Medicine In America Research Articles

Marginal to Mainstream: Alternative Medicine in America

To Mary Ruggie the rise of complementary/alternative medicine (CAM) is a 'social transformation' of healthcare. As indicated by the title, she focuses on the USA—a pity, since most of CAM originates elsewhere. Her book covers such matters as the relation of CAM to conventional medicine, types of evidence, reasons for CAM usage, patterns of growth, research, and the future of CAM— often by asking questions rather than providing answers. Ruggie sees the growth of CAM in terms of a power struggle: 'CAM poses huge challenges not only to the dominance of biomedicine, but also to the fruits of dominance—status and power in decision making about health care and in the livelihood of physicians'. I can never bring myself to seeing things quite as petty as that. The 'struggle', I always thought, is to find treatments that do more good than harm, and all healthcare providers are united in it. The 'dominance' of biomedicine stems from the evidence rather than Machiavellian intrigues. But this is where we obviously differ: healthcare professionals work to help patients, while medical sociologists watch us doing it and interpret according to their particular prejudices. Annoyingly, Ruggie perpetuates the notion that 'only about 15% of medical interventions are supported by evidence'. It fits her bill and she is in good company: the Chair of the NHS Alliance recently stated that 'people argue against complementary therapies on the basis of a lack of evidence. But I'd say only 10 percent of what doctors do in primary care is evidence based'. The argument comes from a BMJ editorial of 13 years ago, and even then it was not supported by good data. More recent evidence shows that 70–80% of our treatments are based on evidence. Isn't it time that we all buried this counterproductive myth? What is the impact of this sort of book? Sadly, I am not sure that it is negligible. When writing about CAM, sociologists sometimes endorse treatments that are not necessarily safe or effective and can have disadvantageous consequences. For instance, Ruggie declares about meditation: 'There is a large and growing literature on the biology of meditation and, despite the inevitable methodological inconsistencies, there is mounting evidence of health benefits'. The truth is that the evidence is unconvincing. Her final conclusion is less than arresting: 'If patients continue to use and demand CAM, if research proves the safety and efficacy of CAM, if physicians accept CAM, if the benefits of CAM extend to cost savings, and if insurers and healthcare plans offer CAM coverage, integrative clinics will prosper and grow.' So is this book all bad? Taken with several pinches of salt, it can serve as a reasonable, mostly well-written, introduction to CAM. And it allows intriguing insights into the often strange logic of sociologists who dabble in the subject.

Marginal to Mainstream: Alternative Medicine in America

Marginal to Mainstream: Alternative Medicine in America

Reagan, Clinton, Tobacco, And Children: An Interview With C. Everett Koop

At eighty-seven years of age, former Surgeon General C. Everett Koop has an extraordinary perspective on health and medicine in America. He reflects on child health from his thirty-five years as a pediatric surgeon; AIDS from his position as Surgeon General at the outset of the epidemic; Presidents Reagan and Clinton, with whom he worked extensively; and smoking from his long battle first in government and then later as public antagonist to what he sees as the duplicitous and deceptive "killer" industry: tobacco.

Missions for Science: U.S. Technology and Medicine in America's African World (review)

Missions for Science: U.S. Technology and Medicine in America's African World (review)

Marginal to Mainstream: Alternative Medicine in America

Marginal to Mainstream: Alternative Medicine in America

Review: Missions for Science: U.S. Technology and Medicine in America's African World

Review: Missions for Science: U.S. Technology and Medicine in America's African World Samuel Roberts, Reviewed by Samuel Roberts, Reviewed by Assistant Professor of History (Columbia University) and Sociomedical Sciences (Mailman School of Public Health), New York 10027 Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of the History of Medicine and Allied Sciences, Volume 59, Issue 1, January 2004, Pages 167–169, https://doi.org/10.1093/jhmas/jrg053 Published: 01 January 2004

Review: Missions for Science: U.S. Technology and Medicine in America's African World

Review: Missions for Science: U.S. Technology and Medicine in America's African World

Missions for Science: U.S. Technology and Medicine in America's African World (review)

Missions for Science: U.S. Technology and Medicine in America's African World (review)

History

History

Missions for science: U.S. technology and medicine in America's African world

Missions for science: U.S. technology and medicine in America's African world

Academic headache medicine in America: report of academic membership survey of the American Headache Society special interest section on academic affairs.

