Shifting priorities at the Health Protection Branch: challenges to the regulatory process

Abstract: The Health Protection Branch (hpb ) of Health Canada has recently undergone considerable policy and organizational renewal, with numerous and broad‐ranging implications for the evaluation of drug product safety and efficacy. From a public‐health perspective, however, the criteria used to develop organizational and policy change at the hpb have provided a sub‐optimal basis for reform, due primarily to the many forms of market failure to which the regulation of pharmaceuticals is subject. For example, thepartnership andefficiency criteria that guided policy renewal have led to the transfer of important responsibilities to partners, with the potential for either a conflict of interest or inadequate information, for which the legal basis is not always clear. The resulting realignment of the hpb's roles and responsibilities may be characterized as leading to a shift from a comprehensive approach to public‐health protection to one based on strategic risk management, with responsibilities dispersed among government, industry, academia and consumers. The rebalancing of goals in the redesign of the regulatory process suggests a change in the role of the state in the context of public‐health protection and highlights issues of concern to the public interest that may not be fully recognized as deregulation occurs in other sectors of the economy. Sommaire: La Direction générale de la protection de la santé (dgps ) de Santé Canada vient de subir un vaste remaniement de politiques et d'organisation qui entraîne de nombreuses et profondes répercussions sur l'évaluation de la sûreté et de l'efficacité des produits pharmaceutiques. Cependant, du point de vue de la santé publique, les critères auxquels on a fait appel pour modifier les politiques et l'organisation de la dgps n'ont permis qu'une base de réforme sous‐optimale, à cause surtout des nom‐breux genres de défaillance du marché qui affligent la réglementation des produits pharmaceutiques. Par exemple, les critières depurtenariat etd'efficacité qui ont guidé le remaniement des politiques ont amené le transfert d'importantes responsabilites à des partenaires moyennant le risque de. conflit d'intérêts ou d'informations inadéqaates, sans pour autant assurer une base juridique Claire. On pourrait donc dire que cette réorientation des rôles et responsabilités de la dgps fait que l'on passe d'une approche globale en matière de protection de la santéà une gestion stratégique du risque, la responsabilité en étant dispersée parmi le gouvernement, l'industrie, les milieux universitaires et les consommateurs. Le rééquilibrage des objectifs dans le remaniement du processus de réglementation suggère une évolution du rôle de l'État en ce qui concerne la protection de la santé publique; il met aussi en relief des questions d'intérêt public qui n'ont peut‐être pas été reconnues alors que la déréglementation prend lieu dans d'autres secteurs économiques.     

Insurgency, counterinsurgency, and the rational peasant

Many rational choice treatments of guerrilla insurgency have focused on the strategic calculus by which government and insurgent elites use the tactical weapons of coercion and benefits to win the support of nonelites. This paper uses Frohlich and Oppenheimer's model of the rational tax payer/tax evader to develop a model of the decision calculus by which nonelites respond to the tactical behavior of elites and thereby choose between supporting the incumbent regime, its insurgent opposition or neither. This model is then used to assess the likely impact of various insurgent and counterinsurgent tactics on nonelite support and loyalty.     

Attributional style,depressive features,and self-esteem: Adult children of alcoholic and nonalcoholic parents

Undergraduate adult children of alcoholics (ACOAs; N=57) were compared to children of nonalcoholic parents (CONAs; N=100) on measures of the Beck Depression Inventory (BDI), selfesteem, and attributional style. ACOA status was determined using the Children of Alcoholics Screening Test (Jones, 1981). ACOAs were found to have significantly higher scores on the BDI and to have significantly lower self-esteem, as measured by the Index of Self-Esteem, than CONAs. ACOAs were also more likely to have a depressive attributional style, in that they perceived failure as more internal, stable, and global than CONAs. Further, females had significantly higher BDI scores than males.Received B.A. from West Virginia University. Research interests: adult children of alcoholics and human sexual behavior.Received Ph.D. from West Virginia University. Research interests: the impact of popular culture on adolescents and the impact of parental conflict on children.Received Ph.D. from University of Massachusetts. Research interests: adolescent suicide risk.     

Building sustainable capacity in the public sector: What can be done?

Effective government performance is central to the creation of market-oriented economies, secure and productive populations, and democratic political systems in developing countries. Capacity building to improve public sector performance is thus an important focus of development initiatives. Several implicit assumptions underlie most such efforts: that organizations or training activities are the logical site for capacity-building interventions; that administrative structures and monetary rewards determine organizational and individual performance; that organizations work well when structures and control mechanisms are in place; and that individual performance improves as a result of skill and technology transfer through training activities. Each of these assumptions is called into question by the findings of research carried out in six developing countries and reported in this article. Our studies indicate designing interventions that most constructively address sources of poor performance must follow from an assessment of a relatively broad set of variables, including the action environment in which all such activities take place. We also found that effective public sector performance is more often driven by strong organizational cultures, good management practices, and effective communication networks than it is by rules and regulations or procedures and pay scales. Our case studies further indicate that individual performance is more affected by opportunities for meaningful work, shared professional norms, teamwork, and promotion based on performance rather than it is by training in specific skills. In this article, we describe a framework or conceptual map that emphasizes that training activities, organizational performance and administrative structures are embedded within complex environments that significantly constrain their success and that often account for training or organizational failure. When it was applied in the six case study countries, the framework proved useful in identifying capacity gaps and providing a tool for the strategic design of interventions that are sensitive to the roots of performance deficits. This allows us to conclude that the assumptions underlying many capacity-building initiatives may focus attention on interventions that do not generate the highest payoffs in terms of improved performance.     

