Tempered by war: the military experiences of Vietnam decision-makers

The article focuses on three senior decision-makers in the John F. Kennedy and Lyndon B. Johnson administrations that each played a key role in the escalation in Vietnam, namely Walt W. Rostow, Roger Hilsman, and John T. McNaughton. It builds on Andrew Preston’s argument in this journal that the dichotomy between ‘hawks’ and ‘doves’ might caricature Vietnam War advisors to suggest the same for the dichotomy between ‘civilians’ and ‘veterans’. Using new material, most notably McNaughton’s wartime diaries and Hilsman’s OSS files, the article suggests that wartime experience was clearly an important formative experience for civilian advisors but in different ways. First, where political scientists tell us that veterans are more likely to espouse certain views, and in particular resist the use force, these examples suggest that proximity to combat - i.e. how much active combat they experienced - mattered more. Second, there was no uniform ‘military’ experience: these advisors were more likely to support the types of tools – i.e. air power or irregular forces - with which they were familiar and only then, if they had become invested in the underlying bureaucratic project of the agency in which they were deployed. In other words, a process of socialization or indoctrination into the armed services happened unevenly. Put together, the examples suggest that the formative experiences in the Second World War cast a long shadow onto the Vietnam War decisions but did so in complex ways

Clinical Utility of Advanced Microbiology Testing Tools

Advanced microbiology technologies are rapidly changing our ability to diagnose infections, improve patient care, and enhance clinical workflow. These tools are increasing the breadth, depth, and speed of diagnostic data generated per patient, and testing is being moved closer to the patient through rapid diagnostic technologies, including point-of-care (POC) technologies. While select stakeholders have an appreciation of the value/importance of improvements in the microbial diagnostic field, there remains a disconnect between clinicians and some payers and hospital administrators in terms of understanding the potential clinical utility of these novel technologies. Therefore, a key challenge for the clinical microbiology community is to clearly articulate the value proposition of these technologies to encourage payers to cover and hospitals to adopt advanced microbiology tests. Specific guidance on how to define and demonstrate clinical utility would be valuable. Addressing this challenge will require alignment on this topic, not just by microbiologists but also by primary care and emergency room (ER) physicians, infectious disease specialists, pharmacists, hospital administrators, and government entities with an interest in public health. In this article, we discuss how to best conduct clinical studies to demonstrate and communicate clinical utility to payers and to set reasonable expectations for what diagnostic manufacturers should be required to demonstrate to support reimbursement from commercial payers and utilization by hospital systems