Treatment Decision-Making in Catastrophic Illness

It is well established that the social and economic environment of medical care distinguishes its provision from that of other goods and services. While scholars have studied the influences of this idiosyncratic environment, there is relatively little empirical knowledge about how it affects decision-making in specific medical contexts. Through general conceptual discussion and consideration of a case study of leukemia chemo-therapy, this paper examines the medical decision-making process in one specific context: the response of physicians to the availability of an innovative treatment for a catastrophic illness. The manner in which the medical profession deals with serious illness is relevant to concerns as diverse as the promotion of economic efficiency and the preservation of human dignity.

The Economics of Smoking

While the tobacco industry is among the most substantial and successful economic enterprises, tobacco consumption kills more people than any other product. Economic analysis of tobacco product markets, particularly for cigarettes, has contributed considerable insight to debates about the industry's importance and appropriate public policy roles in grappling with health consequences of tobacco. The most significant example is the rapidly expanding and increasingly sophisticated body of research on the effects of price increases on cigarette consumption. Because excise tax is a component of price, the resultant literature has been prominent in legislative debates about taxation as a tool to discourage smoking, and has contributed theory and empirical evidence to the growing interest in modeling demand for addictive products. This chapter examines the research and several equity and efficiency concerns accompanying cigarette taxation debates. It includes economic analysis of other tobacco control policies, such as advertising restrictions, prominent in tobacco control debates. Research addressing the validity of tobacco-industry arguments that its contributions to employment, tax revenues, and trade balances are vital to economic health in states and nations is also considered, as it is the industry's principal weapon in the battle against policy measures to reduce tobacco consumption.

Tobacco Industry Response to Public Health Concern: A Content Analysis of Cigarette Ads

Public awareness of the health hazards of smoking intensified when the subject received national publicity. To assess tobacco industry tactics to counter adverse publicity, we performed a content analysis of cigarette ads in selected issues of Time magazine, for selected years from 1929-84. The analysis showed direct responses to health concerns in all of the years of major smoking-and-health "events," with the possible exception of 1964, the year of the first Surgeon General's report. During these years large percentages of ads emphasized health themes instead of the conventional cigarette ad imagery. On average, health-theme ads have a higher verbal content than the more pictorial traditional ads. Correspondingly, they employ many fewer models. Health-theme ads tend to emphasize the "technological fix," such as the scientifically designed filter and the low-tar cigarette. Subtle changes in cigarette advertising include the elimination of visible smoke from ads. A decade's concentration on standard health themes, prompted by the "tar wars" of the 1970s, appears to have ended in the 1980s. Advertisers seem to have reverted to the "good times" nonhealth imagery of a bygone era, though possibly to deliver a subtle implicit health message. Understanding industry advertising tactics can assist public health professionals in developing insights into the promotion of smoking and in formulating smoking control strategies. Though highly exploratory and tentative in nature, this study is offered in the spirit of increasing such understanding.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67221/2/10.1177_109019818501200111.pd

Letters to the Editor

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67846/2/10.1177_109019818901600104.pd

Haze distributions in the troposphere

May, 1969.Includes bibliographical references.Sponsored by the National Aeronautics and Space Administration NAD 5-11631.Sponsored by the National Aeronautics and Space Administration NASr-147

State legislation on smoking and health: A comparison of two policies

The two principal smoking-related state legislative activities stand in sharp contrast to one another. Cigarette excise taxation diffused among the states well before the connection between smoking and illness became a public issue, yet more recent tax increases appear to reflect a response to the national anti-smoking campaign. The growing disparity in cigarette prices between tobacco and other states has created a lucrative market in bootlegged cigarettes and has thereby brought new taxation to a virtual standstill for six years. Laws restricting smoking in public places represent a phenomenon of the 1970's clearly bearing the imprint of the anti-smoking campaign. From 1972 through 1978, the number of states with such laws in effect grew from 5 to 36, and the restrictiveness of the laws also increased. The dramatic correlation between diffusion of the laws and decreases in cigarette consumption rates seems best interpreted as each of these reflecting changes in social attitudes toward smoking.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45442/1/11077_2004_Article_BF00136006.pd

Smoking and schooling : In search of the missing link

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23783/1/0000021.pd

Public policy and automobile occupant restraint: An economist's perspective

Cost-benefit analyses (CBAs) of policies intended to increase occupant restraint in automobiles typically find that such policies generate social benefits that exceed social costs, often by a considerable margin. The analyses are incomplete, however, due to their inability to incorporate potentially important costs and benefits that are hard to measure and monetize. Furthermore, analyses fail to account for distributional and political considerations. Despite these limitations, the evidence produced by the occupant restraint CBAs tends to bolster the case of advocates of mandatory passive restraints and other restraint policies. Support for governmental involvement can also be found in economic theory, although the theoretical case is not necessarily compelling. The principal lesson of this review of economic analysis of the occupant restraint issue is that analysis can inform an injury policy debate, but it cannot provide conclusive answers, nor can it serve as a substitute for the political decision-making process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26814/1/0000372.pd

The need for some innovative concepts of innovation: An examination of research on the diffusion of innovations

This paper examines research on the diffusion of innovation, the final stage in the process of technological change. The focus rests primarily on two traditions in diffusion research: that of economists and that of sociologists. Diffusion researchers in these and related disciplines have made significant contributions to the understanding of the dynamics of processes of change; yet the state of the art in diffusion research is not equal to the sum of its parts. This is due in large measure to disciplinary parochialism: scholars have concentrated on those innovations, diffusion environments, explanatory variables, and analytical methodologies which are most compatible with their particular disciplines, despite the fact that diffusion is not a discipline-specific phenomenon. Deficiencies in current understanding of diffusion are examined in the context of this and other significant problems. The paper concludes by considering the policy relevance of diffusion research and suggesting issues with which future research might productively be concerned.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45455/1/11077_2004_Article_BF00147229.pd