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Every year the average number of prescriptions purchased by Americans increases, as do healthcare expenditures, which are projected to reach one-fifth of the U.S. gross domestic product by 2020. In Drugs for Life, Joseph Dumit considers how our burgeoning consumption of medicine and cost of healthcare not only came to be, but also came to be taken for granted. For several years, Dumit attended pharmaceutical industry conferences; spoke with marketers, researchers, doctors, and patients; and surveyed the industry's literature regarding strategies to expand markets for prescription drugs. He concluded that underlying the continual growth in medications, disease categories, costs, and insecurity is a relatively new perception of ourselves as inherently ill and in need of chronic treatment. This perception is based on clinical trials that we have largely outsourced to pharmaceutical companies. Those companies in turn see clinical trials as investments and measure the value of those investments by the size of the market and profits that they will create. They only ask questions for which the answer is more medicine. Drugs for Life challenges our understanding of health, risks, facts, and clinical trials, the very concepts used by pharmaceutical companies to grow markets to the point where almost no one can imagine a life without prescription drugs.

Unlike earlier work in medical economics, which has focused on medical care, these ten papers stress the production and consequences of health itself. They reveal a serious concern with real-world health problems in their investigation of such subjects as infant mortality, life expectancy, morbidity, and disability. These papers are unusual, as well, in bringing to bear on these problems new and powerful theoretical and statistical tools. They draw on, and in some cases are, original sources for new bodies of data. As such, Economic Aspects of Health comprises a useful blend of relevance and rigor.

The personal testimony of individuals engaged in healing practices and the opposing voices of orthodox and alternative medicines are the center of Healing Powers. Focusing on medical norms and practices and on competing philosophies of the mind, the body, reality, and rationality across radically different "belief systems", Fred Frohock clarifies the social and legal dilemmas represented by "scientific medicine" and "alternative care."

"Frohock goes beyond the often irreconcilable differences between scientific biomedicine and alternative care by clarifying the social and legal dilemmas they present. . . . A noteworthy contribution forcing us to rethink what medical care is all about."—Jeffrey Michael Clare, Journal of the American Medical Association

"The book does more and better than simply provide a social-scientific proposal. It also gives not only a hearing but a voice to those who follow alternative therapies. . . . Frohock's accounts of their stories—along with the stories of the medical professionals—are eloquent and fascinating."—Allen Verhey, Medical Humanities Review

"Contains a storehouse of valuable information about the historical, philosophical, and psychological bases of alternative approaches to healing."—Marshall B. Kapp, New England Journal of Medicine

"Frohock introduces us to the scientific naturopaths and to physicians who believe in the mind's power to heal, to charismatics who believe in but cannot explain their powers, to those who test God and those who merely accept. He writes so well that I felt I had met these people."—Arthur W. Frank, Christian Century

This important collection of essays, originating in a 1989 conference on the disadvantaged in American health care, provides incisive commentary on U.S. health care policy and politics. Examining public responses to health crises and analyzing the political logic of the American community, this volume charts the immobility of U.S. health policy in recent years and points to its disastrous consequences for the 1990s.
Focusing on the particular needs of disadvantaged groups—the elderly, children, people with AIDS, the mentally ill, the chemically dependent, the homeless, the hungry, the medically uninsured—these essays develop strong policy statements. The authors describe the growth in U.S. health care programs, from Kerr-Mills to Medicare, Medicaid, and subsequent revisions, and stress the serious omissions resulting from incremental policy expansion, both in identifying disadvantaged groups and in implementing programs. They report the weakness of the U.S. health care system compared to systems of other technologically developed countries.

