Health: recent issues

Understanding sustained behavior change: the role of life crises and the process of reinvention

Ogden, J., Hills, L. — 2008-09-25

Much research has addressed behavior change but has tended to focus on short term changes. This study aimed to explore the mechanisms behind sustained changes in behavior and involved qualitative interviews with 34 `success stories' who had either lost weight through changes in diet and exercise (n = 24) or stopped smoking (n = 10) and had maintained this change for at least 3 years. The results showed that the majority described how their sustained behavior change had been triggered by a significant life crisis relating to their health, relationships or salient milestones. This initial change was then translated into sustained change if three sustaining conditions were met: the function of the unhealthy behavior was disrupted, the individual perceived that their choice over carrying out the unhealthy behavior had been reduced and they adhered to a behavioral model of their problem. Further, these conditions functioned by enabling a process of reinvention with participants showing a shift in identity toward a new healthier self. The results are discussed in terms of self-regulation and the establishment of a new post-crisis healthier equilibrium.

Resilience and depression: perspectives from primary care

Dowrick, C., Kokanovic, R., Hegarty, K., Griffiths, F., Gunn, J. — 2008-09-25

Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience — ordinary magic and personal medicine — which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 people, drawn from a longitudinal study of the management of depression in primary care in Victoria, Australia. We also assess how respondents rate personal resilience in comparison with help received from professional sources. Our data are obtained from semi-structured telephone interviews, and analysed inductively through refinement of our theoretical framework. We find substantial evidence of resilience both in terms of ordinary magic — drawing on existing social support and affectional bonds; and in terms of personal medicine — building on personal strengths and expanding positive emotions. There is a strong preference for personal over professional approaches to dealing with mental health problems. We conclude that personal resilience is important in the minds of our respondents, and that these elements should be actively considered in future research involving people with experience of mental health problems.

Negotiating the diagnostic uncertainty of contested illnesses: physician practices and paradigms

Swoboda, D. A. — 2008-09-25

In the absence of scientific consensus about contested illnesses such as Chronic Fatigue Syndrome (CFS), Multiple Chemical Sensitivities (MCS), and Gulf War Syndrome (GWS), physicians must make sense of competing accounts and develop practices for patient evaluation. A survey of 800 United States physicians examined physician propensity to diagnose CFS, MCS, and GWS, and the factors shaping clinical decision making. Results indicate that a substantial portion of physicians, including nonexperts, are diagnosing CFS, MCS, and GWS. Diagnosing physicians manage the uncertainty associated with these illnesses by using strategies that enhance bounded rationality and aid in thinking beyond current disease models. Strategies include consulting ancillary information sources, conducting analytically informed testing, and considering physiological explanations of causation. By relying on these practices and paradigms, physicians fit CFS, MCS, and GWS into an explanatory system that makes them credible and understandable to them, their patients, and the medical community. Findings suggest that physicians employ rational decision making for diagnosing contested illnesses, creating a blueprint of how illnesses lacking conclusive pathogenic and etiological explanations can be diagnosed. Findings also suggest that patients with contested illnesses might benefit from working with physicians who use these diagnostic strategies, since they help manage the complexity and ambiguity of the contested illness diagnostic process and aid in diagnosis. In addition, findings provide a window into how emerging illnesses get diagnosed in the absence of medical and scientific consensus, and suggest that diagnosing physicians advance the legitimacy of controversial illnesses by constructing the means for their diagnosis.

Discourse of `transformational leadership' in infection control

Koteyko, N., Carter, R. — 2008-09-25

The article explores the impact of the `transformational leadership' style in the role of modern matron with regards to infection control practices. Policy and guidance on the modern matron role suggest that it is distinctive in its combination of management and clinical components, and in its reliance on transformational leadership. Senior nurses are therefore expected to motivate staff by creating high expectations, modelling appropriate behaviour, and providing personal attention to followers by giving respect and responsibility. In this article, we draw on policy documents and interview data to explore the potential impact of this new management style on infection control practices. Combining the techniques of discourse analysis and corpus linguistics, we identify examples where matrons appear to disassociate themselves from the role of `an empowered manager' who has control over human and financial resources to resolve problems in infection control efficiently.

