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PubMed2002

A loss of faith: the sources of reduced political legitimacy for the American medical profession.

The political legitimacy and policymaking influence of the medical profession have greatly declined in American society over the past 30 years. Despite speculation about the causes, there has been little empirical research assessing the different explanations. To address this gap, data collected in 1995 are used to compare attitudes of the American public and policy elites toward medical authority. Statistical analyses reveal that (1) elites are more hostile to professional authority than is the public; (2) the sources of declining legitimacy are different for the public than they are for policy elites; and (3) the perceptions that most threaten the legitimacy of the medical profession pertain to doubts about professional competence, physicians' perceived lack of altruism, and limited confidence in the profession's political influence. This article concludes with some speculations about the future of professional authority in American medicine.

Attitude to Health↗
PubMed2001

Developing drugs for the developing world: an economic, legal, moral, and political dilemma.

This paper discusses the economic, legal, moral, and political difficulties in developing drugs for the developing world. It argues that large, global pharmaceutical companies have social responsibilities to the developing world, and that they may exercise these responsibilities by investing in research and development related to diseases that affect developing nations, offering discounts on drug prices, and initiating drug giveaways. However, these social responsibilities are not absolute requirements and may be balanced against other obligations and commitments in light of economic, social, legal, political, and other conditions. How a company decides to exercise its social responsibilities to the developing world depends on (1) the prospects for a reasonable profit and (2) the prospects for a productive business environment. Developing nations can either help or hinder the pharmaceutical industry's efforts to exercise social responsibility through various policies and practices. To insure that companies can make a reasonable profit, developing nations should honor pharmaceutical product patents and adhere to international intellectual property treaties, such as the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. To insure the companies have a good business environment, developing nations should try to promote the rule of law, ethical business practices, stable currencies, reliable banking systems, free and open markets, democracy, and other conditions conducive to business. Overall, this paper advocates for reciprocity and cooperation between pharmaceutical companies and developing nations to address the problem of developing drugs for the developing world. In pursuing this cooperative approach, developing nations may use a variety of other techniques to encourage pharmaceutical companies to act responsibly, such as subsidizing pharmaceutical research, helping to design and implement research protocols, providing a guaranteed market, and bulk buying.

Beneficence↗
PubMed1991

Alcohol and other drugs: the response of the political and medical institutions.

Formal and informal social control in shaping individual behaviors toward the use of alcohol and other drugs is discussed. Emphasis is placed on formal social control as it occurs in two major institutions. The state, which embodies the political and legal structures of the society is discussed in terms of the social control of some of the consequences of drinking, such as public drunkenness, alcoholism, operating vehicles with specific blood alcohol levels, and crime and alcohol use. The medical institution's involvement in alcohol and drug control is discussed in terms of the physician's role in diagnosing alcohol and drug dependent individuals. Two contemporary cases, those of pregnant addicts and alcohol-related organ transplant patients, illustrate the significant interactions between the responses of the political and medical institutions, and the broader influences that help shape these responses.

Alcoholism↗
PubMed1983

The development of professional and political awareness in nursing.

The fiduciary relationship between the client and the professional who has been hired to provide a service rarely exists today between nurses and patients, Nurses are employed by the State and operate in organizations where elements of both the bureaucratic and professional models are integrated. This paper discusses nursing's adaptation to the ever-changing health system in the United Kingdom and how this has resulted in the involvement of senior nurses in the political process. The mechanisms which result in policy output are discussed with reference to the power of nurses. It is argued that all nurses have a role in the decision-making process through the use of influence which will result from the development of political awareness.

Attitude of Health Personnel↗
PubMed1991

Cultural and political limitations within a rational approach towards educational change.

