Michael S. Goldstein

The transfer of care : psychiatric deinstitutionalization and its aftermath

Phil Brown provides a comprehensive analysis of recent mental health policy and practice by focusing on three main themes: political-economic structures, the pitfalls of professionalism, and institutional obstacles to adequate care.

Dietary Supplement Use in Individuals Living with Cancer and Other Chronic Conditions: A Population-Based Study

OBJECTIVE Cancer survivors are increasingly turning to complementary and alternative medicine (CAM) to manage short- and long-term treatment sequelae. Population-based data on relative use of dietary supplements among cancer survivors compared to those without a cancer history is lacking. Our objective was to compare supplement use among those with and without cancer and among those with and without other chronic conditions, and to identify correlates of supplement use by cancer status. DESIGN Cross-sectional, population-based survey of participants in the 2003 CAM supplement to the 2001 California Health Interview Survey. SUBJECTS Participants reporting a cancer diagnosis on the 2001 California Health Interview Survey or newly reported diagnosis on the 2003 survey (n=1,844) plus a random oversampling of racial/ethnic minorities (n=7,343). MEASURES Self-reported use of a multivitamin and 27 vitamins, minerals, herbs, and other natural products during the preceding 12 months. STATISTICAL ANALYSES Logistic regression analyses were performed with control for potential confounders. RESULTS Adults with cancer or other chronic conditions had higher prevalence of supplement use than those reporting no illness. The independent effect of cancer was associated with vitamin use, whereas living with other chronic conditions was associated with all types of supplement use, except multivitamins. Correlates of supplement use were similar between cancer survivors and cancer-free individuals-being a woman, advancing age, and greater physical activity, fruit and vegetable intake, and other CAM use. Among cancer survivors, non-Hispanic whites had the lowest prevalence of herbal supplement use. CONCLUSIONS These results indicate that having a chronic medical condition is the major factor associated with supplement use. A diagnosis of cancer, by itself, does not have an independent effect on supplement use. This suggests that most supplement use among cancer survivors is directed at dealing with or preventing the exacerbation of a comorbid condition. Consumers and health professionals should be aware that there is limited information on the effects of dietary supplements taken concurrently with prescription and other over-the-counter medications.

The Emerging Socioeconomic and Political Support for Alternative Medicine in the United States

Complementary and alternative medicine (CAM) is increasingly utilized and accepted by patients and providers throughout the American health care system. Most accounts attribute this growing acceptability to the shortcomings of conventional medicine, the appeal of CAMs core beliefs, and the growing body of research indicating that CAM actually works. These explanations, while all accurate to some degree, neglect the extent to which CAMs recent success is due to economic and political factors. This article describes the emerging relationship between CAM and major economic actors (pharmaceutical firms, managed care companies, insurance companies, media conglomerates, Internet providers, etc.) as well as CAMs relationship with a range of political forces (political parties, bureaucrats, lobbying groups, ethnic- and gender-based movements and organizations, etc.). The convergence of interests between these economic and political forces and many of CAMs goals is one important reason for CAMs recent success.

Alternative health care : medicine, miracle, or mirage?

Acknowledgements 1. The Emergence of Alternative Medicine 2. Victims of Medicine 3. The Core of Alternative Medicine: Age Old Wisdom Made New 4. Medicine and the Spirit 5. Is There Really an Alternative Medicine? 6. The Politics of Alternative Medicine: Personal and Practical 7. Alternative Medicine, Mainstream Markets 8. The Future of Alternative Medicine Notes Bibliography Index

Holistic physicians and family practitioners: Similarities, differences and implications for health policy

Although loosely defined, holistic or alternative medicine has been viewed by most observers as fundamentally at odds with mainstream biomedical approaches. Convergence or integration of the two are seen as highly unlikely. We attempt to assess the potential for such integration empirically through a survey of physicians, members of the American Holistic Medical Association (N = 340) and a comparison group of family practitioners (N = 142). Although social origins of the two groups are similar, they differ in their completion of residency training and a variety of practice characteristics. While the groups differ in the predicted directions in their evaluation and utilization of holistic techniques and in their attitudes toward the nature of medical practice, there is a good deal of overlap. Personal experiences, especially those in the area of religion/spirituality and psychotherapy differ sharply between the groups. Policy concerned with fostering cooperation or convergence between holistic and mainstream medicine should differentiate between clinical attitudes and behaviors (which appear to be more compatible than has been suggested), and the personal world views of physicians (which appear to be much further apart).