What constitutes the typical clinical experience of an academic headache specialist in America is unknown. To clarify this issue, we undertook a survey of academic headache specialists who are members of the American Headache Society. In June 2000, 181 surveys including questions regarding academic rank, departmental and institutional affiliation, and time distribution were sent to members drawn from the 1999-2000 Membership Directory of the American Headache Society whose primary addresses were recognized academic institutions or who, by reputation, had extensive academic affiliation. Additional questions about headache teaching, research, and practice were included. Seventy-two (39.7%) of the surveys were returned. Forty-nine (40%) of the 122 American medical schools were represented. The most prevalent academic rank was professor (38%). Included were 2 departmental chairs, 1 division chief, 1 vice dean, and 1 residency training director. The majority (70.8%) were neurologists. Seventy-two percent of respondents spent at least 50% of their time in a clinic, 79% spent 25% or less of their time on research, and 78% spent 25% or less time in teaching. The average number of new patients seen per week was 9.0 +/- 7.6, with each visit lasting 62.4 +/- 20.8 minutes. Clinicians saw 22.7 +/- 14.6 patients for follow-up per week, with the average visit lasting 24.7 +/- 6.8 minutes. Although it appears that at least informal instruction in headache is provided to medical students, interns, and residents, 19.7% (12 of 61) of respondents reported that no formal medical school lecture on the topic of headache was offered at their institutions. This preliminary survey offers some insight into the clinical experience of academic headache specialists in the American medical system. Suggestions for future studies are discussed.

Alternative Approaches to Healing

Nature Cures . The History of Alternative Medicine in America. James C. Whorton. Oxford University Press, New York, 2002. 384 pp. $30, £22.95. ISBN 0-19-514071-0. Whorton offers a context for current controversy on the role of unconventional medicine in health care by discussing the past two centuries of interactions between mainstream medicine and its numerous unorthodox competitors.

Asian Medicine in America: The Ayurvedic Case

Ayurveda, the classical South Asian medical tradition, was first introduced to American audiences in the mid-1980s as a holistic alternative to biomedical orthodoxy. This article argues that transplanted Ayurveda is shaped not only by aspects of American medical culture, but by millennial, heterodox elements of American religious culture, such as the loose cluster of beliefs and practices known as the New Age. Because New Age Ayurvedic practices occupy the ideological and statutory middle ground between medicine and metaphysics, they face a unique professionalizing dilemma: whether to present themselves as healing religions or as practicing branches of medicine. Drawing on an ethnographic study of this professionalizing dilemma in legal, clinical and popular arenas, this article shows that New Age Ayurveda--far from being a monolith--reveals a wide-ranging plurality of sub-traditions in practice. Taken together, they suggest multiple modes of reinvention and a variety of professionalizing routes that Ayurveda follows other than licensing and institutional credentialization.

Asian Medicine in America: the Ayurvedic Case

Asian Medicine in America: the Ayurvedic Case

Cosmetic surgery: the cutting edge of commercial medicine in America

Cosmetic surgery: the cutting edge of commercial medicine in America

Managed Care and Rehabilitation Medicine in USA.

Managed Care and Rehabilitation Medicine in USA.

Patent medicines for the treatment of genitourinary diseases.

The present article addresses the nineteenth-century advertising of patent medicines in America, sold to "cure" diseases of the kidney and bladder, the "loss of manhood", and "debilitating conditions of the generative system." Most of the proprietary remedies made extravagant claims of effectiveness concerning a wide variety of ailments, and some claimed to cure every disease. Examples of promotional excesses demonstrate how the public was persuaded to buy a kaleidoscope of largely useless and occasionally harmful patent nostrums. The ephemera considered became a part of the history of medicine related to urology.

Aubrey O. Hampton Lecture. Can radiology save managed care? Preserving quality in the face of managed competition.

T he 1990s have been a roller-coaster ride for those of us practicing medicine in America, especially in those states where managed care has made its most aggressive inroads. The changes in health care have altered the relationship between doctors and patients and among members of the health care team. But we have to be careful to distinguish between traditional managed care and managed competition. Managed care in the form of nonprofit staff model health maintenance organizations (HMOs) has been with us for decades. It began in the l930s and 40s, providing relatively low-cost, prepaid health benefits for a segment of the workforce that could not afford indemnity insurance. As late as 1981, 82% of HMOs were nonprofit but, by 1995, the number had fallen to 29% [1]. With the emergence of for-profit HMOs and managed competition, the way providers and payers relate to each other has changed drastically. So far, we in Massachusetts have been spared the excesses of managed competition because our environment is dominated by nonprofit HMOs. But the for-profits are coming, and the not-for-profits are changing to compete. I would like to raise two questions: Can quality be preserved in the current health care system? What is our responsibility as radiologists to preserve that quality? To answer these questions, I will explore three issues: What got us to managed competilion? What went wrong? And how do we fix it?

