- Email: [email protected]
Human aspects of biomedical innovation
656
BooK Revlaws
until bloody and forced to return to their birthplace for a period of three years. One could, of course, argue that relief was expanded inasmuch as the national government recognized its responsibility in this area for the first time. But such an argument would be at best ingenuous. Similar problems of vague definitions arise in the attempt to account for the increase in welfare rolls during the sixties in terms of civil disorders. Since the welfare rolls began to increase signiiicantly in 1960 but the riots did not begin until 1963 or 1964, they had to !ind civil disorders which could be used to explain the earlier increases. Their answers: juvenile delinquency, drug addiction, armed robbery, and burglary, and other crimes. But since crime rates rose. regularly throughout the fifties, this explanation is simply not persuasive. Regarding at least two points, the authors’ interpretation of history does not seem to fully fit the facts. For example, they attribute the increase in relief rolls in the latter half of the eighteenth and early nineteenth centuries to disturbances which resulted from the transformation of agriculture. during the enclosure movement. But the unrest which these changes brought occumd after 1760, while, according to Llewellyn Woodward. poor law expenditures began to rise in 1750. To take another instance, the authors believe that the increase of relief rolls, particularly after 1964, to result from civil disturbances. And the unrest undoubtedly played a contributory role, but the sequence of events in the sixties does not seem to fit the authors’ model. According to their theory, increases in disturbance should follow incre&ses in unemployment, but unemployment decreased from 1962-1968. How then do they account for the disturbances? They refer to unemployment in the fifties and the rise of an unstable black electorate. But why people should respond to past rather than current economic conditions is unclear. Moreover, since, according to the authors’ argument, improving economic conditions should bring forth pressures to reduce welfare programs, it is difficult to understand why welfare programs grew concommitantly with reductions in the unemployment rates. In fact, reductions in welfare have come about only recently, subsequent to a downturn in the economy. One finishes this book wishing the authors had done a better job of it. DAVID ELE$H Institute for Research on Pooerty, University of Wisconsin, Madison, Wise. C&me and Popuiathm: A Collection of Current Studies. Edited by STEVENP~LGAR. Carolina Population Center, University of North Carolina, 1971. 196 pp. Tms collection of 13 articles is ninth in a series of monographs dealing with family planning and natality control. Its scope is broader than that of the others, and the task set, more ambitious. Essentially, Polgar seeks to stimulate greater cross-fertilization between anthropology and demography. In particular, he feels that anthropological concepts and techniques can illuminate the dynamic relationships between family practices and culture, on the one hand, and demographic patterns, on the other.
Only through such research, he cautions, can we desiep family planning programs that fit-rather than fightthe existing cultural realities. The articles are grouped into three sections reflectin; three major interests of “population anthropology” human ecology, family structure and child spacing, ant family planning programs. Ten of the studies offer i closelook at the interplay between demographic pattern and cultural and environmental factors within small non-industrial communities. The sensitivity of the demo graphic response to cultural and environmental influence is effectively demonstrated. Techniques are described fo estimating population parameters where published dat: are scarce, and new approaches to commonly-acceptec demographic propositions are explored. Taken together, these studies emphasize the grea cultural variability of marriage, family, and childbearing patterns. In so doing they imply that any hope for ; broad-spectrum solution to rapid population increas is fantasy. Instead, real progress can be made only b: tailoring particular programs to particular groups 0 people. This in tum depends on accumulating the kind o information included here for countless individual corn munities, each with its special blend of culture attribute and demographic characteristics. ALICE TAYLORDAY, M.A Department of Sociology, Albertus Magnus College, New Haven, Connecticut, U.S.A. Human Aspects of Biomedical Innovation by E~FXET MENDELSOHN,JUDITH P. SWAZEY and IRENE TAVIS~ Harvard University Press, Cambridge, Mass., 1971 234 pp. $9.95. Tms IS a volume of various essays sponsored by tb Harvard Studies in Technology and Society and unitec by a common interest in the relation of medical innova tion to social problems. The articles include a great range of form and content. There is one excellent case study @ Bessman and Swazey of the overevaluation of pseudo medical knowledge in the adoption of PKU legislation il forty-one states, a general discussion of role cotiic between the clinical investigator and the physician b! Louis Lasagna, a somewhat sketchy r&urn6 of a sym posium on behavior control and two critical studies 01 the delivery of health care and medical manpower needs From the point of view of the social scientist, the rnai~ function which these various articles seem to serve is tc show needed research and give new ideas for possible work. The problems are stated either in medical or pure11 historical terms and the fact that social science has some thing to contribute is usually omitted. However, just thi procedure shows the place where social science reaearcl may be valuable. Thus, Pellegrino’s article on new trend in medical ethics leads to the consideration of measure ment of values and assessment of their differential im portance, and Sidel’s article on new technologies in the practice of medicine may be a guide for possible researci projects oz the effect of contraception, vaccines, cask finding in tuberculosis, health examinations, drugs
