Of orphans and balloons

Technologies with significant implications for expenditures continue to reach the health care system. These technologies range from orphan drugs/biologicals used to treat rare diseases to balloons used to treat the common occurrence of benign prostatic hyperplasia (BPH) in aging men. Because payment for these technologies can represent a serious financial drain on third-party payers, utilization has to be carefully evaluated, monitored, and controlled.     

Investigational: what's in a name

The term "investigational" has become the fulcrum upon which coverage decisions turn. All third-party payers, including the federal government, use varying definitions of the term for the purpose of excluding treatments from coverage for payment. Unfortunately, no consistent definition of the term is available to payers to guide them in their coverage decisions.     

Coverage, technology assessment, and the courts

Coverage decisions by third-party payers are relying more and more heavily on the conclusions of technology assessment programs about the safety and effectiveness of technologies applied in specific clinical situations. Assessment programs vary markedly in the sophistication and rigor of their methodology. Payers differ as to how such assessment information is integrated into their decision-making processes. Finally, coverage decisions about a specific technology can vary widely across the country.     

The challenge of world health

2 development specialists have expounded on the demands world health has placed on public health. Striking declines in infant and child mortality occurred with the advent of biomedical and technical interventions in developing countries after World War II. At the same time, these interventions promoted longer lives by curing and/or treating chronic diseases in developed countries. In the 1970s, however, it was apparent that the hospital based, curative approach could not meet health needs and was very costly. In developed countries, biomedical and social sciences showed that chronic diseases did not occur due to modernization but from unhealthy behaviors, diet, and lifestyle. In fact, in 1975, the US Centers for Disease Control announced that unhealthy lifestyles contributed to 50% of all deaths while the medical system was responsible for only 11%. The US and other developed countries then began to promote healthy lifestyles, and in the 1980s, considerable improvements in health occurred, especially among adults. Developing countries which depended on the Western medical model did not experience health gains in the 1970s. Yet developing countries where health systems concentrated on carrying essential services to all people and promoted basic hygiene and sound dietary practices continued to achieve considerable health gains. In 1978, WHO an UNICEF hosted the International Conference on Primary Health Care in Alma Ata, the Soviet Union to hold these developing countries with community based health systems as models of primary health care (PHC). The 1980s witnessed the spread of PHC especially in the form of child survival which focused on oral rehydration therapy and breast feeding. The biomedical and social sciences are needed to move this health policy and program strategy forward. Governments must see to policies that promote healthy people. Political will is needed to make human welfare a high priority.     

RACE-OF-INTERVIEWER EFFECTS IN A PREELECTION POLL VIRGINIA 1989

All published preelection surveys of the 1989 Virginia gubernatorialcontest overestimated the vote share of the black candidateand eventual victor, Douglas Wilder. We offer a "social desirability"interpretation of the polls' inaccuracies and hypothesize thatclaiming support for Wilder was the socially desirable responsefor some whites, especially when the interviewer was black.We show a race-of-interviewer effect on the vote intention ofwhite respondents of 8–11 percentage points in a preelectionsurvey of Virginia voters. The effects were greatest among whiteDemocrats and among whites who were more uncertain of theirvote intention. We discuss the implications of these findingsfor race-of-interviewer research and for improving the accuracyof preelection forecasts in contests with black and white opposingcandidates.     

Recent trends in the process of stratification

Using the 14 annual cross-sections from the General Social Survey, we specify a "basic model" of attainment and describe the year-by-year fluctuations in its parameters. The results are partially consistent with theories describing the gradual growth of universalistic patterns of stratification and mobility. Under a linear model of educational achievement, we find that the direct effects of race are weakening and the returns to class-based advantages are declining in tandem. The contours of the socioeconomic "gender gap" are also changing in important ways, with the male intercept declining at a rapid pace and the female term registering small and insignificant year-by-year gains. At the same time, the returns to experience and schooling are increasing for men, whereas the corresponding returns for women have remained stable over the 15-year period. This pattern of interaction effects implies that the size of the gender gap varies over time and across different population groups.     

Capital accumulation,endogenous population growth,and Easterlin cycles

In this paper we attempt to explain the occurrence of population cycles in industrialised economies where the birth rate depends on the difference between the actual and the expected consumption rate. This model of an endogenously growing population brings together Easterlin's idea of an adapting aspiration level with the neoclassical optimal growth paradigm. It is shown that in this highly aggregated demo-economic system (i.e., without inclusion of the age structure of a population) swings both in the economic and demographic variables may exist. The reason behind this strange optimal behaviour is identified to be an intertemporal substitution effect between current and future levels of consumption.We wish to thank A. Novak for helpful assistance and an anonymous referee for useful comments. Financial support by the Austrian Science Foundation under contract No. P6601 is acknowledged.     

Telling lies in everyday life: Motivational and organizational consequences of sequential preferences

This study of a collection of self-observed lies told in everyday interactions indicated that all informants lied; that lying was, generally, an easy and spontaneous activity; and that our varied informants told lies in much the same manner and for the same reasons. The analysis of the general features of the interactions in which lies were embedded showed that many lies are the consequence of a preference system that promotes acceptance and hides rejection in the sequential organization of interaction. The lies found in pre-acceptance and pre-rejection sequences indicate that both parties contrive for acceptance. The negative cases of lies told in rejection of deprecating assessments suggest a broader theoretical template that encompasses the lies told for acceptance as a subset of the interactional preference for social solidarity. In contrast to the view that telling lies undermines social cohesion by interfering with trust, this study indicates that many lies are told to affirm affiliation.     

Tearoom trade: A research update

Conclusion Like many studies of covert deviance, this paper is based upon a captive sample of persons who have come to the attention of law enforcement agencies. The existence of Laud Humphreys' research, however, makes possible a comparison of police generated data with data obtained through observations and interviews with unapprehended offenders. Because police observations were so detailed, a rare opportunity to replicate a qualitative study presented itself. This research largely substantiates the picture drawn by Humphreys in his classic study,Tearoom Trade: Impersonal Sex in Public Places. Consistent with his observations, most tearoom participants (a) communicate through non-verbal gestures and seldom speak, (b) do not associate outside the tearoom or attempt to learn one another's identity or exchange biographical information, (c) do not use force or coercion or attempt to involve youths or children, (d) are primarily heterosexual and married, (e) depart separately with the insertor leaving first, (f) commit their sex acts out of sight of the entrance and accidental exposure, (g) do not undress or engage in anal sex, (h) break off sexual contact when someone enters the washroom, (i) rarely approach straight men, (j) read and write sexually explicit homosexual graffiti, and (k) linger inside and outside the washroom for someone to appear. In addition, (1) fellatio is generally not reciprocated and fellators are usually older men; (m) most offenders are neat in appearance; (n) some engage in series and simultaneous encounters; (o) encounters are brief, usually not exceeding twenty minutes; and (p) few have criminal records with the exception of those previously convicted of similar offenses.The behavior of players reveals remarkable consistency over time, from community to community, and across national boundaries. Many men, the majority of them married and primarily heterosexual, continue to visit out-of-the-way public washrooms in search of fast, impersonal, and exciting sex despite the risk to family, friends, job, and reputation. Although shopping malls have usurped public parks as the favorite locale of tearoom participants, the basic rules of the game and profile of the players—as Humphreys contends—remain the same over time and place.