Causes of death in hospitalized intravenous drug abusers

The authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital. There were 127 who died from diseases unrelated to intravenous drug abuse, and in 41% of these, chronic alcoholism was implicated. Deaths from overdose syndromes and drug-related organ pathology comprised only 11% of all cases. The mean age at death was 39 years. There was a male/female ratio of 3.6:1. Half of all patients died from infection--72 from acquired immunodeficiency syndrome (AIDS) alone. These findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that AIDS and chronic alcoholism are significant problems. Emphasis should be placed upon detecting "hidden" intravenous drug deaths to provide more accurate statistical information.     

Moral atrophy in the welfare state

The welfare state is often accused of being counterproductive: as the scope of public responsibility expands, private morality (especially altruism and benevolence) atrophies. This essay surveys psychological findings for evidence, which turns out to be broadly consistent with either of two models of moral development, each bearing distinct policy implications. The model of morally keeping in practice that is implicit in the term moral atrophy suggests the need for frequent opportunities to exercise moral skills, which would seem inconsistent with the welfare state. Alternatively, the model of moral character-building favoured by both philosophers and ordinary discourse would require only occasional reminders of one's moral principles. On this model, benevolence could usefully supplement the welfare state.     

Reviews

Orlando Figes, A People's Tragedy: The Russian Revolution 1891–1924. London: Jonathan Cape, 1996, xx + 923 pp., £25.00

Hafeez Malik (ed.), The Roles of the United States, Russia and China in the New World Order. Basingstoke: Macmillan, 1997, xvi + 333 pp., £47.50.

Leszek Buszynski, Russian Foreign Policy after the Cold War. Westport and London: Praeger, 1996, xiv + 243 pp., £46.95.

Mette Skak, From Empire to Anarchy: Postcommunist Foreign Policy and International Relations. London: C. Hurst & Company, 1996, x + 340 pp., £35.00 h/b, £14.95 p/b.

Hans von Zon, The Future of Industry in Central and Eastern Europe. Aldershot: Avebury, 1996, x + 164 pp., £35.00.

Bartlomiej Kaminski (ed.), Economic Transition in Russia and the New States of Eurasia. Armonk, New York: M.E. Sharpe, 1996, xviii + 430 pp.

Ben Fowkes, The Disintegration of the Soviet Union: A Study in the Rise and Triumph of Nationalism. Basingstoke: Macmillan, 1997, xii + 273 pp., £40.00

Juan J. Linz & Alfred Stepan, Problems of Democratic Transition and Consolidation. Southern Europe, South America, and Post‐Communist Europe. London: The Johns Hopkins University Press, 1996, xx + 479 pp., £15.50.

David Lane, The Rise and Fall of State Socialism. Cambridge: Polity Press, 1996, 233 pp., £12.95.

Reneo Lukic & Allen Lynch, Europe from the Balkans to the Urals: The Disintegration of Yugoslavia and the Soviet Union. Oxford: Oxford University Press, 1996, xvii + 436 pp.

Thomas Cushman & Stjepan G. Mestrovic (eds), This Time We Knew: Western Responses to Genocide in Bosnia. New York: New York University Press, 1996, ix + 412 pp., $50.00 h/b, $18.95 p/b.

Derek Hall & Darrick Danta (eds), Reconstructing the Balkans. A Geography of the New Southeast Europe. Chichester: John Wiley & Sons, 1996, xx + 260 pp., £45.00.

Ajay Patnaik. Central Asia. Between Modernity and Tradition. New Delhi: Konark Publishers, 1996, viii + 238 pp.

Rudolf L. Tokes, Hungary's Negotiated Revolution: Economic Reform, Social Change and Political Succession, 1957–1990. Cambridge: Cambridge University Press, 1996, xxiii + 544 pp., £19.95.

John D. H. Downing, Internationalizing Media Theory, Transition, Power, Culture, Reflections on Media in Russia, Poland and Hungary 1980–95. London: Sage, 1996, xviii + 269 pp., £45.00 h/b, £13.95 p/b.

Rogers Brubaker, Nationalism Reframed: Nationhood and the National Question in the New Europe. Cambridge: Cambridge University Press, 1996, xi + 202 pp., £35.00 h/b, £12.95 p/b.

Donald P. Steury (ed.), Intentions and Capabilities: Estimates on Soviet Strategic Forces, 1950–1983. Washington DC: Center for the Study of Intelligence, 1996, xxii + 504 pp.

R. W. Davies, Crisis and Progress in the Soviet Economy, 1931–1933. Basingstoke: Macmillan, 1996, xviii + 612 pp., £65.00.

William Chase, Jeffrey Burds, S. V. Praslova, A. K. Sokolov & E. A. Tiurina (eds), Russian Stale Archive of the Economy: A Research Guide: I. Guide to Collections. Moscow: Blagovest, 1994, xx + 679 pp.

V. P. Butt, A. B. Murphy, N. A. Myshov & G. R. Swain (eds), The Russian Civil War. Documents from the Soviet Archives. London: Macmillan, 1996, xvii + 217 pp., £15.99.

Ilya Somin, Stillborn Crusade: The Tragic Failure of Western Intervention in the Russian Civil War, 1918–1920. New Brunswick, NJ: Transaction Publishers, 1996, ix + 236 pp., £21.95, $32.99.

David R. Shearer, Industry, State, and Society in Stalin's Russia, 1926–1934. Ithaca: Cornell University Press, 1996, xiv + 263 pp., £33.50 h/b, £14.95 p/b.

Peter H. Solomon Jr., Soviet Criminal Justice under Stalin. Cambridge: Cambridge University Press, 1997, xvii + 494 pp., £55.00 h/b, £19.95 p/b.

Richard G. Hovannisian, The Republic of Armenia, Volume III, From London to Sèvres, February‐August 1920, xx + 534 pp., and Volume IV, Between Crescent and Sickle: Partition and Sovietization, xii + 496 pp. Berkeley, University of California Press, 1996. £35.00 each volume.

Ian D. Thatcher & James D. White (eds), Journal of Trotsky Studies. Glasgow: Institute of Russian & East European Studies, 1993–1996, Nos. 1–4, £10.00 (Institutions), £5.00 (Individuals).

Mikhail Baitalsky, Notebooks for the Grandchildren. Recollections of a Trotskyist Who Survived the Stalin Terror, Edited and translated by Marilyn Vogt‐Downey. Atlantic Highlands, New Jersey, 1996, xviii + 447 pp.

Leopoldina Plut‐Pregelj & Carole Rogel, Historical Dictionary of Slovenia. London: The Scarecrow Press, Inc, 1996, xxvii + 345 pp., £63.65.     

The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.