BOOK
&MEWS
ramplants and other topics. Probably the best audience ?f this volume is the student in medical sociology looking [or a dissertation topic, but any other reader interested tn this field will find stimulating ideas from experts in both medicine and the history of science. KURT W. BACK, Ph.D. Deportment of Sociology and Anthropology, Duke University, Durham, North Carolina 27706 Imtbtionalism and Sdkophwia: A Comprehensive Study of Three Mental Hospitals by J. K. WING and G. W. BROWN.Cambridge University Press, Cambridge, Mass. (1970) XIII +260 pp. 812.50. R-IIS study falls in the best British tradition of social medicine and, particularly, in what has come to be recognized as the field of social psychiatry. It is an empirical study that attempts through operational proxdures to probe the relationship between social and Snical evmts as these emerge in the setting of the mental hospital. More specifically, it focuses upon the &al cultural climate and the behavior symptoms of three samples of schizophrenic patients under 60 years of age and with at least two years hospital residency in three mental hospitals in Great Britain, Netheme, Mapperley and !&era&. It attempts to examine this relationship at three points in time, 1960, 1964 and 1968. The general procedure of the investigators was to utilize a series of rating scales that attempt to measure zertain aspects of the hospital social climate as identtied by such variables as outside contact, nurse’s attitudes toward patients, personal possessions of patients, and time doing nothing, and also to measure such symptoms ss social withdrawal, flatness of affect, poverty of speech, incoherence of speech, and incoherently expressed Wusions. The intercorrelations between these social and :llnical variables showed twenty out of thirty-four of them to be significant at the 0.01 level. These interzormlations are for 1964, but previously, they examined the scores for 1960 on these social and clinical variables with the gez~ral finding that there has been an improvement in the “poverty of the social environments” between 1960 and 1964. As the hospital environment improved, so was there an overall change in the intensity d the symptoms in 1964. Their repeat examination of the samples for 1968 tended to show that the improvements in the hospital had declined approaching the same
657
level as they were in 1960, This seemed to be more true for Netheme and Mapperley than for Scveralls. The investigators have collected a voluminous amount of data which they have analyzed in a series of tables and figures organized to emphasize the possibility that social events are actually translated into clinical events at least in the setting of the hospital. The investigators see three hypotheses being tested by these data, but think that the burden of evidence supports the first hypothesis. These hypotheses are: (1) the hospital environment is closely related to changes in the intensity of patient’s symptoms, and as this environment improves, the symptoms of patients decrease in intensity; (2) the social environment is a result of the changing symptoms of the schizophrenics because such patients are likely to “bum” themselves out after a long illnw; (3) the processes of social selection are different in the three hospitals in that the clinically disturbed patients tend to collect in one hospital rather than another. There is no doubt that if the 6rst proposition holds up it might be extended to having a more general application, namely, the manner in which social events may serve as the cause of selected clinical events. Some support is given to this position by the work of Gruenberg and associates in isolating the social breakdown syndrome. The investigators in this study tend to support this conception and state that when a patient on the ward is not permitted to withdraw, but is faced with the impossible demands on the ward, the “underlying thinking disorder becomes clinically manifest in florid symptoms”. I must confess that my preliminary look at the tit two or thne chapters in this study made me highly sceptical of what was to come. I was sap&al because the design of the research was not presented at the outset as sharply as I would have liked and thought most necessary. However, by the time I closed the book, I could not help but think that the investigators deserve several kudos for a significant and imaginative study that, if it did nothing else, tended to support a general notion which we have had around for some time: that the social climate of the mental hospital is conducive to the development of a chronic state in the schizophrenic patient. H. WARRENDUNRAM, Ph.D. Wayne State University School of Medicine, Department of Community and Family Medicine, Detroit% Mi. 48207.
