Chronic disease and disadvantage: the new politics of HIV infection

HIV infection is now perceived as the end stage of a chronic disease that is spreading most rapidly among blacks and Hispanics. The politics of the HIV epidemic in the 1980s were dominated by four interacting factors: fear and fascination; who had the disease and to whom it seemed to be spreading; the endemic problems of United States social policy; and the impact on policy of advances in scientific knowledge. This paper analyzes the political history of each of these factors and describes the dominant policies of the federal government and the states regarding HIV in the areas of surveillance, prevention, research, and financing. Four uncertainties will have a profound influence on the future politics of the HIV epidemic: how the states and the federal government will address the general problems of paying for the care of people with chronic diseases and providing access to care for the uninsured and the underinsured; the number and distribution of the sexual behaviors that transmit infection with HIV and the effectiveness of policies to persuade people to modify these behaviors; precisely who uses addictive drugs and the effectiveness of measures to change their behavior; and the natural history of the virus.     

The political economy of the peace dividend

We develop a model of the peace dividend and use it to predict the fiscal consequences of a reduction in the demand for military spending. The model is based on the assumption that the political process responds to political demands and costs in a way that maximizes net political benefits. The predictions of our model on how a peace dividend will be allocated over nonmilitary spending, tax relief, and deficit reduction is tested against the experience of eight major wars in United States history.     

The use of either the nose or outer ear as a means of determining the postmortem period of a human corpse.

Presented in this paper are the initial results involving the use of the nose or outer ear as temperature measurement sites to determine the postmortem period of the human corpse. Simple mathematical models for both sites are developed based on cooling curves of five corpses. Analysis of errors between actual and calculated postmortem intervals suggest that in its present form, the described methods would not be suitable for use in accurately determining the time since death of human corpses.     

Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.     

Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey     

Trade union behaviour and inter-regional variations in unemployment rates

An important problem in the political economy of the UK is that the disparity of unemployment rates across its regions is much more marked than the corresponding dispersion of wage rates. One possibility is that this is due to the attitude of trade unions to their members in different regions. If unions wish to preserve parity between members in different regions then they will value wage equality between regions over and above wage levels. This may then persuade them to overlook inter-regional productivity differences in setting wages. The price that low-efficiency regions will then pay for this desire for wage equality is higher unemployment rates.Much of the research for this paper was carried out while the author was visiting the Trade Union Economics Research Institute (FIEF), Stockholm in 1989. An earlier version of this paper was presented at a seminar there and the author is gratefully to Villy Bergstrom, Paul Chen, Douglas Hibbs, Eva Udden-Jondal and other institute members for several useful comments. Comments from Kevin Lee, John Spencer and an anonymous referee have also substantially improved the paper. The usual disclaimer applies.