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PubMed1997

Review of five paradigm papers on economic, biomedical, community, sociocultural and political perspectives in improving use of medicines.

This paper presents a review of five paradigm presentations at the first International Conference on Improving Use of Medicines (ICIUM) in Chiang Mai, Thailand, April 1-4, 1997. The paradigm papers covered economic, biomedical, community, socio-cultural and political approaches in improving the use of medicines. Salient points on problems examined by each of the paradigms, limitations of each paradigm, and challenges to be tackled are highlighted in the review from the view point of a health care provider. Some common features of the five paradigms relating to problems in medicine use have been reviewed. These features could provide bases for reaching consensus in finding solutions to some of the burning issues in the area of medicine use. It is becoming increasingly clear that there is growing concern about the way medicines are used: is it rational and in the best interest of the patients?

Cost-Benefit Analysis↗
PubMed1976

Conservatism and liberalism: a psychoanalytic examination of political belief.

A review of the historical development of conservative and liberal through reveals contradictory basic assumptions: the former views man as essentially evil by nature, and places its priorities upon self-restraint; the latter views man as essentially good, and with umlimited capabilities, and celebrates his efforts at creating a perfect society for himself. Three clinical vignettes are recounted in which the patient's intrapyschic organization found support from a hormonious political philosophy. It is suggested that conservatism and liberalism offer the individual an ideological resolution to the narcissistic injuries he experiences as a consequence of life's inevitable and developmentally determined disappointments.

Child Rearing↗
PubMed1998

Tunnel vision information: a paradox of ethics, economics, politics and science.

BACKGROUND: Improvement in vision with spinal manipulation was first observed in the early 1970s. Reports of the phenomenon appeared in the 1980s in the popular press and at scientific meetings, but it was not until the mid-1990s that general discussion of the potential value of this knowledge occurred. Considering the far-reaching implications of the possible ability to improve brain function by spinal manipulation, the delay in consideration and implementation of this concept is a paradox in general terms and a total mystery in the case of the chiropractic profession. OBJECTIVE: To provide explanations for the delay in scientific assessment of the discovery that vision improves, in appropriate patients, when the spine is manipulated and to discuss the implications of this finding. This discovery is now called the "tunnel vision information." DISCUSSION: A schema of pathological hierarchy is depicted in which the level of intervention of spinal manipulation outranks other forms of treatment. The significance of this precedence is portrayed. Possible reasons for the failure to address this hierarchy in light of the tunnel vision information are discussed with reference to established protocols, medical politics, the presentation of the data, the failure of scientific editorship and the illogical aspects of the illness itself. CONCLUSION: In the future, the delay from the initial observation of the tunnel vision discovery to its free discussion in scientific literature may seem incongruous, particularly if the health benefits which it augurs are realized.

Chiropractic↗
PubMed1998

Eradication of schistosomiasis in Guangxi, China. Part 2: Political economy, management strategy and costs, 1953-92.

Reported are the results of a study of the political economy, management, and costs of the successful Guangxi schistosomiasis eradication programme, spanning 40 years from 1953 to 1992. For this purpose we analysed all government data and memoranda on the policy, management, technical support, finance, and the control strategy of the programme. We also interviewed many local staff involved in the programme over the 40-year period and obtained cost data from annual county-level records on seven major categories of variable costs. Schistosomiasis control in Guangxi began with one of the first examples of community participation and rapid assessment in public health history--the use of pre-franked envelopes to return disease questionnaires and suspect snails from rural areas. This approach quickly and accurately delineated the endemic area. This was Mao Zedong's "mass line", incorporating ideas and knowledge from peasants directly into services run for and by them, here the schistosomiasis control programme. Recognition by China's leaders that schistosomiasis was a great economic burden, steadfast prioritizing of the programme over 40 years, local innovative scientific study, agricultural and environmental focus on eradicating the snail hosts and boosting rural production, and mass community education and support were all key factors in the final success. Local leaders motivated programme staff and everyone involved knew the objectives. The programme was always multisectoral, with policy developed centrally, and strategy and collaboration encouraged and rewarded at the grass-roots. These features explain how a very poor autonomous region such as Guangxi finally eradicated schistosomiasis, spending less than US$ 0.50 per protected citizen per year; it is remarkable that the disease and snails were initially found across a large area of complex environments and modern drugs such as praziquantel were not available for most of the 40-year period. The lessons from Guangxi can be adapted elsewhere and should encourage other areas to control endemic schistosomiasis using methods devised to suit the local culture and geography.

China↗
PubMed2006

The social, moral, ethical, legal and political implications of today's biological technologies: an Indian point of view.

