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In the nineteenth century, infants were commonly breast-fed; by the middle of the twentieth century, women typically bottle-fed their babies on the advice of their doctors. In this book, Rima D. Apple discloses and analyzes the complex interactions of science, medicine, economics, and culture that underlie this dramatic shift in infant-care practices and women’s lives. As infant feeding became the keystone of the emerging specialty of pediatrics in the twentieth century, the manufacture of infant food became a lucrative industry. More and more mothers reported difficulty in nursing their babies. While physicians were establishing themselves and the scientific experts and the infant-food industry was hawking the scientific bases of their products, women embraced “scientific motherhood,” believing that science could shape child care practices. The commercialization and medicalization of infant care established an environment that made bottle feeding not only less feared by many mothers, but indeed “natural” and “necessary.” Focusing on the history of infant feeding, this book clarifies the major elements involved in the complex and sometimes contradictory interaction between women and the medical profession, revealing much about the changing roles of mothers and physicians in American society. “The strength of Apple’s book is her ability to indicate how the mutual interests of mothers, doctors, and manufacturers led to the transformation of infant feeding. . . . Historians of science will be impressed with the way she probes the connections between the medical profession and the manufacturers and with her ability to demonstrate how medical theories were translated into medical practice.”—Janet Golden, Isis

Reveals the roots of America's failure to address the health care need of its citizens. In a comprehensive history of the failed efforts to enact universal insurance from the 1940s to the 1990s, the author shows how each attempt to enact national health insurance has met with fierce attacks by stakeholders

In the 21st century, health care has been going through a paradigm shift called digital health. Due to major advances and breakthroughs in information technologies, most recently artificial intelligence, the patriarchy of the doctor-patient relationship has started evolving toward an equal-level partnership with initial signs of patient autonomy. Being an underused resource for centuries, patients have started to contribute to their care with information, data, insights, preferences, and knowledge. It is important to recognize that at its core, digital health represents a cultural transformation, where patient empowerment has likely played the most significant role in driving these changes. This viewpoint paper traces the remarkable journey of patient empowerment from its nascent stages to its current prominence in shaping health care’s future. Spanning over two and a half decades, we explore pivotal moments and technological advancements that have revolutionized the patient’s role in health care. We dive into a few historical milestones, mainly in the United States, that have challenged and redefined societal norms around agency, drawing parallels between patient empowerment and broader social movements, such as the women’s suffrage and civil rights movements. Through these lenses, we argue that patient empowerment is not solely a function of knowledge or technology but requires a fundamental shift in societal attitudes, policies, health care culture, and practices. As we look to the future, we posit that the continued empowerment of patients will play a pivotal role in the development of more equitable, effective, and personalized health care systems. This paper calls for an ongoing commitment to fostering environments that support patient agency, access to resources, and the realization of patient potential in navigating and contributing to their health outcomes with an emphasis on the emerging significance of patient design.

There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system.

Prescription drug monitoring programs (PDMPs) have become a widely embraced policy to address the US opioid crisis. Despite mixed scientific evidence on their effectiveness at improving health and reducing overdose deaths, 49 states and Washington, DC have adopted PDMPs, and they have received strong bipartisan legislative support. This article explores the history of PDMPs, tracking their evolution from paper-based administrative databases in the early 1900s to modern-day electronic systems that intervene at the point of care. We focus on two questions: how did PDMPs become so widely adopted in the United States, and how did they gain popularity as an intervention in the contemporary opioid crisis? Through this historical approach, we evaluate what PDMPs reflect about national drug policy and broader cultural understandings of substance use disorder in the United States today. (Am J Public Health. 2020;110:1191–1197. 10.2105/AJPH.2020.305696)

Physicians assume a primary ethical duty to place the welfare of their patients above their own interests. Thus, for example, physicians must not exploit the patient–physician relationship for personal financial gain through the practice of self-referral. But how far does the duty to patient welfare extend? Must physicians assume a serious risk to their own health to ensure that patients receive needed care? In the past, physicians were expected to provide care during pandemics without regard to the risk to their own health. In recent decades, however, the duty to treat during pandemics has suffered from erosion even while the risks to physicians from meeting the duty has gone down. After exploring the historical evolution of the duty to treat and the reasons for the duty, I conclude that restoring a strong duty to treat would protect patient welfare without subjecting physicians to undue health risks.

In the past 20 years, the number of hospitalists in the United States has grown from a few hundred to more than 50,000. Although challenges remain, many stars have aligned to enable the model to thrive and contribute to high-quality, efficient inpatient care. Twenty years ago, we described the emergence of a new type of specialist that we called a “hospitalist.” 1 Since then, the number of hospitalists has grown from a few hundred to more than 50,000 (see graph) — making this new field substantially larger than any subspecialty of internal medicine (the largest of which is cardiology, with 22,000 physicians), about the same size as pediatrics (55,000), and in fact larger than any specialty except general internal medicine (109,000) and family medicine (107,000). Approximately 75% of U.S. hospitals, including all highly ranked academic health centers, now have hospitalists. The field’s rapid growth . . .

Questions about excluding transgender people from antidiscrimination protections reflect the polarizing nature of definitions of sex. Yet historians of medicine know that the relevant moral and scientific questions touch on age-old themes in medical understanding.

In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce. [PUBLICATION ABSTRACT]

The relationship between patients and doctors is at the core of medical ethics, anchoring many important debates in the field. Over the past several decades, this relationship has evolved along three axes — as it is defined in clinical care, research, and society. The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the past several decades, this relationship has evolved along three interrelated axes — as it is defined in clinical care, research, and society. Many of the pivotal discussions of these issues have appeared in the pages of the Journal (see Key NEJM Articles on Medical Ethics). Clinical Care The relationship between patients and doctors in the clinical realm has historically been framed in terms of benevolent paternalism. Until about 1960, most codes of medical ethics relied heavily . . .