This paper considers the use of a rational curriculum planning model within nurse education. It suggests that the process of change within the model is oversimplified and mechanistic. As such it denies or ignores the experience of individuals involved in the change process by reducing their personal, cultural and political realities to a level of idealogical control. The unrestrained or unmodified application of a rational approach may, by this control, inhibit the development of change arising from subjective experiences. It may further be viewed as a political strategy which benefits powerful groupings within the school thus institutionalizing this power and maintaining the status quo in terms of power and influence.

Conflict, Psychological↗
PubMed2007

Nurses' experiences of practice and political reform in long-term aged care in Australia: implications for the retention of nursing personnel.

AIM: The aim of the study was to explore registered nurses' experiences in long-term aged care in light of the political reform of aged care services in Australia. BACKGROUND: In Australia, the aged care industry has undergone a lengthy period of political and structural reform. Despite reviews into various aspects of these reforms, there has been little consideration of the effect these are having on the practice experiences and retention of nursing staff in long-term care. METHODS: In this critical hermeneutic study, 14 nurses from long-term care facilities in Australia were interviewed about their experiences during the reform period. RESULTS: The data revealed a sense of tension and conflict between nurses' traditional values, roles and responsibilities and those supported by the reforms. Nurses struggled to re-negotiate both their practice roles and values as the reforms were implemented and the system evolved. Nursing management support was an important aspect in mediating the effect of reforms on nursing staff. CONCLUSION: This research highlights both the tensions experienced by nurses in long-term aged care in Australia and the need to re-negotiate nursing roles, responsibilities and values within an evolving care system. This research supports a role for sensitive and proactive nursing management during periods of industry reform as a retention strategy for qualified nursing personnel.

Aged↗
PubMed2005

Things I've learned about personality from studying political leaders at a distance.

Studying the personalities of political leaders requires methods of measuring personality at a distance. One such method is content analysis of speeches, interviews, and other texts. This article reviews the author's research on achievement, affiliation, and power motives of U.S. presidents and other leaders and draws the following conclusions: (1) motivation and personality can be objectively and reliably measured at a distance; (2) personality is complex, consisting of several different elements or kinds of variables (e.g., motives and cognitions as well as traits); (3) personality exists in social contexts, and past social contexts are embodied in personality; (4) political behaviors and outcomes can be predicted from personality, but only in contingent ("if/then") ways.

Achievement↗
PubMed2004

Sociology and political arithmetic: some principles of a new policy science.

This paper advances the position that sociology needs to develop an approach to research which focuses on fundamental social problems. In doing so it shares many of the intellectual values and goals of political arithmetic while seeking to move methodologically beyond it. Since such problems are complex they will require, typically, interdisciplinary input and a concomitant approach to the development and appraisal of theories. We are not, therefore, advocating the primacy of sociology but arguing that it has a distinctive part to play in addressing the fundamental problems of the twenty-first century. However, a policy-oriented sociology has also to take up the task, so clearly defined by the tradition of political arithmetic, which is to hold governments to account. Consequently a central principle of a new policy science is that it should contribute to democratic debate about policy.

Democracy↗
PubMed2006

Species protection, the changing informal economy, and the politics of access to the bushmeat trade in the Democratic Republic of Congo.

Our understanding of the linkages between the bushmeat trade and the wider informal economy is limited. This lack of knowledge is particularly problematic for conservation under conditions of political instability, when the informal economy can be highly dynamic and impacts on wildlife populations can be severe. To explore these interlinked processes, we conducted a study of the bushmeat trade in Garamba National Park, Democratic Republic of Congo, through a combination of market surveys, semistructured interviews, and direct observation. We focused on the sale of protected and unprotected species in urban and rural markets, and the bushmeat commodity chains that supplied these markets, under conditions of political stability and armed conflict. During peacetime, protected species from the park (predominantly elephant and buffalo) rarely appeared in the rural markets, but they comprised more than half of all bushmeat sales in the urban markets. This pattern reflected differences in the rural and urban commodity chains. Automatic weapons were urban trade. The use of such weapons was discouraged by the traditional chiefs, who administered the village markets. During wartime, the sales of protected species in the urban markets increased fivefold because the military officers fled, leaving behind an open-access system that led to a massive increase in the exploitation of protected species. In contrast, the rural markets remained relatively stable because of the continued authority of the village chiefs. Our results indicate that sociopolitical factors can be an important determinant of species offtake and, therefore, that knowledge of the bushmeat commodity chain can be vital to controlling theprocesses that drive species extraction. In addition, our findings suggest that traditional authorities can be potentially valuable partners for bushmeat management.