The artist as surgical ethnographer: participant observers outside the social sciences

Harris, A. — 2008-09-25

Artists and novelists have rarely been considered as ethnographers in the medical social sciences. This article pursues the idea that ethnographically informed artistic works can be viewed as critical cultural texts alongside sociological and anthropological studies of surgery. It is proposed that art provides fresh perspectives on topics of interest in health sociology and medical anthropology while simultaneously expanding our engagement with ethnographic representation. Discussion revolves around a video installation incorporating images of heart surgery by contemporary artist Bill Viola and a recent novel by Ian McEwan detailing the day-in-the-life of a neurosurgeon. Considering an emerging re-engagement, particularly in contemporary art that artists are having with medical themes, and a concurrent `ethnographic turn' in art practice, it seems timely to recognize the potentially critical contribution of non-social scientist ethnographers to our understanding of a rapidly changing medical culture.

Constructions of the self in interaction with the Beck Depression Inventory

Galasinski, D. — 2008-09-25

In this article, I am interested in discourses of people completing the Polish version of the Beck Depression Inventory (BDI). I focus upon the negotiation of the spaces for constructing the self opened by the BDI. My corpus consists of transcripts of 50 sessions in which self-reportedly healthy people were asked to `think aloud' while completing the BDI. I shall demonstrate that in interactions with the `depression scale', the informants mostly rejected the spaces offered by it. Three strategies of such rejection are discussed: reformulation, recontextualization and an explicit challenge to the categories offered by the BDI. I shall argue that the concerns of lived experience in a particular context, when not subdued by the relationship of power in the situation of medical examination, overrule the frame imposed by the a-contextual questionnaire of sadness. Insight into depression or its intensity offered by `context-free' psychological or psychiatric instrument, set outside lived experience, is extremely problematic.

Book review: The body in question: A socio-cultural approach. Alan Peterson. London: Routledge, 2007. 169pp. ISBN 0-415-32162-x (pbk)

Gale, N. K. — 2008-09-25

Book review: Pink ribbons, Inc. breast cancer and the politics of philanthropy. Samantha King. Minneapolis and London: University of Minnesota Press, 2006, 157 pp. ISBN 978-0-8166-4898-6 (paper). $US18.95

Frank, A. W. — 2008-09-25

Book review: Review notices: books on death and dying

Frank, A. W. — 2008-09-25

Family health narratives: midlife women's concepts of vulnerability to illness

Lindenmeyer, A., Griffiths, F., Green, E., Thompson, D., Tsouroufli, M. — 2008-06-25

Perceptions of vulnerability to illness are strongly influenced by the salience given to personal experience of illness in the family. This article proposes that this salience is created through autobiographical narrative, both as individual life story and collectively shaped family history. The article focuses on responses related to health in the family drawn from semi-structured interviews with women in a qualitative study exploring midlife women's health. Uncertainty about the future was a major emergent theme. Most respondents were worried about a specified condition such as heart disease or breast cancer. Many women were uncertain about whether illness in the family was inherited. Some felt certain that illness in the family meant that they were more vulnerable to illness or that their relatives' ageing would be mirrored in their own inevitable decline, while a few expressed cautious optimism about the future. In order to elucidate these responses, we focused on narratives in which family members' appearance was discussed and compared to that of others in the family. The visualization of both kinship and the effects of illness led to strong similarities being seen as grounds for worry. This led to some women distancing themselves from the legacies of illness in their families. Women tended to look at the whole family as the context for their perceptions of vulnerability, developing complex patterns of resemblance or difference within their families.

