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A convincing case for resolving financial conflicts of interest that compromise the judgment of doctors and that bias the clinical choices they make. Whereas lawyers, certain financial professionals, and government officials are considered by law to be fiduciaries- -i.e., obligated to work for the benefit of those they represent- -there's as yet no effective policy to hold doctors accountable in this way. The medical profession has never developed a framework to address this problem, and, according to Rodwin (Law and Public Policy/Indiana University-Bloomington), it's unlikely to do so. Here, Rodwin examines seven activities that lead to significant conflicts of interest among physicians: kickbacks; referral to facilities in which physicians have a financial interest; the selling of medical products that they themselves prescribe; hospital purchases of private practices; payments by hospitals for patient referrals; gifts by pharmaceutical firms; and risk-sharing in health-maintenance organizations (HMOs). Disturbing examples of each of these activities dot the text and dramatize how patients can be adversely affected by them. Rodwin draws on the regulatory approaches of other professions to offer recommendations for solving the medical establishment's conflict- of-interest problems. He argues for setting up new institutions and rules to hold physicians to fiduciary standards, with legislatures taking the lead in laying down the ground rules, and with courts, regulatory agencies, third-party payers, and state attorneys general enforcing them. One interesting concept the author examines is the regulation of the medical industry by a federal commission, similar to the regulation of the securities business by the SEC. A constructive contribution—featuring a well-presented analysis as well as concrete proposals for reform—to the ongoing discussion of our national health-care crisis.

Pub Date: May 1, 1993

ISBN: 0-19-508096-3

Page Count: 400

Publisher: Oxford Univ.

Review Posted Online: May 19, 2010

Kirkus Reviews Issue: March 15, 1993

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If the authors are serious, this is a silly, distasteful book. If they are not, it’s a brilliant satire.

The authors have created a sort of anti-Book of Virtues in this encyclopedic compendium of the ways and means of power.

Everyone wants power and everyone is in a constant duplicitous game to gain more power at the expense of others, according to Greene, a screenwriter and former editor at Esquire (Elffers, a book packager, designed the volume, with its attractive marginalia). We live today as courtiers once did in royal courts: we must appear civil while attempting to crush all those around us. This power game can be played well or poorly, and in these 48 laws culled from the history and wisdom of the world’s greatest power players are the rules that must be followed to win. These laws boil down to being as ruthless, selfish, manipulative, and deceitful as possible. Each law, however, gets its own chapter: “Conceal Your Intentions,” “Always Say Less Than Necessary,” “Pose as a Friend, Work as a Spy,” and so on. Each chapter is conveniently broken down into sections on what happened to those who transgressed or observed the particular law, the key elements in this law, and ways to defensively reverse this law when it’s used against you. Quotations in the margins amplify the lesson being taught. While compelling in the way an auto accident might be, the book is simply nonsense. Rules often contradict each other. We are told, for instance, to “be conspicuous at all cost,” then told to “behave like others.” More seriously, Greene never really defines “power,” and he merely asserts, rather than offers evidence for, the Hobbesian world of all against all in which he insists we live. The world may be like this at times, but often it isn’t. To ask why this is so would be a far more useful project.

If the authors are serious, this is a silly, distasteful book. If they are not, it’s a brilliant satire.

Pub Date: Sept. 1, 1998

ISBN: 0-670-88146-5

Page Count: 430

Publisher: Viking

Review Posted Online: May 19, 2010

Kirkus Reviews Issue: July 15, 1998

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This a book of earlier, philosophical essays concerned with the essential "absurdity" of life and the concept that- to overcome the strong tendency to suicide in every thoughtful man-one must accept life on its own terms with its values of revolt, liberty and passion. A dreary thesis- derived from and distorting the beliefs of the founders of existentialism, Jaspers, Heldegger and Kierkegaard, etc., the point of view seems peculiarly outmoded. It is based on the experience of war and the resistance, liberally laced with Andre Gide's excessive intellectualism. The younger existentialists such as Sartre and Camus, with their gift for the terse novel or intense drama, seem to have omitted from their philosophy all the deep religiosity which permeates the work of the great existentialist thinkers. This contributes to a basic lack of vitality in themselves, in these essays, and ten years after the war Camus seems unaware that the life force has healed old wounds... Largely for avant garde aesthetes and his special coterie.

Pub Date: Sept. 26, 1955

ISBN: 0679733736

Page Count: 228

Publisher: Knopf

Review Posted Online: Sept. 19, 2011

Kirkus Reviews Issue: Sept. 1, 1955

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