Rothschild reversed: explaining the exceptionalism of biomedical research, 1971-1981.

The 'Rothschild reforms' of the early 1970s established a new framework for the management of government-funded science. The subsequent dismantling of the Rothschild system for biomedical research and the return of funds to the Medical Research Council (MRC) in 1981 were a notable departure from this framework and ran contrary to the direction of national science policy. The exceptionalism of these measures was justified at the time with reference to the 'particular circumstances' of biomedical research. Conventional explanations for the reversal in biomedical research include the alleged greater competence and higher authority of the MRC, together with its claimed practical difficulties. Although they contain some elements of truth, such explanations are not wholly convincing. Alternative explanations hinge on the behaviour of senior medical administrators, who closed ranks to ensure that de facto control was yielded to the MRC. This created an accountability deficit, which the two organizations jointly resolved by dismantling the system for commissioning biomedical research. The nature and working of medical elites were central to this outcome.

Health Planning in 1960s Africa: International Health Organisations and the Post-Colonial State.

This article explores the programme of national health planning carried out in the 1960s in West and Central Africa by the World Health Organization (WHO), in collaboration with the United States Agency for International Development (USAID). Health plans were intended as integral aspects of economic development planning in five newly independent countries: Gabon, Liberia, Mali, Niger and Sierra Leone. We begin by showing that this episode is treated only superficially in the existing WHO historiography, then introduce some relevant critical literature on the history of development planning. Next we outline the context for health planning, noting: the opportunities which independence from colonial control offered to international development agencies; the WHO's limited capacity in Africa; and its preliminary efforts to avoid imposing Western values or partisan views of health system organisation. Our analysis of the plans themselves suggests they lacked the necessary administrative and statistical capacity properly to gauge local needs, while the absence of significant financial resources meant that they proposed little more than augmentation of existing structures. By the late 1960s optimism gave way to disappointment as it became apparent that implementation had been minimal. We describe the ensuing conflict within WHO over programme evaluation and ongoing expenditure, which exposed differences of opinion between African and American officials over approaches to international health aid. We conclude with a discussion of how the plans set in train longer processes of development planning, and, perhaps less desirably, gave bureaucratic shape to the post-colonial state.

Advances in Occupational Health in Guatemala.

Occupational health in Guatemala has come a long way. In 1958, the first Regulation of Occupational Health by the Guatemalan Social Security Institute was published. There wasn´t another Directive in the country regarding this issue until the year 2000, when the National Council for Occupational Safety and Health was created. In 2014, it published the Governmental Agreement 229-2014 Occupational Health and Safety Regulations, which came into force on September 8th, 2015. Nowadays there are other institutions that care about this topic. Some of these institutions promote occupational health training through courses, workshops, seminars, etc., but there is not a formal education program yet. There are some other institutions, such as the National Institute of Statistics, which generates information concerning employment, unemployment, characteristics, composition, structure, and functioning of the labor market through surveys. And finally, there are other institutions like the Health, Labor and Environment Program of Central America SALTRA, which promotes investigation in this topic, generates information as well as endorses training regarding occupational safety as an important issue in the country.

Rubbing Elbows and Blowing Smoke: Gender, Class, and Science in the Nineteenth-Century Patent Office.

The United States Patent Office of the 1850s offers a rare opportunity to analyze the early gendering of science. In its crowded rooms, would-be scientists shared a workplace with women earning equal pay for equal work. Scientific men worked as patent examiners, claiming this new occupation as scientific in opposition to those seeking to separate science and technology. At the same time, in an unprecedented and ultimately unsuccessful experiment, female clerks were hired to work alongside male clerks. This article examines the controversies surrounding these workers through the lens of manners and deportment. In the unique context of a workplace combining scientific men and working ladies, office behavior revealed the deep assumption that the emerging American scientist was male and middle class.

Psychogeriatrics in England: Its Route to Recognition by the Government as a Distinct Medical Specialty, c.1970-89.

Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. 'General psychiatrists', nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London.

Ahead of its time? Reflecting on New Zealand's Pharmac following its 20th anniversary.

New Zealand's Pharmaceutical Management Agency (Pharmac) was created in 1993. Unusual in international terms, Pharmac's objective is to work within a fixed budget while ensuring the New Zealand public receives an adequate range of government-subsidised medicines. Following its 20th anniversary, this article reflects on Pharmac's development and role within the New Zealand health system, various changes over time to the agency's scope and activities, its performance and its present challenges.

[Health-care services in the GDR during the 1980s: A status report based on the files of the state security agency]. / Das DDR-Gesundheitswesen in den 1980er Jahren: Ein Zustandsbild anhand von Akten der Staatssicherheit.

