Rutgers University Press

Critical Issues in Health and Medicine

Edited by Janet Golden and Rima D. Apple

Published by: Rutgers University Press

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Critical Issues in Health and Medicine

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In the Public Interest

Medical Licensing and the Disciplinary Process

Ruth Horowitz

How do we know when physicians practice medicine safely? Can we trust doctors to discipline their own? What is a proper role of experts in a democracy? In the Public Interest raises these provocative questions, using medical licensing and discipline to advocate for a needed overhaul of how we decide public good in a society dominated by private interest groups. Throughout the twentieth century, American physicians built a powerful profession, but their drive toward professional autonomy has made outside observers increasingly concerned about physicians’ ability to separate their own interests from those of the general public. Ruth Horowitz traces the history of medical licensure and the mechanisms that democratic societies have developed to certify doctors to deliver critical services. Combining her skills as a public member of medical licensing boards and as an ethnographer, Horowitz illuminates the workings of the crucial public institutions charged with maintaining public safety. She demonstrates the complex agendas different actors bring to board deliberations, the variations in the board authority across the country, the unevenly distributed institutional resources available to board members, and the difficulties non-physician members face as they struggle to balance interests of the parties involved.In the Public Interest suggests new procedures, resource allocation, and educational initiatives to increase physician oversight. Horowitz makes the case for regulations modeled after deliberative democracy that promise to open debates to the general public and allow public members to take a more active part in the decision-making process that affects vital community interests.

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Just Don't Get Sick

Access to Health Care in the Aftermath of Welfare Reform

Karen Seccombe and Kim A Hoffman

The ability to obtain health care is fundamental to the security, stability, and well-being of poor families. Government-sponsored programs provide temporary support, but as families leave welfare for work, they find themselves without access to coverage or care. The low-wage jobs that individuals in transition are typically able to secure provide few benefits yet often disqualify employees from receiving federal aid.

Drawing upon statistical data and in-depth interviews with over five hundred families in Oregon, Karen Seccombe and Kim Hoffman assess the ways in which welfare reform affects the well-being of adults and children who leave the program for work. We hear of asthmatic children whose uninsured but working mothers cannot obtain the preventive medicines to keep them well, and stories of pregnant women receiving little or no prenatal care who end up in emergency rooms with life-threatening conditions.

Representative of poor communities nationwide, the vivid stories recounted here illuminate the critical relationship between health insurance coverage and the ability to transition from welfare to work.

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Making the American Mouth

Dentists and Public Health in the Twentieth Century

Alyssa Picard

Why are Americans so uniquely obsessed with teeth? Brilliantly white, straight teeth?

Making the American Mouth is at once a history of United States dentistry and a study of a billion-dollar industry. Alyssa Picard chronicles the forces that limited Americans' access to dental care in the early twentieth century and the ways dentists worked to expand that access--and improve the public image of their profession. Comprehensive in scope, this work describes how dentists' early public health commitments withered under the strain of fights over fluoride, mid-century social movements for racial and gender equity, and pressure to insure dental costs. It explains how dentists came to promote cosmetic services, and why Americans were so eager to purchase them. As we move into the twentyfirst century, dentists' success in shaping their industry means that for many, the perfect American smile will remain a distant--though tantalizing--dream.

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Managing Madness in the Community

The Challenge of Contemporary Mental Health Care

Kerry Michael Dobransky

While mental illness and mental health care are increasingly recognized and accepted in today’s society, awareness of the most severely mentally ill—as well as those who care for them—is still dominated by stereotypes. Managing Madness in the Community dispels the myth. Readers will see how treatment options often depend on the social status, race, and gender of both clients and carers; how ideas in the field of mental health care—conflicting priorities and approaches—actually affect what happens on the ground; and how, amid the competing demands of clients and families, government agencies, bureaucrats and advocates, the fragmented American mental health system really works—or doesn’t.In the wake of movies like One Flew Over the Cuckoo’s Nest and Shutter Island, most people picture the severely or chronically mentally ill being treated in cold, remote, and forbidding facilities. But the reality is very different. Today the majority of deeply troubled mental patients get treatment in nonprofit community organizations. And it is to two such organizations in the Midwest that this study looks for answers. Drawing upon a wealth of unique evidence—five months of ethnographic observations, 91 interviews with clients and workers, and a range of documents—Managing Madness in the Community lays bare the sometimes disturbing nature and effects of our overly complex and disconnected mental health system.Kerry Michael Dobransky examines the practical strategies organizations and their clients use to manage the often-conflicting demands of a host of constituencies, laws, and regulations. Bringing to light the challenges confronting patients and staff of the community-based institutions that bear the brunt of caring for the mentally ill, his book provides a useful broad framework that will help researchers and policymakers understand the key forces influencing the mental health services system today.

