The current environment for medical decision making: Alternative efficiency concepts and decision motivation

Health services delivery is rapidly changing in the U.S. and along with it the incentives and motives for making decisions about the use of services. This paper discusses the economic criteria for making good decisions from both individual and social perspectives. The position is taken that individual criteria for decision-making efficiency in health services is quite different from social efficiency criteria but the two perspectives can be viewed as complementary. These criteria are used to examine current developments in health services, including aggressively competitive managed care. The analysis concludes that current directions may be in conflict with both social and individual efficiency. Alternative public policies are required to alter motives and incentives such that decisions better meet the complementary efficiency criteria.Originally prepared for presentation at the Annual Meeting of the American Association for the Advancement of Science, Atlanta, Georgia, February 17, 1995, as part of the symposium Cognitive Interpersonal, and Societal Influences on Medical Decision Making (A. M. Isen and B. S. Moore, Chairs).     

The timing effects of accent production in synchronization and continuation tasks performed by musicians and nonmusicians

Two groups of subjects differing in their musical expertise produced periodic finger-tapping sequences involving a pattern of accentuation. In some situations, the taps were synchronized with the clicks of a metronome. We recorded the trajectory of the subjects' finger displacement in the vertical plane, and the force and the moment of occurrence of the taps on the response key. Musicians tended to equalize the durations of the downstrokes at all positions in the sequence. Nonmusicians moved their finger quickly to produce the accent, and more slowly to produce the subsequent tap. These variations in the movement-execution time were partly compensated by opposite variations in the onsets of the movements, e.g., the short-duration movements were delayed. Despite these differences in their movement strategies, musicians and nonmusicians generated very similar tap-timing profiles. The intertap interval after the accent was lengthened regardless of the subjects' musical expertise and the metronome conditions (metronome present or absent). The lengthening did not depend on whether the interval before the accent was shortened (without the metronome) or not (with the metronome). It is suggested that an internal timekeeper may generate temporal goal points at which the keytaps should occur. The lengthening of the interval after the accent is attributed to transient changes in the working of the internal clock.     

Book reviews

Science as Salvation: a Modern Myth and its Meaning, Mary Midgley, 1994. London, Routledge x +256pp., Hb 04 15062713, £35; Pb 04 15107733, £8.99

Philosophical Naturalism, David Papineau, 1993 Oxford, Basil Blackwell xii +219pp., Hb 0631189025, £40; Pb 0631189033, £14.99

F. H. Bradley, Writings on Logic and Metaphysics, James W. Allard & Guy Stock (Eds), 1994. Oxford, Clarendon Press xv+357pp, Hb 0–198–24445–2, £40.00; Pb 0–198–24438‐X, £14.95

Invariance and Heuristics: Essays in Honour of Heinz Post, Steven French & Harmke Kamminga (Eds), 1993 Boston Studies in the Philosophy of Science, Vol. 148 Kluwer Academic Publishers, Dordrecht

Beyond Reason: Essays on the Philosophy of Paul Feyerabend, GONZALO MUNÉVAR (Ed.), 1991. Dordrecht, Kluwer Academic Publishers xxi + 535pp., hb, ISBN 0–7923–1272–4, £104.20

World Changes: Thomas Kuhn and the Nature of Science, Paul Horwich (Ed.), 1993. Cambridge, MA, Bradford Books/MIT Press vi + 356pp., pb, ISBN 0262581388, £14.95

Realism Rescued: How Scientific Progress is Possible, Jerold L. Aronson, Rom Harré & Eileen Cornell Way, 1994 London, Duckworth vii +213pp., Hb 0715624768, £30.00

Scientific Nihilism: On the Loss and Recovery of Physical Explanation, Daniel Athearn, 1994. State University of New York Press, Albany ix + 387pp., Hb ISBN 0–7914–1807–3, £52

Theism, Atheism, and Big Bang Cosmology, William Lane Craig & Quentin Smith, 1993. Oxford, Clarendon Press x +342pp., Hb 0198263481, £35; Pb 019826383X, £13.95     

Piaget and Vygotsky Revisited: Dialogue or Assimilation?

In response to suggestions for merging Piagetian and Vygotskian psychology on the basis of their apparent similarity (e.g., Glassman, 1994), it is argued that numerous differences between the two paradigms constitute fundamental principled disagreements, and that these ought not to be minimized or simplified. Some fundamental differences involve underlying philosophy, social influences on development, the nature of the developmental process itself, developmental stages, and universality of cognitive structures. It is argued that a project of combining Piagetian and Vygotskian psychology would be premature at best, and that continued dialogue between these two distinct perspectives would be of greater value.     