BooK Revlaws
until bloody and forced to return to their birthplace for a period of three years. One could, of course, argue that relief was expanded inasmuch as the national government recognized its responsibility in this area for the first time. But such an argument would be at best ingenuous. Similar problems of vague definitions arise in the attempt to account for the increase in welfare rolls during the sixties in terms of civil disorders. Since the welfare rolls began to increase signiiicantly in 1960 but the riots did not begin until 1963 or 1964, they had to !ind civil disorders which could be used to explain the earlier increases. Their answers: juvenile delinquency, drug addiction, armed robbery, and burglary, and other crimes. But since crime rates rose. regularly throughout the fifties, this explanation is simply not persuasive. Regarding at least two points, the authors’ interpretation of history does not seem to fully fit the facts. For example, they attribute the increase in relief rolls in the latter half of the eighteenth and early nineteenth centuries to disturbances which resulted from the transformation of agriculture. during the enclosure movement. But the unrest which these changes brought occumd after 1760, while, according to Llewellyn Woodward. poor law expenditures began to rise in 1750. To take another instance, the authors believe that the increase of relief rolls, particularly after 1964, to result from civil disturbances. And the unrest undoubtedly played a contributory role, but the sequence of events in the sixties does not seem to fit the authors’ model. According to their theory, increases in disturbance should follow incre&ses in unemployment, but unemployment decreased from 1962-1968. How then do they account for the disturbances? They refer to unemployment in the fifties and the rise of an unstable black electorate. But why people should respond to past rather than current economic conditions is unclear. Moreover, since, according to the authors’ argument, improving economic conditions should bring forth pressures to reduce welfare programs, it is difficult to understand why welfare programs grew concommitantly with reductions in the unemployment rates. In fact, reductions in welfare have come about only recently, subsequent to a downturn in the economy. One finishes this book wishing the authors had done a better job of it. DAVID ELE$H Institute for Research on Pooerty, University of Wisconsin, Madison, Wise. C&me and Popuiathm: A Collection of Current Studies. Edited by STEVENP~LGAR. Carolina Population Center, University of North Carolina, 1971. 196 pp. Tms collection of 13 articles is ninth in a series of monographs dealing with family planning and natality control. Its scope is broader than that of the others, and the task set, more ambitious. Essentially, Polgar seeks to stimulate greater cross-fertilization between anthropology and demography. In particular, he feels that anthropological concepts and techniques can illuminate the dynamic relationships between family practices and culture, on the one hand, and demographic patterns, on the other.
Only through such research, he cautions, can we desiep family planning programs that fit-rather than fightthe existing cultural realities. The articles are grouped into three sections reflectin; three major interests of “population anthropology” human ecology, family structure and child spacing, ant family planning programs. Ten of the studies offer i closelook at the interplay between demographic pattern and cultural and environmental factors within small non-industrial communities. The sensitivity of the demo graphic response to cultural and environmental influence is effectively demonstrated. Techniques are described fo estimating population parameters where published dat: are scarce, and new approaches to commonly-acceptec demographic propositions are explored. Taken together, these studies emphasize the grea cultural variability of marriage, family, and childbearing patterns. In so doing they imply that any hope for ; broad-spectrum solution to rapid population increas is fantasy. Instead, real progress can be made only b: tailoring particular programs to particular groups 0 people. This in tum depends on accumulating the kind o information included here for countless individual corn munities, each with its special blend of culture attribute and demographic characteristics. ALICE TAYLORDAY, M.A Department of Sociology, Albertus Magnus College, New Haven, Connecticut, U.S.A. Human Aspects of Biomedical Innovation by E~FXET MENDELSOHN,JUDITH P. SWAZEY and IRENE TAVIS~ Harvard University Press, Cambridge, Mass., 1971 234 pp. $9.95. Tms IS a volume of various essays sponsored by tb Harvard Studies in Technology and Society and unitec by a common interest in the relation of medical innova tion to social problems. The articles include a great range of form and content. There is one excellent case study @ Bessman and Swazey of the overevaluation of pseudo medical knowledge in the adoption of PKU legislation il forty-one states, a general discussion of role cotiic between the clinical investigator and the physician b! Louis Lasagna, a somewhat sketchy r&urn6 of a sym posium on behavior control and two critical studies 01 the delivery of health care and medical manpower needs From the point of view of the social scientist, the rnai~ function which these various articles seem to serve is tc show needed research and give new ideas for possible work. The problems are stated either in medical or pure11 historical terms and the fact that social science has some thing to contribute is usually omitted. However, just thi procedure shows the place where social science reaearcl may be valuable. Thus, Pellegrino’s article on new trend in medical ethics leads to the consideration of measure ment of values and assessment of their differential im portance, and Sidel’s article on new technologies in the practice of medicine may be a guide for possible researci projects oz the effect of contraception, vaccines, cask finding in tuberculosis, health examinations, drugs
