This book brings an unusual opportunity to explore the peculiarities of America's health care industry's approach to fraud control, when compared with the financial services sector, credit card companies, or the Internal Revenue Service—all of which have to defend themselves against fraud.
Motivated by the explosion of molecular data on humans-particularly data associated with individual patients-and the sense that there are large, as-yet-untapped opportunities to use this data to improve health outcomes, Toward Precision Medicine explores the feasibility and need for "a new taxonomy of human disease based on molecular biology" and develops a potential framework for creating one. The book says that a new data network that integrates emerging research on the molecular makeup of diseases with clinical data on individual patients could drive the development of a more accurate classification of diseases and ultimately enhance diagnosis and treatment. The "new taxonomy" that emerges would define diseases by their underlying molecular causes and other factors in addition to their traditional physical signs and symptoms. The book adds that the new data network could also improve biomedical research by enabling scientists to access patients' information during treatment while still protecting their rights. This would allow the marriage of molecular research and clinical data at the point of care, as opposed to research information continuing to reside primarily in academia. Toward Precision Medicine notes that moving toward individualized medicine requires that researchers and health care providers have access to very large sets of health- and disease-related data linked to individual patients. These data are also critical for developing the information commons, the knowledge network of disease, and ultimately the new taxonomy.
When the vast wartime factories of the Manhattan Project began producing plutonium in quantities never before seen on earth, scientists working on the top-secret bomb-building program grew apprehensive. Fearful that plutonium might cause a cancer epidemic among workers and desperate to learn more about what it could do to the human body, the Manhattan Project's medical doctors embarked upon an experiment in which eighteen unsuspecting patients in hospital wards throughout the country were secretly injected with the cancer-causing substance. Most of these patients would go to their graves without ever knowing what had been done to them. Now, in The Plutonium Files, Pulitzer Prize-winning reporter Eileen Welsome reveals for the first time the breadth of the extraordinary fifty-year cover-up surrounding the plutonium injections, as well as the deceitful nature of thousands of other experiments conducted on American citizens in the postwar years. Welsome's remarkable investigation spans the 1930s to the 1990s and draws upon hundreds of newly declassified documents and other primary sources to disclose this shadowy chapter in American history. She gives a voice to such innocents as Helen Hutchison, a young woman who entered a prenatal clinic in Nashville for a routine checkup and was instead given a radioactive "cocktail" to drink; Gordon Shattuck, one of several boys at a state school for the developmentally disabled in Massachusetts who was fed radioactive oatmeal for breakfast; and Maude Jacobs, a Cincinnati woman suffering from cancer and subjected to an experimental radiation treatment designed to help military planners learn how to win a nuclear war. Welsome also tells the stories of the scientists themselves, many of whom learned the ways of secrecy on the Manhattan Project. Among them are Stafford Warren, a grand figure whose bravado masked a cunning intelligence; Joseph Hamilton, who felt he was immune to the dangers of radiation only to suffer later from a fatal leukemia; and physician Louis Hempelmann, one of the most enthusiastic supporters of the plan to inject humans with potentially carcinogenic doses of plutonium. Hidden discussions of fifty years past are reconstructed here, wherein trusted government officials debated the ethical and legal implications of the experiments, demolishing forever the argument that these studies took place in a less enlightened era. Powered by her groundbreaking reportage and singular narrative gifts, Eileen Welsome has created a work of profound humanity as well as major historical significance. From the Hardcover edition.
Each year in the United States, 250,000 infants are born too soon, weighing too little. For these low birth weight, premature infants, the future is uncertain, since they are at risk for a variety of serious medical and developmental problems—including behavioral and learning disorders that may have damaging effects for the rest of their lives. The extent to which a comprehensive early intervention program could improve or prevent these adverse outcomes was examined in the Infant Health and Development Program, a randomized controlled trial involving almost 1,000 infants in eight cities in the United States. This book describes in detail the program, its research methodology, the progress of the program, and the results of the clinical trial. The program was administered by an interdisciplinary team composed of physicians, biostatisticians, child development specialists, and researchers from several disciplines. It was instituted upon the discharge of the infants from the neonatal nursery and was maintained for three years. One-third of the infants were randomly assigned to an intervention group, the remainder to a follow-up group. Infants in both groups received pediatric care and community referral services, but only those in the intervention group participated in a program that included extensive home visits, attendance at a child development center, and group meetings for parents. The results of the program proved to be clinically important; at age three, the children in the intervention group had significantly higher IQ scores, greater cognitive development, and fewer behavioral problems. The implications of the findings for public policy are equally important, for there is increasing interest in the prevention, early detection, and management of developmental disabilities in children, as evidenced by such legislation as the Education for All Children Act. Strategies to minimize the problems of low birth weight children, with their potential for long-term savings through the prevention of disabilities and their attendant costs, could have significant repercussions in such governmental areas as medical care, education, and social welfare.
With this important resource, health care leaders from the board room to the point-of-care can learn how to apply the science of safe and best practices from industry to healthcare by changing leadership practices, models of service delivery, and methods of communication.
Introducing theories and concepts essential for human services administration, this book covers organization theory and management, budgeting and financial management, personnel administration and labor relations, laws and regulations, innovation and change, and data administration and information systems. The author explores bioethics and managing "Babies Doe," legal right to refuse treatment, nursing home payments, and more. He applies important general concepts to specific concerns such as organizational structure and service delivery arrangements, internal financial planning, innovations in drug services delivery, and implementing medical information systems.
The traditional lines of demarcation between service providers and service users are shifting. Professionals in managed service organizations are working to incorporate the voices of service users into their missions and the way they function, and service users, with growing access to knowledge, have taken on the semblances of professional expertise. Additionally, the human services environment has been transformed by administrative imperatives. The drive toward greater efficiency and accountability has weakened the bond between users and providers. Reimagining the Human Service Relationship is informed by the premise that the helping relationship should be seen as developing in the interactive space between those who provide human services and those who receive them. The contributors to this volume redefine the contours, roles, institutional divisions, means, and aims of providing and receiving services in a range of settings, including child welfare, addiction treatment, social enterprise, doctoring, mental health, and palliative care. Though they advocate an experience-near approach, they remain sensitive to the ambiguities and competing rationalities of the service relationship. Taken together, these chapters reimagine the service relationship by making visible the working relevancies of service delivery.