Results by title

From mad-cow disease and E. coli-tainted spinach in the food supply to anthrax scares and fears of a bird flu pandemic, national health threats are a perennial fact of American life. Yet not all crises receive the level of attention they seem to merit. The marked contrast between the U.S. government's rapid response to the anthrax outbreak of 2001 and years of federal inaction on the spread of AIDS among gay men and intravenous drug users underscores the influence of politics and public attitudes in shaping the nation's response to health threats. In Disease Prevention as Social Change, sociologist Constance Nathanson argues that public health is inherently political, and explores the social struggles behind public health interventions by the governments of four industrialized democracies. Nathanson shows how public health policies emerge out of battles over power and ideology, in which social reformers clash with powerful interests, from dairy farmers to tobacco lobbyists to the Catholic Church. Comparing the history of four public health dilemmas—tuberculosis and infant mortality at the turn of the last century, and more recently smoking and AIDS—in the United States, France, Britain, and Canada, Nathanson examines the cultural and institutional factors that shaped reform movements and led each government to respond differently to the same health challenges. She finds that concentrated political power is no guarantee of government intervention in the public health domain. France, an archetypical strong state, has consistently been decades behind other industrialized countries in implementing public health measures, in part because political centralization has afforded little opportunity for the development of grassroots health reform movements. In contrast, less government centralization in America has led to unusually active citizen-based social movements that campaigned effectively to reduce infant mortality and restrict smoking. Public perceptions of health risks are also shaped by politics, not just science. Infant mortality crusades took off in the late nineteenth century not because of any sudden rise in infant mortality rates, but because of elite anxieties about the quantity and quality of working-class populations. Disease Prevention as Social Change also documents how culture and hierarchies of race, class, and gender have affected governmental action—and inaction—against particular diseases. Informed by extensive historical research and contemporary fieldwork, Disease Prevention as Social Change weaves compelling narratives of the political and social movements behind modern public health policies. By comparing the vastly different outcomes of these movements in different historical and cultural contexts, this path-breaking book advances our knowledge of the conditions in which social activists can succeed in battles over public health.

In this provocative book, Sylvia Tesh shows how "politics masquerades as science" in the debates over the causes and prevention of disease. Tesh argues that ideas about the causes of disease which dominate policy at any given time or place are rarely determined by scientific criteria alone. The more critical factors are beliefs about how much government can control industry, who should take risks when scientists are uncertain, and whether the individual or society has the ultimate responsibility for health. Tesh argues that instead of lamenting the presence of this extra-scientific reasoning, it should be brought out of hiding and welcomed. She illustrates her position by analyzing five different theories of disease causality that have vied for dominance during the nineteenth and twentieth centuries, and discusses in detail the political implications of each theory. Tesh also devotes specific chapters to the multicausal theory of disease, to health education policy in Cuba, to the 1981 air traffic controller's strike, to the debate over Agent Orange, and to an analysis of science as a belief system.

Along the way she makes these principal points: She criticizes as politically conservative the idea that diseases result from a multifactorial web of causes. Placing responsibility for disease prevention on "society" is ideological, she argues. In connection with the air traffic controllers she questions whether it is in a union's best interests to claim that workers' jobs are stressful. She shows why there are no entirely neutral answers to questions about the toxicity of environmental pollutants. In a final chapter, Tesh urges scientists to incorporate egalitarian values into their search for the truth, rather than pretending science can be divorced from that political ideology.

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.