Reluctant entrepreneurs: patents and state patronage in new technosciences, circa 1870-1930

At a time when neoliberalism and financial austerity are together encouraging academic scientists to seek market alternatives to state funding, this essay investigates why, a century ago, their predecessors explicitly rejected private enterprise and the private ownership of ideas and inventions available to them through the patent system. The early twentieth century witnessed the success of a long campaign by British scientists to persuade the state to assume responsibility for the funding of basic research ("pure science"): their findings would enter the intellectual commons; their rewards would be primarily reputational (financial only secondarily, through consequent career advancement). The essay summarizes recent research in three separate fields of British techno-science--electricity, aviation, and agricultural botany--all of which were laying claim, at this time, to a heightened commercial or military importance that raised new questions about the ownership of scientific ideas. It suggests that each of the three established an idiosyncratic relationship with the patent system or with other forms of "intellectual property," which would both influence their emergent disciplines and affect the extent to which commercial enterprise could remain a viable funding strategy.

The mental health sector and the social sciences in post- World War II USA. Part 2: The impact of federal research funding and the drugs revolution

The second of two linked papers examining the interactions of psychiatry and the social sciences since World War II examines the role of NIMH on these disciplines. It analyses the effects of the prominence and the decline of psychoanalysis, and the impact of the psychotropic drugs revolution and the associated rise of biological psychiatry on relations between psychiatry and clinical psychology; and it explores the changing relationships between psychiatry and sociology, from collaboration to conflict to mutual disdain.

Psychic aftershocks: crisis counseling and disaster relief policy

Though crisis counseling following disasters has become a commonplace in the 21st century, we have little to no sense of how and when it became part of federally supported disaster relief services. In 1974, as part of a broad overhaul of federal disaster policy, an authorization to fund counseling services, and mental health training to disaster relief workers, was inserted into the Disaster Relief Act passed in that year--despite little to no empirical evidence that such counseling was necessary or effective. As this article demonstrates, unlike the drive for community mental health programs at mid-century, federal support for disaster mental health did not come as a result of a long campaign waged from well-connected institutions. Rather, it was largely the result of local practitioners, informed by larger currents in thinking about crisis intervention, who discerned these needs in a spontaneous and ad hoc manner. Disaster mental health services came into being thanks to the flourishing of a broad network of therapeutic practitioners in places as far flung as Rapid City, South Dakota, Wilkes-Barre Pennsylvania, and Logan County, West Virginia, who implemented mental health pilot projects in response to disasters in the early 1970s. Their efforts caught the attention of journalists already attuned to therapeutic discourse, and to sympathetic national legislators, to whom the proposition that disaster victims would suffer from psychological damage simply seemed like common sense and a logical service to include as part of a general broadening of federal assistance to disaster victims.

The crisis, the humanities and medical history

Non-controversially, the full version of this article argues that the crisis in British higher education will impoverish teaching and research in the arts and humanities; cut even more deeply into these areas in the post-1992 sector; and threaten the integrity of every small sub-discipline, including the history of medicine. It traces links between the Thatcherite reforms of the 1980s and the near-privatisation of universities proposed by the Browne Report and partly adopted by the coalition. The article ends by arguing that it would be mistaken to expect any government-driven return to the status quo ante. New ideas and solutions must come from within. As economic and cultural landscapes are transformed, higher education will eventually be rebuilt, and the arts and social sciences, including medical history, reshaped in wholly unexpected ways. This will only happen, however, if a more highly politicised academic community forges its own strategies for recovery.

Spring cleaning: rural water impacts, valuation, and property rights institutions

Using a randomized evaluation in Kenya, we measure health impacts of spring protection, an investment that improves source water quality. We also estimate households' valuation of spring protection and simulate the welfare impacts of alternatives to the current system of common property rights in water, which limits incentives for private investment. Spring infrastructure investments reduce fecal contamination by 66%, but household water quality improves less, due to recontamination. Child diarrhea falls by one quarter. Travel-cost based revealed preference estimates of households' valuations are much smaller than both stated preference valuations and health planners' valuations, and are consistent with models in which the demand for health is highly income elastic. We estimate that private property norms would generate little additional investment while imposing large static costs due to above-marginal-cost pricing, private property would function better at higher income levels or under water scarcity, and alternative institutions could yield Pareto improvements.

