Since the 1970s health care costs in the United States have doubled, insurance premiums have far outpaced inflation, and the numbers of the uninsured and underinsured are increasing at an alarming rate. At the same time the public expects better health care and access to the latest treatment technologies. Governments, desperate to contain ballooning costs, often see a market-based approach to health care as the solution; critics of market systems argue that government regulation is necessary to secure accessible care for all.

The Catholic Church generally questions the market's ability to satisfy the many human needs intrinsic to any care delivery system yet, although the Church views health care as a basic human right, it has yet to offer strategies for how such a right can be guaranteed. Mary J. McDonough, a former Legal Aid lawyer for medical cases, understands the advantages and disadvantages of market-based care and offers insight and solutions in Can a Health Care Market Be Moral?

Drawing on Catholic social teachings from St. Augustine to Pope John Paul II, McDonough reviews health system successes and failures from around the world and assesses market approaches to health care as proposed by leading economists such as Milton Friedman, Regina Herzlinger, Mark Pauly, and Alain Enthoven. Balancing aspects of these proposals with Daniel Callahan's value-dimension approach, McDonough offers a Catholic vision of health care in the United States that allows for some market mechanisms while promoting justice and concern for the least advantaged.

An innovative theory proposes a new therapeutic strategy to break the stalemate in the war on cancer. It is called cancer stem cell (CSC) theory, and Lucie Laplane offers a comprehensive analysis, based on an original interdisciplinary approach that combines biology, biomedical history, and philosophy.

Rather than treat cancer by aggressively trying to eliminate all cancerous cells—with harmful side effects for patients—CSC theory suggests the possibility of targeting the CSCs, a small fraction of cells that lie at the root of cancers. CSCs are cancer cells that also have the defining properties of stem cells—the abilities to self-renew and to differentiate. According to this theory, only CSCs and no other cancer cells can induce tumor formation.

To date, researchers have not agreed on the defining feature of CSCs—their stemness. Drawing from a philosophical perspective, Laplane shows that there are four possible ways to understand this property: stemness can be categorical (an intrinsic property of stem cells), dispositional (an intrinsic property whose expression depends on external stimuli), relational (an extrinsic property determined by a cell’s relationship with the microenvironment), or systemic (an extrinsic property controlled at the system level). Our ability to cure cancers may well depend upon determining how these definitions apply to different types of cancers.

One of the major concerns about the changing U.S. health-care systems is whether they will improve or diminish the quality and cost-effectiveness of medical care. The shift from a fee-for-service to a prepaid method of reimbursement has greatly changed the incentives of patients to seek care as well as those of providers to supply it. This change poses a particular challenge for care of depressed patients, a vulnerable population that often does not advocate for its own care. This book documents the inefficiencies of our national systems--prepaid as well as fee-for-service--for treating depression and explores how they can be improved.

Although depression is a major illness affecting millions of people, it is seriously undertreated in the United States. The ongoing shift of mental-health care away from specialists and toward primary medical-care providers is causing fewer depressed patients to be appropriately diagnosed and treated. Depression is frequently more devastating than other major illnesses, such as arthritis and heart disease, because it often begins at a younger age, when people are at their productive peak and thus at risk of permanently damaging their careers. It also differs from many medical conditions in that its indirect costs are usually much higher than direct treatment costs.

The authors urge the integration of both medical and economic considerations in designing policies for the treatment of depression. They show that by spending more money efficiently on care, the nation will gain greater health improvements per dollar invested and a more productive population.

“Sandel explores a paramount question of our era: how to extend the power and promise of biomedical science to overcome debility without compromising our humanity. His arguments are acute and penetrating, melding sound logic with compassion.”
—Jerome Groopman, author of How Doctors Think

Breakthroughs in genetics present us with a promise and a predicament. The promise is that we will soon be able to treat and prevent a host of debilitating diseases. The predicament is that our newfound genetic knowledge may enable us to manipulate our nature—to enhance our genetic traits and those of our children. Although most people find at least some forms of genetic engineering disquieting, it is not easy to articulate why. What is wrong with re-engineering our nature?