BACKGROUND: The situation of the health-care services in the GDR during the 1980s has been reconstructed on the basis of the in part not previously released files of the Ministry for State Security (Stasi files). METHOD: A research application was submitted to the responsible German Agency to examine the Stasi files on district physicians in the GDR. 78 extensive files were made available and evaluated according to the topics drugs and other medicinal aids, medical techniques, building status, procurement of foreign currencies, hygiene, Chernobyl, appeals and shortage of physicians. RESULTS: The Stasi files reveal a dismal picture for the status of health-care services in the GDR during the 1980s. The authorities responsible for public health and the Ministry for State Security were well informed about the existing problems. Towards the end of the GDR the Ministry of Sate Security admitted internally that research and technology were lagging about 10 years behind that in Western countries. CONCLUSION: The discrepancy between the official reports and inofficial opinions was considerable. The Ministry of State Security worked mainly passively in an ideological fantasy world in which all such discrepencies had to be denied.

Utopian dream: a new farm bill.

In the fall of 2011, I taught a graduate food studies course at New York University devoted to the farm bill, a massive and massively opaque piece of legislation passed most recently in 2008 and up for renewal in 2012. The farm bill supports farmers, of course, but also specifies how the United States deals with such matters as conservation, forestry, energy policy, organic food production, international food aid, and domestic food assistance. My students came from programs in nutrition, food studies, public health, public policy, and law, all united in the belief that a smaller scale, more regionalized, and more sustainable food system would be healthier for people and the planet.

[40th anniversary of the 736th Main Center of State Sanitary and Epidemiological Surveillance of the Russian Defense Ministry].

In November 2012 736th Main Center of State Sanitary and Epidemiological Supervision of the Ministry of Defense of the Russian Federation celebrates 40th anniversary. It is a multidisciplanary prevention and treatment facility of high level standing at the top of the sanitary-epidemiological institutions of the army and navy. The Main Center is included into a united, centralized system of state sanitary-epidemiological control of Russia with the main purpose--organization and conduction of surveillance and anti-epidemic (preventive) measures in the army and navy. The article provides a consistent presentation of historical perspective of creation and development of the institution and its mission today.

A Lipskian analysis of child protection failures from Victoria Climbié to "Baby P": a street-level re-evaluation of joined-up governance.

This paper explores the issue of joined-up governance by considering child protection failures, firstly, the case of Victoria Climbié who was killed by her guardians despite being known as an at risk child by various public agencies. The seeming inability of the child protection system to prevent Victoria Climbié's death resulted in a public inquiry under the chairmanship of Lord Laming. The Laming report of 2003 looked, in part, to the lack of joined-up working between agencies to explain this failure to intervene and made a number of recommendations to improve joined-up governance. Using evidence from detailed testimonies given by key personnel during the Laming Inquiry, the argument of this paper is that we cannot focus exclusively on formal structures or decision-making processes but must also consider the normal, daily and informal routines of professional workers. These very same routines may inadvertently culminate in the sort of systemic failures that lead to child protection tragedies. Analysis of the micro-world inhabited by professional workers would benefit most, it is argued here, from the policy-based concept of street-level bureaucracy developed by Michael Lipsky some 30 years ago. The latter half of the paper considers child protection failures that emerged after the Laming-inspired reforms. In particular, the case of 'Baby P' highlights, once again, how the working practices of street-level professionals, rather than a lack of joined-up systems, may possibly complement an analysis of, and help us to explain, failures in the child protection system. A Lipskian analysis generally offers, although there are some caveats, only pessimistic conclusions about the prospects of governing authorities being able to avoid future child protection disasters. These conclusions are not wholeheartedly accepted. There exists a glimmer of optimism because street-level bureaucrats still remain accountable, but not necessarily in terms of top-down relations of authority rather, in terms of interpersonal forms of accountability ­ accountability to professionals and citizen consumers of services.

Healthy vocations: field nursing and the religious overtones of public health.

This article argues that the Office of Indian Affairs (OIA) field nursing program of the 1930s, which continued much of the same assimilation-style health care practices begun generations earlier by missionaries and field matrons, perpetuated the nineteenth-century link between religion and health care. Following in the footsteps of their female predecessors, field nurses targeted native women for health education, emphasizing personal hygiene and individual responsibility at the expense of socioeconomic causes of illness. Native women nonetheless appear to have maintained agency and power in negotiating health and health care. Peaking during the era of OIA Commissioner John Collier's Indian New Deal, the history of field nursing problematizes this period, particularly with regard to women's experiences. The article is significant for its exploration of field nursing as a contested site of cultural negotiation, revealing issues of power and difference in the lives of American women.

