Misplaced Priorities Research Articles

The Buck Stops Here

The title of this article was a sign on President Harry Truman's desk in 1945. Truman knew very well that with authority comes great responsibility. Leaders for ages have known that the ultimate responsibility for their organization stops at their desk. Leaders, managers, or supervisors of an air medical operation can have all the superficial trappings of a safety management system yet still be at risk for catastrophic failures if the organization's leadership culture has tragic flaws. BP and Toyota may be prime examples of organizational failures and misplaced priorities, as evidenced by the high-profile failures of their quality control and safety systems. Theoretically, those corporations had systems in place to prevent either quality control of safety issues but broke down seemingly by failing to listen to those small but critically important voices screaming for attention within the organization.

Screening practice and misplaced priorities

To estimate cancer screening coverage among a large sample of Greek individuals. 7012 adults from 30 Hellenic areas were surveyed. Tests included: faecal occult blood test, sigmoidoscopy,chest X-ray, urine test, testicular examination,trans-rectal ultrasound, full blood count, skin examination,digital rectal examination, PSA, Pap test, mammography,clinical breast examination (CBE), self breast examination and breast ultrasound. Eighty-eight percent of males and 93% of females declared being interested in cancer screening; 37.8% of men and 37.9% of women had had a medical consultation for screening purpose in the previous 2 years. Less than 2%reported having received screening for colorectal cancer or skin malignancies. Screening for cervical cancer, mammography and CBE was reported by 39.6%, 22.8% and 27.9% of females respectively. Twenty percent of males reported screening for prostate cancer. The actual opportunistic screening approach presents important deficiencies with displaced priorities in test performance and a low proportion of individuals undergoing recommended tests.

Cancer screening practice and misplaced priorities in Greece

1536 Background: Data comparison between EUROCARE and SEER database provided evidence that cancer survival in USA is higher than in Europe. Differences in survival rates were particularly higher fo...

Rethinking economics of misplaced priorities within the Hellenic opportunistic cancer screening policy

17521 Background: Screening is a significant method for cancer control. Nevertheless a high implementation of non cost effective tests constitutes a major health economics burden. Purpose of the study was to perform a cost analysis in order 1) to estimate the expenses used for evidence-based (EB), non-EB and undefined evidence (UE) screening tests among a large sample of Hellenic individuals and 2) to assess potential benefit of a correct redistribution of resources in screening performance. Methods: A questionnaire based cross sectional survey was conducted in Greece. 7,012 individuals entered the study. Annual cumulative costs were calculated for screening tests in the following settings EB, non EB and UE, according with current European Code against Cancer guidelines. Among males: EB tests = fecal occult blood test (FOBT); Non-EB tests = chest x-ray, urine and transrectal ultrasound; UE tests = full blood count (FBC) and PSA. Among female: EB tests = Pap test (PAP), mammography (MRX), FOBT. Non-EB tests = chest X-ray, urine test, breast ultrasound (USB); UE tests = FBC. Since we considered 80% population coverage with EB tests as optimal standard, we calculate the annual baseline costs for an EB maximal screening benefit (EBmax). Results: Among males the cumulative costs spent per EB was 1% of EBmax while the redistribution of the actuarial expenses of non-EB and UE provide 107% coverage of EBmax. For females the actual coverage represents the 29.1% of EBmax. When both non-EB and UE tests are considered further 17.4% of EBmax is provided accounting altogether to 46.5% of EBmax. Summing up the money saved from male EBmax screening a total 52.7% of female EBmax is still covered. Conclusions: Actuarial opportunistic screening is expensive and not satisfactory. Our cost analysis indicates that a rationale redistribution of actuarial spending could provide the health system the EBmax coverage among male and a notable part of resources needed for EBmax among female. Thereafter a national EBmax screening implementation seems economically feasible. No significant financial relationships to disclose.

