Helping oneself by helping others: evaluation of a service credit banking demonstration

Between 1987 and 1990, the Robert Wood Johnson Foundation funded six service credit banking demonstration programs among the elderly in which participants delivered services in return for credits, entitling them to later service. This evaluation of the demonstrations found that these six sites successfully attracted elders for the delivery of household support services to a relatively old, frail population with potentially limited social networks. Evidence on the significance of the "credit" in attracting volunteers was mixed, but the programs have attracted new volunteers, and have not substituted for other volunteer activities. Program development has entailed considerable staff investment in volunteer support; programs are better understood as community membership organizations than as mechanical exchanges.     

Multistate life-tables and regression models

"A survey is given of the use of modern statistical techniques in event history analysis, and in particular in the study of multi-state life-tables in demography. Emphasis is placed on the interplay between partial likelihood and nonparametric maximum likelihood based methods, a) when analysing semi-Markov models or models with repeated spells, and b) in frailty models for unobservable heterogeneity."     

Breast implants, Hippocrates, and burden of proof

The author argues that the burden of proof for the safety and efficacy of some medical devices properly lies with the manufacturers of the devices and with the providers who use them. The controversy over breast implants is used as a case for this shift in the burden of proof of safety and effectiveness.     

Biotechnology: will it break the health care bank?

Pharmaceuticals traditionally have been viewed as a cost-effective component in medicine's technological armamentarium. The use of pharmaceuticals has been estimated to account for 6-8 percent of the nation's total expenditures on health care. The first wave of pharmaceuticals/biologicals that has been produced by the biotechnology industry has offered therapies that can provide much benefit to patients, but it has also raised concern about the cost of these new recombinant drugs. In addition to pricing, methods of promotion and modifications in the FDA approval process have raised concerns.