Contributors. Deborah A. Stone and Theodore R. Marmor, Judith Feder, Alice Sardell, Bruce C. Vladeck, Michael Lipsky and Marc A. Thibodeau, Daniel M. Fox, William E. McAuliffe, M. Gregg Bloche and Francine Cournos, Lawrence D. Brown, James A. Morrone

When federal and state policy makers’ efforts to enact sweeping health care reform in the mid-1990s ended in stalemate, the private sector unleashed initiatives that have affected virtually every aspect of health care. With updated essays first published in issues of the Journal of Health Politics, Policy and Law, Healthy Markets? offers the most comprehensive and critical examination yet found in a single volume of the economic, political, and social implications of this recent market transformation of health care in the United States.
With original contributions from leading social science health policy analysts, this volume addresses the full context of health system change. Believing that the analysis of health care change is too important to be left to economists alone, Mark A. Peterson has collected a mulitdisciplinary group of experts who revisit the contentious debate over the market approaches to health care and consider the disparate effects of these approaches on cost, quality, and coverage of both managed care and Medicaid and Medicare. While market enthusiasts applaud the enhanced efficiency, reduced excess capacity, and abatement of the decades-long health care cost explosion, a backlash has emerged among many providers and the public against the perceived excesses of the market: diminished access to care, commercialization of the physician-patient relationship, and exacerbated inequality. Contributors assess these varied responses while examining the impact that market-based applications are likely to have for future health policy making, the significance of the U.S. experience for policy makers abroad, and the lessons that these changes might provide for thinking sensibly about the future of our health care system.
This volume will be useful for public policy analysts, economists, social scientists, health care providers and administrators, and others interested in the future—and in understanding the past—of American health care.

Contributors. Gary S. Belkin, Lawrence D. Brown, Robert G. Evans, Martin Gaynor, Paul B. Ginsburg, Marsha Gold, Theodore R. Marmor, Cathie Jo Martin, Jonathan B. Oberlander, Mark V. Pauly, Mark A. Peterson, Thomas Rice, Deborah A. Stone, William B. Vogt, Kenneth E. Thorpe

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.

This unique comparative study looks at efforts to regulate carcinogenic chemicals in several Western democracies, including the United States, and finds marked national differences in how conflicting scientific interpretations and competing political interests are resolved. Whether risk issues are referred to expert committees without public debate or debated openly in a variety of forums, patterns of interaction among experts, policy makers, and the public reflect fundamental features of each country's political culture. "A provocative argument....Poses interesting questions for the sociology of science, especially science produced for public debate."—Contemporary Sociology A Volume in the Russell Sage Foundation's Social Science Frontiers Series

Will ever-more sensitive screening tests for cancer lead to longer, better lives?  Will anticipating and trying to prevent the future complications of chronic disease lead to better health?  Not always, says Robert Aronowitz in Risky Medicine. In fact, it often is hurting us.  

Exploring the transformation of health care over the last several decades that has led doctors to become more attentive to treating risk than treating symptoms or curing disease, Aronowitz shows how many aspects of the health system and clinical practice are now aimed at risk reduction and risk control. He argues that this transformation has been driven in part by the pharmaceutical industry, which benefits by promoting its products to the larger percentage of the population at risk for a particular illness, rather than the smaller percentage who are actually affected by it. Meanwhile, for those suffering from chronic illness, the experience of risk and disease has been conflated by medical practitioners who focus on anticipatory treatment as much if not more than on relieving suffering caused by disease. Drawing on such controversial examples as HPV vaccines, cancer screening programs, and the cancer survivorship movement, Aronowitz argues that patients and their doctors have come to believe, perilously, that far too many medical interventions are worthwhile because they promise to control our fears and reduce uncertainty.   
 
Risky Medicine is a timely call for a skeptical response to medicine’s obsession with risk, as well as for higher standards of evidence for risk-reducing interventions and a rebalancing of health care to restore an emphasis on the actual curing of and caring for people suffering from disease.      

The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations.

The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice.

Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine.