The psychologization of humanitarian aid: skimming the battlefield and the disaster zone

Humanitarian aid's psycho-therapeutic turn in the 1990s was mirrored by the increasing emotionalization and subjectivation of fund-raising campaigns. In order to grasp the depth of this interconnectedness, this article argues that in both cases what we see is the post-Fordist production paradigm at work; namely, as Hardt and Negri put it, the direct production of subjectivity and social relations. To explore this, the therapeutic and mental health approach in humanitarian aid is juxtaposed with the more general phenomenon of psychologization. This allows us to see that the psychologized production of subjectivity has a problematic waste-product as it reduces the human to 'Homo sacer', to use Giorgi Agamben's term. Drawing out a double matrix of a de-psychologizing psychologization connected to a politicizing de-politicization, it will further become possible to understand psycho-therapeutic humanitarianism as a case of how, in these times of globalization, psychology, subjectivity and money are all interrelated.

Land rent and housing policy: a case study of the San Francisco Bay area rental housing market

In the San Francisco Bay Area, where residential rent is among the highest in the United States, an analysis of data from several sources demonstrates that high rent cannot be accounted for by higher quality, higher operating costs, or higher construction costs. At least one-third of the total rent paid is land rent. Despite increases in real incomes, very-low-income tenants in the Bay Area today have less income remaining after payment of rent than tenants did in 1960. High land rent is a long-term feature of the Bay Area rental market that results mostly from its geography, the density of its urban centers, and a strong economy, rather than from regulatory barriers to new multifamily construction. Deregulation is not a sufficient response to the effects of land rent on low-income tenants. Government should subsidize non-profit housing organizations, particularly land trusts that remove residential land from the market. Taxes on land rent would be a particularly appropriate funding source.

The role of the public sector in the provision of housing supply in Turkey, 1950–2009

This study examines the changing role of the public sector in Turkey with regard to housing provision since 1950, and particularly since 2000, and seeks to clarify how public intervention has affected housing provision and urban development dynamics in major cities. Three periods may be identified, with central government acting as a regulator in a first period characterized by a ‘housing boom’. During the second period, from 1980 to 2000, a new mass housing law spurred construction activity, although the main beneficiaries of the housing fund tended to be the middle classes. After 2000, contrary to emerging trends in both Northern and Southern European countries, the public sector in Turkey became actively involved in housing provision. During this process, new housing estates were created on greenfield sites on the outskirts of cities, instead of efforts being made to rehabilitate, restore or renew existing housing stock in the cities. Meanwhile, the concept of ‘urban regeneration’ has been opportunistically incorporated into the planning agenda of the public sector, and — under the pretext of regenerating squatter housing areas — existing residents have been moved out, while channels for community participation have been bypassed.

Why the Medical Research Council refused Robert Edwards and Patrick Steptoe support for research on human conception in 1971

BACKGROUND

In 1971, Cambridge physiologist Robert Edwards and Oldham gynaecologist Patrick Steptoe applied to the UK Medical Research Council (MRC) for long-term support for a programme of scientific and clinical 'Studies on Human Reproduction'. The MRC, then the major British funder of medical research, declined support on ethical grounds and maintained this policy throughout the 1970s. The work continued with private money, leading to the birth of Louise Brown in 1978 and transforming research in obstetrics, gynaecology and human embryology.

METHODS

The MRC decision has been criticized, but the processes by which it was reached have yet to be explored. Here, we present an archive-based analysis of the MRC decision.

RESULTS

We find evidence of initial support for Edwards and Steptoe, including from within the MRC, which invited the applicants to join its new directly funded Clinical Research Centre at Northwick Park Hospital. They declined the offer, preferring long-term grant support at the University of Cambridge, and so exposed the project to competitive funding mode. Referees and the Clinical Research Board saw the institutional set-up in Cambridge as problematic with respect to clinical facilities and patient management; gave infertility a low priority compared with population control; assessed interventions as purely experimental rather than potential treatments, and so set the bar for safety high; feared fatal abnormalities and so wanted primate experiments first; and were antagonized by the applicants' high media profile. The rejection set MRC policy on IVF for 8 years, until, after the birth of just two healthy babies, the Council rapidly converted to enthusiastic support.

CONCLUSIONS

This analysis enriches our view of a crucial decision, highlights institutional opportunities and constraints and provides insight into the then dominant attitudes of reproductive scientists and clinicians towards human conception research.

Surreptitious surgery on Long Island Sound: The oral cancer surgeries of President Grover Cleveland

Grover Cleveland rose from being the mayor of Buffalo to the governor of New York to the president of the United States. At the start of Cleveland's second term as president, the nation was involved in a severe financial crisis, the extent of which was not known by the general public. President Cleveland was to make a strong appeal to Congress in the coming months to repeal the Sherman Silver Purchase Act of 1890. He thought this would set the nation on the road to fiscal recovery. However, his vice president, Adlai Stevenson, strongly opposed repeal of the Sherman Act. Prior to scheduling his appearance before Congress, President Cleveland noticed a rough spot on his palate. A biopsy confirmed that it was cancer, and it was determined that surgery was needed. Cleveland and his advisors thought the nation would be thrown into a panic if the President's health did not remain a secret. A surgical team, which included a dentist, performed the surgery in secrecy while traveling aboard a yacht. A prosthetic obturator was fabricated by a New York prosthodontist to close the surgical defect. Cleveland recovered well, made a forceful speech before Congress, had the Sherman Act repealed and lived without a recurrence of his oral cancer for the rest of his life. The public remained unaware, for the most part, of the gravity of President Cleveland's health for decades.

