Relman's 60 years as researcher, clinician, teacher, government consultant, licensing board member, and editor in chief of the New England Journal of Medicine give him enormous credibility on the subject of health-care reform. He's for national single-payer insurance but believes America's health-care system must change, too, or spiraling costs--and spiraling inequity--won't be contained. The greatest threat to U.S. health care, as he sees it, is the commercialization of medicine since the late 1960s, which, according to free-market ideology, should bring better care at lower cost but hasn't delivered (and never will, Relman believes). Doctors need to renew the sense of themselves as disinterested and compassionate healers rather than money-grubbing entrepreneurs. Relman proposes that most physicians be salaried by a national financing system, associate in self-run group practices to pool expertise and resources, and reclaim the professional self-regulation lost in a 1943 Supreme Court antitrust decision (exemption from antitrust law should be sought, Relman thinks). Everyone interested in its issues must read Relman's argument. Ray Olson
Dr. Arnold Relman, Professor Emeritus at Harvard Medical School and former editor-in-chief of The New England Journal of Medicine brings together sixty years of experience in medicine in a book that holds the keys to a new structure for healthcare based on voluntary private contracts between individuals and not-for-profit, multi-specialty groups of physicians. Timely, provocative, and newly updated, A Second Opinion is a clarion call to action. If we heed Dr. Relman's plan, Americans could at last achieve a lasting, sensible solution to national healthcare.
The Textbook of Influenza is a comprehensive resource covering all aspects of influenza, from the genetic and molecular biology of the virus through to clinical aspects of the disease and the latest drug developments and treatments. This new edition has been completely revised and reflects the integration of disciplines concerning the emergence, evolution, pathogenesis and control of influenza viruses in the field of human and veterinary public health. Textbook of Influenza examines the lessons learnt from the latest pandemic and provides the current state of knowledge for many yet unresolved issues related to virus origin, spread, pathogenesis and disease severity to better prepare for future pandemics. It covers the background to recent advances in influenza genomics and reverse genetics which have allowed the identification of virus virulence factors and the analysis and reconstruction of influenza viruses such as the 1918 Spanish flu strain. This new edition is divided into eight key sections, containing chapters co-written by international experts from both the clinical and scientific communities, covering: • Influenza Perspectives • Structure and Replication • Evolution and Ecology • Epidemiology and Surveillance • Immunology • Vaccines and Vaccine Development • Clinical Aspects and Antivirals • Public Health Textbook of Influenza is for all those working in the area of influenza including clinical and basic scientists, immunologists, molecular and structural virologists, public health officials and global pandemic control planners.
This important new study explores how American health care evolved in the 1990s, as well as the changes in public support and policy. Birenbaum examines where the interests of consumers and professionals have dovetailed and where they differ. He considers the health care system's future and suggested ways the system must be adjusted to provide better and wider coverage at reasonable costs. This volume is essential reading for scholars, students, and professionals in the medical field, as well as general readers concerned with health care issues. The 90s saw the country moving toward a realization that health care had become unaffordable—or an enormous financial burden for people with otherwise adequate incomes. Health care providers and consumers alike worried that the problem was becoming uncontrollable. Doctors saw their autonomy and control eroded, employers saw their costs rising significantly, the costs began shifting to employees, and alternative approaches to cost containment were explored.
Written for a variety of readers -- whether interested citizens, students, or practicing health professionals -- the book provides a systematic understanding of how health care is provided in the United States. It is a readable, candid and thoughtful dissection of the problems confronted by both individuals and institutions within the health sector. Focus is on a detailed analysis of external environmental issues, financial as well as regulatory, affecting providers, as well as on the structural shifts in health care delivery, with both intended and unintended consequences.
Has postmodern American culture so altered the terrain of medical care that moral confusion and deflated morale multiply faster than both technological advancements and ethical resolutions? The Ethos of Medicine in Postmodern America is an attempt to examine this question with reference to the cultural touchstones of our postmodern era: consumerism, computerization, corporatization, and destruction of meta-narratives. The cultural insights of postmodern thinkers—such as such as Foucault, Deleuze and Guattari, Lyotard, Baudrillard, Bauman, and Levinas—help elucidate the changes in healthcare delivery that are occurring early in the twenty-first century. Although only Foucault among this group actually focused his critique on medical care itself, their combined analysis provides a valuable perspective for gaining understanding of contemporary changes in healthcare delivery. It is often difficult to envision what is happening in the psychosocial, cultural dynamic of an epoch as you experience it. Therefore it is useful to have a technique for refracting those observations through the lens of another system of thought. The prism of postmodern thought offers such a device with which to “view the eclipse” of changing medical practice. Any professional practice is always thoroughly embedded in the social and cultural matrix of its society, and the medical profession in America is no exception. In drawing upon of the insights of key Continental thinkers such and American scholars, this book does not necessarily endorse the views of postmodernism but trusts that much can be learned from their insight. Furthermore, its analysis is informed by empirical information from health services research and the sociology of medicine. Arnold R. Eiser develops a new understanding of healthcare delivery in the twenty-first century and suggests positive developments that might be nurtured to avoid the barren “Silicon Cage” of corporate, bureaucratized medical practice. Central to this analysis are current healthcare issues such as the patient-centered medical home, clinical practice guidelines, and electronic health records. This interdisciplinary examination reveals insights valuable to anyone working in postmodern thought, medical sociology, bioethics, or health services research.
Relman's 60 years as researcher, clinician, teacher, government consultant, licensing board member, and editor in chief of the New England Journal of Medicine give him enormous credibility on the subject of health-care reform. He's for national single-payer insurance but believes America's health-care system must change, too, or spiraling costs--and spiraling inequity--won't be contained. The greatest threat to U.S. health care, as he sees it, is the commercialization of medicine since the late 1960s, which, according to free-market ideology, should bring better care at lower cost but hasn't delivered (and never will, Relman believes). Doctors need to renew the sense of themselves as disinterested and compassionate healers rather than money-grubbing entrepreneurs. Relman proposes that most physicians be salaried by a national financing system, associate in self-run group practices to pool expertise and resources, and reclaim the professional self-regulation lost in a 1943 Supreme Court antitrust decision (exemption from antitrust law should be sought, Relman thinks). Everyone interested in its issues must read Relman's argument. Ray Olson
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