Health affairs
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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.
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Two disputed cases about withholding life support (Terri Schiavo and Son Hudson) call for greater public discussion. Confusion arises from intermixing three kinds of cases: those (1) in which demanded treatment is physiologically futile, (2) involving competition for scarce resources, and (3) in which the treatment would likely achieve the patient's goals although the clinician perceives those goals to be valueless. This Perspective argues that clinicians should unilaterally refuse the first but do not have legitimate roles in blocking access to the second and third. Absent scarcity, patients should have access to effective life-prolonging treatments even if clinicians see no value in them.
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Controversy over vaccine safety has achieved high visibility over the past decade. At the same time, however, levels of coverage for routinely recommended childhood vaccines in the United States are at their highest ever. ⋯ We consider the ways in which concerns over vaccine safety have emerged and diffused through the popular media, legislative hearings, and Internet-based activism. As a case study, we review the controversy over the alleged connection between autism and the measles-mumps-rubella (MMR) vaccine and consider why it had a dramatic effect on the vaccine's acceptance in Great Britain but virtually none in the United States.
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This study reviews Medicaid policies to restrict access to psychiatric medications. Policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics are reviewed. All states apply one or more of those policies to medications for mental illness, and many apply several. ⋯ Other psychiatric medications are less well protected. Some states appear to restrict access severely. Questions have been raised as to whether these policies actually save money in the long term.