Evolving An Effective Trade Policy Against Agricultural Subsidies Of Developed Countries: An Analysis Of Nigeria's Trade Policy

Global trade as presently structured is skewed in favour of developed countries. This is as a result of a number of factors, one of which is agricultural subsidies. It is an amount paid by government to upset part of the production cost or in exporting of a product. This makes it possible for farmers in developed countries to dispose of their products at artificially low prices. The response of developing countries to this trend has been a weak and uncoordinated trade policy. They have been unable to effectively curtail the onslaught of dumping. This paper is an analysis of Nigeria's trade policy in tackling the issue of agricultural subsidies. This took the form of an in-depth assessment of the impact of agricultural subsidies, drawing from the experiences of other African countries and qualitative analysis of Nigeria's present trade policy. This revealed a lack of coordination and misplaced priorities in dealing with trade issues. A mixed strategy is suggested, that is done within the framework of a comprehensive and integrated development policy, emphasizing the importance of trade negotiations. Keywords: Trade policy, Agricultural subsidiesJOAFSS Vol. 4 (1) 2006: pp. 9-21

Chronic Disease Prevention and Management

It is an old saying that an ounce of prevention is worth a pound of cure. Unfortunately, the American health infrastructure has not maintained an adequate focus on prevention--and now we are paying the price. The United States spends more on health care than any other industrialized country, but falls behind when it comes to health status. Why? It is because too often we attempt to address people's health concerns only after they become sick. It is time to transform the way that America thinks about health care: it is time to focus on prevention. While our nation needs a robust prevention infrastructure to defend us against a broad range of health problems, from infectious diseases to injuries, nowhere is the need for prevention more apparent than in the realm of chronic diseases. Some three-quarters of the $2.2 trillion our nation spends annually on health care goes toward care for chronic diseases like diabetes, heart disease, and cancer, many cases of which are preventable. The high and rising cost of health care increasingly is squeezing individuals and families, placing far too many at risk of financial ruin if they become ill. The cost of treating chronic diseases also strains the public purse: the share of Medicare funds spent on obese beneficiaries tripled between 1987 and 2002, and over 76 percent of all Medicare funds are spent on individuals with five or more chronic conditions. Diabetes care alone costs the federal government $80 billion per year--one out of every eight federal health care dollars. Despite this, the government spends less than $4 billion on diabetes prevention each year. Indeed, less than five percent of our federal health care dollars go toward prevention. This is unwise and unacceptable. My plan for universal health care will reorder these misplaced priorities. It will forge an American health care system that is smart and focused, one that saves money and leads to a healthier America. I believe that the key to help every American utilize preventive services is to get every American covered. Research shows that people without insurance coverage are much less likely to obtain the preventive services they need. For example, less than half of uninsured women between the ages of 50 and 63 received a mammogram in the last two years, compared to 75 percent of those with coverage. (1) My plan would ensure affordable, high quality coverage for every American by building on existing programs, offering choices of affordable coverage without creating new bureaucracies. Every American would have the choice to keep his or her current coverage or obtain the same coverage as members of Congress and the President have. A refundable, sliding-scale tax credit would help families who cannot afford coverage otherwise. My plan also would allow older Americans between the ages of 55 and 64 to join Medicare. Through this commonsense approach, Americans 55 and older would have better access to the appropriate preventive care that will allow them to live healthier, longer lives. For example, mammograms and colon cancer screenings are proven, cost-effective preventive measures that save lives. Without good health coverage, however, Americans between the ages of 55 and 64 often miss out on the life-saving preventive measures recommended for their age group and are more likely to die at younger ages than those with insurance. (2) Recent research suggests that allowing older adults to join Medicare not only could improve their health, but also could reduce Medicare costs by increasing access to preventive care. (3) Health care coverage also must be focused on prevention. My plan ensures that every American gets the preventive services he or she needs by requiring all health plans to cover a standard set of proven preventive services, including well-child visits, cancer screenings, and chronic disease management programs. An independent board of physicians, medical researchers, and patients will update the standard set of preventive services each year, using models already in place to evaluate and prioritize preventive care. …