Race, urban governance, and crime control: creating model cities

In the late 1960s and early 1970s, the city of Seattle received federal Department of Housing and Urban Development “Model cities” funds to address issues of racial disenfranchisement in the city. Premised under the “Great Society” ethos, Model cities sought to remedy the strained relationship between local governments and disenfranchised urban communities. Though police-community relations were not initially slated as an area of concern in the city's grant application, residents of the designated “model neighborhood” pressed for the formation of a law and justice task force to address the issue. This article examines the process and outcome of the two law-and-justice projects proposed by residents of the designated “model neighborhood”: the Consumer Protection program and the Community Service Officer project. Drawing on the work of legal geographies scholars, I argue that the failure of each of these efforts to achieve residents' intentions stems from the geographical imagination of urban problems. Like law-and-order projects today, the geographical imagination of the model neighborhood produced a discourse of exceptionality that subjected residents to extraordinary state interventions. The Model cities project thus provides an example of a “history of the present” of mass incarceration in which the geographical imagination of crime helps facilitate the re-creation of a racialized power structure.

A greater society: the transformation of the federal role in education

The federal role in education will soon be transformed in ways that could produce an even greater society than President Lyndon B. Johnson envisioned. The authors identify underlying principles of this new role and describe how it represents a significant departure from the past. Historically, for example, the federal government has been prescriptive about the kinds of practices that states and districts must adopt as a condition of receiving federal funds, but it has not specified outcomes. Under the new approach, the federal government would specify the goals and outcomes while allowing states, districts, and schools flexibility in how they use federal funds to innovate and adopt best practices. The authors argue for immediate action. Every day of delay, they note, yields another seven thousand dropouts and leaves schools and communities without the tools and resources that can help turn the situation around.

Forty six years of health financing in Fiji (1962 - 2008)

This paper provides an analysis of the Fiji Ministry of Health (MoH) budget for the last 46 years, its share of the national budget and annual percentage of GDP, its revenues, per-capita health expenditure, staff costs, and the performance on key population health indicators and Millennium Development Goals (MDGs). Despite annual increases in dollar terms, the proportion of GDP allocated to the national public health system has fallen from 4% to 2.6% over the last 15 years. Consequently the national performance on key health service indicators and MDGs is declining and health staff are migrating. We outline factors to retrieve the public health system in Fiji, such as the need for political commitment to the health of the people, public policy debate on the nature of the health system, the revision of hospital charges, the need to protect the poor by strengthening means testing, and propose compulsory health insurance for the employed.

The value of tuberculosis elimination and of progress in tuberculosis control in twentieth-century England and Wales

OBJECTIVE

To calculate the monetary value of tuberculosis (TB) elimination and of progress in TB control in twentieth-century England and Wales.

METHODS

An original methodology that utilises original data is used, which facilitates the calculation of the number of life years that have been saved as a result of the decline in the TB mortality rate, prevalence rate and quality of life burden.

RESULTS

The magnitude of the decline in the mortality and morbidity burden of TB is estimated at 104,425 life years, which is valued to be worth in excess of US$127 billion. The value of improvements in morbidity contributes nearly as much as the more obvious gains for mortality.

CONCLUSION

Such significant results indicating the value of improvements in TB control have important implications for our understanding of these achievements and justify increased spending in developing countries that continue to be plagued by high rates of TB prevalence.

Radioisotopes "economy of promises": on the limits of biomedicine in public legitimization of nuclear activities

This paper aims to examine the rise and the fall of biomedicine in the public legitimization of the development of nuclear energy. Until the late 1950s, biological and medical applications of radioisotopes were presented as the most important successes of the peaceful uses of atomic energy. I will argue that despite the major financial investment, the development of the uses of radioisotopes and their important impact on biology and clinical practices, the assessment of medical uses remained relatively limited. As consequence, the place of biomedicine in the public legitimization of financial investment and civilian uses of nuclear energy began to decline from the late 1950s.

