- Email: [email protected]
Vision and aging: Issues in social work practice
1338
Book Reviews
CHntcal Evaluation of Psycllmtrol~ Drugs for PsydLiatri¢
Disorders: Principles u d Propo~d Guidelines, edited by Paul Grof, M. [ftikhar Akhter, Magda Campbell, Carl G. Gottfries, lnayat Khan, Yvon D. Lapierre, Louis Lemberger, Bruno Muller-Oerlinghausen and Brigette Woggon. Published on behalf of the World Health Organization by Hogrefe & Huber Publishers, Seattle, 1993. 202 pp., $38 (hardback). This book is one in a series prepared by specialists participating in the World Health Organization's programme on biological approaches to psychiatry. Edited by members of a working group, formed in 1986, the current volume offers a detailed review of the methods for clinical investigations of psychotropic drugs in order to assist those who are recent newcomers to these investigations. The book is described as an "'umbrella document" (p. 7) because it focuses on general principles considered essential for the evaluation of psychotropic drugs, while, at the same time, not being limited to a particular group of drugs. The editors point out that as guidelines, these principles reflect current standards for clinical evaluation. Therefore, these principles are not intended to define codified standards or rules of excellence. Furthermore, given that the medico-legal and socio-cultural contexts under which clinical evaluations of drugs for psychiatric disorders take place vary from country to country, the creative application of these principles, a theme which often remains hidden in this type of work, is underlined. Two initial discussions provide the reader with a brief introduction into the subject area and an overview of drug evaluation. Here, launching a review on the phases of evaluation, the editors outline key preclinical considerations which, in their view, should be understood prior to embarking on clinical evaluations. For example, important considerations before administering a drug to humans include a complete understanding of animal and toxicologic data as well as familiarity with the pharmacological properties of the drug. Chapters I to 4 follow quite closely the standard, four phases (i.e. clinical pharmacology, early therapeutic, main therapeutic and extended studies) of clinical drug evaluation. Chapters 5 and 6 outline ethical aspects of studies in children and the elderly respectively. The final chapter (Chapter 7) considers transcultural issues which affect drug evaluation. These issues include pharmacological variations (e.g. differences in drug responsiveness and dosing, pharmacokinetic differences, differences related to antipsychotic agents, etc.); cultural setting (e.g. personnel, training, availability of medication, etc.);
Vision and Aging:. l~ues in Social Work Practice, edited by Nancy Weber. The Haworth Press, Binghamton, NY, 1991, 196 pp., U.S $24.95 (cloth), $14.95 (pb). The book is a compilation of writings edited by a social worker who has extensive experience in the provision of services to elderly people who are visually impaired. The writings are broadly focused and address issues related to service delivery as well as cultural, social and psychological factors affecting people in their middle and older years who experience vision loss. Several of the authors are social workers but a number of other disciplines are represented as well including, for example, Public Administration, Recreation, Rehabilitation, Speech Pathology and Audiology, Education, Medicine and Public Health. The book is timely given that the proportion of elderly people in society is
sample selection; measurement; influence of folk medicines; and migration. Besides a useful glossary of terms, additional work at the end of the document includes a selection of WHO publications related to psychopharmacology; references recommended for further reading; lists of cited instruments, studies, tables, figures and diagrams; and a copy of the Declaration of Helsinki on Human Experimentation. Overall, the book is a useful clinical compedium, helping those involved in these investigations to carry out efficient and thoughtful evaluations. In particular, readers should find many of the comprehensive tables detailing or summarising key studies, scales and protocols of particular interest. At their best, the editors exhibit great sensitivity and a heightened awareness of the complex ethical issues involved in this type of work. However, one could argue that this should be a requirement of a document initiated by the World Health Organization. Nevertheless, two, albeit minor, shortcomings emerge. First, a potential investigator, working in the field of substance abuse, could take issue with the use of former narcotic drug users as subjects in studies of abuse liability (pp. 51-52). Here, this investigator may rightly ask, "If 'to be forewarned is to be forearmed', how can I as a clinician ensure that the effects of the drug will be beneficial to my subjects, if predominantly adverse events and prolonged misuse of a related substance or substances have been my subjects' experiences?" Secondly, the editors note early on in the text that "ethical considerations evolve with time and public perception and change with place and culture" (p. 25). Yet, nowhere in the chapter on transcultural issues are the deeper implications of this statement discussed. Perhaps, this omission is to be expected, given that the chapter is described as a commentary on important issues and not a "comprehensive treatise" (p. 170). On the other hand, it would have been worthwhile in this context to demonstrate how ethical issues intersect with cultural and ethnic differences. In spite of these faults, this book is a must for those involved in contemporary, clinical psychotropic drug evaluations.