Potential Health and Economic Consequences of Misplaced Priorities

Northfield, Ill: College of American Pathologists; 2006. 19. Hsu J, Price M, Huang J, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354:2349-2359. 20. Brown AF, Gregg EW, Stevens MR, et al. Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2005; 28:2864-2870. 21. Huang ES, Shook M, Jin L, Chin MH, Meltzer DO. The impact of patient preferences on the cost-effectiveness of intensive glucose control in older patients with new-onset diabetes. Diabetes Care. 2006;29:259-264. 22. National Committee for Quality Assurance. Bridges to Excellence. http://www .bridgestoexcellence.org/physicians/dcl.htm. Accessed November 12, 2006. 23. Vijan S, Hofer TP, Hayward RA. Estimated benefits of glycemic control in microvascular complications in type 2 diabetes. Ann Intern Med. 1997;127:788795. 24. Pogach LM, Rajan M, Aron DC. Comparison of weighted performance measurement and dichotomous thresholds for glycemic control in the Veterans Health Administration. Diabetes Care. 2006;29:241-246. 25. Engelgau MM. Trying to predict the future for people with diabetes: a tough but important task. Ann Intern Med. 2005;143:301-302.

Viewpoint: Look Before Taking Another Leap for Mankind—Ethical and Social Considerations in Rebuilding Society in Space

Commercial space travel is looking more like a real possibility than science fiction, but tied to that ambition we may be held back by the gravity of emerging ethical dilemmas. This viewpoint article surveys a range of social, economic, and political questions, and critically evaluates reasons why we should explore space. The usual ethical issues related to environmental and safety concerns are just the beginning, as there are other interesting questions, such as: what would be a fair process for commercializing or claiming property in space; how likely would a separatist movement be among space settlements who want to be free and independent states; and are reasons to explore space, like for adventure, wanderlust, or “backing up the biosphere,” good enough to justify our exploration of space? The point here that we should explore space; and if we are to move forward with our journey, which may be unstoppable anyway, then we should seriously consider these issues. At the least, this would give the public more confidence—amid questions of misplaced priorities and wasteful spending, along with an increased focus on ethics in science—that we are looking ahead before we take another leap for mankind.

Take the Abundance Road

As the reality of higher energy and raw materials prices settles in, we in R&D are challenged to find solutions. A recent book on the wealth creation driven by innovation and an article in HBS Working Knowledge on abundance and scarcity in economics brought to my attention how important an awareness of this issue is to R&D management (1,2). So often we are directed to do more with less, to squeeze the last half-percent-improvement out of existing processes, and reduce energy usage. All these directives fall under the scarcity mentality. Although important and difficult to disagree with, they are not going to change the fundamental dynamics and vulnerability of the business. They are easy to justify in terms of the resources and offer little downside risk in terms of career or strategy. The abundance mentality takes a completely different perspective and, I would argue, is the source of innovation. You see signs of this thinking in some of the responses to the energy crisis we are facing. The fact that the sun provides more energy every day than our annual needs is one example. The abundance mentality changes our perspective and opens up new approaches. It can easily be argued that it is simplistic and doesn't account for the effort required to achieve the desired result. In this example, solar cells are still expensive to produce, not viable in certain environments, etc., yet technology is making rapid strides in this area and the United States has the greatest solar resource available worldwide. It is abundant. Organization Optimists A simple analogy would compare abundance to optimism and scarcity to pessimism. I believe there is validity in this comparison. As R&D leaders, we are the optimists of our organizations, knowing that we can solve the problems given appropriate time, resources and latitude. You can see the scarcity mentality slipping into the last statement. Maybe it's not about resources and time, but emphasis. The paradigm of scarcity is broken down by innovation. Suddenly people are realizing that intellectual assets create value, unpredictable by the extrapolations of scarcity. We didn't run out of oil in the time frames originally predicted. Novel methods allowed us to find more, extract more and use it more efficiently-none of which was known at the time of the predictions. The abundance mentality does not excuse us from waste and misplaced priorities. In the U. S., we use energy at an unacceptable per-capita rate. A recent trip to Europe reinforced the existence of simple solutions to reducing energy usage that they use but Americans largely ignore. One example is that a room key is required to turn on hotel-room lights, and the lights go off when you leave the room and remove the key. Another is the greater acceptance of public transportation and smaller cars. The good news is that our priorities are changing. …