The last 50 years have seen an increasing emphasis on ethical, moral, social, legal, political and economic implications of science for reasons that are discussed in this article. Biotechnology has been no exception to this trend. Areas of biotechnology where the above implications have been important, are briefly described. Ethical and related issues in today's biology-based technologies are discussed with special reference to India. Examples of technological exploitation within a country, or of one country by another, using modern biology-based technologies are given. The possible implications of one new and emerging biology-based technology are discussed. It is concluded that a well-informed and knowledgeable society is the only assured insurance against possible misuse of biology-based technologies of today and tomorrow, including their use for the exploitation of people. The recent decision of the Prime Minister of India to set up a National Knowledge Commission is mentioned in this context.

Biotechnology↗
PubMed2002

The impact of political conflict on moral maturity: a cross-national perspective.

This cross-national study of moral reasoning among adolescents in Northern Ireland, Scotland and the Republic of Ireland, addresses the problem of possible moral truncation in Northern Ireland due to the political conflict. The Sociomoral Reflection Measure-Short Form (SRM-SF; Gibbs et al. (1992) Moral Maturity: Measuring the Development of Sociomoral Reflection. Englewood Cliffs, NJ: Erlbaum. was presented to a proportionate stratified sample of 14-15 year olds (n = 613) from three locations including a small town, large town and city in each country to control for urbanization. This adolescent sample consisted of participants from both of Northern Ireland's religious communities and was matched for age and sex. Analysis of the results suggested that despite the violent atmosphere over the last 30 years, the Northern Irish adolescents were not developmentally delayed in moral terms as previously feared (Fraser (1972) Special Education,61, 6-8; Fields (1973). A Society on the Run: A Psychology of Northern Ireland. Harmondsworth, Middlesex: Penguin; (1976) Northern Ireland: Society Under Siege. New Brunswick and London: Transaction Books; Lyons (1973) The Northern Teacher, 19-30)

Adolescent↗
PubMed1992

Political and interpersonal aspects of ethics consultation.

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.

Bioethical Issues↗
PubMed1996

Political Benefits as Barriers to Assessment of Environmental Costs in Brazil's Amazonian Development Planning: The Example of the Jatapu Dam in Roraima

Development projects are rapidly changing the landscape in Brazilian Amazonia. Environmental impact assessments have been required since 1986, and the regulatory system is evolving as precedents are set by each new development project. The Jatapu Dam in Roraima provides an illustration of underlying impediments to assessment of environmental costs and to due consideration being given to these assessments when decisions are made. The high priority placed on the dam by the Roraima state government is unexplainable in terms of economic returns. The place of the dam in a long-term political strategy provides the best of several possible explanations, any one of which is incompatible with a "rational" weighing of economic and environmental costs and benefits. A number of lessons can be drawn from the experience of Jatapu, but some of the problems have no solution. The barriers to rational decision making illustrated by Jatapu apply to development projects in many parts of the world.KEY WORDS: Jatapu Dam; Amazonia; Dams; Hydroelectric development; Brazil; Tropical forest; Environmental impact assessment

Journal Article↗
PubMed1995

Rationing health care: from needs to markets? The politics of destruction: rationing in the UK health care market.

Rationing health care is not new. As governments world wide struggle to contain the costs of health care, health policy analysts debate how rationing should be done. However, they too often neglect how the mechanisms for funding and allocating health care resources are themselves vehicles for rationing treatment. In the UK, where health care rationing debates currently abound, there has been no formal evaluation of the role of the market in allocating scarce health care resources. The market in health care has increased administration, fragmented services, eroded local accountability, and decreased choice. This fragmentation, and the associated competition between purchasers and providers, means that resource allocation can no longer be monitored and evaluated in a national context. The loss of a population focus has left a vacuum in planning. Services cannot be planned rationally, and so are not able consistently to avoid duplication or to respond cogently to estimates of need. The loss of accountability means that decisions about the allocation of health care resources are no longer open to scrutiny by local people. Increasingly, especially in social and long term care the cost of care is being transferred to the individual. The new mechanisms for resource allocation are distributing resources unfairly: away from the poor, the sick and the elderly. The great myth of the market is that it has enabled decision-making to become explicit. This is not the case. To make health care resource allocation appear rational and acceptable to the public, health authorities have resorted to exercises in consumer consultation, and value laden guidelines where clinical cloaks are used to disguise political decisions on funding. In the UK, until the true role of the internal market is acknowledged, myths and subterfuge will conceal the winners and losers in the new system of rationing health care.

Decision Making, Organizational↗
PubMed2005

Significant genetic differentiation between Poland and Germany follows present-day political borders, as revealed by Y-chromosome analysis.