B. Reviews: general

i. SHADOWS ON THE SAND: THE MEMOIRS OP SIR GAWAIN BELL. By (SIR) GAWAIN BELL. London, C.Hurst/New York, St Martins, 1983. pp.xiv, 258, 2 maps and index. El3.50.

ii. THE SUDAN MEMOIRS OF CARL CHRISTIAN GIEGLER PASHA. Edited by RICHARD HILL. Translated from the German by THIRZA KÜPPER. With a foreword by the Pasha's great‐granddaughter, HEIDI GROHA. Oxford, Oxford University Press (for the British Academy), pp. xxxii, 231, 3 maps, 12 plates. £18.00.

iii. EGYPT IN THE REIGN OF MUHAMMAD ALI. By AFAF LUTFI AL‐SAYYID MARSOT. (Cambridge Middle East Library) Cambridge, Cambridge University Press, 1984. pp.x, 300. £25.00.

iv. URBAN NOTABLES AND ARAB NATIONALISM: THE POLITICS OF DAMASCUS. By PHILIP S. KHOURY. (Cambridge Middle East Library) Cambridge, Cambridge University Press, 1983. pp.153, 2 maps.

v. VICTIMS OF A MAP. Translated by ABDULLAH AL‐UDHARI. London, Al‐Saqi Books, 1984. pp.165. £4.95.

vi. PALESTINE AND MODERN ARAB POETRY. By KHALID A. SULAIMAN. London, Zed Books Ltd., 1984. pp.240. £6.95.

vii. L'ARABIE DU SUD: HISTOIRE ET CIVILISATION. By JOSEPH CHELHOD and others. Paris, Maisonneuve & Larose, 1984. pp.264. 21 illustrations, maps, tables. FF 94.

viii. THE TWO YEMENS. By ROBIN BIDWELL. Harlow (UK), Longman/Boulder (USA), Westview. 1983. pp.350.

ix. BAHRAIN AND THE GULF: PAST PERSPECTIVES AND ALTERNATIVE FUTURES. Edited by JEFFREY B. NUGENT and THEODORE H. THOMAS. London, Croom Helm, 1985. pp.221, 26 tables, 4 figs., bibliography. £16.95.

x. THE ARABS. New Edition. By PETER MANSFIELD. Harmondsworth, Penguin, 1985. pp.510, map, index. £4.95/$6.95.

xi. THE EVOLUTION OF MIDDLE EASTERN LANDSCAPES: AN OUTLINE TO AD 1840. By J.M. WAGSTAFF. London, Croom Helm, 1983. pp.304, 459 maps and figs., 5 tables.

xii. THE GREEK MINORITY OF ISTANBUL AND GREEK‐TURKISH RELATIONS 1918–1974. By ALEXIS ALEXANDRIS. Athens, Centre for Asia Minor Studies, 1983.

xiii. SEX AND SOCIETY IN ISLAM: BIRTH CONTROL BEFORE THE NINETEENTH CENTURY. By B.F.MUSALLAM. (Cambridge Studies in Islamic Civilizations). Cambridge, Cambridge University Press, 1983. pp.ix, 176. £17.50.

xiv. TOWARDS A JUST MONETARY SYSTEM. By MUHAMMAD U. CHAPRA. Leicester (UK), The Islamic Foundation, 1985. pp.292. £10.00 (hardback); £4.75 (paperback).

xv. INSURANCE IN AN ISLAMIC ECONOMY. By MUHAMMAD NEJATULLAH SIDDIQUI. Leicester (UK), The Islamic Foundation, 1985. £5.50 (hardback); £2.00 (paperback).

xvi. PARTNERSHIP AND PROFIT SHARING IN ISLAMIC LAW. By MUHAMMAD NEJATULLAH SIDDIQUI. Leicester (UK), The Islamic Foundation, 1985. pp.111. £6.50 (hardback); £2.25 (paperback).

xvii. THE IMMORTAL ATATURK: A PSYCHOBIOGRAPHY. By VAMIK D. VOLKAN and NORMAN ITZKOWITZ. Chicago‐London, Chicago University Press, 1984. pp.xxv, 374. £34.50.

xviii. TURKEY. MERI REPORT. Compiled by MIDDLE EAST RESEARCH INSTITUTE. London, Croom Helm, 198 3. pp.181. £35.00

xix. BORDER AND TERRITORIAL DISPUTES. Edited by ALAN J.DAY. (A Keesing's Reference Publication). Harlow, Longman, 1982. pp.406, 44 maps. £45.00

xx. ‘IF ONLY MY PEOPLE...’ By IMMANUEL JAKOBOVITS. London, Weidenfeld & Nicolson, 1984. pp.288.

xxi. L'IMPRIMERIE ARABE EN OCCIDENT (XVIe, XVIIe XVIIIe SIÈCLES). By JOSÉE BALAGNA. (Islam & Occident, 2.) Paris, Maisonneuve & Larose, 1984. pp.153. 68F.