The Case against Perfection explores these and other moral quandaries connected with the quest to perfect ourselves and our children. Michael Sandel argues that the pursuit of perfection is flawed for reasons that go beyond safety and fairness. The drive to enhance human nature through genetic technologies is objectionable because it represents a bid for mastery and dominion that fails to appreciate the gifted character of human powers and achievements. Carrying us beyond familiar terms of political discourse, this book contends that the genetic revolution will change the way philosophers discuss ethics and will force spiritual questions back onto the political agenda.

In order to grapple with the ethics of enhancement, we need to confront questions largely lost from view in the modern world. Since these questions verge on theology, modern philosophers and political theorists tend to shrink from them. But our new powers of biotechnology make these questions unavoidable. Addressing them is the task of this book, by one of America’s preeminent moral and political thinkers.

From prescriptions to pain killers to transplantation of human organs, the perplexities of medical ethics extend far beyond the confines of medicine. This book offers over 100 engrossing case studies that guide the reader to an understanding of the ethical aspects of medical care. The cases illustrate dilemmas arising in everyday practice—what to tell a dying patient, selecting a surgical approach, choosing between brand-name and generic drugs—as well as the ethical consequences of advanced technology—prenatal diagnosis that might result in the decision to abort, or keeping an irreversibly comatose patient alive with support methods.

Robert M. Veatch first shows readers how to identify ethical issues and points out that an important element in making a decision is to identify the person responsible for it. Then, in analyzing the classical moral question "What is the right thing to do?" he cites situations that were actually faced by patients and medical professionals. He explores a number of specific ethical problems in contemporary medicine: abortion, sterilization, contraception, transplantation, hemodialysis, genetic counseling, and human experimentation, among others. The last chapter focuses on death and dying.

Ethical positions are never forced upon the reader. Instead, the author is careful to present alternatives and to discuss the consequences of a particular decision. His book is written for patients, their families and friends, nurses, technicians, counselors, social workers, physicians, employers, and lawyers—indeed for anyone affected by the burgeoning power of medical intervention.

Childbirth is a quintessential family event that simultaneously holds great promise and runs the risk of danger. By the late nineteenth century, the birthing room had become a place where the goals of the new scientific professional could be demonstrated, but where traditional female knowledge was in conflict with the new ways. Here the choice of attendants and their practices defined gender, ethnicity, class, and the role of the professional.

Using the methodology of social science theory, particularly quantitative statistical analysis and historical demography, Charlotte Borst examines the effect of gender, culture, and class on the transition to physician-attended childbirth. Earlier studies have focused on physician opposition to midwifery, devoting little attention to the training for and actual practice of midwifery. As a result, until now we knew little about the actual conditions of the midwife's education and practice.

Catching Babies is the first study to examine the move to physician-attended birth within the context of a particular community. It focuses on four representative counties in Wisconsin to study both midwives and physicians within the context of their community. Borst finds that midwives were not pushed out of practice by elitist or misogynist obstetricians. Instead, their traditional, artisanal skills ceased to be valued by a society that had come to embrace the model of disinterested, professional science. The community that had previously hired midwives turned to physicians who shared ethnic and cultural values with the very midwives they replaced.

Although cerebral dominance, the specialization of each side of the brain for different functions, was discovered in the 1860s, almost nothing was known for many years about its biological foundations, the study of which has undergone what can only be described as a revolution in the past decade and a half.

Norman Geschwind and Albert Galaburda, two of the leaders of this new field, have assembled a distinguished group of investigators, each a pioneer in some aspect of the biology of dominance. The authors document human brain asymmetry at gross and microscopic levels in both adults and fetuses, its visualization in life by radiological methods, and its manifestation in brain waves. The evolutionary history of brain asymmetry over more than 300,000 years is shown in fossil skulls of humans and apes. In a dramatic reversal of older beliefs, asymmetry of anatomy, function, and chemistry has been demonstrated in many nonhuman species, and experiments have shown the role of hormones and other prenatal influences in the production of asymmetry. The surprising associations of non-right-handedness with twinning and immune disorders are discussed, as well as the asymmetrical malformation of the cortex in childhood dyslexia.

