Politics ahead of patients: The battle between medical and chiropractic professional associations over the inclusion of chiropractic in the American Medicare System

Health care professions struggling for legitimacy, recognition, and market share can become disoriented to their priorities. Health care practitioners are expected to put the interests of patients first. Professional associations represent the interests of their members. So when a professional association is composed of health care practitioners, its interests may differ from those of patients, creating a conflict for members. In addition, sometimes practitioners’ perspectives may be altered by indoctrination in a belief system, or misinformation, so that a practitioner could be confused about the reality of patient needs. Politicians, in attempting to find an expedient compromise, can value a “win” in the legislative arena over the effects of that legislation. These forces all figure into the events that led to the acceptance of chiropractic into the American Medicare system. Two health care systems in a political fight lost sight of their main purpose: to provide care to patients without doing harm. Dans leur recherche de légitimité, de reconnaissance et d’une juste part sur le marché de la santé, les professionnels de la santé peuvent perdre de vue leurs priorités. Ces praticiens doivent donner préséance aux intérêts des patients tandis que les associations professionnelles représentent ceux de leurs membres. Lorsqu’une association professionnelle regroupe des praticiens de la santé cependant, ses intérêts s’opposent parfois à ceux des patients, créant ainsi un conflit pour les membres. De plus, les praticiens peuvent être endoctrinés par un système de valeurs ou mal informés, au point de se tromper dans l’évaluation des besoins réels des patients. De leur côté, les politiciens peuvent préférer une « victoire » dans l’arène législative à une juste appréciation des impacts d’une loi. Ces forces ont toutes participé aux évènements qui ont mené à l’acceptation de la chiropraxie par le système américain Medicare. Dans cette bataille politique, deux systèmes de santé ont négligé leur principal objectif : soigner des patients sans leur nuire

Live-aboard dive boats in the Great Barrier Reef: regional economic impact and the relative values of their target marine species

Using data collected from more than 1,000 tourists on live-aboard dive boats operating in the Cairns/Cooktown management area of the Great Barrier Reef, this paper estimates the regional economic impact of that live-aboard industry. It also uses a subset of these data (247 respondents) to investigate some of the relative ‘values’ of key marine species seen on the trips that included the Coral Sea location of Osprey Reef and which targeted multiple species of wildlife. The authors find that (i) each year, the live-aboard dive boats are directly responsible for generating at least AU$16 million worth of income in the Cairns/Port Douglas region; (ii) visitors participating in different types of trips gain their highest levels of ‘satisfaction’ from interacting with different types of species; and (iii) visitors to Osprey\ud Reef would be willing to pay more for a ‘guaranteed’ sighting of sharks than they would for a ‘guaranteed’ sighting of large fish, marine turtles or a ‘wide variety of species’