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Mapping "Race"

Critical Approaches to Health Disparities Research

Laura E. Gómez

Researchers commonly ask subjects to self-identify their race from a menu of preestablished options. Yet if race is a multidimensional, multilevel social construction, this has profound methodological implications for the sciences and social sciences. Race must inform how we design large-scale data collection and how scientists utilize race in the context of specific research questions. This landmark collection argues for the recognition of those implications for research and suggests ways in which they may be integrated into future scientific endeavors. It concludes on a prescriptive note, providing an arsenal of multidisciplinary, conceptual, and methodological tools for studying race specifically within the context of health inequalities.

Contributors: John A. Garcia, Arline T. Geronimus, Laura E. Gómez, Joseph L. Graves Jr., Janet E. Helms, Derek Kenji Iwamoto, Jonathan Kahn, Jay S. Kaufman, Mai M. Kindaichi, Simon J. Craddock Lee, Nancy López, Ethan H. Mereish, Matthew Miller, Gabriel R. Sanchez, Aliya Saperstein, R. Burciaga Valdez, Vicki D. Ybarra


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Medical Professionalism in the New Information Age

Edited and with an Introduction by David J. Rothman and David Blumenthal

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

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Medical Research for Hire

The Political Economy of Pharmaceutical Clinical Trials

Jill A. Fisher

Focusing on the professional roles of those involved, as well as key research practices, Fisher assesses the risks and advantages for physicians and patients alike when pharmaceutical drug studies are used as an alternative to standard medical care.

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The Morning After

A History of Emergency Contraception in the United States

Heather Munro Prescott

Since 2006, when the “morning-after pill” Plan B was first sold over the counter, sales of emergency contraceptives have soared, becoming an $80-million industry in the United States and throughout the Western world. But emergency contraception is nothing new. It has a long and often contentious history as the subject of clashes not only between medical researchers and religious groups, but also between different factions of feminist health advocates.

The Morning After tells the story of emergency contraception in America from the 1960s to the present day and, more importantly, it tells the story of the women who have used it. Side-stepping simplistic readings of these women as either radical feminist trailblazers or guinea pigs for the pharmaceutical industry, medical historian Heather Munro Prescott offers a portrait of how ordinary women participated in the development and popularization of emergency contraception, bringing a groundbreaking technology into the mainstream with the potential to alter radically reproductive health practices.

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Neurasthenic Nation

America's Search for Health, Happiness, and Comfort, 1869-1920

David G. Schuster

As the United States rushed toward industrial and technological modernization in the late nineteenth century, people worried that the workplace had become too competitive, the economy too turbulent, domestic chores too taxing, while new machines had created a fast-paced environment that sickened the nation. Physicians testified that, without a doubt, modern civilization was causing a host of ills—everything from irritability to insomnia, lethargy to weight loss, anxiety to lack of ambition, and indigestion to impotence. They called this condition neurasthenia.


Neurasthenic Nation investigates how the concept of neurasthenia helped doctors and patients, men and women, and advertisers and consumers negotiate changes commonly associated with “modernity.” Combining a survey of medical and popular literature on neurasthenia with original research into rare archives of personal letters, patient records, and corporate files, David Schuster charts the emergence of a “neurasthenic nation”—a place where people saw their personal health as inextricably tied to the pitfalls and possibilities of a changing world.

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Nursing with a Message

Public Health Demonstration Projects in New York City

Patricia D'Antonio

Mandated by the Affordable Care Act, public health demonstration projects have been touted as an innovative solution to the nation’s health care crisis. Yet, such projects actually have a long but little-known history, dating back to the 1920s. This groundbreaking new book reveals the key role that these local health programs—and the nurses who ran them—influenced how Americans perceived both their personal health choices and the well-being of their communities. 
 
Nursing with a Message transports readers to New York City in the 1920s and 1930s, charting the rise and fall of two community health centers, in the neighborhoods of East Harlem and Bellevue-Yorkville. Award-winning historian Patricia D’Antonio examines the day-to-day operations of these clinics, as well as the community outreach work done by nurses who visited schools, churches, and homes encouraging neighborhood residents to adopt healthier lifestyles, engage with preventive physical exams, and see to the health of their preschool children. As she reveals, these programs relied upon an often-contentious and fragile alliance between various healthcare providers, educators, social workers, and funding agencies, both public and private. Assessing both the successes and failures of these public health demonstration projects, D’Antonio also traces their legacy in shaping both the best and worst elements of today’s primary care system. 
 

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