This volume, combining scholarly authority and the excitement of the birth of a new discipline, will be welcomed by those to whom the implications of dominance are becoming evident—neuroscientists, neurologists, linguists, psychologists, experts in learning disorders, speech pathologists—and by specialists in nearly every branch of biology, medicine, and psychology.

Of his friend of many years, Dr. John Fothergill, Benjamin Franklin wrote: "I can hardly conceive that a better man has ever existed." Fothergill's letters provide a fascinating perspective of his time--a totally different view from that given by his contemporaries Horace Walpole and Dr. Johnson.

The "Quaker internationalist" (as his editors aptly call him) was during the middle decades of the eighteenth century one of the half dozen leading physicians of London, a horticulturist of great distinction, an educational reformer, a patron of many philanthropic causes, and a tireless friend of Americans and the cause of American rights. He was exceedingly generous as a patron of scientific undertakings and of young Americans abroad. He founded a famous Quaker school for boys and girls which is still flourishing; he helped found various benevolent and educational institutions in America and he continually subsidized worthy books and gave them to worthy recipients.

All these activities and others are recorded in the some two hundred letters here selected for publication. They throw light on Quaker history on both sides of the Atlantic, on advances in medical science and institutional care of the sick, on discoveries in natural history, and on political developments from the Jacobite Rebellion through the American Revolution. From the beginnings of the rift between colonies and mother country, Fothergill served as a vigorous advocate of conciliatory measures and commonwealth status for America, speaking with equal frankness and impartiality to leaders on both sides until well after hostilities began.

A few weeks before he died (at the end of 1780), he wrote Franklin in France to say that with all Europe leagued against England nothing could be hoped for her from this war, but that the world might hope for the establishment of a tribunal to settle disputes among nations and preclude war as an instrument of policy.

This edition includes a substantial introduction, and the letters have been annotated with great skill and authority. Lyman Butterfield, well known editor of the Adams Papers, says, "I have never encountered annotation on bibliographical, biographical, medical, botanical, and topographical matters that is more unfailingly readable per se. The transatlantic combination of editors was obviously just right. Toward understanding one prominent strand in the cultural history of the 18th century, this book is a uniquely valuable contribution."

In 2003, in the face of errors and accidents caused by medical and surgical trainees, the American Council of Graduate Medical Education mandated a reduction in resident work hours to eighty per week. Over the course of two and a half years spent observing residents and staff surgeons trying to implement this new regulation, Katherine C. Kellogg discovered that resistance to it was both strong and successful—in fact, two of the three hospitals she studied failed to make the change. Challenging Operations takes up the apparent paradox of medical professionals resisting reforms designed to help them and their patients. Through vivid anecdotes, interviews, and incisive observation and analysis, Kellogg shows the complex ways that institutional reforms spark resistance when they challenge long-standing beliefs, roles, and systems of authority.

At a time when numerous policies have been enacted to address the nation’s soaring medical costs, uneven access to care, and shortage of primary-care physicians, Challenging Operations sheds new light on the difficulty of implementing reforms and offers concrete recommendations for effectively meeting that challenge.

This biography of one of the most prominent pediatricians of the twentieth century describes his illustrious medical family and his remarkable tenure of nearly three decades as Thomas Morgan Rotch Professor of Pediatrics at Harvard Medical School and head of the department of medicine at Children's Hospital, Boston. During this period Janeway built the first department of pediatrics in the nation with subspecialties based upon the new developments in basic sciences. Janeway and his colleagues defined the gamma globulin disorders that resulted in children's increased susceptibility to infections and associated arthritic disorders.

Janeway was the most visible U.S. pediatrician on the world scene in the last half of the 20th century. He traveled widely, taught modern pediatrics to thousands of physicians throughout the developing world, and brought many of them to the U.S. for further training. He was instrumental in starting teaching hospitals in Shiraz, Iran, and Cameroon.