Department of Sociology ,~bo Academy University 00250 Abo, Finland and Department of Sociology Helsinki University 00014 Helsinki, Finland
Elizabeth Ettorre
increasing and vision impairment or loss is a common problem among people as they age. The book can also be commended for its inclusion of content on services to minority populations (Cunningham) and qualitative research emphasizing the feelings and life issues of older adults with visual impairments (Burack-Weiss/Miller). There is also an informative chapter on loss and adjustment by older people and their families when blindness or deteriorating vision becomes an issue (Orr). The primary emphasis of the book is on service delivery. In "A Model of Comprehensive Community-Based Services" a service delivery model implemented by a not-forprofit agency serving blind and visually impaired older adults in New York City is described (Ludwig and Schneider). A second article (Rogers and Long) discusses the barriers to effective service delivery, outlines several
Book Reviews
1339
community service models and makes suggestions for implementing these models nationwide. A third article (Stuen) reports on the results of a survey designed to assess the awareness of aging services personnel of resources and services available for persons with age-related vision loss. Other articles specifically address rehabilitation services. One (Weiner) discusses the rehabilitative needs of older adults with visual impairments and describes the role and functions of rehabilitation teachers and another (Crews) outlines methods for measuring rehabilitation outcomes as a function of public policy implementation. A third article (Ycadon) focuses on service utilization and the development of a comprehensive service plan for rehabilitation that addresses the complex issues facing older adults with visual impairments and a fourth (Wainapel) on a comparison of the medical and vision rehabilitation systems with suggestions for coordination and cooperation between systems. Several articles focus on assessment. Research on the development of a vision screening questionnaire for older
people is reported (Horowitz, Teresi and Casseis). A survey study is also included which reports on sample demographic characteristics and self-reported needs of blind or severely visually impaired people over 70 years old. Another article (Rose) uses a developmental framework for identifying age-related health issues of importance at various states in the adult life cycle. The book provides a good overview of the issues related to aging and vision loss and should prove to be useful to inform administrators, practitioners and researchers who work with this population or are studying service implementation and public policy.
Medicine and Charity before the Welfare State, edited by Jonathan Barry and Colin Jones. Routledge, London, first published in 1991, paperback edition, 1994.
Another important topic is the role of charities in the pdestablishment of professional roles and market relationships. Here again, the case studies presented in the book contradict the simplistic opposition between 'for profit" and "non-profit' organizations, or between 'lay' and 'professional' care of the sick. For example, Ann Summers shows that the early nursing charities organized by religious groups were able to obtain an influential position by firmly establishing themselves in the market place through the acquisition of permanent contracts. From the Renaissance on, charities contributed to the development of medicine and to the reinforcement of the professional status of doctors. 17th and 18th century charities, Katherine Park and Jonathan Andrews propose, were already not concerned exclusively with the saving of souls, but also with cures, and competed through their perceived therapeutic efficacy. This trend was maintained and reinforced in the 19th and 20th centuries. Finally, several essays point to the role of charities in the establishment of the power positions of specific dominating groups and in the mutual shaping of lay and professional interests. They also indicate the ways charities were used by the poor as a means to advance their social or economic position and to increase their 'social worth'. In conclusion, the studies included in Medicine and Charity before the Welfare State cast new light not only on past relationships between medicine and charity, but also on the larger problem of medicine as a cultural, social, economic and political activity. This book may be seen as an apt illustration of Rudolf Virchow's statement in 1848 that "medicine is a social science".