Neuropsychological Features of Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is the epitome of a subcortical dementia process. Due to its relative rarity, there is only a small literature on the neuropsychological consequences of PSP. The findings to date demonstrate that PSP patients have dramatically slowed information processing and motor execution, rapid forgetting, problems in orienting attentional resources, and difficulty in planning and shifting conceptual sets. The pattern and severity of these deficits are unique to PSP and suggest that the study of PSP patients can provide a special insight into brain-behavior relations.     

Training Soviet immigrant therapists in the field of group psychotherapy

Between 1970 and 1990 about one-half million Jews immigrated to Israel, most of them from the former Soviet Union, including many mental health therapists who had trained and worked in the Soviet Union. This article addresses the special characteristics of this population, in general, and of the mental health therapists, in particular. It relates these characteristics to training for group psychotherapy. Key issues include their unique experience of the inner world as a source of danger, the specific defensive modes connected with this experience, their perception of authority as an agent of ideology, and their representation of the group as a persecutory entity and as a vehicle of indoctrination.     

You and me as she and he: The meaning of gender-related concepts in other- and self-perception

This study compares and contrasts the use of gender-related concepts in other-and self-perception. The schematic use and stereotypic and affective meanings of feminine and masculine were derived from hierarchical classes analysis (HICLAS) of participants' (N = 72; 50 females, 22 males, 54% white) ratings of self and significant others. The study reveals that people use these concepts differently in their perception of others than in their perception of self. In addition, the meaning of masculine and feminine constructed by these participants differs significantly from their traditional definitions. Finally, being feminine is evaluated more positively than being masculine in the perception of others, while the ego protective function of gender leads participants to evaluate their own gender's features most positively in self-perception.This article was presented at the 1993 Eastern Psychological Association, Washington, DC, April 1993. The collection of the data reported in this paper was supported by National Institute of Mental Health Grant MH40871-03/04. We thank the Institute for its support. We also thank the participants in this study for sharing their lives with us. Finally we would like to thank Richard Ashmore, Rae Carlson, and Basil Englis for comments on earlier drafts of this paper.     

Certification of Specialties: Not If,But How

The guest editorial and featured articles have established the fact of counseling specialties and also that counselors have no clear or consistent scheme to recognize professional specialization. If counselors expect external recognition of and respect for their credentials, the credentials first must be recognized and understood by counselors. The experiences of other professions suggest strategies, but counselors must determine their own way of recognizing specialties without denying counselors' common identity. The profession and practice of counseling will be strengthened if all counselors have a minimum foundation of counseling knowledge and competencies and build accepted specializations on that foundation. The counseling profession must distinguish among work settings, professional interests, and specializations as a prerequisite to a coherent scheme of recognizing specialties.     

The earth summit and the promotion of environmentally sound industrial innovation in developing countries

With the end of the cold war, issues of environment and economic development are assuming greater international salience. By the 1970s, environmental degradation was becoming pervasive, with growing global effects. Increasingly, global and emergent globalized problems are forcing environmental interdependence on the world. Transboundary threats cannot be addressed unilaterally by any single country or group of countries. The global environmental agenda is reviving the North-South debate and rejuvenating the Third World coalition in international fora. The encouragement of environmentally sustainable forms of industrialization in the South requires expanded and improved international cooperation. However, the North’s greater resources and greater responsibility in causing global environmental degradation require its continuing involvement in the search for solutions, including ones applicable to newly industrializing countries. In June 1992, the largest intergovernmental conference ever held was convened in Rio de Janeiro to address these issues: the United Nations Conference on Environment and Development (UNCED, or the Earth Summit). It produced a consensus action plan of about 700 pages: Agenda 21. Agenda 21 presents massive challenges for international cooperation as well as for national and private actors and scientific and technical institutions. It reflects a complex configuration of demands for institutional arrangements that support environmentally sustainable technical and socioeconomic change. One of the most consistent of the Agenda 21 themes, and one of the most intractable issues, concerns “access to technology.” This can be as straightforward as diagnosing and improving the efficiency of a production process in a small manufacturing firm, or as complex as engineering a technological revolution in which production and consumption take place with virtually no material or energy loss to the environment. The selection of entry points for action is a critical strategic problem as well as an important operational issue. In this paper I identify and describe new initiatives intended to improve the environmental performance of industry in the South, and find that they largely aim to promote incremental industrial innovation through international technology transfer and diffusion. This strategy raises many questions about how to promote effective technology transfer and diffusion. This is a revised version of a paper prepared for the ORSTOM/UNESCO Conference “20th Century Science: Beyond the Metropolis,” Paris, 19–23 Sept. 1994.