Jae-Mahn Shim

Attention to local health burden and the global disparity of health research.

Most studies on global health inequality consider unequal health care and socio-economic conditions but neglect inequality in the production of health knowledge relevant to addressing disease burden. We demonstrate this inequality and identify likely causes. Using disability-adjusted life years (DALYs) for 111 prominent medical conditions, assessed globally and nationally by the World Health Organization, we linked DALYs with MEDLINE articles for each condition to assess the influence of DALY-based global disease burden, compared to the global market for treatment, on the production of relevant MEDLINE articles, systematic reviews, clinical trials and research using animal models vs. humans. We then explored how DALYs, wealth, and the production of research within countries correlate with this global pattern. We show that global DALYs for each condition had a small, significant negative relationship with the production of each type of MEDLINE articles for that condition. Local processes of health research appear to be behind this. Clinical trials and animal studies but not systematic reviews produced within countries were strongly guided by local DALYs. More and less developed countries had very different disease profiles and rich countries publish much more than poor countries. Accordingly, conditions common to developed countries garnered more clinical research than those common to less developed countries. Many of the health needs in less developed countries do not attract attention among developed country researchers who produce the vast majority of global health knowledge—including clinical trials—in response to their own local needs. This raises concern about the amount of knowledge relevant to poor populations deficient in their own research infrastructure. We recommend measures to address this critical dimension of global health inequality.

The Limit of Equality Projects: Public-Sector Expansion, Sectoral Conflicts, and Income Inequality in Postindustrial Economies

In this study, we investigate how structural economic changes constrain an equality project, the public-sector expansion strategy. First, we describe a three-stage process in which a growing productivity gap between the private-manufacturing and public-service sectors disrupts traditional class solidarity. We contend that emerging conflicts between private and public sectors due to public-sector expansion and a growing inter-sectoral productivity gap eventually lead to employment and budget crises, as well as the weakening of coordinated wage-setting institutions. Furthermore, political, institutional, and economic transformations originating from sectoral cleavages and imbalance lead to increased income inequality. We test this argument using an unbalanced panel dataset on 16 advanced industrial democracies from 1971 to 2003. We find that public-sector employment has a strong negative effect on income inequality when the productivity gap between sectors is low. In such situations, public-sector employment fulfills its promise of equality and full employment. However, as the inter-sectoral productivity gap increases, the negative effect of public-sector expansion on income inequality evaporates. The findings suggest that severely uneven productivity gaps due to different degrees of technological innovations significantly weaken and limit the effectiveness of left-wing governments’ policy interventions through public-service expansion.

Patterns of user disclosure of complementary and alternative medicine (CAM) use.

Objective:To investigate patterns of complementary and alternative medicine (CAM) use disclosure across medical and sociobehavioral factors and to provide a model that takes into account factors in explaining those patterns. Subjects:A total of 21,849 CAM use episodes from 7347 respondents in the 2007 US National Health Interview Survey which involves the latest survey on CAM use. Research Design:Respondents were a representative sample of US national population. Logistic hierarchical linear models specify how characteristics of users and their CAM use episodes influence user disclosure behaviors. Results:At the individual level, users were more likely to disclose CAM use to health care professionals when they had health problems and when they were insured. At the episode level, CAM use episodes were more likely to be disclosed when they were intended to treat a specific medical condition and recommended by a health professional. Disclosure rates were high among most susceptible users (ie, sick people intending to treat specific conditions with CAM) and among the biologically based CAM modalities (eg, herbal supplements) that are most likely to produce adverse interactions with conventional biomedical treatments. Conclusions:User disclosure was affected not only by users’ demographic and socioeconomic characteristics but also by episode-specific factors. Efforts to improve provider-user communication of CAM use should consider the varying effects of these factors.