Duke University Press is pleased to announce the second edition of the bestselling Social Medicine Reader. The Reader provides a survey of the challenging issues facing today’s health care providers, patients, and caregivers by bringing together moving narratives of illness, commentaries by physicians, debates about complex medical cases, and conceptually and empirically based writings by scholars in medicine, the social sciences, and the humanities. The first edition of The Social Medicine Reader was a single volume. This significantly revised and expanded second edition is divided into three volumes to facilitate use by different audiences with varying interests.

Praise for the 3-volume second edition of The Social Medicine Reader:
“A superb collection of essays that illuminate the role of medicine in modern society. Students and general readers are not likely to find anything better.”—Arnold S. Relman, Professor Emeritus of Medicine and Social Medicine, Harvard Medical School

Praise for the first edition:
“This reviewer strongly recommends The Social Medicine Reader to the attention of medical educators.”—Samuel W. Bloom, JAMA: The Journal of the American Medical Association

Volume 3:

Over the past four decades the American health care system has witnessed dramatic changes in private health insurance, campaigns to enact national health insurance, and the rise (and perhaps fall) of managed care. Bringing together seventeen pieces new to this second edition of The Social Medicine Reader and four pieces from the first edition, Health Policy, Markets, and Medicine draws on a broad range of disciplinary perspectives—including political science, economics, history, and bioethics—to consider changes in health care and the future of U.S. health policy. Contributors analyze the historical and moral foundation of today’s policy debates, examine why health care spending is so hard to control in the United States, and explain the political dynamics of Medicare and Medicaid. Selections address the rise of managed care, its impact on patients and physicians, and the ethical implications of applying a business ethos to medical care; they also compare the U.S. health care system to the systems in European countries, Canada, and Japan. Additional readings probe contemporary policy issues, including the emergence of consumer-driven health care, efforts to move quality of care to the top of the policy agenda, and the implications of the aging of America for public policy.

Contributors: Henry J. Aaron, Drew E. Altman, George J. Annas, Robert H. Binstock, Thomas Bodenheimer, Troyen A. Brennan, Robert H. Brook, Lawrence D. Brown, Daniel Callahan, Jafna L. Cox, Victor R. Fuchs, Kevin Grumbach, Rudolf Klein, Robert Kuttner, Larry Levitt, Donald L. Madison, Wendy K. Mariner, Elizabeth A. McGlynn, Jonathan Oberlander, Geov Parrish, Sharon Redmayne, Uwe E. Reinhardt, Michael S. Sparer, Deborah Stone

Duke University Press is pleased to announce the second edition of the bestselling Social Medicine Reader. The Reader provides a survey of the challenging issues facing today’s health care providers, patients, and caregivers by bringing together moving narratives of illness, commentaries by physicians, debates about complex medical cases, and conceptually and empirically based writings by scholars in medicine, the social sciences, and the humanities. The first edition of The Social Medicine Reader was a single volume. This significantly revised and expanded second edition is divided into three volumes to facilitate use by different audiences with varying interests.

Praise for the 3-volume second edition of The Social Medicine Reader:
“A superb collection of essays that illuminate the role of medicine in modern society. Students and general readers are not likely to find anything better.”—Arnold S. Relman, Professor Emeritus of Medicine and Social Medicine, Harvard Medical School

Praise for the first edition:
“This reviewer strongly recommends The Social Medicine Reader to the attention of medical educators.”—Samuel W. Bloom, JAMA: The Journal of the American Medical Association

Volume 1:

A woman with what is quite probably a terminal illness must choose between courses of treatment based on contradictory diagnoses. A medical student causes acute pain in his patients as he learns to insert a central line. One doctor wonders how to react when a patient asks him to pray with her; another struggles to come to terms with his mistakes. A physician writes in a prominent medical journal about facilitating a dying woman’s wish to end her life on her own terms; letters to the editor reflect passionate responses both in support of and in opposition to his actions. These experiences and many more are vividly rendered in Patients, Doctors, and Illness, which brings together nineteen pieces that appeared in the first edition of The Social Medicine Reader and eighteen pieces new to this edition. This volume examines the roles and training of health care professionals and their relationship with patients, ethics in health care, and end-of-life experiences and decisions. It includes fiction and nonfiction narratives and poetry; definitions and case-based discussions of moral precepts in health care, such as truth telling, informed consent, privacy, and autonomy; and readings that provide legal, ethical, and practical perspectives on many familiar but persistent ethical and social questions raised by illness and care.