The impact of psychosocial factors on neck pain and disability outcomes among primary care patients: Results from the UCLA Neck Pain Study

Purpose. The purpose of this study is to estimate the associations of psychosocial factors with pain and disability outcomes among neck-pain patients enrolled in a randomized clinical trial of chiropractic treatments. Methods. Neck-pain patients were randomized to one of 8 modes of chiropractic treatment. Health status and psychosocial variables were measured at baseline. Changes in neck pain severity and disability from baseline to 6 months were the primary outcome variables. Multivariable regression models were used to estimate effects of psychosocial variables adjusted for potential confounders. Results. Of 960 eligible patients, 336 were enrolled and 80% were followed up through 6 months. Coping strategies involving self-assurance resulted in better disability outcomes, whereas getting angry or frustrated resulted in worse pain and disability outcomes. Participants with high levels of social support from individuals were more likely to experience clinically meaningful reductions in pain and disability. No consistent relations of internal health locus of control, and physical and psychological job demands with improvements in pain and disability were detected. Conclusions. We found some evidence that certain coping strategies and types of social support are associated with pain and disability outcomes in this population of largely subacute and chronic neck-pain patients.

Social Support, Health-Promotive Beliefs, and Preventive Health Behaviors Among the Elderly

A high level of social support was a consistent predictor of preventive health behaviors among 936 elderly members of a health maintenance organization. Beliefs about the importance of preventive health behaviors contributed more toward predicting their performance than did other respondent characteristics. These results suggest that efforts to increase the practice of preventive health behaviors by the elderly might be augmented by strengthening both theirsocial support networks and their health-promotive beliefs.

Complementary and alternative medicine: Its emerging role in oncology

Abstract Complementary and alternative medicine (CAM) is a rapidly growing aspect of how patients respond to having cancer. CAM is not solely a set of clinical interventions, it is a broad social movement that seeks to recast the meaning of health and illness. Professionals in psychosocial oncology need such a perspective to truly understand why patients are turning toward CAM. CAMs appeal emerges from its five core beliefs: holism, vitalism, spirituality, a positive definition of health, and a distinctive view of the healing process. These five beliefs are well matched to how many people with cancer experience their bodies and illness, and they also form a coherent response to the difficulties many patients have when dealing with conventional medicine. Increasingly, some elements in conventional medicine are accepting of CAM. Hospital chains, managed care organizations, drug companies, and retailers of health care products are less likely to make sharp distinctions between CAM and conventional care. CAM is likely to continue growing as a factor in the professional lives of health professionals who deal with cancer.

The Persistence and Resurgence of Medical Pluralism

��� For Paul Starr, medicine is the dream of reason partially come true, and the recognition and acceptance of this view by most Americans is what has largely determined the development of our health care system. Starr’s efforts to advance this vision led him to neglect the extent to which medical pluralism survived and thrived in America. In the first chapter of The Social Transformation of American Medicine (1982) (hereafter TSTAM), Starr describes a time (1760‐1850) when doctors had little in the way of status or respect. Physicians’ knowledge about disease and their skills as healers were questioned by practitioners of many stripes, including those within their own ranks. In fact, the very need for specialized medical practitioners was doubted by those who saw the home as the natural locus of health care, and family members (informed by popular medical manuals) as the natural and best providers. This cacophony of views was widespread and reflected the diverse set of beliefs held by most of the population, as well as its leaders. The American ethos was to distrust specialized knowledge, particularly knowledge that was “secret” or inaccessible to the average citizen. What changed all of this, in Starr’s view, was the rise and public recognition of scientific rationality. The populace began to recognize that the natural world had a “legitimate complexity” that might not be equally accessible to all. The democratic belief that everyone could know how the natural world really worked no longer seemed accurate or apt to bring about the cure of illness. The growth of education and literacy, along with

Holistic physicians: implications for the study of the medical profession.

This study compares members of the American Holistic Medical Association (N= 340) and a group of California family practice physicians (N= 142). The groups are similar in demographic characteristics. The holistic doctors are distinct in their training, practice characteristics, attitudes, clinical behaviors, motivations, and feelings of marginality. Personal experiences with religion/spirituality, psychotherapy, and maintaining a personal health regimen appear to be important distinguishing factors. These experiences are related to each other and to a holistic practice style among both types of physicians. The overall findings indicate a dimension of diversity among physicians which has been neglected until now.