The market for health care: where is the patient?

In 1980 I wrote an article in the New England Journal of Medicine (1) in which I said that the most important new development in the US health care system was the recent, relatively unheralded rise of a huge new industry that supplied medical services for profit. Without attracting much public attention, investor-owned businesses had begun to take over large parts of a health system which until then had been largely community-based and not-for-profit. At that time the major components of this new industry were proprietary hospitals and nursing homes, diagnostic laboratories, home-care and emergency room services, and hemodialysis centers. In total, these businesses had already captured almost a quarter of all the revenues spent for personal health care and I predicted their rapid growth would soon make them not only a dominating force in our health care delivery system, but also a major influence on public policy. There was an obvious analogy between this burgeoning, highly profitable new industry and the “military-industrial complex” that Dwight Eisenhower had warned about in his farewell address as President in 1961, so I called it the “new medical-industrial complex”. As the significance of the commercial transformation of this country’s health care system became increasingly apparent, this subject began to attract widening interest in the popular media and in the professional literature. Paul Starr’s 1982 landmark study of the social and economic development of medicine in America (2) was the first major scholarly work to take up this theme and put it in broad historical context. After devoting most of his book to the rise of the medical profession and its struggle for professional autonomy, Starr wrote a final chapter, entitled “The Coming of the Corporation”, which described the new corporate transformation of the US health care system and its growing threat to the …

Intimations of Solidarity? The Popular Culture Responds to Assisted Suicide

Perhaps no health care issue since Clinton's failure at health care reform has attracted as much attention in the media as the Supreme Court's long-awaited, unsurprising, and unanimous decision to deny a last right for the dying to physician-assisted suicide. The denial of this terminal liberty provoked a cascade of responses, an outcome the justices themselves requested. On the narrowly legal side, expert commentator after commentator pointed out that there are numerous directions available for generating new litigation, so that the judicial issue is far from closed. Respondents who write and talk about American politics observed that here was yet another sign of our times, in which key political decisions are being turned over from the federal government to the states. Popular responses to the moral question repeatedly have shown that the theme of assisted suicide is, as anthropologists say, good to think as a mise-en-scene for examining different and often much wider ranging issues in the social transformation of health care that is remaking the economic, organizational, and cultural aspects of medicine in America. For example, pundits and commoners alike have shrugged their shoulders at the moral irony the Court intensified by its argument that the availability of end-of-life palliation should be the real issue for patients and families. That is bizarre in a society in which more than forty million citizens have no health insurance, access to care overall has been made more complex and uncertain by managed care, and economic measures of outcome overwhelm assessment of the quality of the experience of illness and care, and in which there is little empirical or conceptual agreement on what end-of-life experiences should be like. The public moral questioning, as reported in the press for example, turns frequently to a different but clearly closely connected matter: the increasingly stated fear that the effect of the managed care revolution is creating a degree of time and space compression that so limits physicians' autonomy as well as patient control that the very valuation of what is at stake in care giving and receiving (not just at end-of-life but in routine practice as well) has undergone a radical redefinition. This shift is expressed by many lay persons as a perceived transvaluation of clinical values into economic ones, and by practitioners as the shared perception that medicine has become a business like any other with issues of efficiency, cost cutting, and market share replacing concern with caring and even competence. Assisted suicide is only one item in a much larger inventory of criticisms and complaints. The band of broadcast public opinion on physician-assisted suicide per se seems to me at least to be about as broad (and differentiated) as the spectrum of waves and channels of communication. Many patients claim that they plan to control how they die. How they will accomplish that is usually not clear, but the commitment of Americans to the idea of crafting an individualized death is impressive. For example, in France, where I am writing this report, the established institutions--the church, the medical profession, the huge and omnipresent state bureaucracy--seem hardly to be challenged over this question when compared with the United States. Furthermore, more and more American physicians are willing to admit either in print or in live interviews that in practice they assist patients and family members in providing such personalized control not just for pain management but even for the timing of death. That palliative care, which includes speeding up the natural process of dying via narcotic analgesics that work by depressing respiration in those vulnerable to respiratory failure, is now collectively recognized as a euphemism can scarcely be challenged. At the very moment when the Supreme Court has authorized the dichotomy between active assisted suicide (denied) and passive palliation (allowed), few seem to believe there is such a clear-cut distinction. …