Tension, compression, and shear: directions, stresses, and outcomes of health care cost control

"Control" of health care costs is often portrayed as a struggle between external, "natural" forces pushing costs up and individuals, groups, and societies trying to resist the inevitable. This picture is false. Control includes strenuous efforts by some to raise costs, and by others to resist those increases, and/or to transfer costs to someone else. But all such forces originate in the purposes and interests of individuals and groups. Health care cost control is a struggle among conflicting interests over the priorities of a society, and claims of "inevitability" are simply part of the political rhetoric of that struggle. International experience supports certain conclusions. First, there is no basis for the claim that limits on expenditure growth must threaten the health of (some members of) a society. Second, there is a substantial variety of experience with cost control. Failure in the United States is often presented as evidence of the impossibility of control, but most other countries have succeeded. Finally, control requires the direct confrontation of interests, with substantial build-up of stress. Advocates of expansion are more successful if they can transform compressive forces into efforts to shift the burden onto someone else. Pressures from providers in every country for "privatization" and/or payment by users reflect this recognition of economic interest.     

Pitfalls in state-authorized treatment of minors

Recently a federal court in Georgia ruled that several physicians and several state officials could be sued for state-authorized treatment of a minor over his father's objection. State authorization protects providers only if it is properly obtained and the authorizing official has the power to grant the authorization in the existing circumstances.     

Euthanasia: a challenge for the forensic toxicologist

People die daily in the hospital. Mostly, they die because their illnesses were no longer treatable (natural death). Unfortunately, some people die an unnatural death, in particular, as the result of euthanasia. In contrast to the situation in most countries, in the Netherlands euthanasia is accepted by the courts under strict conditions. It can be very difficult for the legal authorities to establish whether a person has died from natural causes or from suicide, euthanasia, or murder. In addition to the pathologist and the lawyer, the toxicologist also has a number of problems in showing whether euthanasia has been carried out. These can consist of the following analytical problems: (a) interactions--the patients involved have frequently been receiving a large number of toxic and nontoxic drugs simultaneously; (b) identification--not all drugs administered are included in general screening procedures; (c) metabolites--a large number of metabolites may have accumulated toward the end of a long therapeutic regimen; and (d) determination--determination of quaternary muscle relaxants and their various metabolites, as well as other drugs, can be problematic. There are also toxicokinetic problems; because of poor kidney and liver function, low serum albumen, general malaise, and interactions between these factors and other drugs, the kinetics of a given drug can differ from normal. This makes it all the more difficult to determine whether the patient died from an accumulation of medication or from a so-called "euthanetic" drug mixture.(ABSTRACT TRUNCATED AT 250 WORDS)     

2 fatalities due to hyperthermia in infancy. A contribution to forensic medicine case reports of death caused by heat

Two infants aged 4 1/2 and 8 months are reported to have been exposed to overheating by an electric blanket and a heating fan in bed for a period of up to approx. 19 hours. Dehydration complicated the effects of overheating. Due to the case history in combination with the autopsy and histological findings as well as the absence of toxicological findings the following diagnosis could be established: "Death from exhaustion as a consequence of long-lasting heat effect and dehydration." The necessity of thorough investigations in causes of death during infancy is shown by means of the two cases above. If possible, the rectal temperature should already be taken by the coroner. The public should get informed about the risks caused by the use of electric cushions, heating fans as well as floorboard heating.     

Between hermeneutics and semiotics

Translated by David Pellauer from the French, Entre herméneutique et sémiotique,Nouveaux Actes Sémiotiques (Vol.II, 1990, forthcoming).     

Religious influence on parental attitudes toward the use of corporal punishment

Certain Biblical passages if interpreted literally can be understood as advocating the use of corporal punishment in disciplining children. The purpose of this research was to determine if persons affiliated with religious denominations which emphasized a literal belief in the Bible would demonstrate less appropriate attitudes with regard to discipline than their counterparts who were affiliated with religious denominations which do not subscribe to a literal interpretation of the Bible. The sample consisted of 881 persons who were members of denominations classified as literal or nonliteral believers. Statistically significant differences were noted on the Physical Punishment Scale of the Adult Adolescent Parenting Inventory with persons, regardless of gender or their level of education, who were members of churches subscribing to a literal belief in the Bible preferring the use of corporal punishment over alternate methods of discipline as compared to their nonliteral counterparts.     

Underlying patterns in a current economic development model

Public officials may subjectively use a variety of elements, including economic characteristics and political considerations, in their selection of locations and allocation of resources for economic development. Policy capture is a method that determines the impartial weighting of a broad number of elements which influence these decision makers as they operationalize programs. Non-political criteria that may influence the selection of sites for local economic development provide the basis of the analysis conducted in this paper. Public officials at various levels of responsibility assessed the chances of creating jobs for disadvantaged residents (employment success) for a variety of hypothetical areas chosen as an enterprise zone. Their responses give insight into policy decisions. There is a comparison of both individual responses and groups of respondents to the hypothetical data as well as to actual zones that were recently selected. Concluding remarks will discuss these results and the application of this method for enterprise zones and other policy analyses.We wish to acknowledge the extensive helpful suggestions of the editor and two anonymous reviewers.     

C. Reviews: general

THE HISTORY OF AL‐TABARI. VOL. III: THE CHILDREN OF ISRAEL. Translated by WILLIAM M. BRINNER. Albany, N.Y., SUNY Press, 1991. xii, 194 pp. $44.00 (hb), $14.95 (pb).