Fear of the unknown: ultrasound and anxiety about fetal health

Harpel, T. S. — 2008-06-25

Using a qualitative approach, this study sought to explore the role of ultrasound in fetal health anxiety. One semi-structured interview was conducted with 30 pregnant women. Data analysis was inductive, following the principles of the template and editing organizing styles of coding and analysis. Overall, 93 percent of the women reported anxiety over fetal health, with 96.5 percent of these women indicating that ultrasound played a role in their anxiety. The women reported heightened fetal health anxiety in anticipation of the ultrasound, as well as during the ultrasound due to the sonographer's behavior and an inability to see the monitor. Findings indicated that fetal health anxiety was relieved by the ultrasound, particularly when women had access to the visual image and received encouraging verbal feedback. The findings are discussed with regard to their implications for policy and obstetric practice.

Enabling healthy choices: is ICT the highway to health improvement?

Lindsay, S., Bellaby, P., Smith, S., Baker, R. — 2008-06-25

The White Paper Choosing health acknowledges that there is no lack of information in the system about healthy lifestyles, but the manner of communication of risk and the level of support for lifestyle change need improvement. Action also has to be taken to address inequalities in health and to focus on securing better access to healthier choices for people in disadvantaged groups or areas. Accordingly, this randomized controlled trial examined whether access to a purpose-built health portal for heart disease could enable patients to manage better their heart conditions. We recruited 108 men and women aged 50—74 from coronary heart disease registries from a deprived area of Greater Manchester. Every participant received a new computer and one-year broadband subscription; however, only the experimental group received access to the Hearts of Salford health portal. Our results indicate that the experimental group changed their diet significantly. Specifically, they reported eating `bad foods' (such as chips, sweets, crisps, fried foods, ready meals and cakes/biscuits) significantly less often compared to the controls.

Conceptualizing autonomy in the context of chronic physical illness: relating philosophical theories to social scientific perspectives

2008-06-25

The aim of this article is to conceptualize autonomy in the context of chronic physical illness. To this end, we compare and contrast a selection of contemporary philosophical theories of autonomy with social scientific perspectives on chronic illness, particularly models of disability and symbolic interactionism. The philosophical theories mainly depart from a positive conceptualization of autonomy, which involves actively shaping one's life and identifying with fundamental values. This conceptualization is preferred over a negative conceptualization, which defines autonomy as non-interference, for its compatibility with social models of disability and with the assumption that people are interdependent. Interference may disable, but also enable people with a chronic illness to shape their lives. What matters is that people can realize what they want to realize. We suggest that, in the context of chronic physical illness, autonomy might be conceptualized as correspondence between what people want their lives to be like and what their lives are actually like. Disturbed autonomy might be restored either by expanding opportunities to arrange life or by adjusting how one wants life to be arranged. The grounds for the latter approach might be questioned, first, if people have not adjusted what they want carefully, and second, if reorganization of the material and social environment would have made it unnecessary to adjust one's arrangement of life.

Endurance and contest: women's narratives of endometriosis

Markovic, M., Manderson, L., Warren, N. — 2008-06-25

Endometriosis is an often painful medical condition in which, in response to hormones associated with the menstrual cycle, the uterine lining grows in the peritoneum and other organs, bleeding into the surrounding organs and tissues. Diagnosis is not always straightforward, and women and health professionals alike may have difficulties recognizing period pain as a sign of anomaly, considering it instead as an inevitable part of menstruation. This article describes the illness narratives of Australian women with endometriosis, drawing on data collected during a study conducted in Victoria in 2004—5. Thirty women (aged 20—78 years) from various socio-demographic backgrounds participated in in-depth interviews. We explore the influence of socio-demographic background and social and family norms on women's illness narratives of endurance and contest. Narratives of endurance are characterized by the normalization of period pain by young women, their families and health professionals, and, with diagnosis, long-term exposure to biomedical treatments. In contrast, narratives of contest are dominated by how women's subjective experience is challenged by doctors, their requirements for a patient-centered approach, and their desire to have access to complementary treatments.