Contributors: Yehuda Amichai, Marcia Angell, George J. Annas, Marc D. Basson, Doris Betts, Amy Bloom, Abenaa Brewster, Raymond Carver, Eric J. Cassell, Larry R. Churchill, James Dickey, Gerald Dworkin, James Dwyer, Miles J. Edwards, Charles R. Feldstein, Chris Feudtner, Leonard Fleck, Arthur Frank, Benjamin Freedman, Atul Gawande, Jerome Groopman, Lawrence D. Grouse, David Hilfiker, Nancy M. P. King, Perri Klass, Melvin Konner, Bobbie Ann Mason, Steven H. Miles, Sharon Olds, Katha Pollitt, Timothy E. Quill, David Schenck, Daniel Shapiro, Susan W. Tolle, Alice Stewart Trillin, William Carlos Williams

Duke University Press is pleased to announce the second edition of the bestselling Social Medicine Reader. The Reader provides a survey of the challenging issues facing today’s health care providers, patients, and caregivers by bringing together moving narratives of illness, commentaries by physicians, debates about complex medical cases, and conceptually and empirically based writings by scholars in medicine, the social sciences, and the humanities. The first edition of The Social Medicine Reader was a single volume. This significantly revised and expanded second edition is divided into three volumes to facilitate use by different audiences with varying interests.

Praise for the 3-volume second edition of The Social Medicine Reader:
“A superb collection of essays that illuminate the role of medicine in modern society. Students and general readers are not likely to find anything better.”—Arnold S. Relman, Professor Emeritus of Medicine and Social Medicine, Harvard Medical School

Praise for the first edition:
“This reviewer strongly recommends The Social Medicine Reader to the attention of medical educators.”—Samuel W. Bloom, JAMA: The Journal of the American Medical Association

Volume 2:

Ranging from a historical look at eugenics to an ethnographic description of parents receiving the news that their child has Down syndrome, from analyses of inequalities in the delivery of health services to an examination of the meaning of race in genomics research, and from a meditation on the loneliness of the long-term caregiver to a reflection on what children owe their elderly parents, this volume explores health and illness. Social and Cultural Contributions to Health, Difference, and Inequality brings together seventeen pieces new to this edition of The Social Medicine Reader and five pieces that appeared in the first edition. It focuses on how difference and disability are defined and experienced in contemporary America, how the social categories commonly used to predict disease outcomes—such as gender, race and ethnicity, and social class—have become contested terrain, and why some groups have more limited access to health care services than others. Juxtaposing first-person narratives with empirical and conceptual studies, this compelling collection draws on several disciplines, including cultural and medical anthropology, sociology, and the history of medicine.

Contributors: Laurie K. Abraham, Raj Bhopal, Ami S. Brodoff, Daniel Callahan, David Diamond, Liam Donaldson, Alice Dreger, Sue E. Estroff, Paul Farmer, Anne Fausto-Sterling, Jerome Groopman, Gail E. Henderson, Linda M. Hunt, Barbara A. Koenig, Donald R. Lannin, Sandra Soo-Jin Lee, Carol Levine, Judith Lorber, Nancy Mairs, Holly F. Mathews, James P. Mitchell, Joanna Mountain, Alan R. Nelson, Martin S. Pernick, Rayna Rapp, Sally L. Satel, Robert S. Schwartz, Brian D. Smedley, Adrienne Y. Stith, Sharon Sytsma, Gordon Weaver, Bruce Wilson, Irving Kenneth Zola