Health affairs
-
Within the past decade, complementary and alternative medicine (CAM) has penetrated mainstream U. S. health care. Major medical journals are publishing research on the efficacy of specific CAM therapies, physicians are attending oversubscribed continuing medical education courses on CAM, and hospitals are offering CAM services, sometimes through outpatient integrative medicine clinics. This paper presents factors behind the growth of CAM, analyzes its relationship with conventional medicine, and suggests how the integration of CAM and conventional medicine can be more effectively guided.
-
Americans have reached consensus that (1) people have a right to refuse life-sustaining medical interventions, and (2) interventions that can be terminated include artificial nutrition and hydration. The one unresolved issue is how to decide for mentally incompetent patients. Only about 20 percent of Americans have completed living wills, and data show that family members are poor at predicting patients' wishes for life-sustaining care. But despite court cases and national consensus that these are private and not legislative matters, the Schiavo case is unlikely to change practices except to increase the number of Americans who complete living wills.
-
As editors of the Robert Wood Johnson Foundation's (RWJF's) anthology series, we have examined the entire range of the foundation's grant making since 1972. We found that the RWJF has enjoyed considerable success in building fields--from nurse practitioners to tobacco control to end-of-life care. The RWJF has done this by shaping fields as they were emerging, by adopting a wide-ranging "bear hug" approach, and by staying the course. The lessons from the RWJF's field-building efforts are relevant for both large and small foundations: Small funders can develop strategic plans aimed at building fields in their home state or locality.