Biomedical subjects
E F Lawlor
Publications and source records attributed to E F Lawlor.
The demand for policy analysis in health reform: the view from the Romanian partnership.
Health reform initiatives in Central and Eastern Europe (CEE) assume the existence of two kinds of infrastructure: 1) health care resources that can be mobilized to provide services in a market context and 2) intellectual resources that can be mobilized to plan, design, analyze, implement and evaluate new policy. Considerable attention has been devoted to the requirements for management in health sector reform in the CEE (JHAE, Fall 1994). Relatively little attention has been paid to the intellectual and workforce requirements for policy analysis and leadership in the health sector as well as related policy areas (Berman 1995). This paper begins with an overview of the broad contours and expectations for health reform in the CEE region. It then asks what analytic and public management capital is necessary to guide these policy changes within countries. A specific example of the need for analytic and management capacity is drawn out of the recent Romanian proposal to create health insurance houses (plans) in the 40 judets (districts) across the country. Finally, the paper examines the obstacles and issues involved in expanding the role and number of policy analysts in the CEE.
The state of geriatrics training programs: findings from the National Study of Internal Medicine Manpower (NaSIMM)
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Prostate cancer, race, and socioeconomic status: inadequate adjustment for social factors in assessing racial differences.
BACKGROUND: This paper reviews the state of the art in analyzing race, social factors, and economic factors in cancer research, with an emphasis on prostate cancer and the role of socioeconomic status (SES) in racial differences in mortality. It analyzes the quality of articles in the literature that assess the role of SES in cancer mortality. METHODS: English-language titles were identified using MEDLINE with publication dates from mid-1985 through July 1994. Articles in the references of these articles were also included in the final selection, based originally on title and ultimately on content, dating back to 1978. Articles that included SES information and distinguished between whites and African-Americans were chosen, resulting in a final selection of 21 articles. Articles are summarized with consideration of five criteria considered minimal requirements of a well-designed study of the role of race in cancer mortality: (1) SES measure(s) should be on an individual level, not census level; (2) SES should be controlled for when making comparisons between whites and blacks; (3) SES should include at least (individual level) measures of income and education; (4) sample sizes are sufficient for the relevant populations; and (5) specific cancer sites should be studied separately. RESULTS: Of the articles reviewed, only two meet the minimum standards, neither of which studied prostate cancer. It is not clear whether observed racial differences in prostate cancer are directly attributable to race or reflect underlying social factor differences between whites and African-Americans. CONCLUSIONS: In the future, specific characteristics of SES should be measured at the individual level; there is a need for expansion and standardization of data in terms of social and economic content; other methodological advances are needed in modeling to take into consideration the influence of SES in outcome research related to cancer.
Reforming the system under such a deadline is perilous.
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Quality-adjusted life-years. Ethical implications for physicians and policymakers.
Quality-adjusted life-years have been used in economic analyses as a measure of health outcomes, one that reflects both lives saved and patients' valuations of quality of life in alternative health states. The concept of "cost per quality-adjusted life year" as a guideline for resource allocation is founded on six ethical assumptions: quality of life can be accurately measured and used, utilitarianism is acceptable, equity and efficiency are compatible, projections of community preferences can substitute for individual preferences, the old have less "capacity to benefit" than the young, and physicians will not use quality-adjusted life-years as clinical maxims. Quality-adjusted life-years signal two shifts in the locus of control and the nature of the clinical encounter: first, formal expressions of community preferences and societal usefulness would counterbalance patient autonomy, and second, formal tools of resource allocation and applied decision analysis would counterbalance the use of clinical judgment. These shifts reflect and reinforce a new financial ethos in medical decision making. Presently using quality-adjusted life-years for health policy decisions is problematic and speculative; using quality-adjusted life-years at the bedside is dangerous.
Photoallergic contact dermatitis to rhubarb wine.
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