Mary Ruggie

The State and Working Women: A Comparative Study of Britain and Sweden

Mary Ruggies controversial study of British and Swedish labor market, anti-discrimination, and child care programs argues that gender-based policy alone cannot substantially raise the economic status of women workers. Rather, policies for women must be developed within the context of more general economic and social policiesOriginally published in 1984.The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

Learning from Other Countries: Comparing Experiences and Drawing Lessons for the United States

Are there any medical sociologists who believe in the notion of American “exceptionalism” and resist considering US healthcare policy in comparative perspective? Alternatively, are there any who question whether comparisons of seemingly vastly different settings can yield fruitful lessons for the US? This paper seeks to convince the dubious in the worlds of both academia and healthcare policymaking that a comparative lens best illuminates the successes and failures of American health care and the unique framework within which it operates. We have much to learn from the experiences of other countries, not only about healthcare policy but also about the political and social parameters and the norms and values that shape it and its outcomes. Moreover, despite apparent differences, there are important similarities between our struggles and those of other countries. Understanding how and why their efforts have succeeded or failed can inform a more fruitful direction for American endeavors.

Handbook of the Sociology of Medical Education

How do poor people cope with, and even make sense of, toxic danger? This book is a ‘‘story of silent habituation to contamination and of almost complete absence of mass protest against toxic onslaught’’ (p. 4). As such, it is distinct from much of the social movement literature, and also the ethnographies of the poor. The dependent variable in the social movement literature is community protest; we find protest, and try to explain its appearance, citing such things as ‘‘cognitive liberation.’’ But what about the many more communities that would seem ripe for protest, but do not? How, in particular, can we explain the ‘‘silent habituation to contamination’’ that is often associated with slum communities? Why the ‘‘perpetuation of ignorance, mistake, and confusion’’ (p. 8) on the part of the residents, despite ample evidence of contamination? The book explores ‘‘the reproduction of uncertainty, misunderstanding, division, and ultimately, inaction in the face of sustained toxic assault’’ (p. 8). ‘‘Uncertainty and ignorance,’’ they claim ‘‘have not been a dominant focus among ethnographers’’ (p. 12). True or not, here the authors explore it in rich detail. The place is a settlement on the edge of Buenos Aires. With two-and-one-half years of intensive fieldwork they have intimate knowledge of the community, and the second author, Debora Swistun, was born and raised in the town, and only left at the end of the fieldwork. Javier Auyero, no stranger to poverty research in Latin America, came in from the University of Texas for long stays. This is an ethnography, loosely structured, and like most ethnographies it is theoretically undernourished. The repeated references to Bourdieuian aphorisms such as ‘‘symbolic violence,’’ ‘‘schemata of perception,’’ ‘‘how domination works,’’ and the curious ‘‘site effects’’ (where ‘‘what is lived and seen on the ground’’ is really ‘‘elsewhere’’) (p. 159) do not structure the argument. The authors’ excellent narratives make it clear that the domination is more material than symbolic, and the pervasiveness of the pollution—air, water, soil—speaks to the silent contamination more strongly than the mechanisms and metaphors in the literature they repeatedly cite. Though much of the material has appeared elsewhere in scholarly journals, where it is more tightly organized, the leisurely pace and intimacy of this presentation has many virtues. Unfortunately, however, the lack of a decent index, so easily constructed on a computer, is not one of them. In addition to its dramatic focus upon ignorance, mistake and confusion in the community, there is a striking emphasis upon the link between environment and misery. Scholars, they say, have remained silent for a long time about environmental factors as the key determinants in the reproduction of destitution and inequity. They see it as the missing dimension in the study of poverty in Latin America. Graphically, and in wrenching detail, they show how the polluted space the urban poor live in compounds the normal problems of poverty. The silent, often invisible, steady accumulation of poisons appears to feed the resignation and displace the blame. It may be the shantytowns of Argentina which have had protests have not had the full environmental assault Flammable has had. The settlement was once an area with many small farms and fruit trees, clean water from a river, and a white-sand beach in the estuary. Gradually, but implacably, it became a hellhole, a toxic dumping ground, surrounded by one of the largest petrochemical compounds in the country. The Shell refinery is the biggest, but there is another oil refinery, three plants that store oil, several that store chemical products, one that manufactures chemical products, and a power plant. The settlement expanded into the

Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials:

Jill Fisher tells a fascinating yet often disturbing story about the process of testing pharmaceuticals on human subjects. Based on observations at several private-sector, non-academic sites and interviews with various participants, Fisher takes us through the stages of clinical trials while focusing on participants’ motives, roles and perspectives. We learn that physicians are considered principal investigators but largely delegate tasks to their staff, creating a problem of “phantom investigators.” The ten physicians Fisher managed to interview freely admitted that the primary reason for their involvement was the money they receive for recruiting patient-subjects and overseeing the progress of trials. Nurses or “coordinators” are, unsurprisingly, the most important actors in clinical trials—educating patients about the protocols, monitoring patients’ diaries, and encouraging patients to fulfill their responsibilities. Dedicated as they are, however, coordinators are not above using “manipulative explanation” to convince patient-subjects who are not improving that compliance is in their best interest (p.196). Most of the physicians and nurses Fisher interviewed had bought into the pharmaceutical industry’s “rhetoric” that clinical trial research promotes the “benefit of humanity” and “medical progress.” But some were torn between the ethics of care and the requirements of science. Unable to handle the duplicity and role conflict, one of the coordinators quit her job. The others apparently rationalized their continued participation by emphasizing the positive outcomes they had witnessed and the hope they and their patients harbored. Although patient-subjects may benefit from participation in clinical trials, Fisher’s main concern is the many ways in which participants are misled and misused. Some patients become subjects because their debilitating conditions have not responded well to available treatments and they are desperate for relief. Although they are told that they may be randomized to a placebo group and the fine print in consent forms may indicate that their conditions could worsen, Fisher finds that coordinators tend to “emphasize the logistics” and “downplay the .|.|. risks” (p.172) of participation. Patients have the right to withdraw at any time during the study. But pharmaceutical companies judge study sites on their ability to retain subjects; new contracts are a reward. Accordingly, coordinators engage in considerable re-education, walking a fine line between coercion and self-interest on one hand and patient care on the other. This situation exists in all countries where clinical trials occur; other circumstances that Fisher discusses, in which patient-subjects’ vulnerabilities are interwoven with socioeconomic disparities and lack of health care, may be more specific to the United States. For instance, Phase II clinical trials test new products for safety and commonly call for healthy subjects. Fisher finds that lowincome minority men, drawn by financial compensation, predominate in these studies. Of course, these men are also highly likely to be uninsured. Phase III trials, which test for efficacy, attract primarily white middle-class women, who are more “altruistic” and have the time to comply with record-keeping and site visits. Uninsured women are also attracted to Phase III (and sometimes Phase II) trials, especially when recruiters frame the study as offering access to health care. As Fisher emphasizes, however, clinical trials are not oriented toward care; their purpose is data collection. Even when investigators or coordinators suspect that a patient-subject is receiving the placebo and deteriorating, or suffering from overly adverse side effects, their contractual obligation is to enable “soldiering on.” These dilemmas make for captivating reading. Those who are new to the subject will learn much, but should be cautioned that Fisher writes within a limited framework. She tries to weave her own assessments into what is essentially an ethnographic and descriptive study. But the analysis does not go beyond the concept of neoliberalism, which Fisher overuses. It is intended to capture the structural failings of our health and

Shifts in the Welfare Mix: Their Impact on Work, Social Services and Welfare Policies.@@@Needs and Welfare.

Significant features in countries with market economies significant features in countries with planned economies a summary of trends and prospects.

Women and European Politics: Contemporary Feminism and Public Policy.@@@Women of Europe: Women MEPs and Equality Policy.

Although women are severely under-represented in national politics in Europe, in the European Parliament they are better represented than they are in the national parliaments of the EEC member states. This book examines why this is so. Based largely on their detailed interviews with women MEPs, the authors describe the latters backgrounds, attitudes and political experience. They also explain the history, structure and organisation of the European Parliament and outline the complexities of the European legal system. A particular concern of the book is the contribution that women MEPs have made to legislation and policy, expecially in the context of recent Community legislation on sex equality, and what impact their presence has had on issues relating to womens interests.