To test for human population substructure and to investigate human population history we have analysed Y-chromosome diversity using seven microsatellites (Y-STRs) and ten binary markers (Y-SNPs) in samples from eight regionally distributed populations from Poland (n = 913) and 11 from Germany (n = 1,215). Based on data from both Y-chromosome marker systems, which we found to be highly correlated (r = 0.96), and using spatial analysis of the molecular variance (SAMOVA), we revealed statistically significant support for two groups of populations: (1) all Polish populations and (2) all German populations. By means of analysis of the molecular variance (AMOVA) we observed a large and statistically significant proportion of 14% (for Y-SNPs) and 15% (for Y-STRs) of the respective total genetic variation being explained between both countries. The same population differentiation was detected using Monmonier's algorithm, with a resulting genetic border between Poland and Germany that closely resembles the course of the political border between both countries. The observed genetic differentiation was mainly, but not exclusively, due to the frequency distribution of two Y-SNP haplogroups and their associated Y-STR haplotypes: R1a1*, most frequent in Poland, and R1*(xR1a1), most frequent in Germany. We suggest here that the pronounced population differentiation between the two geographically neighbouring countries, Poland and Germany, is the consequence of very recent events in human population history, namely the forced human resettlement of many millions of Germans and Poles during and, especially, shortly after World War II. In addition, our findings have consequences for the forensic application of Y-chromosome markers, strongly supporting the implementation of population substructure into forensic Y chromosome databases, and also for genetic association studies.

Chromosomes, Human, Y↗
PubMed2002

Does health technology assessment benefit health services and politics? The experiences of an established HTA institution: the Danish Centre for Evaluation and HTA.

Health technology assessment (HTA) was introduced in Denmark 20 years ago. However, it only came into fashion a few years ago. This happened when politicians and health service decision-makers realized that due to the increasing pressure on resources prioritization was an inescapable fact. HTA was supposed to support this effort by providing a broad spectrum of information designed for decision-making. Events speeded up from that point on: a national HTA strategy, a national HTA institution, satellite institutions, and many HTA projects were set up - at national, regional, and local levels. The diversity and decentralization of decision-making combined with a broad and interdisciplinary approach to methodology guided the development of Danish HTA. Experiences with HTA were gained from successful applications and disappointing encounters with uncontrollable political processes. Politicians seem in general to be content with the development. An evaluation of the impact of HTA has not yet been undertaken, and a good deal of work lies ahead. The implementation of HTA results will be one of the greatest challenges of the years ahead.

Journal Article↗
PubMed2005

Making a political statement or refusing to grow up--reflections on the situation of the academic youth in postwar British literature.

The author attempts to apply the psychoanalytic concept of "prolonged adolescence" to two literary works, both of which are embedded in England's postwar social and political climate. The discussion of John Wain's Hurry on Down ([1953] 1979) and John Osborne's Look Back in Anger ([1956] 1989), by necessity, involves a look at those factors responsible for shaping the cultural "mood" in those days. However, the author's primary concern lies with how two particular (fictional) individuals, or antiheroes, deal with the frustration, which, although generally felt among contemporary academia, in their cases seems to hide a much deeper layer of mental insecurity and instability. In fact, we come to feel that the characters have not achieved a proper sense of identity ("self") and are, from the point of view of maturity, delayed and, hence, "unfitted" to cope adequately with the external world. Having long achieved formal adulthood, they seem to have gotten "stuck" somewhere along the passage of growing up. Essential papers by Sigmund Freud and his daughter Anna, as well as a very early paper on the topic by Siegfried Bernfeld, are, among others, taken into account, as is the profound research done by Peter Blos on the subject in question.

Adolescent↗
PubMed1991

Organization and development of pediatric medical-psychiatric units. Part I: Administrative, financial, and political issues.

The growing literature regarding the development of medical-psychiatric units to facilitate diagnosis and treatment of patients with combined medical and psychiatric disorders is primarily limited to adult populations. Almost no published information is available concerning combined pediatric medical-psychiatric units. This article, the first in a two-part series, outlines the organization and development of a child and adolescent medical-psychiatric unit within a pediatric hospital. Various academic, administrative, political, financial, and clinical issues that must be considered during the developmental process are delineated and discussed. The second part of the series will address clinical management issues.

Adolescent↗
PubMed1986

The political economy of doctors' strikes in Nigeria: a Marxist interpretation.

Professions have been traditionally conceptualized as special occupational categories with distinguishing traits called to provide needed service. The social and economic context of these attributes is assumed unproblematic or taken for granted. This study of doctor's strikes in Nigeria critiques this conception and offers a political economy alternative. It analyses professions and their traits within a given context, and in relation to other groups. It is suggested that doctors in Nigeria are a powerful and privileged group, a view they seem to successfully use to pursue their interests.

Hospitals, Public↗
PubMed1987

Behind shamanism: changing voices of Siberian Khanty cosmology and politics.