Pakistan: democracy, development, and security issues

Introduction - M P Singh and Veena Kukreja Causes of Democratic Downslide in Pakistan - Mohammad Waseem Pakistan Since the 1999 Coup - Veena Kukreja Prospects of Democracy Pakistan - Saleem M M Qureshi Islamic Ideology and the Failed State? Language, Power and Ideology in Pakistan - Tariq Rahman Pakistan - Ayesha Siddiqa Political Economy of National Security Pakistan's Political Economy - Veena Kukreja Misplaced Priorities and Economic Uncertainties Pakistan - Lawrence Zining Terrorism in Historical Perspective Prospects of South Asian Cooperation in the Transformed World - J N Dixit Post 11 September Reassessing Pakistan as a Long-Term Security Threat - Satish Kumar Cross-Border Terrorism - Rajen Harsh[ac]e Roadblock to Peace Initiative Peace Process Between India and Pakistan - M P Singh and Veena Kukreja

In Search of Hugo Chávez

ALMOST AS SOON as a collapsing bridge forced the government of President Hugo Chavez Frfias to shut down the only highway linking Venezuela's main airport and capital city in January, the recriminations began. Ch avez's opponents accused him of wasting the country's oil bonanza on politically driven projects abroad while neglecting infra structure at home. His supporters, in turn, charged the traditional elite that governed before him with squandering resources and ignoring fundamental needs for decades. In fact, both sets of charges were nearly identical. And both were right. Venezuela's leaders, Ch avez as well as his predecessors, have long been guilty of misplaced priorities. As with so many things today in Latin America's most politically polarized society, they all share the responsibility for failing to maintain what is arguably the most important stretch of road in Venezuela. Just before Chavez took office in February 1999, Gabriel Garcfa M arquez accompanied him on a flight to Caracas from Havana, Cuba, where the Venezuelan president-elect had visited with Fidel Castro. was overwhelmed by the feeling that I had just been traveling and chatting pleasantly with two opposing men, the Colombian Nobel laureate later wrote. One to whom the caprices of fate had given an opportunity to save his country. The other, an illusionist, who could pass into the history books as just another despot.

Televising sin: efforts to restrict the televised advertisement of cigarettes and alcohol in the united states, 1950s to 1980s

Near the end of 2001, the National Broadcasting Company announced a departure in its advertising policy: the network would effectively break the taboo against spirits advertising on television by a...

'It is Better to Leave, We Can't Protect You': Flight in the First Months of United Nations Transitional Administrations in Kosovo and East Timor

In both East Timor and Kosovo international intervention allowed for the rapid return of displaced populations but also led to new flight, mainly of those sympathetic to the previous regime. A principal cause was a breakdown in law and order and subsequent revenge attacks or the fear of such attacks. Delays in re-establishing law and order were caused by inadequacies in the mandates of the two UN administrations, an initial lack of resources, poor planning and misplaced perceptions and priorities. An analysis of these shortcomings allows a number of lessons to be drawn for future transitional administrations.

Energy services in sub-Saharan Africa: how conducive is the environment?

The bulk of rural populations in sub-Saharan Africa have no access to electricity and are under-served by any other form of modern infrastructure. The cost of infrastructure to mainly scattered communities has been perennially cited as largely to blame. This is an undeniable truth, but only part of it. There are in addition, myriads of social, economic and political obstacles that play an unquantified and frequently unrecognized negative role. At the route of the problem lies a subdued role of the would-be recipients who in fact, unlike anybody else, are conversant with their problems. Consequently, a number of products may come as impositions or misplaced priorities. Consumer participation for sustainable development has been articulated at international forums and in publications as being advantageous. In practice however, the concept appears to be generally shunned and even when, occasionally, tried the needs of the consumers are presumed and their roles prescribed. This paper discusses a range of social, economic and political issues that constitute major obstacles to the realisation of sustainable rural development.

Visualizing Decisionmaking: Perspectives on Collaborative and Participative Approach to Sustainable Urban Planning and Management

Over the last two decades shifting human resources, socioeconomic potentials, and innovations in information technology and communication have all but overthrown the formal order of the planning and management of urban systems. The authors trace the causes to misplaced priorities in urban governance and related issues, via the interface of infrastructure systems and land use. They survey some major theoretical and applied decision-support systems collaborative planning systems, and collaborative decision-support systems which have been advanced to date, indicating their strengths and weaknesses with regard to their ability to anchor public participation and professional collaboration in key planning and management issues. They highlight the fact that, although relevant multivariate, disaggregated, and incoherent small-scale researches do yield high dividends, their lack of cohesive interrelationship is related to the fragmentation of urban systems—despite various attempts at bringing about sustainable development. They suggest that decisionmaking can be effective when all aspects involved are visually related and collectively executed. They conclude by emphasizing that a comprehensive approach needs to be adopted for the planning and management of urban centers in order to enhance systems performance, human interaction, and contained developments.