Persons with acquired profound hearing loss (APHL): how do they and their families adapt to the challenge?

Hallam, R., Ashton, P., Sherbourne, K., Gailey, L. — 2008-06-25

The study examined the impact of acquired profound hearing loss (APHL) on the relationship between the hearing impaired person and their normally hearing close family member, usually a partner, and identified the kinds of adjustment leading to maintenance or deterioration of the relationship. The participants were 25 people with APHL and 25 family members, interviewed separately in their own home. Analysis of the interview transcripts adopted a grounded theory methodology. The different levels of analysis were linked in terms of a core category based on the social construction of a committed relationship. The conceptual codes were grouped as: (a) aural impairments giving rise to the need for adjustment; (b) pragmatic adjustments to spoken communication and family activities; (c) managing the adjustments without negative consequences; (d) adjustments leading to negative interaction. The results suggest that APHL places considerable strain on relationships and increases their vulnerability to failure, consistent with previous research. They highlight the need for professional support and suggest that a systemic conceptual framework is needed that includes the public response to profound hearing impairment.

Disruption foreclosed: older women's cancer narratives

Sinding, C., Wiernikowski, J. — 2008-06-25

A challenge has emerged to Bury's (1982) conceptualization of chronic illness as biographical disruption. The idea that certain life circumstances — notably older age or the presence of significant health and social problems — render the experience of chronic illness biographically `continuous' or `reinforcing' has gained currency in the social study of chronic illness.

This article draws from a qualitative study with women diagnosed with cancer in their 70s or 80s. Respondents' narratives suggest that a long life, especially a life characterized by struggle, does provide a context for the assessment of cancer as non-disruptive. However, the study offers evidence that a long life characterized by sufficiency may also be associated with an assessment of cancer as non-disruptive, and that older age and hardship sometimes render chronic illness especially problematic.

Centrally, the article examines respondents' oft-cited commitment to avoid `dwelling' on illness, highlighting how broad cultural and moral discourses, patterns of social interaction and structures of power combine to foreclose older women's accounts of disruption.

The role of the Internet in cancer patients' engagement with complementary and alternative treatments

Broom, A., Tovey, P. — 2008-04-09

This article draws on a study of 80 National Health Service cancer patients and their experiences of using the Internet within disease and treatment processes. It focuses on the role the Internet plays in the context of potential or actual engagement with complementary and alternative medicine (CAM). The results depart from previous conceptualizations of the Internet as a major source of CAM knowledge, and second, as a major pathway to patient CAM usage. Moreover, the results highlight significant anxiety as patients attempt to process vast amounts of complex biomedical diagnostic and prognostic information online. For patients attempting to embrace alternative therapeutic models of cancer care, exposure to prognostic data may pose considerable risks to individual well-being and engagement with healing practices. On the basis of these results we problematize social theorizations of the Internet as contributing to such things as: the democratization of knowledge; the deprofessionalization of medicine; and patient empowerment. We emphasize, instead, the potential role of the Internet in reinforcing biomedicine's paradigmatic dominance in cancer care.

Discourses on menopause -- Part I: Menopause described in texts addressed to Danish women 1996--2004

Hvas, L., Gannik, D. E. — 2008-04-09

To understand Danish women's very different ways of interpreting menopausal experiences and the way they construct meaning relating to menopause, it is necessary to include the context in which meaning is constructed as well as the background of cultural attitudes to menopause existing in the Danish society. Using documentary material, the aim of this article was to describe different discourses on menopause in Denmark that present themselves to menopausal women, and to discuss how these discourses may affect women's identity and constitute their scope of action. One hundred and thirty-two pieces of text under the heading or subject of `menopause' or `becoming a middle-aged woman', published from 1996 to 2004, were included. All material was addressed to Danish women, and consisted of booklets and informational material, articles from newspapers and magazines and popular science books. Seven different discourses on menopause were identified: the biomedical discourse; the `eternal youth' discourse; the health-promotion discourse; the consumer discourse; the alternative discourse; the feminist/ critical discourse; and the existential discourse. The biomedical discourse on menopause was found to be dominant, but was expanded or challenged by other discourses by offering different scopes of action and/or resting on different fundamental values. The discourses constructed and positioned individual women differently; thus, the women's position varied noticeably from one discourse to another. Depending on the discourse drawn upon, the woman's position could be that of a passive patient or that of an empowered woman, capable of making her own choices in relation to her health.

