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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

Since Roe v. Wade, abortion has continued to be a divisive political issue in the United States. In contrast, it has remained primarily a medical issue in Britain and Canada despite the countries’ shared heritage. Doctors and Demonstrators looks beyond simplistic cultural or religious explanations to find out why abortion politics and policies differ so dramatically in these otherwise similar countries.

 

Drew Halfmann argues that political institutions are the key. In the United States, federalism, judicial review, and a private health care system contributed to the public definition of abortion as an individual right rather than a medical necessity. Meanwhile, Halfmann explains, the porous structure of American political parties gave pro-choice and pro-life groups the opportunity to move the issue onto the political agenda. A groundbreaking study of the complex legal and political factors behind the evolution of abortion policy, Doctors and Demonstrators will be vital for anyone trying to understand this contentious issue.

Doctors are obviously influential in determining the costs of their services. But even more important, many believe, is the influence physicians have over the use and cost of nonphysician health-care resources and services. Doctors and Their Workshops is the first comprehensive attempt to use economic analysis to understand some of the physician effects on nonphysician aspects of health care.

All advanced health care systems face severe difficulties in financing the delivery of today’s sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables—the autonomy of the state and the strength and cohesiveness of organized medicine—explain this variance.
In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult.
Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession’s clinical autonomy and physicians’ incomes.

All advanced health care systems face severe difficulties in financing the delivery of today’s sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables—the autonomy of the state and the strength and cohesiveness of organized medicine—explain this variance.
In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult.
Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession’s clinical autonomy and physicians’ incomes.

Recent surveys of medical students reveal stark conditions: more than a quarter have experienced episodes of depression during their medical school and residency careers, a figure much higher than that of the general population. Compounded by long hours of intellectually challenging, physically taxing, and emotionally exhausting work, medical school has been called one of the most harrowing experiences a student can encounter. Plumbing the diaries, memoirs, and blogs of physicians-in-training, Suzanne Poirier’s Doctors in the Making illuminates not just the process by which students become doctors but also the physical, emotional, and spiritual consequences of the process.

Through close readings of these accounts, Poirier draws attention to the complex nature of power in medicine, the rewards and hazards of professional and interpersonal relationships in all aspects of physicians’ lives, and the benefits to and threats from the vulnerability that medical students and residents experience.

Although most students emerge from medical education as well-trained, well-prepared professionals, few of them will claim that they survived the process unscathed. The authors of these accounts document—for better or for worse—the ways in which they have been changed. Based on their stories, Poirier recommends that medical education should make room for the central importance of personal relationships, the profound sense of isolation and powerlessness that can threaten the wellbeing of patients and physicians alike, and the physical and moral vulnerability that are part of every physician’s life.

Mechanisms and standards exist to safeguard the health and welfare of the patient, but for electroconvulsive therapy (ECT)—used to treat depression and other mental illnesses—such approval methods have failed. Prescribed to thousands over the years, public relations as opposed to medical trials have paved the way for this popular yet dangerous and controversial treatment option.

Doctors of Deception is a revealing history of ECT (or shock therapy) in the United States, told here for the first time. Through the examination of court records, medical data, FDA reports, industry claims, her own experience as a patient of shock therapy, and the stories of others, Andre exposes tactics used by the industry to promote ECT as a responsible treatment when all the scientific evidence suggested otherwise.

As early as the 1940s, scientific literature began reporting incidences of human and animal brain damage resulting from ECT. Despite practitioner modifications, deleterious effects on memory and cognition persisted. Rather than discontinue use of ECT, the $5-billion-per-year shock industry crafted a public relations campaign to improve ECT’s image. During the 1970s and 1980s, psychiatry’s PR efforts misled the government, the public, and the media into believing that ECT had made a comeback and was safe.

Andre carefully intertwines stories of ECT survivors and activists with legal, ethical, and scientific arguments to address issues of patient rights and psychiatric treatment. Echoing current debates about the use of psychopharmaceutical interventions shown to have debilitating side-effects, she candidly presents ECT as a problematic therapy demanding greater scrutiny, tighter control, and full disclosure about its long-term cognitive effects.

In this book, Douglas Biow traces the role that humanists played in the development of professions and professionalism in Renaissance Italy, and vice versa. For instance, humanists were initially quite hostile to medicine, viewing it as poorly adapted to their program of study. They much preferred the secretarial profession, which they made their own throughout the Renaissance and eventually defined in treatises in the late sixteenth and early seventeenth centuries.

Examining a wide range of treatises, poems, and other works that humanists wrote both as and about doctors, ambassadors, and secretaries, Biow shows how interactions with these professions forced humanists to make their studies relevant to their own times, uniting theory and practice in a way that strengthened humanism. His detailed analyses of writings by familiar and lesser-known figures, from Petrarch, Machiavelli, and Tasso to Maggi, Fracastoro, and Barbaro, will especially interest students of Renaissance Italy, but also anyone concerned with the rise of professionalism during the early modern period.