Siberian shamanism has roots in hunting traditions, kinship organization and soul beliefs which have changed under Soviet rule. Aspects of shamanic epistemology and curing survive, although native medical logic sometimes clashes with modern positivist medicine. Assumptions behind Siberian, particularly Khanty, shamanism are examined through analysis of training, seances and cosmology. The changing social context of shamanism is explored in a framework of Soviet pressure to reject shamanic 'superstitution' and 'exploration.' Shamans themselves have adapted their politics, diagnoses and symbolic actions to an increasingly cold social climate. Data results from ethno-historical and field research, including a summer 1975 trip to the Ob-Ugrian Khanty (Ostiak).

Ethnicity↗
PubMed1988

[Selective health systems: a trap for health politics in the Third World].

The authors examine the evolution of the PHC approach in historical perspective, present definitions and criteria of what PHC actually means, look upon deviations of conceptual content and practice of PHC and end up with a socio-political as well as a technical critique of the so-called 'selective' PHC. Modern health systems evolved in developing countries modelled on the 'western' biomedical health care systems. Yet even colonial medical services contained also progressive elements, as e.g. the acceptance of the need to de-centralise hospital care to peripheral health posts, or the stress on more rational distribution and utilisation of drugs. The vertical programmes developed under this approach showed clearly their limitations and the conference of Alma-Ata can be looked at as a turning point, where a new model of health care, i.e. PHC, was designed. Though there exists a widespread resistance in industrialised countries against adopting this new model, it was not at all limited only to developing countries. As with every innovative idea, the PHC strategy provoked contradictory views and large differences in interpretation. But, the authors stress, PHC is neither a doctrine, or a theory but the outcome of decades of field-experience of concerned scientists and practitioners. The essential criteria of PHC include: Accessibility: need for improved first contact with the health care system, demanding efforts of decentralising the existing health system without neglecting the quality of care on higher-level medical services. PHC is essentially an action-programme designed around the well-known eight PHC elements, designed to meet effective demand and to rationalise medical offer. The eight elements rather underline the multiplicity of health action required--they are not considered to serve as 'chapters' of PHC policy. PHC is a strategy for re-organising health services. The hospitals should serve the peripheral health centres and not the other way round. At the same time, curative preventive and promotive actions have to be integrated. This necessitates community participation, as the global health problems cannot be solved by the health services alone. PHC in so far re-defines the role of medicine and looks at health in a holistic way. Medicine is being de-mystified and individuals and communities are encouraged to take over responsibility for their own health. This is not at all the consequence of an idealistic view, but derived from field experiences in various circumstances. PHC as a new philosophy of health services delivery therefore, stresses: holistic action for global health issues, equity, participation, and cost/efficiency.(ABSTRACT TRUNCATED AT 400 WORDS)

Developing Countries↗
PubMed1989

[The political economy of health policy in the socialist government: the record after five years of power in France, l981-1986].

One cannot say that health was put to the forefront of the reform projects of the left-wing parties and, in particular, of the Socialist Party before their coming to power in May 1981. One cannot say, either, that after the departure of the Socialists in April 1986, the reforms that they accomplished in this area have been considerable. However, some of them are not negligible, even if one cannot yet measure all their effects completely. The policy drive has been marked by two periods. The first was characterized by a profusion of projects and by strong political promises, i.e. from June 1981 to March 1983. It was the period when the Minister of Health was a Communist and when the Social Security administration was linked to another ministry. It was the period of reforms which were promised but not realised, e.g. those concerned with health and labour, those that touched on the issue of psychiatric hospitals. It was the period, nevertheless, when some of the reforms could have been undertaken with success: the reforms of medical education, of the establishment of the Regional Observatories of Health, of the decentralisation of some sectors of the health system, of the elimination of private sector beds in public hospitals. The second, from April 1983 to July 1985, was characterised by an attempt to modify the modality of the functions of the health system. It was during this period that the office of the Minister of Health was reduced to that of Secretary of State attached to the Minister of Social Affairs, whose main concern was with research regarding balancing budgets and who, relatively speaking, succeeded in his rigorous attempt to curb medical costs. One can point out, however, that an attempt was made to bring about 'the integrated health centre', an attempt corresponding to the wish of the militant socialists but which was to have no effect except as a symbolic gesture. But the main reform, launched by the law of 19 January, 1983, was that which was concerned with the mode of financing hospitals by replacing daily hospital fees with general financial budgets, the amounts of which were to be negotiated between the hospitals and the administrative boards. This reform would expand into broader activities, i.e. the creation of the entire organisation of hospitals to a great extent. This reform attempted to introduce the advantage of collective discussion of problems among the persons responsible, no longer nominated by the central authority but elected by their peers.(ABSTRACT TRUNCATED AT 400 WORDS)

Economics, Hospital↗