BOOK
&MEWS
ramplants and other topics. Probably the best audience ?f this volume is the student in medical sociology looking [or a dissertation topic, but any other reader interested tn this field will find stimulating ideas from experts in both medicine and the history of science. KURT W. BACK, Ph.D. Deportment of Sociology and Anthropology, Duke University, Durham, North Carolina 27706 Imtbtionalism and Sdkophwia: A Comprehensive Study of Three Mental Hospitals by J. K. WING and G. W. BROWN.Cambridge University Press, Cambridge, Mass. (1970) XIII +260 pp. 812.50. R-IIS study falls in the best British tradition of social medicine and, particularly, in what has come to be recognized as the field of social psychiatry. It is an empirical study that attempts through operational proxdures to probe the relationship between social and Snical evmts as these emerge in the setting of the mental hospital. More specifically, it focuses upon the &al cultural climate and the behavior symptoms of three samples of schizophrenic patients under 60 years of age and with at least two years hospital residency in three mental hospitals in Great Britain, Netheme, Mapperley and !&era&. It attempts to examine this relationship at three points in time, 1960, 1964 and 1968. The general procedure of the investigators was to utilize a series of rating scales that attempt to measure zertain aspects of the hospital social climate as identtied by such variables as outside contact, nurse’s attitudes toward patients, personal possessions of patients, and time doing nothing, and also to measure such symptoms ss social withdrawal, flatness of affect, poverty of speech, incoherence of speech, and incoherently expressed Wusions. The intercorrelations between these social and :llnical variables showed twenty out of thirty-four of them to be significant at the 0.01 level. These interzormlations are for 1964, but previously, they examined the scores for 1960 on these social and clinical variables with the gez~ral finding that there has been an improvement in the “poverty of the social environments” between 1960 and 1964. As the hospital environment improved, so was there an overall change in the intensity d the symptoms in 1964. Their repeat examination of the samples for 1968 tended to show that the improvements in the hospital had declined approaching the same
657
level as they were in 1960, This seemed to be more true for Netheme and Mapperley than for Scveralls. The investigators have collected a voluminous amount of data which they have analyzed in a series of tables and figures organized to emphasize the possibility that social events are actually translated into clinical events at least in the setting of the hospital. The investigators see three hypotheses being tested by these data, but think that the burden of evidence supports the first hypothesis. These hypotheses are: (1) the hospital environment is closely related to changes in the intensity of patient’s symptoms, and as this environment improves, the symptoms of patients decrease in intensity; (2) the social environment is a result of the changing symptoms of the schizophrenics because such patients are likely to “bum” themselves out after a long illnw; (3) the processes of social selection are different in the three hospitals in that the clinically disturbed patients tend to collect in one hospital rather than another. There is no doubt that if the 6rst proposition holds up it might be extended to having a more general application, namely, the manner in which social events may serve as the cause of selected clinical events. Some support is given to this position by the work of Gruenberg and associates in isolating the social breakdown syndrome. The investigators in this study tend to support this conception and state that when a patient on the ward is not permitted to withdraw, but is faced with the impossible demands on the ward, the “underlying thinking disorder becomes clinically manifest in florid symptoms”. I must confess that my preliminary look at the tit two or thne chapters in this study made me highly sceptical of what was to come. I was sap&al because the design of the research was not presented at the outset as sharply as I would have liked and thought most necessary. However, by the time I closed the book, I could not help but think that the investigators deserve several kudos for a significant and imaginative study that, if it did nothing else, tended to support a general notion which we have had around for some time: that the social climate of the mental hospital is conducive to the development of a chronic state in the schizophrenic patient. H. WARRENDUNRAM, Ph.D. Wayne State University School of Medicine, Department of Community and Family Medicine, Detroit% Mi. 48207.