Title VII and the development and promotion of national initiatives in training primary care clinicians in the United States

The Title VII, Section 747 (Title VII) legislation, which authorizes the Training in Primary Care Medicine and Dentistry grant program, provides statutory authority to the Health Resources and Services Administration (HRSA) to award contracts and cooperative agreements aimed at enhancing the quality of primary care training in the United States.More than 35 contracts and cooperative agreements have been issued by HRSA with Title VII federal funds, most often to national organizations promoting the training of physician assistants and medical students and representing the primary care disciplines of family medicine, general internal medicine, and general pediatrics. These activities have influenced generalist medicine through three mechanisms: (1) building collaboration among the primary care disciplines and between primary care and specialty medicine, (2) strengthening primary care generally through national initiatives designed to develop and implement new models of primary care training, and (3) enhancing the quality of primary care training in specific disease areas determined to be of national importance.The most significant outcomes of the Title VII contracts awarded to national primary care organizations are increased collaboration and enhanced innovation in ambulatory training for students, residents, and faculty. Overall, generalist competencies and education in new content areas have been the distinguishing features of these initiatives. This effort has enhanced not only generalist training but also the general medical education of all students, including future specialists, because so much of the generalist competency agenda is germane to the general medical education mission.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

The American Medical Student Association's contributions to advancing primary care

The American Medical Student Association (AMSA) Foundation is the programming arm of AMSA. The AMSA Foundation has administered several Title VII contracts designed to enhance the primary care education, leadership development, and cultural competence of the next generation of physicians, dentists, and other graduate-level health professionals. The authors discuss several AMSA programs developed with Title VII funding: Generalist Physicians in Training; Promoting, Reinforcing, and Improving Medical Education; National Primary Care Week; Leadership Seminar Series; and Achieving Diversity in Dentistry and Medicine. This article summarizes the work of these programs and discusses the impact that decreased funding has had on the training of our nation's future health professionals.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

The impact of Title VII on general and pediatric dental education and training

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Two decades of Title VII support of a primary care residency: process and outcomes

PURPOSE

To assess 23 years of Health Resources and Services Administration (HRSA) Title VII Training in Primary Care Medicine and Dentistry funding to the New York University School of Medicine/Bellevue Primary Care Internal Medicine Residency Program. The program, begun in 1983 within a traditional, inner-city, subspecialty-oriented internal medicine program, evolved into a crucible of systematic innovation, catalyzed and made feasible by initiatives funded by the HRSA. The curriculum stressed three pillars of generalism: psychosocial medicine, clinical epidemiology, and health policy. It developed tight, objectives-driven, effective, nonmedical specialty blocks and five weekly primary care activities that created a paradigm-driven, community-based, role-modeling matrix. Innovation was built in. Every block and activity was evaluated immediately and in an annual, program-wide retreat. Evaluation evolved from behavioral checklists of taped interviews to performance-based, systematic, annual objective structured clinical examinations.

METHOD

The authors reviewed eight grant proposals, project reports, and curriculum and program evaluations. They also quantitatively and qualitatively surveyed the 122 reachable graduates from the first 20 graduating classes of the program.

RESULTS

Analysis of program documents revealed recurring emphases on the use of proven educational models, strategic innovation, and assessment and evaluation to design and refine the program. There were 104 respondents (85%) to the survey. A total of 87% of the graduates practice as primary care physicians, 83% teach, and 90% work with the underserved; 54% do research, 36% actively advocate on health issues for their patients, programs, and other constituencies, and 30% publish. Graduates cited work in the community and faculty excitement and energy as essential elements of the program's impact; overall, graduates reported high personal and career satisfaction and low burnout.

CONCLUSIONS

With HRSA support, a focused, innovative program evolved which has already met each of the six recommendations for future innovation of the Alliance for Academic Internal Medicine Education Redesign Task Force. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Excellence in physician assistant training through faculty development

Once again, experts predict a shortage of health care providers by 2020. The physician assistant (PA) profession was created in the 1960s to address a similar need. Currently, there are 141 accredited PA training programs in the United States, 75 of them established in the 10 years between 1993 and 2002. Historically, PA education and practice models have been responsive to the ever-changing landscape of health care. It may be the profession's flexibility and adaptability that has enabled it to survive and flourish in a competitive service environment. The growth of new PA programs mandates a need for continuing faculty development, as increasing numbers of educators hail primarily from clinical practice and come equipped with minimal teaching experience. PA faculty development addresses these new recruits' needs to develop model curricula, implement new courses, and enhance instruction-all with the goal of improving both access to and quality of health care.The author describes the impact of Health Resources and Service Administration Title VII, Section 747 (Title VII) contracts in addressing this need. Title VII-funded PA education projects, considered innovative at the time of implementation, included both faculty development workshops that promoted active learning of basic teaching and administrative skills and new curricula designed to enhance faculty teaching in genomics and practice management. These projects and others resulted in enduring professional resources that have not only strengthened the PA community but also enjoyed broad applicability within other health professions groups.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.