The paperback edition of the book, Medicine and Charity before the Welfare State (Jonathan Barry and Colin Jones, eds), first published in 1991 will facilitate the access of graduate and undergraduate students and the general academic public to this important collection of historical essays. Doctors, but also sociologists of medicine, may have a tendency to simplify the past, to favor linear histories, to pay attention only to events and concepts which are in agreement with present-time rationality, and to 'read backward' today's institutions and organizations into historical events. The studies included in this book avoid the pitfalls of viewing history as the "pathway to modern welfare state" and offer rich accounts of the multilayer interactions between medicine and charity. One of the central subjects in the book is the relationship between the modern state and charities. The two are sometimes opposed, and the modern state is viewed as taking over the function of charities. In fact, however, as several essays stress, charity intervention and state intervention grew together. Charitable institutions were an important resource for liberal governments because they supplied means for dealing with acute problems of the poor and a way of relieving complex social problems without being obliged to admit that access to health care is a right of the poor. In the 19th century, Paul Weindling and Allan Mitchell explain, the policies of charity were inseparably intertwined with the politics of public welfare. The latter did not "replace' the former, but rather the extended patronage of the state was often matched by growing capacities of private organization and of non-governmental agencies. This tendency, Bernard Harris and David Cantor argue, was extended well into the 20th century.
World Health ~ World P o l l ~ T h e World Health Orgalzation and The U.N. System, by Javed Siddiqi. C. Hurst and Co. (Publishers) Ltd, London, 1995. 272 pp. (inc. Appendices, Biblio., Index), U.K. £32.50 (hb).
The volume, with 30 chapters, in four parts, sets out an analytic framework (effectiveness and politicization);
Department of Sociology, Elise M. FuUmer Anthropology and Social Work University of North Carolina at Charlotte Charlotte, NC 28223 U.S.A.
U- 158 INSERM Pavilion Archambault H6pital des Enfants Malades Paris France
liana L6wy
describes WHO's attempts to build a decentralized, universal health organization; reports on a case study of WHO's malaria eradication programme; and gives a summary and conclusions. The impression is of a series of essays written at different times. Information sources are WHO internal documents; records of meetings; reports (WHO and others); books and journal articles: and interviews with selected WHO personnel.
Book Reviews
CHntcal Evaluation of Psycllmtrol~ Drugs for PsydLiatri¢
Disorders: Principles u d Propo~d Guidelines, edited by Paul Grof, M. [ftikhar Akhter, Magda Campbell, Carl G. Gottfries, lnayat Khan, Yvon D. Lapierre, Louis Lemberger, Bruno Muller-Oerlinghausen and Brigette Woggon. Published on behalf of the World Health Organization by Hogrefe & Huber Publishers, Seattle, 1993. 202 pp., $38 (hardback). This book is one in a series prepared by specialists participating in the World Health Organization's programme on biological approaches to psychiatry. Edited by members of a working group, formed in 1986, the current volume offers a detailed review of the methods for clinical investigations of psychotropic drugs in order to assist those who are recent newcomers to these investigations. The book is described as an "'umbrella document" (p. 7) because it focuses on general principles considered essential for the evaluation of psychotropic drugs, while, at the same time, not being limited to a particular group of drugs. The editors point out that as guidelines, these principles reflect current standards for clinical evaluation. Therefore, these principles are not intended to define codified standards or rules of excellence. Furthermore, given that the medico-legal and socio-cultural contexts under which clinical evaluations of drugs for psychiatric disorders take place vary from country to country, the creative application of these principles, a theme which often remains hidden in this type of work, is underlined. Two initial discussions provide the reader with a brief introduction into the subject area and an overview of drug evaluation. Here, launching a review on the phases of evaluation, the editors outline key preclinical considerations which, in their view, should be understood prior to embarking on clinical evaluations. For example, important considerations before administering a drug to humans include a complete understanding of animal and toxicologic data as well as familiarity with the pharmacological properties of the drug. Chapters I to 4 follow quite closely the standard, four phases (i.e. clinical pharmacology, early therapeutic, main therapeutic and extended studies) of clinical drug evaluation. Chapters 5 and 6 outline ethical aspects of studies in children and the elderly respectively. The final chapter (Chapter 7) considers transcultural issues which affect drug evaluation. These issues include pharmacological variations (e.g. differences in drug responsiveness and dosing, pharmacokinetic differences, differences related to antipsychotic agents, etc.); cultural setting (e.g. personnel, training, availability of medication, etc.);
