Health care policy in the United States

Health care policy in the United States

1336 Book Reviews Prostate Cancer: Making Survival Decisions, by Sylvan Meyer and Seymour C. Nash. University of Chicago Press, Chicago, IL, 1994, 2...

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Book Reviews

Prostate Cancer: Making Survival Decisions, by Sylvan Meyer and Seymour C. Nash. University of Chicago Press, Chicago, IL, 1994, 264 pp. U.S. $19.95. The growing belief that patients should be fully informed and active participants in therapeutic choices has created a need for up-to-date, authoritative, medical information in forms accessible to lay readers. Doctors, governments, and private organizations provide an enormous amount of literature designed to help patients, and those who support and counsel them, to deal with long-term diseases. A part of this outpouring, and a substantial part as can easily be judged by linear feet of shelf space devoted to it in bookstores, are books on cancer, AIDS, heart disease, lupus, and other chronic conditions addressed to sufferers and those family and friends sometimes called 'therapy management groups' by medical anthropologists. This general trend is extremely helpful. Patients who desire to become very knowledgeable about their conditions and those who want or can understand only the basic facts can easily find useful material, while those who prefer to leave things entirely in the hands of professionals can ignore such works. The value of this avalanche of factual and advice literature is directly proportional to its accuracy and intelligibility. Good books can be a blessing; bad ones a disaster. There certainly is a need for information on prostrate cancer, a common disease with increasing incidence in North America. Meyer, the main author, like the writers of many works of this genre, suffers from the disease he writes about. His collaborator Nash is a noted authority on prostate cancer

Health Care Policy in the United States, by Keith J. Mueller. University of Nebraska Press, Lincoln, NE, 1993, 216 pp. U.S. $30.00 (cloth). This single-author work constructs a remarkably comprehensive yet compact evaluation of the evolution of health policy in the United States. The author avoids the strategy--common to much of the health policy literature---which focuses on economic debates for and against potential approaches to policy formation. Instead he seeks to increase our understanding of health policy change by concentrating on the fluctuating political forces instrumental in its creation. Mueller, a professor of political science at the University of Nebraska and director of the Center for Rural Health Research at the University of Nebraska Medical Center, asks us to understand health policy within the context of the political climate, the demands of the citizenry, and the power of special interest groups as they exist at a particular point in time. Such an orientation may seem almost unquestionably appropriate, yet many policy analyses seem to give these factors little attention when, in fact, they are key to determining what change and how much change is actually possible. The author increases our appreciation of political and social influences and how they have combined with the data of policy research to frame the debate in the health policy arena. In his own words, " . . . a thorough understanding of the development of health policy requires both knowledge of the actions of key actors within the political system and of the persuasiveness of research concerning specific policy sugggestions." His first three chapters seek to do this in the

and a prominent urologist. The book began with Meyer's diagnosis and his desire to learn as much as possible about prostate cancer and treatment options. It is, indeed, directed toward like-minded persons who want detailed information. Guided by Nash, Meyer has surveyed much of the medical literature and consulted with leading researchers, urologists, oncologists and radiologists, as well as dozens of fellowpatients. Readers learn what it is like to be on the receiving end of various tests and procedures, are given detailed information on the nature and progression of the disease, and are presented with extensive data on the efficacy and complications of surgery, external beam and localized radiation, hormone therapy, cryosurgery and 'watchful waiting' at various stages of the disease. Side effects are fully discussed. Meyer correctly stresses the tentative nature of much of recent knowledge and the rapid pace of research. Patients and their doctors may rationally choose different courses of action, and it is crucial to ask questions and keep abreast of new developments. This is a well-researched book with numerous references for those who wish to explore further. While the going can be tough as clinical studies are summarized in rapid succession, the prose is generally clear. The book meets the test of accuracy and honesty. It also meets at least this reviewer's test of practicality; as a member of a 'therapy management group' I am glad that I read it.

Cameron Applied Research Center K. David Patterson University of North Carolina at Charlotte Charlotte, N.C., U.S.A.

broadest sense, covering The Politics of Health Care; The U.S. Political System and Health Policy; and Government, Business, and Issues of Payment. Mueller's writing style is clear and crisp, a pleasant combination in a health policy book. While some of the facts presented may be known to those who have been active in studying or working in the health policy field, Mueller's special contribution is to analytically weave these facts together in ways which highlight the context in which change can occur and which encourage us to form new perspectives and insights on common health policy themes such as those covered in chapters 4 through 8: Health Care Cost-Containment Policies; Issues in Access to Health Care; Issues in Quality in Health Care; Health Care Reform: Lessons From Abroad and National Health Insurance; and The Future of Health Care Policy in the United States. Written before the consideration of the Clinton health care package, the author accurately concludes that, while a growing number may recognize the need for more "radical reform', the critical mass for such a change is nonetheless lacking. Based on an analysis of the political forces at work, Mueller predicts that what change may come--if and when it comes--will necessarily be much more modest and incremental in nature. So it appears to be. This book should prove especially useful at the graduate level and among persons interested in gaining insight into the dynamics of health policy change in the United States.

Department of Health Sciences University of Nevada Reno, NI/ 89557, U.S.A.

Gregory J. Hayes