and the medical establishment.

In Mozambique, where more than half of the national health care budget comes from foreign donors, NGOs and global health research projects have facilitated a dramatic expansion of medical services. At once temporary and unfolding over decades, these projects also enact deeply divergent understandings of what care means and who does it. In Medicine in the Meantime, Ramah McKay follows two medical projects in Mozambique through the day-to-day lives of patients and health care providers, showing how transnational medical resources and infrastructures give rise to diverse possibilities for work and care amid constraint. Paying careful attention to the specific postcolonial and postsocialist context of Mozambique, McKay considers how the presence of NGOs and the governing logics of the global health economy have transformed the relations—between and within bodies, medical technologies, friends, kin, and organizations—that care requires and how such transformations pose new challenges for ethnographic analysis and critique.

Medicine, Religion, and Health: Where Science and Spirituality Meet will be the first title published in the new Templeton Science and Religion Series, in which scientists from a wide range of fields distill their experience and knowledge into brief tours of their respective specialties. In this, the series' maiden volume, Dr. Harold G. Koenig, provides an overview of the relationship between health care and religion that manages to be comprehensive yet concise, factual yet inspirational, and technical yet easily accessible to nonspecialists and general readers.

William G. Anlyan, a dedicated doctor and gifted administrator, was a leader in the transformation of Duke University Hospital from a regional medical center into one of America’s foremost biomedical research and educational institutions. Anlyan’s fifty-five-year career at Duke University spanned a period of extraordinary change in the practice of medicine. He chronicles those transformations—and his role in them—in this forthright memoir.

Born in Alexandria, Egypt, in 1925, and schooled in the British tradition, Anlyan attended Yale University as an undergraduate and medical student before coming to the relatively unknown medical school at Duke University in 1949 for an internship in general and thoracic surgery. He stayed on, first as a resident, then as a staff surgeon. By 1961, he was a full professor of surgery. In 1964, Anlyan was named dean of the medical school, the first in a series of administrative posts at the medical school and hospital. Anlyan’s role in the transformation of the Duke University Medical Center into an internationally renowned health system is manifest: he restructured the medical school and hospital and supervised the addition of almost four million square feet of new or renovated space. He hired outstanding administrators and directed a staff that instituted innovative programs and groundbreaking research centers, such as the Cancer Center and the Physician’s Assistant Program.

Anlyan describes a series of metamorphoses in his own life, in the world of medicine, in Durham, and at Duke. At the time of his prep school upbringing in Egypt, medicine was a matter of controlling infectious diseases like tuberculosis and polio. As he became an immigrant medical student and then a young surgeon, he observed vast advances in medical practice and changes in the financing of medical care. During his tenure at Duke, Durham was transformed from a sleepy mill and tobacco town into the “City of Medicine,” a place where patients routinely travel for open-heart surgery and cutting-edge treatments for cancer and other diseases.

Anyone interested in health care, medical education, and the history of Duke University will find Anlyan’s memoir of interest.

In the nineteenth century, infants were commonly breast-fed; by the middle of the twentieth century, women typically bottle-fed their babies on the advice of their doctors.  In this book, Rima D. Apple discloses and analyzes the complex interactions of science, medicine, economics, and culture that underlie this dramatic shift in infant-care practices and women’s lives.
    As infant feeding became the keystone of the emerging specialty of pediatrics in the twentieth century, the manufacture of infant food became a lucrative industry.  More and more mothers reported difficulty in nursing their babies.  While physicians were establishing themselves and the scientific experts and the infant-food industry was hawking the scientific bases of their products, women embraced “scientific motherhood,” believing that science could shape child care practices.  The commercialization and medicalization of infant care established an environment that made bottle feeding not only less feared by many mothers, but indeed “natural” and “necessary.”  Focusing on the history of infant feeding, this book clarifies the major elements involved in the complex and sometimes contradictory interaction between women and the medical profession, revealing much about the changing roles of mothers and physicians in American society.

“The strength of Apple’s book is her ability to indicate how the mutual interests of mothers, doctors, and manufacturers led to the transformation of infant feeding. . . . Historians of science will be impressed with the way she probes the connections between the medical profession and the manufacturers and with her ability to demonstrate how medical theories were translated into medical practice.”—Janet Golden, Isis