The Relationship Between the Use of Complementary and Alternative Medicine and the Use of Biomedical Services Evidence From East Asian Medical Systems

To provide East Asian evidence to the relationship between the use of complementary and alternative medicine (CAM) and the use of biomedicine, this article examines the institutionalization of traditional East Asian medicine (EM) in China, Korea, and Japan and how it affects the relationship between EM use and biomedicine use. It uses the 2010 East Asian Social Survey. Logistic regressions specify the statistical association between EM use and biomedical physician visits. These models show that the high institutional acceptance of EM promotes the concurrent use of EM and biomedicine. In addition, since these countries feature different ways of institutionalizing EM (unification in China, equalization in Korea, and subjugation in Japan), the concurrent use is more obvious under the Chinese and the Korean system than the Japanese system. It concludes that the CAM use can be complementary to biomedicine, depending on how CAM and biomedicine are institutionalized in medical systems.

Institutional heterogeneity in globalization: Co-development of western-allopathic medicine and traditional-alternative medicine

Are globalized social interactions accompanied by homogeneous or heterogeneous institutions? Which social factors are at work in each case? As an investigation of this cultural-institutional aspect of globalization, this article reflects on relationships between traditional-alternative medicine (TAM) and western-allopathic medicine (WAM) through a quantitative cross-national analysis. First, it is found that the global scene of medical institutional developments is characterized by institutional heterogeneity in which locally diverse TAMs develop simultaneously with WAM. This co-development relationship supports the heterogeneity thesis over the homogeneity thesis regarding the global character of national institutional developments. Second, this heterogeneous institutional arrangement is found to be stronger with a rising mortality burden. Third, this medical institutional heterogeneity is yet open to an antithetical development toward homogenization, depending on the extent to which the world polity pressure for WAM develops. However, the authors suggest a qualification of any notion of the unconditional significance of the world polity’s homogenizing force.

Cross-national differences in the holistic use of traditional East Asian medicine in East Asia

Complementary and alternative medicine (CAM) has been one of the popular strategies for health promotion. Traditional East Asian medicine (TEAM) is one of the most popular CAM practices in the world and there are suggestions that its holistic utilization is important for users to gain its effects for health promotion. In this context, this study investigates the extent to which TEAM users in East Asian countries utilize various modalities of TEAM holistically. It provides a model that explains cross-national differences in the extent of the holistic use of TEAM between China, Japan, Korea and Taiwan. Using the 2010 East Asian Social Survey, regression models specify the relationship between the holistic use of TEAM and the geographical location (country). The presence of TEAM doctors who hold the comprehensive and exclusive practice rights over TEAM is found to be conducive to the holistic utilization of various TEAM modalities. Thus, Taiwanese and Koreans use TEAM more holistically than Chinese and even more so than Japanese. The result suggests that the manner in which TEAM is institutionalized affect the extent to which TEAM users utilize various TEAM modalities together and potentially the health promotion effects of TEAM.

The influence of social context on the treatment outcomes of complementary and alternative medicine: the case of acupuncture and herbal medicine in Japan and the U.S.

BackgroundComplementary and alternative medicine (CAM), such as acupuncture and herbal medicine, is popular in many countries. Yet, treatment outcomes of CAM are found to vary significantly between medical trials in different social environments. This paper addresses how the social organization of medicine affects medical treatment outcomes. In particular, it examines the extent to which two popular complementary and alternative medicine (CAM) interventions (acupuncture and herbal medicine) are coordinated with biomedicine and how coordination characteristics are related to the treatment outcomes of the two CAM interventions.MethodsThis paper conducts an archival analysis of the institutional settings of the CAM interventions in Japan and the U.S. It also conducts a systematic content analysis of the treatment outcomes in 246 acupuncture reports and 528 herbal medicine reports that are conducted in Japan or the U.S. and registered in the Cochrane Library’s Central Register of Controlled Trials (CENTRAL), and 716 acupuncture reports and 3,485 herbal medicine reports that are from Japan or the U.S. and listed in MEDLINE. It examines the association between the treatment outcomes of the two interventions and the geographical location of the reports; it also explores how the institutional settings of the interventions are related to the treatment outcomes.ResultsJapanese herbal medicine is integrated into the national medical system the most and American herbal medicine the least; American acupuncture and Japanese acupuncture fall in the middle. Treatment outcomes are the most favorable for Japanese herbal medicine and the least favorable for American herbal medicine. The outcomes of American acupuncture and Japanese acupuncture fall in the middle.ConclusionsThe co-utilization of CAM with biomedicine can produce difficulties due to tensions between CAM and biomedicine. These difficulties and subsequent CAM treatment outcomes vary, depending on how CAM is institutionalized in relation to biomedicine in the national medical system. Coordinated CAM interventions are more likely to be effective and synergic with biomedicine, when compared to uncoordinated ones.