Coordination processes and outcomes in the public service: the challenge of inter-organizational food safety coordination in Norway.

In 2004 Norway implemented a food safety reform programme aimed at enhancing inter-organizational coordination processes and outcomes. Has this programme affected inter-organizational coordination processes and outcomes, both vertically and horizontally ­ and if so how? This article employs the concept of inter-organizational coordination as an analytical tool, examining it in the light of two theoretical perspectives and coupling it with the empirical findings. The argument presented is that the chances of strong coordination outcomes may increase if inter-organizational processes feature a clear division of labour, arenas for coordination, active leadership, a lack of major conflicting goals, and shared obligations.

"Mr. Burk is most interested in their welfare": J.G. Burk's campaign to help the Anishinabeg of northwestern Ontario, 1923-53.

Although there is a small but growing body of literature on Euro-Canadians who acted "with good intentions" towards the First Nations (Haig-Brown and Nock 2006), precious little has been written about those within the ranks of the Department of Indian Affairs who acted benevolently towards the Aboriginal peoples. James Gerry Burk, Indian agent for the Anishinabeg of the western Lake Superior region for three decades (1923-53), was one such individual. He chose to ignore the department's prevailing racist ideology in favour of nurturing the incipient desire for industry and enterprise that he saw first-hand among the Aboriginal constituents of his agency. In the process, he was compelled to overcome numerous obstacles that Indian Affairs placed in his way. As a result, Burk's career stands as a glowing testament to the indomitable spirit of one departmental official's commitment to assisting the Aboriginal peoples.

[The constitution and attribution of government research agencies. A matter of need for science-generated policy knowledge?]. / Errichtung und Zurechnung von Ressortforschungseinrichtungen. Eine Frage des Bedarfs an wissenschaftlicher Expertise?

Government research agencies are a form of extra-university research institutions. In contrast to other extra-university research facilities they are subordinate to and financed by respective German governmental departments. As their mission they provide science-generated information, services, and monitoring to support the governmental departments. In science studies researchers proclaim a rigid association between the installation, attribution, and development of government research agencies and the increasing need for science-generated policy knowledge. The article examines this assumed association based on the personal, institutional, financial, and mission specific development of government research agencies between the years 1965 and 2005. According to the results the expansion of government research agencies stagnates--like science in general.

Short history of PACS. Part I: USA.

This historical review covers the PACS development in the USA during the past 28 years from 1982 to 2010. General historical remarks of PACS and international scene in three stages from infancy, puberty to adolescence are presented. Early PACS development was mostly financed by the federal government including the National Institutes of Health (NIH) and the U.S. Army Medical Research and Materiel Command. PACS evolution went through several stages. The earliest stages included the definition of large-scale PACS, establishment of the DICOM and other standards, the development of some early key PACS related technologies, and PACS implementation strategies. The later stages were in the concept of enterprise PACS, IHE (Integrating the Healthcare Enterprise) workflow profiles, and ePR with image distribution. The current most excited accomplishment is in the development of the new field in medical imaging informatics. This review goes through these stages and events in the USA during these 28 years, whenever an event involved participants from other countries, the contributors are cited.

Race categorization and the regulation of business and science.

Despite the lack of consensus regarding the meaning or significance of race or ethnicity amongst scientists and the lay public, there are legal requirements and guidelines that dictate the collection of racial and ethnic data across a range of institutions. Legal regulations are typically created through a political process and then face varying kinds of resistance when the state tries to implement them. We explore the nature of this opposition by comparing responses from businesses, scientists, and science-oriented businesses (pharmaceutical and biotechnology companies) to U.S. state regulations that used politically derived racial categorizations, originally created to pursue civil rights goals. We argue that insights from cultural sociology regarding institutional and cultural boundaries can aid understanding of the nature of resistance to regulation. The Food and Drug Administration's guidelines for research by pharmaceutical companies imposed race categories on science-based businesses, leading to objections that emphasized the autonomy and validity of science. In contrast, similar race categories regulating first business by the Equal Employment Opportunity Commission (EEOC) and later scientific research sponsored by the National Institutes of Health (NIH) encountered little challenge. We argue that pharmaceutical companies had the motive (profit) that NIH-supported scientists lacked and a legitimate discourse (boundary work of science) that businesses regulated by the EEOC did not have. The study suggests the utility of a comparative cultural sociology of the politics of legal regulation, particularly when understanding race-related regulation and the importance of examining legal regulations for exploring how the meaning of race or ethnicity are contested and constructed in law.