Food security in an era of economic volatility.

This article analyzes international commodity price movements, assesses food policies in response to price fluctuations, and explores the food security implications of price volatility on low-income groups. It focuses specifically on measurements, causes, and consequences of recent food price trends, variability around those trends, and price spikes. Combining these three components of price dynamics shows that the variation in real prices post-2000 was substantially greater than that in the 1980s and 1990s, and was approximately equal to the extreme volatility in commodity prices that was experienced in the 1970s. Macro policy, exchange rates, and petroleum prices were important determinants of price variability over 2005­2010, highlighting the new linkages between the agriculture-energy and agriculture-finance markets that affect the world food economy today. These linkages contributed in large part to misguided expectations and uncertainty that drove prices to their peak in 2008. The article also argues that there is a long-lasting effect of price spikes on food policy around the world, often resulting in self-sufficiency policies that create even more volatility in international markets. The efforts by governments to stabilize prices frequently contribute to even greater food insecurity among poor households, most of which are in rural areas and survive on the margin of net consumption and net production. Events of 2008­and more recently in 2010­underscore the impact of price variability for food security and the need for refocused policy approaches to prevent and mitigate price spikes.

Mental health reform not always beneficial.

History is instructive even when the lessons learned cannot be easily transposed to a new time and place. The aim of this paper is to describe psychiatric reforms implemented one hundred years ago in Germany and how, contrary to their intention, they resulted, with changes in economics, politics and ideology, in disaster for psychiatric patients. The conclusion for our time is that the new and seemingly expedient need always to be questioned. If nothing else, the paper reviews an important era in the history of our profession.

The Trading with the Enemy Act of 1917 and synthetic drugs: relieving scarcity, controlling prices, and establishing pre-market licensing controls.

The "Trading with the Enemy Act" (TWEA) was enacted in October 1917 after America's entry into World War I and during a period of wartime scarcity and rising prices of synthetic drugs and dyestuffs that began in 1914. It was described as "An Act to define, regulate, and punish trading with the enemy, and for other purposes." The act and subsequent executive orders authorized an "Alien Property Custodian" to take control of all enemy property within the United States. Also, The Federal Trade Commission (FTC) was authorized to issue licenses for the use of enemy owned patents, which covered a range of industrial and consumer products. Significantly, the FTC was given the power to set the conditions for use of the patents and to fix the price for those products necessary for health. The effect of these measures was to bring federal pre-marketing control over the production, testing, and pricing of the most therapeutically significant synthetic drugs of the day. Enactment of the TWEA and the events preceding and surrounding it are significant parts of the history of the American pharmaceutical industry and federal regulation.

Behind closed doors: accountability and responsibility in patient care.

In this paper, I examine the notion of accountability and its historical evolution in health care. Using medical mistakes and adverse patient outcomes as my focus, I examine the interests served by particular models of accountability and argue for a model of collective fiduciary responsibility in U.S. health care today.

Case management: a rich history of coordinating care to control costs.

The process of case management has been used to coordinate health and human services in the United States for more than a century. Throughout its history, case management has been practiced by a variety of disciplines, primarily nursing and the social service disciplines. Regardless of the degree of sophistication of the case management model or the discipline practicing case management, historically the goal has been the same--coordination of complex, fragmented services to meet the needs of the client while controlling the costs of services. As the health care industry continues to evolve during the managed care era, case management seems to be pervading all health care delivery systems as a means of dealing with the issues of access and quality while containing costs. The long history of case management provides a strong foundation for the refinement of case management systems to meet the needs of clients in the 1990s.

The looming fight over health care reform: what we can learn from past debates.

There have been numerous debates over reforming our health care system. A careful examination of the outcome of these debates may indicate what lies ahead for you when you make your next doctor's appointment.