Int J Health Serv
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Can we still rely on the World Health Organization? It has not openly opposed the greed of the major global pharmaceutical companies, and its director-general, Gro Harlem Brundtland, has deferred to them.
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Eight interrelated reasons for the decline of the golden age of doctoring are discussed in this article. Major extrinsicfactors (generally outside the control of the profession) include (1) the changing nature of the state and loss of its partisan support for doctoring, (2) the bureaucratization (corporatization) of doctoring; (3) the emerging competitive threat from other health care workers; (4) the consequences of globalization and the information revolution; (5) the epidemiologic transition and changes in the public conception of the body; and (6) changes in the doctor-patient relationship and the erosion of patient trust. Major intrinsic factors are (7) the weakening of physicians' labor market position through oversupply; and (8) the fragmentation or weakening of the physicians, union (AMA). ⋯ S. medicine, our thinking remains wedded to a now inadequate theoretical approach. A future sociology of the professions can no longer overlook now pervasive macrostructural influences on provider behavior (corporate dominance). Until these influences are appropriately recognized and incorporated in social analyses, most policies designed to restore the professional ideal have little chance of success.
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Comparative Study
Does investor-ownership of nursing homes compromise the quality of care?
Quality problems have long plagued the nursing home industry. While two-thirds of U. S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. ⋯ Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.
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World Bank loan policies in Mozambique have almost killed off the country's cashew-processing industry by requiring the removal of the export tariff on raw cashews, a tax that Mozambique had instituted to ensure the cashew supply for local factories.
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International scientific organizations have been subject to repeated efforts by Canadian government officials and representatives of the asbestos industry to issue reports that would be favorable to the industry on questions of asbestos use and public health implications. In recent years these efforts have been met with international opposition from scientists, governments, unions, and environmental groups, and a pattern of improprieties, often involving the same individuals and tactics, has emerged. This has been a serious threat to scientific objectivity at the most respected international scientific bodies in the world. The manipulation of these international organizations takes on unprecedented significance in this age of the World Trade Organization.