"This book is about the historical influence of late nineteenth-century medical beliefs and values on the perceived benefits of physical activity for women across their life span. The practice of medicine and the knowledge which underpins it have never been simple and logical progressions from one truth to another. Rather, scientific knowledge, medical practice and social perception have interacted to affect views concerning what kinds of amounts of physical activity, including sport and healthful exercise, might be most appropriate for girls and women at different points in their life course.
 
"A review of thinking is needed in the field of sociohistorical analysis concerning attitudes toward the female body and attempts to regulate female physical activity. Such analyses may generate new insights into the questions of both social control and the unevenness of progress in women's real or perceived opportunities for participating freely and fully in sports and exercise of their choice."
 

From Popular Medicine to Medical Populism presents the history of medical practice in Costa Rica from the late colonial era—when none of the fifty thousand inhabitants had access to a titled physician, pharmacist, or midwife—to the 1940s, when the figure of the qualified medical doctor was part of everyday life for many of Costa Rica’s nearly one million citizens. It is the first book to chronicle the history of all healers, both professional and popular, in a Latin American country during the national period.
Steven Palmer breaks with the view of popular and professional medicine as polar opposites—where popular medicine is seen as representative of the authentic local community and as synonymous with oral tradition and religious and magical beliefs and professional medicine as advancing neocolonial interests through the work of secular, trained academicians. Arguing that there was significant and formative overlap between these two forms of medicine, Palmer shows that the relationship between practitioners of each was marked by coexistence, complementarity, and dialogue as often as it was by rivalry. Palmer explains that while the professionalization of medical practice was intricately connected to the nation-building process, the Costa Rican state never consistently displayed an interest in suppressing the practice of popular medicine. In fact, it persistently found both tacit and explicit ways to allow untitled healers to practice. Using empirical and archival research to bring people (such as the famous healer or curandero Professor Carlos Carbell), events, and institutions (including the Rockefeller Foundation) to life, From Popular Medicine to Medical Populism demonstrates that it was through everyday acts of negotiation among agents of the state, medical professionals, and popular practitioners that the contours of Costa Rica’s modern, heterogeneous health care system were established.

Sudhir Kakar, a psychoanalyst and scholar, brilliantly illuminates the ancient healing traditions of India embodied in the rituals of shamans, the teachings of gurus, and the precepts of the school of medicine known as Ayurveda.

"With extraordinary sympathy, open-mindedness, and insight Sudhir Kakar has drawn from both his Eastern and Western backgrounds to show how the gulf that divides native healer from Western psychiatrist can be spanned."—Rosemary Dinnage, New York Review of Books

"Each chapter describes the geographical and cultural context within which the healers work, their unique approach to healing mental illness, and . . . the philosophical and religious underpinnings of their theories compared with psychoanalytical theory."—Choice

Sister Kenny was first published in 1976. Minnesota Archive Editions uses digital technology to make long-unavailable books once again accessible, and are published unaltered from the original University of Minnesota Press editions.

Sister Elizabeth Kenny, the Australian-born nurse, is remembered by thousands of grateful parents and grandparents of young polio patients, as well as others who were less personally affected, as the woman who successfully fought the medical profession to win acceptance of her techniques to combat the crippling effects of this disease.

In this biography Victor Cohn, a prize-winning science writer, details the life of Sister Kenny and her significant role in the history of medicine. It is an inspiring story and one which will be of particular interest to those of the present generation who are engaged in the movement for women's equality. Sister Kenny's struggle against the bitter opposition of many doctors to her concepts for the treatment of polio dramatized the then common attitude of male chauvinism on the part of the medical profession toward nurses.

The biography traces Sister Kenny's life from her birth in Australia, through her early nursing career in the bush, to her rise to prominence in America. Much of the narrative focuses on her confrontation with the medical establishment. Throughout, the author writes from an objective viewpoint, and in conclusion he assesses Sister Kenny's accomplishments.

Unevenly distributed resources and rising costs have become enduring problems in the American health care system. Health care is more expensive in the United States than in other wealthy nations, and access varies significantly across space and social classes. James A. Schafer Jr. shows that these problems are not inevitable features of modern medicine, but instead reflect the informal organization of health care in a free market system in which profit and demand, rather than social welfare and public health needs, direct the distribution and cost of crucial resources.

The Business of Private Medical Practice is a case study of how market forces influenced the office locations and career paths of doctors in one early twentieth-century city, Philadelphia, the birthplace of American medicine. Without financial incentives to locate in poor neighborhoods, Philadelphia doctors instead clustered in central business districts and wealthy suburbs. In order to differentiate their services in a competitive marketplace, they also began to limit their practices to particular specialties, thereby further restricting access to primary care. Such trends worsened with ongoing urbanization.

Illustrated with numerous maps of the Philadelphia neighborhoods he studies, Schafer’s work helps underscore the role of economic self-interest in shaping the geography of private medical practice and the growth of medical specialization in the United States.