Janeway believed that through teaching by example he might further the cause of peace in the world. His life is an inspiration to everyone in medicine, and serves as a model that all can seek to improve the health of the world's millions and promote a more peaceful future.

A century ago, a plump child was considered a healthy child. No longer. An overweight child is now known to be at risk for maladies ranging from asthma to cardiovascular disease, and obesity among American children has reached epidemic proportions. Childhood Obesity in America traces the changes in diagnosis and treatment, as well as popular understanding, of the most serious public health problem facing American children today.

Excess weight was once thought to be something children outgrew, or even a safeguard against infectious disease. But by the mid-twentieth century, researchers recognized early obesity as an indicator of lifelong troubles. Debates about its causes and proper treatment multiplied. Over the century, fat children were injected with animal glands, psychoanalyzed, given amphetamines, and sent to fat camp. In recent decades, an emphasis on taking personal responsibility for one’s health, combined with commercial interests, has affected the way the public health establishment has responded to childhood obesity—and the stigma fat children face. At variance with this personal emphasis is the realization that societal factors, including fast food, unsafe neighborhoods, and marketing targeted at children, are strongly implicated in weight gain. Activists and the courts are the most recent players in the obesity epidemic’s biography.

Today, obesity in this age group is seen as a complex condition, with metabolic, endocrine, genetic, psychological, and social elements. Laura Dawes makes a powerful case that understanding the cultural history of a disease is critical to developing effective health policy.

In his 2006 State of the Union speech, President George W. Bush asked the U.S. Congress to prohibit the "most egregious abuses of medical research," such as the "creation of animal–human hybrids." The president's message echoed that of a 2004 report by the President's Council on Bioethics, which recommended that hybrid human–animal embryos be banned by Congress.

Discussions of early interspecies research, in which cells or DNA are interchanged between humans and nonhumans at early stages of development, can often devolve into sweeping statements, colorful imagery, and confusing policy. Although today's policy advisory groups are becoming more informed, debate is still limited by the interchangeable use of terms such as chimeras and hybrids, a tendency to treat all forms of interspecies alike, the failure to distinguish between laboratory research and procreation, and not enough serious policy justification. Andrea Bonnicksen seeks to understand reasons behind support of and disdain for interspecies research in such areas as chimerism, hybridization, interspecies nuclear transfer, cross-species embryo transfer, and transgenics. She highlights two claims critics make against early interspecies studies: that the research will violate human dignity and that it can lead to procreation. Are these claims sufficient to justify restrictive policy?

Bonnicksen carefully illustrates the challenges of making policy for sensitive and often sensationalized research—research that touches deep-seated values and that probes the boundary between human and nonhuman animals.

Chinese Medicine and Healing is a comprehensive introduction to a rich array of Chinese healing practices as they have developed through time and across cultures. Contributions from fifty-eight leading international scholars in such fields as Chinese archaeology, history, anthropology, religion, and medicine make this a collaborative work of uncommon intellectual synergy, and a vital new resource for anyone working in East Asian or world history, in medical history and anthropology, and in biomedicine and complementary healing arts.

This illustrated history explores the emergence and development of a wide range of health interventions, including propitiation of disease-inflicting spirits, divination, vitality-cultivating meditative disciplines, herbal remedies, pulse diagnosis, and acupuncture. The authors investigate processes that contribute to historical change, such as competition between different types of practitioner—shamans, Daoist priests, Buddhist monks, scholar physicians, and even government officials. Accompanying vignettes and illustrations bring to life such diverse arenas of health care as childbirth in the Tang period, Yuan state-established medical schools, fertility control in the Qing, and the search for sexual potency in the People’s Republic.

The two final chapters illustrate Chinese healing modalities across the globe and address the challenges they have posed as alternatives to biomedical standards of training and licensure. The discussion includes such far-reaching examples as Chinese treatments for diphtheria in colonial Australia and malaria in Africa, the invention of ear acupuncture by the French and its worldwide dissemination, and the varying applications of acupuncture from Germany to Argentina and Iraq.