THE HISTORY OF AL‐TABARI. VOL. XXXIII: STORM AND STRESS ALONG THE NORTHERN FRONTIERS OF THE ‘ABBASID CALIPHATE. Translated by C.E. BOSWORTH. Albany, N.Y., SUNY Press, 1991. xix, 239 pp. $57.50 (hb), $18.95 (pb).

THE AWAKENING OF PERSIA: THE REIGN OF NASR AL‐DIN SHAH 1848–1896. By A.J. ABRAHAM. USA, Vande Vere Publishing, 1992. 64pp. $18.95.

THE EMERGENCE OF KURDISH NATIONALISM AND THE SHAIKH SAID REBELLION, 1880–1925. By ROBERT OLSON. Austin, University of Texas Press, 1992.

THE ARAB BUREAU: BRITISH POLICY IN THE MIDDLE EAST, 1916–1920. By BRUCE WESTRATE. University Park, PA, Pennsylvania State University Press, 1992. xvi, 240 pp. $35.

DIE TÜRKEI UND ÄGYPTEN IN DER WELTWIRTSCHAFTSKRISE 1929–1933. By CAMILLA DAWLETSCHIN‐LINDER. (Studien zur modernen Geschichte, 40). Stuttgart, Franz Steiner Verlag, 1989. xviii, 187 pp. 20 tables, 6 diagrams. DM 68‐.

EGYPT FROM INDEPENDENCE TO REVOLUTION, 1919–1952. By SELMA BOTMAN. Syracuse, Syracuse University Press, 1991.

EXPULSION OF THE PALESTINIANS: THE CONCEPT OF ‘TRANSFER’ IN ZIONIST POLITICAL THOUGHT 1882–1948. By NUR MASALHA. Washington, DC, Institute for Palestine Studies, 1992. iii, 235pp. $24.95 (hb), $11.95 (pb).

TRANSITION TO SELF‐GOVERNMENT: PRACTICAL STEPS TOWARD ISRAELI‐PALESTINIAN PEACE. Report of a study group convened by the American Academy of Arts and Sciences, ANN MOSELY LESCH, principal author. Indiana University Press, 1993. 160pp. £22.50 (hb), £9.99 (pb).

GREATER SYRIA: THE HISTORY OF AN AMBITION. By DANIEL PIPES. New York and Oxford, Oxford University Press, 1990. viii, 240pp.

IBN SAUD: FOUNDER OF A KINGDOM. By LESLIE McLOUGHLIN. Basingstoke, Macmillan in association with St Antony's College, Oxford, 1993. 240pp. £40.00.

THE DESPAIRING DEVELOPER: DIARY OF AN AID WORKER IN THE MIDDLE EAST. By TIMOTHY MORRIS. London, Tauris, 1991.

A MODERN CULTURAL HISTORY OF BAHRAIN. By SAMI A. HANNA. Bahrain, National Council for Culture Arts and Literature, 1991. 107pp.

THE ECONOMIC CONSEQUENCES OF THE GULF WAR. By KAMRAN MOFID. London, Routledge, 1990. xxiv, 177pp.

EARLY ARABIC POETRY: MARATHI AND SU'LUK POEMS, Vol. 1. Edition, translation, and commentary by ALAN JONES. (Oxford Oriental Institute Monographs, 14.) Reading, Ithaca Press, 1992. ix, 270 pp. Map. £25.00.

RELIGION, LEARNING AND SCIENCE IN THE ‘ABBASID PERIOD. Edited by M.J.L. YOUNG, J.D. LATHAM and R.B. SERJEANT. (The Cambridge History of Arabic Literature.) Cambridge, Cambridge University Press, 1991. xxi, 587pp. £ 60.00 (hb).

THREE SHADOW PLAYS. By MUHAMMAD IBN DANIYAL. Edited by PAUL KAHLE. Critical apparatus by DEREK HOPWOOD. Introductory Essay by MUSTAFA BADAWI. (E.J.W. Gibb Memorial, New Series, 32.) Cambridge and Warminster, Gibb Memorial Trust/Aris and Phillips, 1992. 154pp. in Arabic and 30pp. in English. £12.00.

GENRE AND LANGUAGE IN MODERN ARABIC LITERATURE. By SASSON SOMEKH. Wiesbaden, Harrassowittz, 1991.

DER ARABISCHE DIALEKT DER JUDEN VON ‘AQRA UND ARBIL (Semitica Viva, 5.) By OTTO JASTROW. Wiesbaden, Harrassowitz, 1990. 438pp. DM 112.‐

1 For technical reasons, the symbol ‘e’ has been substituted for the ‘inverted e’ of the original throughout this review. [—Ed.]

WADAAN: REINFORCING READING/WRITING/FIRST LEVEL ARABIC COURSE, Vol.4. By DIONISIUS A. AGIUS, and PARWEEN N. ARIF. Leeds, University of Leeds, 1991. 65 pp.

HAYYAN BINA: KITAB AL‐TAMARIN. DRILLS/FIRST LEVEL ARABIC COURSE, Vol.5. By DIONISIUS A. AGIUS. Leeds, University of Leeds, 1991. 111 pp.

MUGHAMARAT ‘AJIBA FI QISAS MUFIDA: THIRD LEVEL ARABIC COURSE BOOK 1. By PARWEEN N. ARIF and DIONISIUS A. AGIUS. Leeds, University of Leeds, 1991. 64 pp.

UNVEILING ISLAM. By ROGER DU PASQUIER. Cambridge, Islamic Texts Society, 1992. viii, 157pp. £6.95.

CULTURAL SCHIZOPHRENIA. By DARYUSH SHAYEGAN. London, Saqi Books, 1992. vii, 188pp.