Vision and Aging:. l~ues in Social Work Practice, edited by Nancy Weber. The Haworth Press, Binghamton, NY, 1991, 196 pp., U.S $24.95 (cloth), $14.95 (pb). The book is a compilation of writings edited by a social worker who has extensive experience in the provision of services to elderly people who are visually impaired. The writings are broadly focused and address issues related to service delivery as well as cultural, social and psychological factors affecting people in their middle and older years who experience vision loss. Several of the authors are social workers but a number of other disciplines are represented as well including, for example, Public Administration, Recreation, Rehabilitation, Speech Pathology and Audiology, Education, Medicine and Public Health. The book is timely given that the proportion of elderly people in society is
sample selection; measurement; influence of folk medicines; and migration. Besides a useful glossary of terms, additional work at the end of the document includes a selection of WHO publications related to psychopharmacology; references recommended for further reading; lists of cited instruments, studies, tables, figures and diagrams; and a copy of the Declaration of Helsinki on Human Experimentation. Overall, the book is a useful clinical compedium, helping those involved in these investigations to carry out efficient and thoughtful evaluations. In particular, readers should find many of the comprehensive tables detailing or summarising key studies, scales and protocols of particular interest. At their best, the editors exhibit great sensitivity and a heightened awareness of the complex ethical issues involved in this type of work. However, one could argue that this should be a requirement of a document initiated by the World Health Organization. Nevertheless, two, albeit minor, shortcomings emerge. First, a potential investigator, working in the field of substance abuse, could take issue with the use of former narcotic drug users as subjects in studies of abuse liability (pp. 51-52). Here, this investigator may rightly ask, "If 'to be forewarned is to be forearmed', how can I as a clinician ensure that the effects of the drug will be beneficial to my subjects, if predominantly adverse events and prolonged misuse of a related substance or substances have been my subjects' experiences?" Secondly, the editors note early on in the text that "ethical considerations evolve with time and public perception and change with place and culture" (p. 25). Yet, nowhere in the chapter on transcultural issues are the deeper implications of this statement discussed. Perhaps, this omission is to be expected, given that the chapter is described as a commentary on important issues and not a "comprehensive treatise" (p. 170). On the other hand, it would have been worthwhile in this context to demonstrate how ethical issues intersect with cultural and ethnic differences. In spite of these faults, this book is a must for those involved in contemporary, clinical psychotropic drug evaluations.
Department of Sociology ,~bo Academy University 00250 Abo, Finland and Department of Sociology Helsinki University 00014 Helsinki, Finland
Elizabeth Ettorre
increasing and vision impairment or loss is a common problem among people as they age. The book can also be commended for its inclusion of content on services to minority populations (Cunningham) and qualitative research emphasizing the feelings and life issues of older adults with visual impairments (Burack-Weiss/Miller). There is also an informative chapter on loss and adjustment by older people and their families when blindness or deteriorating vision becomes an issue (Orr). The primary emphasis of the book is on service delivery. In "A Model of Comprehensive Community-Based Services" a service delivery model implemented by a not-forprofit agency serving blind and visually impaired older adults in New York City is described (Ludwig and Schneider). A second article (Rogers and Long) discusses the barriers to effective service delivery, outlines several
Book Reviews
1339
community service models and makes suggestions for implementing these models nationwide. A third article (Stuen) reports on the results of a survey designed to assess the awareness of aging services personnel of resources and services available for persons with age-related vision loss. Other articles specifically address rehabilitation services. One (Weiner) discusses the rehabilitative needs of older adults with visual impairments and describes the role and functions of rehabilitation teachers and another (Crews) outlines methods for measuring rehabilitation outcomes as a function of public policy implementation. A third article (Ycadon) focuses on service utilization and the development of a comprehensive service plan for rehabilitation that addresses the complex issues facing older adults with visual impairments and a fourth (Wainapel) on a comparison of the medical and vision rehabilitation systems with suggestions for coordination and cooperation between systems. Several articles focus on assessment. Research on the development of a vision screening questionnaire for older
people is reported (Horowitz, Teresi and Casseis). A survey study is also included which reports on sample demographic characteristics and self-reported needs of blind or severely visually impaired people over 70 years old. Another article (Rose) uses a developmental framework for identifying age-related health issues of importance at various states in the adult life cycle. The book provides a good overview of the issues related to aging and vision loss and should prove to be useful to inform administrators, practitioners and researchers who work with this population or are studying service implementation and public policy.