Animals↗
PubMed1990

Disappeared: semantic and somatic effects of political repression in a family seeking therapy.

The admission interview and a brief course of therapy with a family of six living in a repressive political context is presented. The context is described, the initial interview detailed, and seven sessions summarized. This is followed by a discussion of the effects of the political climate on the family's language, social adaptation, and health, and of the goals of therapy with families of disappeared people (desaparecidos).

Argentina↗
PubMed1998

Therapist in distress: team-supervision of social workers and family therapists who work and live under political uncertainty.

This article describes and analyzes a 2-year supervision process with social workers and family therapists who live and work under conditions of uncertainty on the West Bank. The systemic orientation used in this specific approach to supervision emphasizes the double role of the therapist: one as part of the therapeutic system, and the second as a member of the same community that is living in political uncertainty. The analysis revealed that a long-term supervision process, in which the supervisor encouraged a containing context, was meaningful to the group. As a result of this secure atmosphere, the group was ready to talk about painful issues like loss as the result of war and terrorist attacks, loss as a result of immigration, and loss of ideals. Furthermore, the members of the group were ready to confront the possibility of relocation and their role in such a situation. The techniques used in the process, such as narrative and metaphors, were implemented by the members in their daily professional interventions. The flexibility between working on regular professional issues and issues related to stress and uncertainty seemed useful to the supervision, as well as the political dialogue that was created between the supervisor and the group.

Adaptation, Psychological↗
PubMed2000

The politics of population policy in the Islamic Republic of Iran.

The Islamic Republic of Iran arguably has one of the most successful family planning programs in the developing world. This success is all the more interesting for advocates of population programs because the political leaders of the Islamic regime were once strongly opposed to family planning. Indeed, after gaining power following the 1979 revolution, they were responsible for dismantling Iran's relatively new family planning program and introducing pronatalist policies. This article provides an account of the different phases of the population policy in Iran and examines the diverse elements that led politico-religious leaders to revise their views about fertility control and to participate in creating a workable family planning program. The complex formal and informal strategies that the political experts, the media, the religious authorities, and the government of the Islamic Republic adopted in order to achieve this about-face are described. The analysis is based on data collected by the first author during anthropological field research in 1993-96, by means of informal interviews with officials, with medical personnel, with family planning clients, and with religious leaders.

Family Planning Policy↗
PubMed2004

Political issues in emergency medicine: The United States.

The format of the paper is to allow three authors to discuss what they believe are the most significant political issues facing emergency medicine (EM) in their country or region. Each author writes independently and does not see any other contributing author's work, therefore potential overlap of subject matter is inevitable. However, we were soliciting their individual opinions about the serious issues confronting us today, rather than a consensus. An additional author, well familiar with the topics being discussed, wrote the Commentary from an overview perspective on the writings of the other authors. This supplemental opinion was offered as a method for enhanced cohesiveness in describing the political situations impacting the specialty of emergency medicine. The three authors for the United States are James Hoekstra, Professor and Chair, Wake Forest University Health Sciences; Robert McNamara, Professor and Chair, Temple University School of Medicine, and Robert Schafermeyer, Associate Chair, Department of Emergency Medicine, North Carolina School of Medicine. Between them, they represent more than 50 years experience in clinical and academic emergency medicine. They write from a personal perspective. Their views are their own, and do not represent any organization(s) with which they may have or had affiliations.