Discourses on menopause -- Part II: How do women talk about menopause?

Hvas, L., Gannik, D. E. — 2008-04-09

The aim of this article is to describe which of the different available discourses women relate to as revealed in the way they talk about menopause. We use a discourse analytic approach, which implies that meaning is ascribed to things according to how we talk about them. Twenty-four menopausal women from Denmark were interviewed. They were selected to cover a broad spectrum of Danish women with different menopausal experiences and social background factors. Seven previously identified discourses could be found in the interviews, though to varying degrees from woman to woman. Nearly all women used terms from the biomedical sphere like `a period of decline and decay', even if they did not necessarily agree with this view. Also the existential discourse permeated most of the interviews, especially when the conversation turned to the ageing process, femininity and self-development. The way the menopause was talked about almost became kaleidoscopic when images speedily changed from the decrepit osteoporotic woman or a woman with lack of vitality and sex-appeal to a healthy and strong woman with control over her body and self. Since many women contact doctors in relation to menopause, and since the way doctors talk about menopause is influential, doctors should carefully consider which words and images they use in the counselling. The medical way of perceiving menopause is just one of many, and doctors must be aware that there are other different and partially contradicting discourses at play in society and in the women's universes.

Structural constraints and opportunities for CAM use and referral by physicians, nurses, and midwives

Hirschkorn, K.A., Bourgeault, I.L. — 2008-04-09

Thisarticleexaminestheattitudesandreportedbehaviorsof physicians, nurses, and midwives regarding complementary and alternative medicine (CAM), with respect to one key theme that emerged from a broader qualitative study. Of central interest are the structural influences identified by study participants that either act as constraints or opportunities for their professional use of or referral for CAM. In an effort to interpret these results, the analysis is situated within the sociology literature that documents the influences of professional socialization, practice philosophy, regulation, and organizations on professional behavior. These influences are classified as either professional-level structures or work/organizational structures. The main conclusion is that future research should pay more attention to such structural dimensions that may be exerting influence on the decisions of providers about whether or not to professionally use or refer for CAM. This article is offered as a conceptual starting point for doing so.

Governing the contagious body: genital herpes, contagion and technologies of the self

Oster, C., Cheek, J. — 2008-04-09

Genital herpes is a prevalent sexually transmitted viral infection. While genital herpes is not life-threatening, it can cause physical discomfort and psychosocial difficulties, and may increase the risk of contracting HIV. Given that genital herpes cannot be cured, both the condition itself, and the possibility of passing it on to others, becomes a part of the everyday reality of those individuals diagnosed with genital herpes. In this article we explore the ways in which people with genital herpes attending the Sexually Transmitted Infections (STI) clinic govern their `contagious bodies'. The discussion draws on the Foucauldian concept of governmentality, and uses Foucault's idea of ethics as a framework to identify the technologies of the self by which individuals with genital herpes govern their own thoughts and behaviours in relation to the contagiousness of the condition. Implications for practice and other ways of thinking about what happens in the STI clinic context are suggested.

