Political Analysis and American Medical Care: Essays ed. by Theodore R. Marmor (review)

And the neglected story of Ludwig Fleck is told. Fleck pioneered concepts in the philosophy of science and the diagnostic use of white blood cells while imprisoned in the ghettos of Poland and the camps of Dachau and Buchenwald during World War II. One of my favorites, however, is "Foucault and the Bag Lady." This essay begins with the admission of an elderly derelict, frost-bitten and barely alive, to monolithic Bellevue Hospital of New York. As he works up her history, performs tests, and treats her many disorders, Weissmann imagines incidents in her life. He braids together comments on her strange appearance (due partly to an unusual skin disorder called scleroderma), his own imaginings, and our treatment of the insane since the time of Foucault. One of the most interesting aspects of this essay is the enormous sympathy and understanding the author projects for this discard of society, with whom, except for the briefest of moments, he cannot even communicate. Weissmann has, too, a special flair for the grand, the magnificent, the spectacular . He describes "Nobel Week, 82," from the brilliant receptions and solemn ceremonies, through the fascinating and sometimes willful personalities, the costumes, food, and music, to the almost euphoric atmosphere of life at this highest of intellectual "fast lanes." The title essay, on the other hand, follows his musings during the annual cantata (on this occasion Vivaldi's "Gloria") by the summer community of the Marine Biological Laboratory at Woods Hole, Massachusetts. As the music "churns gloriously on," Weissmann recalls some of the great men and moments and the day-to-day drudgery of this world-famous research center. He ponders the fact that Catholic liturgy fills an Episcopal church while Moslem sits in harmony with Jew, Indian with Pakistani, Yale with Harvard. In the cemetery outside , the great physiologist and atheistJacques Loeb lies buried among the Godfearing families of New England while his students sing Gloria Dei Patris. This is an elegant, wise, witty, and oh so human little book! Highly recommended . Robert J. Doyle Department of Biology University of Windsor, Windsor, Ontario Political Analysis and American Medical Care: Essays. Edited by Theodore R. Marmor. New York: Cambridge University Press, 1983. Pp. 268. $37.50; $12.95 (paper). Even to the most casual observer, it is readily apparent that government intervention has become a central feature of the American medical care system. Increasing public involvement in the provision of medical care is by no means unique to the United States. Concerns about the cost and availability of health care have been universally shared in modern industrial societies. But responses have varied widely. There are significant differences in both the organization of the American health system and the character of the political debates that have shaped this system. 304 Book Reviews In his collection of essays Political Analysis and American Medical Care, Theodore Marmor undertakes an ambitious task. He seeks to acquaint the unfamiliar reader simultaneously with the tools of political analysis and with the politics of medicine. He succeeds on both counts. Drawing on essays spanning a decade of research, Marmor's volume is an excellent introduction both to the perspective of political science and to the world of medical politics. Because of the retrospective character of the volume, the picture Marmor presents of this world, while familiar, reflects the recent past rather than the immediate present. But in many ways this is one of the volume's important strengths. The focus of health policy and debates in the United States has shifted dramatically since the early 1970s, when Marmor embarked on the research agenda encompassed here. Where once equity and access were the watchwords, concerns about cost containment now reign supreme. At the same time, there has been a growing tendency, at least rhetorically, to turn to the market for solutions. Published between 1972 and 1981, Marmor's essays, many of them coauthored with former students, both document and elucidate these shifts. And in doing so, they provide welcome perspective in a field where experts and laymen alike tend to become overwhelmed with the details of the latest spate of regulations. As Marmor notes in his introduction, there is no single politics of medicine. Rather...