Emergency Medicine↗
PubMed1996

The politics of school-based programs which address sexual orientation.

This study examined both the content of school district programs related to sexual orientation, and the social and political determinants of these school programs. Data were collected from districts within all 126 U.S. communities with legal protection against discrimination on the basis of sexual orientation, and from a random sample of 129 U.S. jurisdictions without such legislation. Results showed that most school districts are not offering recommended program elements related to sexual orientation issues. Districts within localities with gay rights protection are doing more than those without. Although compositional factors account for some of the differences in educational efforts, a politically engaged constituency also made a major difference in school district efforts. To the extent that gays and lesbians served in local public office and mobilized to influence school elections, they were able to affect school programs and policies.

Civil Rights↗
PubMed1986

Evaluations of political violence by English and Northern Irish schoolchildren.

In a study of attitudes to violence in English and Northern Irish schoolchildren, 178 children, 10-11-years-old, completed a questionnaire relating to eight examples of political and non-political violence. The children were distinguished by sex, religion and geographical location. The expected differences between religious groups in Northern Ireland did not emerge: significant differences arose only between English and Irish children and were apparent for only three of the questions. The implications of these findings are discussed.

Child↗
PubMed2002

Suicide and political regime in New South Wales and Australia during the 20th century.

STUDY OBJECTIVE: Australia has had a two party parliamentary political system for most of the period since its Federation in 1901, dominated either by a social democratic (Labor) or a conservative ideological perspective. This paper investigates whether such political differences at Federal and State levels have influenced suicide rates in the state of New South Wales (NSW) for the period 1901-1998. DESIGN: Federal government type, NSW State government type, and combinations of both Federal and NSW State government type were examined. Poisson regression models were stratified by sex and controlled for the effects of age, annual change in gross domestic product, sedative availability, drought, and both world wars. RESULTS: When both Federal and NSW State governments were conservative the relative risk of suicide for NSW men was 1.17 (p<0.001) and for women 1.40 (p<0.001) compared with both governments being Labor (1.00). A statistically significant linear trend (p<0.001) in suicide risk was evident across the continuum of Federal/State government combinations, from both Labor (lowest), to mixed (intermediate), to both conservative (highest). CONCLUSION: Significantly higher suicide risk was associated with conservative government tenures compared with social democratic incumbents. Results are discussed in terms of the differences underpinning conservative and social democratic government programme ideology, and their relevance to Durkheim's theories of suicide, social regulation, and integration.

Adolescent↗
PubMed2005

The patent is political: the consequences of patenting the BRCA genes in Britain.

OBJECTIVES: The paper explores the attempt by an American biotechnology company, Myriad Genetics, to use its patent rights over the BRCA genes to transfer its technology of genetic testing for breast and ovarian cancer to Britain. It also investigates the responses of British scientists, health care professionals and patient advocates to this attempted technology transfer. METHODS: This paper is based on approximately 100 in-depth interviews, document analysis and ethnographic observation conducted in the United States and Britain from 1998 to 2001. RESULTS: The BRCA gene patents inspired political resistance and mobilized opposition to the patenting of genes in general. They also provided an opportunity for the British to assert their national identity as they argued that a British BRCA testing service needed to be available within the context of the National Health Service to all citizens equally. CONCLUSIONS: Patents are not only legal documents and technical descriptions, but political tools as well. As they are increasingly deemed vital to economic globalization, patents have become mobilizing tools for anti-globalization activists and non-governmental organizations from less developed countries, and for asserting local and national identities.

Breast Neoplasms↗
PubMed1979

The impact of political process on hospital psychiatry.

Political forces motivated the New York State Department of Health to withhold payment for Medicaid-financed inpatients on therapeutic passes. The elimination of therapeutic passes had many negative effects on patient care. The authors believe this experience demonstrates that political factors can overwhelm standard clinical practice and reasoned health planning to force irrational change on health care delivery.

Deinstitutionalization↗