A `little world of your own': stigma, gender and narratives of venereal disease contact tracing

Kampf, A. — 2008-04-09

As in other countries, in order to protect the public from venereal disease (syphilis and gonorrhoea), contact tracing in New Zealand has been a public health strategy since the mid-20th century. So far, scholars have predominantly focused on the aspect of control of the cases traced. Based on a rare interview with a female contact tracer, together with a range of archival material, this article aims to expand the scholarship by focusing on the tracer instead of the patient. Using Erving Goffman's original concept of `courtesy stigma', the article will show that his idea can be nuanced to take into account contact tracers and the ways in which this stigma can be refracted through gender. Working as a tracer had a distinct impact on her life and possibly even her marital status, which were compromised by secrecy, stigma, morality and the demands of public health policies — aspects that were, paradoxically, quite similar to those she traced. The courtesy stigma that contact tracers for venereal disease acquired limited their professional options, as well as isolated them in the non-stigmatized social world.

Medicalization and beyond: the social construction of insomnia and snoring in the news

Williams, Simon. J., Seale, C., Boden, S., Lowe, P., Steinberg, D. L. — 2008-04-09

What role do the media play in the medicalization of sleep problems? This article, based on a British Academy funded project, uses qualitative textual analysis to examine representations of insomnia and snoring in a large representative sample of newspaper articles taken from the UK national press from the mid-1980s to the present day. Constructed as `common problems' in the population at large, insomnia and snoring we show are differentially located in terms of medicalizing—healthicizing discourses and debates. Our findings also suggest important differences in the gendered construction of these problems and in terms of tabloid and `broadsheet' newspaper coverage of these issues. Newspaper constructions of sleep, it is concluded, are complex, depending on both the `problem' and the paper in question.

Book review: The Body in Question: A Socio-Cultural Approach. Alan Peterson. London: Routledge, 2007. 169pp. ISBN 0-415-32162-x (pbk)

Gale, N. K. — 2008-04-09

Editorial

Traynor, M. — 2007-12-11

Menopause and the virtuous woman: the importance of the moral order in accounting for medical decision making

Stephens, C., Breheny, M. — 2007-12-11

Whether or not to use hormone replacement therapy (HRT) around the time of menopause is seen as an important decision for many mid-aged women. Recent studies of information provided to women to assist them in making a medical decision about the use of HRT have highlighted the importance of understanding the broader social context of the decision. In this article we examine one important aspect of western mid-aged women's social world: the moral order and the imperative of virtue. Qualitative data from a survey, focus group discussions, and interviews with mid-aged women about HRT use are used to provide examples of the importance of the local moral order in women's talk about menopause and HRT use. The implications of these data will be discussed in terms of the different narrative resources available to construct menopause and HRT, the role of morality, and the demonstration of virtue in daily social life, including medical decision making.

Disciplining death: hypertension management and the production of mortal subjectivities

Banerjee, A. — 2007-12-11

Medicine powerfully mediates the relationship between life and death. This article argues that in the name of health, modern medicine constitutes a pathological mortal subjectivity, encouraging individuals to experience death as disease, to understand mortality as morbidity, and to approach living instrumentally as a means to longevity. This article uses the example of hypertension management to illustrate how this vision of death is transformed into a form of life.Through the analysis of a number of disciplinary technologies — from technical definitions of health to blood pressure monitoring — it illustrates how individuals are incited to relate to death in an antagonistic, impersonal, and technical fashion. While contemporary forms of capital accumulation in the health field require an intensification of such relations, this article suggests that there much to be gained from exploring visions of health that are not at odds with death.

Constructing health news: possibilities for a civic-oriented journalism

Hodgetts, D., Chamberlain, K., Scammell, M., Karapu, R., Waimarie Nikora, L. — 2007-12-11

Health is a very prominent news category. However, we know little about the production processes of journalists leading to the health stories we encounter on a daily basis. Such knowledge is crucial for ensuring a vibrant public sphere for health. This article draws on interviews with eight health journalists in New Zealand to document what they consider to constitute a health story, their professional norms and practices, their perceptions of audiences, and the need for increased civic deliberations regarding health. Journalists privilege biomedical stories involving lifestyle and individual responsibility, and have limited frames for presenting stories that involve socio-political concerns. Stories are strongly shaped by journalists' considerations of their target audience, the sources they draw on, their professional norms, and institutional practices. This results in the omission of stories that have relevance for minority and disadvantaged groups and limits the nature of the stories told to ones that reflect the views of the majority. However, journalists are also reflective about these issues and receptive to ways to overcome them. This raises possibilities for health researchers to engage with journalists in order to repoliticise health and promote a more civic-oriented form of health journalism.