Fiebre amarilla en Africa: su impacto en salud pública y perspectivas para su control en el siglo XXI

In the last two decades, yellow fever re-emerged with vehemence to constitute a major public health problem in Africa. The disease has brought untold hardship and indescribable misery among different populations in Africa. It is one of Africa's stumbling blocks to economic and social development. Despite landmark achievements made in the understanding of the epidemiology of yellow fever disease and the availability of a safe and efficacious vaccine, yellow fever remains a major public health problem in both Africa and America where the disease affects annually an estimated 200,000 persons causing an estimated 30,000 deaths. Africa contributes more than 90% of global yellow fever morbidity and mortality. Apart from the severity in morbidity and mortality, which are grossly under reported, successive outbreaks of yellow fever and control measures have disrupted existing health care delivery services, overstretched scarce internal resources, fatigued donor assistance and resulted in gross wastage of vaccines. Recent epidemics of yellow fever in Africa have affected predominantly children under the age of fifteen years. Yellow fever disease can be easily controlled. Two examples from Africa suffice to illustrate this point. Between 1939 and 1952, yellow fever virtually disappeared in parts of Africa, where a systematic mass vaccination programme was in place. More recently, following the 1978-1979 yellow fever epidemic in the Gambia, a mass yellow fever vaccination programme was carried out, with a 97% coverage of the population over 6 months of age. Subsequently, yellow fever vaccination was added to the EPI Programme. The Gambia has since then maintained a coverage of over 80%, without a reported case of yellow fever, despite being surrounded by Senegal which experienced yellow fever outbreaks in 1995 and 1996. The resurgence of yellow fever in Africa and failure to control the disease has resulted from a combination of several factors, including: 1) collapse of health care delivery systems; 2) lack of appreciation of the full impact of yellow fever disease on the social and economic development of the affected communities; 3) insufficient political commitment to yellow fever control by governments of endemic countries; 4) poor or inadequate disease surveillance; 5) inappropriate disease control measures, and 6) preventable poverty coupled with misplaced priorities in resource allocation. Yellow fever can be controlled in Africa within the next 10 years, if African governments seize the initiative for yellow fever control by declaring an uncompromising resolve to control the disease, the governments back up their resolve with an unrelenting commitment and unwavering political will through adequate budgetary allocations for yellow fever control activities, and international organisations, such as WHO, UNICEF, GAVI, etc., provide support and technical leadership and guidance to yellow fever at risk countries. Over a ten-year period, of stage-by-stage mass yellow fever vaccination campaigns, integrated with successful routine immunisation, Africa can bring yellow fever under control. Subsequently, for yellow fever to cease being a public health problem, Africa must maintain at least an annual 80% yellow fever vaccine coverage of children under the age of 1 year, and sustain a reliable disease surveillance system with a responsive disease control programme. This can be achieved at an affordable annual expenditure of less than US$1.00 per person per year, with a reordering of priorities.

Newborn Medicine and Society: European Background and American Practice (1750-1975) (review)

