Caring for the elderly: a European perspective on today and tomorrow

There is always a temptation to suppose that one's own problems (whether personal or national) are unique. They rarely are. The "problem" of the elderly is no exception and so there is no particular point in looking to the specific characteristics of one's own health, social service, and social security systems for causes. There is, however, every reason to be looking at them for the consequences. They can also exacerbate the causes. In this paper we sketch the principal features (economic, social, and demographic) that have contributed to the "problem" of the elderly in Europe and then outline the main intellectual issues that need to be explored and resolved. That sounds a bit pompous but, if one is to avoid an intellectual morass consisting of the various assertions about needs, obligations, and so on that emanate from rival concerned parties and various professional interests on the one hand, and simplistic political slogans whose only virtue is that they cut the Gordian Knot (but provide no real enlightenment) on the other, then we need to be doing just this. We shall take a few things for granted: that cost-containment is not the be-all-and-end-all of policy; that value for money depends equally on what you get as on what you spend; that overall expenditure per head is mainly determined by income per head (though some countries have managed to get and stay below the regression line); and that it "ain't so" that all one needs to do is to "leave it to the market." To have justified each of these would have taken too much space so we can only assert them and trust that, in swallowing these camels, you won't strain at the gnats to come.     

Regulating (for the benefit of) future persons: a different perspective on the FDA's jurisdiction to regulate human reproductive cloning

The Food and Drug Administration (FDA) has taken the position that human reproductive cloning falls within its regulatory jurisdiction. This position has been subject to criticism on both procedural and substantive grounds. Some have contended that the FDA has failed to follow administrative law principles in asserting its jurisdiction, while others claim the FDA is ill suited to the task of addressing the ethical and social implications of human cloning. This Article argues, that, notwithstanding these criticisms, the FDA could plausibly assert jurisdiction over human cloning as a form of human gene therapy, an area in which the FDA is already regarded as having primary regulatory authority. Such an assertion would require that the FDA's jurisdiction extend to products affecting future persons, i.e., those not yet born. This Article demonstrates, for the first time, that such jurisdiction was implicit in the enactment of the 1962 Kefauver-Harris Amendments to the Federal Food, Drug, and Cosmetic Act and that the FDA has historically relied on such authority in promulgating regulations for drugs and devices.     

Advocacy for the mentally impaired elderly: a case study analysis

The authors present a case study to illustrate how a mentally impaired but socially intact nursing home resident, who had no one to act as an advocate for her, was denied appropriate treatment for an acute illness which ultimately resulted in her death. The case raises important questions about advocacy for the mentally-impaired, acutely-ill institutionalized patient. This Article explores the role of the advocate, how advocates are selected, what qualities and talents they should possess, and what responsibilities should be assigned to them. The authors suggest that nursing home residents should be encouraged to engage in self-advocacy to the greatest extent possible. The competent elderly should be urged to name their preferred advocates. Individuals who serve in advocacy roles should be advised to seek information regarding the patient's wishes from those who know the patient well. Furthermore, there is a need for quality education and training of those who serve in advocacy roles on behalf of nursing home residents, and state laws need to specify the responsibilities of persons who serve as advocates.     

Toward a continuum of care for the elderly: a note of caution

The search for better ways to care for the chronically ill elderly has led to "alternatives to institutional care." A study fo geriatric day care and homemaker services finds that they were used as an add-on to existing care, few patients benefited, and costs were 60-71% higher than costs of a control group. Four more studies have confirmed the lack of substitution effects. Services could be targeted on those who need them even though it is very difficult to do so, and efficacy should be demonstrated before benefits are expended to new services.     

Dulcin: a centennial perspective

The discovery of dulcin, the second synthetic sweetener, has been traced to the work of J. Berlinerblau. Early studies of this sweetener revealed a very effective sweetener that showed toxicity at high doses. Dulcin never achieved great recognition nor usage but was utilized slightly until a long-term study clearly pointed out its toxicity under sustained use with small doses.     

Smoking in the workplace: a management perspective

Caution is warranted when undertaking smoking measures that go beyond those required by state or local laws and do not accommodate the interests of all employees. Twenty states and the District of Columbia have enacted laws regulating smoking in the private workplace. In contrast, twenty-two states recently have enacted laws that protect persons who smoke outside the workplace from being subjected to adverse employment actions. Although these laws vary widely in their language and specifics, most pose practical and compliance problems for employers. The following article updates the author's more comprehensive examination in 1988 of judicial, legislative, and employer responses to the workplace smoking issue published in 14 Employee Relations Law Journal 359 (1988).     

Monitoring the uninsured: a state policy perspective

Because states have primary responsibility for the implementation of public health insurance programs, states need timely, good quality data to evaluate programs, monitor trends in the number and characteristics of the uninsured, and better understand the dynamics of health insurance coverage. This article provides a synthesis of the data sources available to states for monitoring rates of health insurance coverage. Information was collected through a comprehensive review of state and national health surveys and in-depth interviews with state analysts in all fifty states. Our findings suggest that national surveys do not meet states' needs for data, and in response, states have initiated their own household surveys. We provide information on thirty-six household surveys that are used to estimate state levels of health insurance coverage. We recommend that national and state efforts be better coordinated to facilitate efficient use of resources to achieve good state-level date.     

Prison privatization: a perspective on core governmental functions

Prison privatization in the US illustrates the challenge of privatization to the traditional state monopoly over “inherently governmental” functions. From a perspective on core governmental functions, this paper provides a new logical explanation of this phenomenon and argues that prison privatization demonstrates the political rationality of governments. Conservative social control and economic neoliberalism were two major political reasons for prison privatization in the US. These factors aggravated the instrumental problems of the public prison system and reinforced the urgency to address them. This logic is applied to explain the variation in the magnitude of prison privatization in the 50 states. Drawing on the results of a Tobit analysis, this paper confirms that both political factors and instrumental factors significantly influence the preference of state governments for prison privatization.