Federal antitrust policy and physician discontent: defining moments in the struggle for congressional relief

Organized medicine has battled the Federal Trade Commission (FTC) since the 1970s over enforcement of the antitrust laws. Physicians' discontent stems from the belief that federal policy allows managed care organizations to achieve dominance in health care markets just as it discourages physicians from taking collective action to protect their interests. This article examines two important efforts by organized medicine over a twenty-year interval to alter federal antitrust policy. In 1982, physicians and other professionals sought a special exemption from FTC jurisdiction; beginning in 1998, physicians promoted legislation that would exempt independent practitioners from the antitrust laws for collective bargaining purposes. Both initiatives passed in the House of Representatives but failed in the Senate. This article uses an advocacy coalition framework to reinterpret the events and to assess the reasons for legislative failure. The evidence suggests that in both instances, although twenty years apart, consumer groups and federal bureaucrats determined the outcome in favor of corporate medicine.     

An unusual case of driving under the influence of enflurane

An unusual case of driving under the influence of the volatile anaesthetic enflurane is reported. A markedly affected anaesthetist was sniffing at an enflurane-moistened handkerchief before he crashed into a lorry at a red traffic light. In the blood sample enflurane (2.92 mg/l) as well as diclofenac (0.28 mg/l) and 4-aminophenazone (24.4 mg/l) were found. The way of driving and the accident and the deficiency symptoms could be explained by the central suppressing effects of enflurane. The physician was considered as impaired and not suitable to drive at the time of the incidence.     

NOT (QUITE) A HORSE AND CARRIAGE

This note critically interrogates the Civil Partnership Act 2004. Through an examination of the legislative background and some of the provisions of the Act, it is argued that civil partnership mirrors a marriage model with some exceptions. In creating this new legal status, the legislation also exacerbates the exclusion of some relationship forms from dominant legal norms. It should be understood as part of an agenda for social inclusion, rather than as radical social change.     

Factors Associated with Physician Discussion of Health Behaviors with Adolescents

Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues associated with these discussions. A Cross sectional survey of urban adolescents was conducted. Trained interviewers administered surveys over a three month period in 2001 at an urban academic pediatric and adolescent clinic. The 252 adolescents surveyed had a mean age of 15 with 49% categorized as being at risk for overweight/overweight and 51% as normal weight using the CDC percentiles for BMI. While 16% of the adolescents reported that their physician or nurse discussed the amount of television they watched, rates of discussion related to exercise (58%), and weight (54%) were much higher. In multivariate analyses, health care provider discussions with adolescents regarding exercise were more common for overweight (O.R.=2.42, 95% C.I. [1.28–4.57]) and at risk for overweight (O.R.=1.98, 95% C.I. [1.03–3.81]) adolescents, whereas physician discussion of television viewing was not associated with weight. Discussions of weight were more common for female (O.R.=2.18, 95% C.I. [1.21–3.95]), African-American (O.R.=2.53, 95% C.I. [1.40–4.57]), and overweight (O.R.=3.92, 95% C.I. [1.97–7.81]) adolescents. Even after adjusting for weight, race and gender strongly influenced the frequency of discussions about weight in physician offices. Although health care providers frequently address weight and exercise with adolescents, more discussions related to sedentary behaviors such as television viewing may be warranted to address adolescent obesity.Received PhD in Epidemiology from University of California, San Diego. Research interests include smoking prevention and cessation among adolescents and health promotion interventions.Received MD from University of Missouri-Kansas City and MPH from Johns Hopkins University. Research interests include health services research and research in support of measurable, systematic improvements in the quality of medical care.Received medical degree from Christian Medical College, Punjab, India and Master of Public Health from University of Kansas School of Medicine. Research interests include diet and physical activity behaviors, role of the environment in obesity and obesity prevention, especially among children and adolescents.Received MBBS from Allama Iqbal Medical College, Punjab University, Lahore, Pakistan and MPH from University of Kansas Medical Center. Research interests include smoking cessation, database design, implementation, data management and analysis, and use of information technology in health care settings.Director, Cancer Prevention, Control, and Population Sciences, Kansas Cancer Institute. Received MD/MPH from Tulane University and MS from Harvard School of Public Health. Research interests include disparities in healthcare; smoking cessation among underserved populations, specifically African Americans; diet, nutrition, obesity, and physical activity.     

Existential Anxiety in Adolescents: Prevalence, Structure, Association with Psychological Symptoms and Identity Development

Existential anxiety is hypothesized to be a core human issue in a great deal of theoretical and philosophical writing. However, little is known about the emergence of these concerns and their relation to emotional functioning in youth. The purpose of this study was to examine the phenomenon of existential anxiety in a sample of adolescents. Data on existential concerns, identity development and psychological symptoms were collected on a sample of 139 youth in grades 9–12. Results indicated that existential anxiety concerns have a theoretically consistent factor structure, are common among adolescents, and are associated with psychological symptoms, as well as identity issues. Results are discussed with regard to the importance of existential concerns in the lives of youth and the need for additional research.Received PhD from Florida International University. Interests are identity development including associated anxiety and distress, cross-national comparisons, and the development of identity interventions.Received PhD from Florida International University. Interests focus on the developmental psychopathology of anxiety and depression.Received PhD from the University of Arizona. Interests include a range of topics in developmental psychopathology, prevention, program evaluation, and research methodology.     

An analytical history of terrorism, 1945–2000

This paper traces the history of modern terrorism from the end of the Second World War to the beginning of the twenty-first century. It divides that history into three stylized waves: terrorism in the service of national liberation and ethnic separatism, left-wing terrorism, and Islamist terrorism. Adopting a constitutional political economy perspective, the paper argues that terrorism is rooted in the artificial nation-states created during the interwar period and suggests solutions grounded in liberal federalist constitutions and, perhaps, new political maps for the Middle East, Central Asia and other contemporary terrorist homelands.