Health technology assessment between our health care system and our health

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals. So as to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites. We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit.     

Interactionism,Social Organization,and Social Processes: Looking Back and Moving Ahead

With its roots in American pragmatism, symbolic interactionism has created a distinctive perspective and produced numerous important contributions and now offers significant prospects for the future. In this article, I review my intellectual journey with this perspective over forty years. This journey was initiated within the American society, sociology, and symbolic interaction of circa 1960. I note many of the contributions made by interactionists since that time, with particular focus on those who have contributed to the study of social organization and social process. I offer an agenda for the future based on currently underdeveloped areas that have potential. These are inequality orders, institutional analysis, collective action across space and time, and the integration of temporal and spatial orders. The article concludes with calls for further efforts at cross‐perspective dialogues, more attention to feminist scholars, and an elaborated critical pragmatism.     

Earnings Inequality in the Nonmetropolitan United States: 1967–19901

Abstract Nonmetropolitan (nonmetro) inequality patterns are contrasted with those of metropolitan (metro) areas to assess the utility of neoclassical and restructuring theoretical frameworks. Inequality measures are constructed from March Current Population Surveys for the years 1968–1991. Results indicate that inequality is greater in nonmetro areas than in metro areas. Results of decomposition procedures suggest that the observed inequality is due to a mix of neoclassical and restructuring factors that account for more inequality in metro than nonmetro areas. National policies must take account of metro/nonmetro differences in patterns and sources of inequality.     

UNDERSTANDING THE DECISION TO PARTICIPATE IN A SURVEY

The lack of full participation in sample surveys threatens theinferential value of the survey method. We review a set of conceptualdevelopments and experimental findings that appear to be informativeabout causes of survey participation; offer an integration ofthat work with findings from the more traditional statisticaland survey methodological literature on nonresponse; and, giventhe theoretical structure, deduce potentially promising pathsof research toward the understanding of survey participation.     

An introduction to econometric applications of empirical process theory for dependent random variables

This paper discusses some uses in econometrics of empirical process theory for dependent rendom variables. Examples considered include non-standard parametric hypotheses tests and semiparametric estimation. The application of bracketing functional limit results is discussed in some detail     

The peripheral position of sex in a psychotherapy: An illustrative case of a mirror transference

Understanding the role of sexualization in a depressed patient gives us the opportunity to re-examine the place of sexual activity in psychopathology. The self psychological concept of the mirror transference is used to explain the therapist's activity in the case illustration.     

Sexual identity in the ghetto

The more things change, the worse they get.Presented April 18, 1991, Duke University, at the Department of Psychiatry's Grand Rounds, this paper condenses, integrates and updates the author's earlier publication. Acknowledgement and thanks for funding and professional sponsorship of the four research studies this paper draws from are selectively due to the Eugene and Agnes E. Meyer Foundation, the Edgar Stern Family Fund, The National Institute for Mental Health, the Baltimore-Washington Institute for Psychoanalysis and the Department of Psychiatry, Children's Hospital National Medical Center.     

Interracial rape: Examining the increasing frequency argument

A number of researchers have recently challenged the long-held notion among criminologists that rape, along with most other violent crimes, is an intraracial crime. Based on analysis of survey data they concluded that black rapists “prefer” or “seek out” white victims and that the likelihood of a black offender selecting a white victim has been increasing during recent years. Data presented here (1977–88 National Crime Surveys) refute the notion that black rapists “prefer” white victims. Moreover these same data fail to support the contention that rapes involving black offenders and white victims have been increasing. According to National Crime Survey estimates, the proportion of black offenders that victimize whites has been declining. An earlier version of this paper was presented at the annual meetings of the American Society of Criminology, November 1991.