You are old, ill, in pain, and your doctor asks you what you want to do about it. You may be uncertain but you're definitely not alone. By the year 2020, some 50 million Americans will be over sixty-five, and as the nation ages we must all ask what we ought to do about the health and medical care of our elderly. Our response will have profound consequences, not just for individuals and families, but for society as a whole. This book helps us start to form an answer.

To make decisions about medical care in old age, we need to know more about the reality of being elderly and sick, and Choosing Medical Care in Old Age gives us the opportunity. Muriel Gillick, a noted physician who specializes in the care of the elderly and in medical ethics, presents a panoply of stories drawn from her clinical experience. These encounters, with the robust and the frail, the demented and the dying, capture the texture of the experience of being old and faced with critical medical questions. From the stories of older people struggling to make choices in the face of acute illness, stories that are often poignant and sometimes tragic, Gillick develops broad guidelines for medical decision–making for the elderly. Within this framework, she confronts particular concerns and questions. When are certain procedures too burdensome to be justified? What are unacceptable risks? Should family members serve as exclusive spokespersons for relatives who can no longer speak for themselves? Gillick's bold and personal prescription for medical care for the elderly calls for a change in the way medicine is understood and practiced, as well as for changes in the institutions that serve the elderly, such as hospitals and nursing homes. An intelligent and deeply compassionate inquiry into the difficult issues and real–life dilemmas raised by current practices, her book offers a first step toward those changes.

Christian health care professionals in our secular and pluralistic society often face uncertainty about the place religious faith holds in today's medical practice. Through an examination of a virtue-based ethics, this book proposes a theological view of medical ethics that helps the Christian physician reconcile faith, reason, and professional duty.

Edmund D. Pellegrino and David C. Thomasma trace the history of virtue in moral thought, and they examine current debate about a virtue ethic's place in contemporary bioethics. Their proposal balances theological ethics, based on the virtues of faith, hope, and charity, with contemporary medical ethics, based on the principles of beneficence, justice, and autonomy. The result is a theory of clinical ethics that centers on the virtue of charity and is manifest in practical moral decisions.

Using Christian bioethical principles, the authors address today's divisive issues in medicine. For health care providers and all those involved in the fields of ethics and religion, this volume shows how faith and reason can combine to create the best possible healing relationship between health care professional and patient.

Chronic Condition provides a compelling analysis of the causes of the current health care crisis and of the shortcomings of reform proposals. It also offers an ingenious new framework for reform that, while minimizing government interference, would provide a means for financing care for the less affluent.

Sherry Glied shows that rising health care spending is consistent with a rising standard of living. Since we can, as a nation, afford more health care, reform must address not the overall level of health care costs but the distribution of health care spending.

Prior reform proposals, Glied argues, have failed to account for the tension between the clearly manifested desire for improving the quality of health care and the equally widespread interest in assuring that the less fortunate share in these improvements. After careful analysis of the ill-fated Clinton plan, Glied proposes a new solution that would make the willingness to pay for innovation the means of financing health care improvements for the less affluent. While rejecting the idea that the distribution of health care should be perfectly equal, Glied's proposal would enable all Americans to benefit from the dynamics of the free market.

Chronic pain is the leading cause of disability in the United States, affecting as many as 48 million people in this country alone. It can demoralize and depress both patient and family, especially when there is no effective pain control and no hope for relief. Improperly managed, chronic pain can lead to substance abuse (usually painkillers) and to acute psychological and emotional distress. Pain begets stress and stress begets pain in a wretched downward spiral.

Silver reviews the causes and characteristics of chronic pain and explores its impact on individual family relationships and on the extended family, covering such issues as employment, parenting, childbearing and inheritance, and emotional health. Silver treats aspects of chronic pain not covered in a typical office visit: how men and women differ in their experience of chronic pain, the effect of chronic pain on a toddler's behavior or an older child's performance in school, the risks of dependence on and addiction to pain medications, and practical ways for relatives beyond the immediate family circle to offer help and support to the person in pain.

An investigation of how the expansion of modern medicine in Turkey transformed young boys’ experiences of circumcision.