Reviewed by: Newborn Medicine and Society: European Background and American Practice (1750–1975) Jeffrey P. Baker Murdina MacFarquhar Desmond. Newborn Medicine and Society: European Background and American Practice (1750–1975). Austin, Tex.: Eakin Press, 1998. xxxvi + 304 pp. Ill. $26.95. One of the central themes of twentieth-century pediatrics has been the recognition of the distinctiveness of the newborn period. Newborn infants were once largely out of the medical spotlight, raised at home or, later, in hospital nurseries under the direction of nurses rather than physicians. Medical care was largely of a “hands-off” nature, emphasizing simple hygienic measures such as breast-feeding, warmth, and cleanliness. The modern intensive care nursery could hardly offer a greater contrast. It is both credited for astonishing rescues of tiny premature infants, and blamed as a spectacular example of the misplaced priorities of American medicine. Murdina Desmond, herself one of the leading figures in the development of newborn medicine, has produced a remarkably balanced assessment of the origins of newborn intensive care. While in many ways working in the tradition of the pediatric clinician-historian Thomas Cone’s History of the Care and Feeding of the Premature Infant (1985), she has built upon her predecessor’s foundation in a number of respects. She is highly aware that the story of newborn medicine cannot be told simply in terms of scientific and technological innovation. Desmond is the kind of perceptive observer whose own training has taught what many [End Page 743] historians have long come to recognize: that patterns of disease are shaped and transformed by their social context. Desmond traces the evolution of neonatal care in terms of two larger frameworks. First, she stresses the importance of who cared for the newborn. The medical care of young infants passed from mothers to obstetricians in the nineteenth century, and then to pediatricians, and ultimately neonatologists, in the twentieth. Far from simply celebrating this transition, however, she recognizes its potential to draw artificial lines in the campaign to reduce neonatal mortality. Second, she firmly situates her medical narrative against the still wider backdrop of society’s attitudes toward infancy. She goes beyond her predecessor Cone in calling attention to the Children’s Bureau and the early-twentieth-century infant-welfare movement, and ably describes the rise of governmental support after the Second World War. This ambitious project is more successful when it deals with the years that are familiar to the author personally. Desmond has examined a staggering amount of source material, and is aware of some of the more recent social histories of infant mortality—but this is not to say that she can be characterized as a social historian. Some of her readers may note on her part a tendency to read more harmony into her narrative than actually existed. For example, while she relates the opening of the first premature-infant nurseries in the United States side by side with other “infant welfare” approaches to relieving infant mortality, in fact many infant-welfare reformers were quite ambivalent about the consequences of saving “weaklings” to grow up quite possibly into “weak” adults. The Sheppard-Towner era of the 1920s thus focused on prenatal care, rather than on premature-infant technology. This led the first American premature-infant specialist, Julius Hess, to spend much of his career proving that premature babies could become normal adults. But to dwell on such issues is perhaps to miss the point of this work. It is the product of a generous spirit not prone to focus on division, but rather on the bigger story of how a beleaguered minority of newborn-care advocates made great strides without much recognition from the public. Desmond’s work opens many exciting areas for further historical exploration. It is an accessible work that deserves a broad clinical audience. Jeffrey P. Baker Duke University Copyright © 1999 The Johns Hopkins University Press

India and Pakistan: the first fifty years

Introduction Selig S. Harrison, Paul H. Kreisberg and Dennis Kux Part I. India: 1. Politics: democratic progress and problems Paul Brass 2. Economics: much achieved, much to achieve John Adams 3. Society: growth and inequity Sonalde Desai and Katharine Sreedhar Part II. Pakistan: 4. Politics: a nation still in the making Robert LaPorte Jr 5. Economics: misplaced priorities, missed opportunities Marvin Weinbaum 6. Society: progress and challenges Anita Weiss Part III. Foreign and Security Policy: 7. India: policies past and future Sumit Ganguly 8. Pakistan: fifty years of insecurity Thomas Thornton 9. The US India, and Pakistan: retrospect and prospect Stephen Philip Cohen.

Civic Education and Liberal Legitimacy

Soulevant le paradoxe de l'obligation de l'education civique des enfants et de l'apprentissage des valeurs fondamentales du liberalisme telle que l'autonomie de l'individu, l'A. montre que la permissibilite de l'education civique pose probleme, tant du point de vue de l'autorite de l'ecole en matiere d'enseignement et de l'autorite des parents en matiere d'education, que du point de vue de la legitimite de l'etat liberal au regard du consentement hypothetique des citoyens. Examinant les arguments en faveur de l'education civique developpes par W. Galston et A. Gutmann, ainsi que l'argument instrumental en faveur de l'education falicitant l'autonomie, l'A. montre que le debat souleve la question de la place de la famille religieuse de l'enfant et la question des programmes scolaires dans le cadre limite de la doctrine liberale

Lost memory: the paper drives of World War II

The author reviews the wholesale destruction of priceless and irreplaceable records as a consequence of the misplaced enthusiasms and priorities of wartime; he suggests that the full extent of such losses has yet to be measured.