`I'd rather not take Prozac': stigma and commodification in antidepressant consumer narratives

Smardon, R. — 2007-12-11

This article explores the idea that narrative is the primary vehicle through which antidepressant consumers negotiate their sense of identity and reality. Antidepressant consumers represent a unique consumer culture because of the stigma that society attaches to mental illness. Recent media attention, including direct to consumer (DTC) advertising, appears to decrease the stigma surrounding antidepressant use while at the same time commodifying and branding them for mass consumption. Antidepressant consumers must negotiate the threat of stigma and the threat of commodification through the process of constructing narratives. Exploring the narrative process of identity negotiation reveals how the interconnected cultural processes of stigma and commodification are undergoing historical shifts. Among these shifts are the intensification of branding and an expansion of consumer culture. Implications for health promotion and further research are discussed.

Redefining accountability in health care: managing the plurality of medical interests

Sorensen, R., Iedema, R. — 2007-12-11

Conflict in health service delivery is common. It is often attributed to disputes between clinicians and patients or their families about treatment decisions and is particularly common in intensive care units (ICUs), in the form of `futility disputes' between families and medical clinicians about decisions to terminate the active treatment of a dying family member. More common, but less prominent in the literature, is conflict within the medical profession about patient care goals and treatment. We contend that managing the plurality of medical interests is essential in achieving a more managed and positive experience for patients and families of the care they receive, and for achieving standards of quality and resource use. From an ethnographic study undertaken in a large ICU in Sydney, Australia, we found that the knowledge and practice differences of multiple medical decision-makers generated conflict, inconsistency of practice and subjectivity of decision-making that impeded coherent clinical decision-making and integrated patient care planning, coordination and care review. Improving patients' and families' experience of care requires medical clinicians and medical managers to accept responsibility for institutionalizing effective communication and decision-making processes within clinical networks and between clinical and managerial domains. Thus, strategies to improve patient care will need to extend beyond the medical profession to incorporate administrative management. We conclude that restructuring communication and decision-making processes is imperative to achieve clinical accountability in the workplace and systems accountability in the organization.

News media coverage of direct-to-consumer pharmaceutical advertising: implications for countervailing powers theory

Hartley, H., Coleman, C.-L. — 2007-12-11

Since a 1997 regulatory shift on the part of the US Food and Drug Administration (FDA), there has been an explosion of televised direct-to-consumer (DTC) pharmaceutical advertising in the United States. The introduction and growth of this form of advertising, as well as other recent evolutions in the health care arena, have altered relationships among key countervailing powers in the health care system, suggesting the need to recast countervailing powers theory so as to account for these changes. Coming from the perspective that the news media play an important role in reflecting the balance of power among the various countervailing powers, the paper advances this theoretical framework through an empirical assessment of the relative prominence of those entities in print news media coverage of the DTC advertising phenomenon. The study finds that `corporate sellers' (pharmaceutical industry) are accorded more prominence in news coverage than are providers, consumers, corporate purchasers, or state players and that DTC critics, in particular, have minimal representation. In addition, the findings point toward two modifications for countervailing powers theory: (1) an incorporation of the role of academic/research organizations, and (2) a consideration of the universe of possibilities with respect to each of the countervailing powers.

Book review: Dolly Mixtures: The Remaking of Genealogy Sarah Franklin. Durham, NC, Duke University Press, 2007. 253 pp. ISBN 13 978 0-8223 3903 8 (pbk). US$22.95

Blue, G., Rock, M. — 2007-12-11