In Turkey, circumcision is viewed as both a religious obligation and a rite of passage for young boys, as communities celebrate the ritual through gatherings, gifts, and special outfits. Yet the procedure is a potentially painful and traumatic ordeal. With the expansion of modern medicine, the social position of sünnetçi (male circumcisers) became subject to the institutional arrangements of Turkey’s evolving health care and welfare system. In the transition from traditional itinerant circumcisers to low-ranking health officers in the 1960s and hospital doctors in the 1990s, the medicalization of male circumcision has become entangled with state formation, market fetishism, and class inequalities.

Based on Oyman Başaran’s extensive ethnographic and historical research, Circumcision and Medicine in Modern Turkey is a close examination of the socioreligious practice of circumcision in twenty-five cities and their outlying towns and villages in Turkey. By analyzing the changing subjectivity of medical actors who seek to alleviate suffering in male circumcision, Başaran offers a psychoanalytically informed alternate approach to the standard sociological arguments surrounding medicalization and male circumcision.

Developments in biotechnology, such as cloning and the decoding of the human genome, are generating questions and choices that traditionally have fallen within the realm of religion and philosophy: the definition of human life, human vs. divine control of nature, the relationship between human and non-human life, and the intentional manipulation of the mechanisms of life and death.

In Claiming Power over Life, eight contributors challenge policymakers to recognize the value of religious views on biotechnology and discuss how best to integrate the wisdom of the Christian and Jewish traditions into public policy debates. Arguing that civic discourse on the subject has been impoverished by an inability to accommodate religious insights productively, they identify the ways in which religious thought can contribute to policymaking. Likewise, the authors challenge religious leaders and scholars to learn about biotechnology, address the central issues it raises, and participate constructively in the moral debates it engenders.

The book will be of value to policymakers, religious leaders, ethicists, and all those interested in issues surrounding the intersection of religion and biotechnology policy.

Cancer has become a leading cause of death and disability and a serious yet unforeseen challenge to health systems in low- and middle-income countries. A protracted and polarized cancer transition is under way and fuels a concentration of preventable risk, illness, suffering, impoverishment from ill health, and death among poor populations. Closing this cancer divide is an equity imperative. The world faces a huge, unperceived cost of failure to take action that requires an immediate and large-scale global response.

Closing the Cancer Divide presents strategies for innovation in delivery, pricing, procurement, finance, knowledge-building, and leadership that can be scaled up by applying a diagonal approach to health system strengthening. The chapters provide evidence-based recommendations for developing programs, local and global policy-making, and prioritizing research. The cases and frameworks provide a guide for developing responses to the challenge of cancer and other chronic illnesses. The book summarizes results of the Global Task Force on Expanding Access to Cancer Care and Control in Developing Countries, a collaboration among leaders from the global health and cancer care communities worldwide, originally convened by Harvard University. It includes contributions from civil society, global and national policy-makers, patients and practitioners, and academics representing an array of fields.

It inspired written testimonials from William McKinley, Thomas Edison, and Sarah Bernhardt; merited a medal from Pope Leo XIII; produced "exhilaration and lasting euphoria" in Sigmund Freud. Once the stimulant of choice of the enlightened and the elite, cocaine has become, a century later, a plague, ravaging the lives of millions. This book is the first to draw together all the facts about this pervasive drug--from its natural occurrence in a tea-like native South American plant to its devastating appearance as crack in the inner cities of the United States.

Drawing on the latest work in medicine, psychiatry, neuroscience, pharmacology, epidemiology, social work, and sociology, the volume is a highly accessible reference on the history and use of cocaine, its physical and psychological effects, and the etiology and epidemiology of cocaine addiction. It also provides a critical evaluation of the pharmaceutical agents and psychosocial interventions that have been used to treat this addiction. Author Jerome J. Platt answers such basic questions as: What is cocaine? What forms does it come in? How is it administered? What does it do? What are the medical complications of cocaine addiction? What are the treatments, and how successful are they?

Uniquely comprehensive, Cocaine Addiction makes all the latest information on this urgent subject readily available to medical professionals and practitioners, social workers and scholars, and anyone who cares to know more about this perennially troubling drug.