The association between the use of biomedical services and the holistic use of traditional East Asian medicine: a national survey of outpatients in South Korea

Objectives The holistic use of a system of complementary and alternative medicine (CAM) is potentially linked to its treatment outcomes. This paper examines how the use of biomedicine is associated with the holistic use of CAM, focusing on traditional East Asian medicine (EM) that is uniquely integrated in the medical system in South Korea. Design/Settings A representative national sample of EM outpatients in South Korea. Participants 3861 survey respondents. Methods By using the 2011 Korean National Survey of EM patients, ordered logistic regression models specify the relationship between EM outpatients’ use of biomedicine and their holistic use of EM modalities. Results Among EM outpatients who used at least one EM modality in the past 3 months, people who used two (33.3%) or three (29.4%) modalities together are the two highest proportions, followed by users of four (18.1%), five (7.2%), six (2.1%) and seven (0.6%) modalities. The odds for EM users to use EM holistically are 17% greater among EM users who used biomedicine as well, compared with EM users who did not use biomedicine. Conclusions The healthcare community should recognise that CAM use likely becomes holistic as people use biomedicine concomitantly, when the practice rights over a CAM system are comprehensively and exclusively entitled to a group of CAM professionals who are independent from practitioners of biomedicine.

Three plural medical systems in East Asia: interpenetrative pluralism in China, exclusionary pluralism in Korea and subjugatory pluralism in Japan

Amid persistent interest in and concerns about traditional, complementary and alternative medicine (TCAM) in low-, middle- and high-income countries, the global community of healthcare is in need of learning ways to institutionalize TCAM with biomedicine. By investigating how traditional East Asian medicine (TEAM), one of the most popular forms of TCAM in the world, is institutionalized in China, Korea and Japan, this study finds three different ways of instituting a plural medical system in which TCAM and biomedicine intersect with each other. In the interpenetrative pluralism in China and the exclusionary pluralism in Korea, TEAM and biomedicine are institutionalized as independent and equivalent systems of medical practices. However, TEAM and biomedicine are conditioned to cross over into each other unconditionally in practice in the former, whereas the two exclude each other very strictly in the latter. In the subjugatory pluralism in Japan, the crisscrossing of TEAM and biomedicine is allowed, yet in an asymmetrical way whereby the practice of TEAM is dependent upon and subordinated into biomedicine. The practice of various TEAM modalities is overseen by TEAM doctors, biomedicine doctors or integrative TEAM-biomedicine doctors in interpenetrative pluralism, by TEAM doctors only in exclusionary pluralism, and by biomedicine doctors only in subjugatory pluralism. These varying characteristics demonstrate a variety of plural medical systems. They also provide useful cues in accounting for the varying behaviours of medical service providers and users who encounter TCAM as well as biomedicine in their everyday practices. In addition, the growing literature about the outcomes of TCAM and plural medical systems can take advantage of these findings.

The coordination of plural logics of action and its consequences: Evidence from plural medical systems

Drawing on the theory of social action in organizational and institutional sociology, this paper examines the behavioral consequences of plural logics of action. It addresses the question based on the empirical case of plural medical systems that are composed of both biomedicine and alternative medicine. Applying mixed methods of a cross-national panel data analysis and a content analysis of medical journal articles, it finds that plural systems affect health outcomes negatively when tensions between biomedicine and alternative medicine are unaddressed. In contrast, plural systems produce tangible health benefits when biomedicine and alternative medicine are coordinated through government policies or by health care organizations/professionals. This paper proposes plurality coordination as an important mechanism that modifies the behavioral consequences of plural logics. This proposition contributes to providing theoretical answers to the sociological puzzle that plural logics of action produce inconsistent behavioral consequences.