Medicine and Charity before the Welfare State, edited by Jonathan Barry and Colin Jones. Routledge, London, first published in 1991, paperback edition, 1994.
Another important topic is the role of charities in the pdestablishment of professional roles and market relationships. Here again, the case studies presented in the book contradict the simplistic opposition between 'for profit" and "non-profit' organizations, or between 'lay' and 'professional' care of the sick. For example, Ann Summers shows that the early nursing charities organized by religious groups were able to obtain an influential position by firmly establishing themselves in the market place through the acquisition of permanent contracts. From the Renaissance on, charities contributed to the development of medicine and to the reinforcement of the professional status of doctors. 17th and 18th century charities, Katherine Park and Jonathan Andrews propose, were already not concerned exclusively with the saving of souls, but also with cures, and competed through their perceived therapeutic efficacy. This trend was maintained and reinforced in the 19th and 20th centuries. Finally, several essays point to the role of charities in the establishment of the power positions of specific dominating groups and in the mutual shaping of lay and professional interests. They also indicate the ways charities were used by the poor as a means to advance their social or economic position and to increase their 'social worth'. In conclusion, the studies included in Medicine and Charity before the Welfare State cast new light not only on past relationships between medicine and charity, but also on the larger problem of medicine as a cultural, social, economic and political activity. This book may be seen as an apt illustration of Rudolf Virchow's statement in 1848 that "medicine is a social science".
The paperback edition of the book, Medicine and Charity before the Welfare State (Jonathan Barry and Colin Jones, eds), first published in 1991 will facilitate the access of graduate and undergraduate students and the general academic public to this important collection of historical essays. Doctors, but also sociologists of medicine, may have a tendency to simplify the past, to favor linear histories, to pay attention only to events and concepts which are in agreement with present-time rationality, and to 'read backward' today's institutions and organizations into historical events. The studies included in this book avoid the pitfalls of viewing history as the "pathway to modern welfare state" and offer rich accounts of the multilayer interactions between medicine and charity. One of the central subjects in the book is the relationship between the modern state and charities. The two are sometimes opposed, and the modern state is viewed as taking over the function of charities. In fact, however, as several essays stress, charity intervention and state intervention grew together. Charitable institutions were an important resource for liberal governments because they supplied means for dealing with acute problems of the poor and a way of relieving complex social problems without being obliged to admit that access to health care is a right of the poor. In the 19th century, Paul Weindling and Allan Mitchell explain, the policies of charity were inseparably intertwined with the politics of public welfare. The latter did not "replace' the former, but rather the extended patronage of the state was often matched by growing capacities of private organization and of non-governmental agencies. This tendency, Bernard Harris and David Cantor argue, was extended well into the 20th century.
World Health ~ World P o l l ~ T h e World Health Orgalzation and The U.N. System, by Javed Siddiqi. C. Hurst and Co. (Publishers) Ltd, London, 1995. 272 pp. (inc. Appendices, Biblio., Index), U.K. £32.50 (hb).
The volume, with 30 chapters, in four parts, sets out an analytic framework (effectiveness and politicization);
Department of Sociology, Elise M. FuUmer Anthropology and Social Work University of North Carolina at Charlotte Charlotte, NC 28223 U.S.A.
U- 158 INSERM Pavilion Archambault H6pital des Enfants Malades Paris France
liana L6wy
describes WHO's attempts to build a decentralized, universal health organization; reports on a case study of WHO's malaria eradication programme; and gives a summary and conclusions. The impression is of a series of essays written at different times. Information sources are WHO internal documents; records of meetings; reports (WHO and others); books and journal articles: and interviews with selected WHO personnel.