Document dYp3gXb87Bo6j35QqzxepOVwR

H EALTH PAC E3 jitpp r ~p c nJLr li JL C-JL l i l t _E 0 i.J c_JL H ealth P o licy A d visory Center VolumMeayII/l,uNneu,m1b9er805 HPICSSBNAR00111(75-)910-5316 1 Losing Patience: AINLTOHOEKABSBAECSKTOAST ICNODRUPSOTRRYA.TREeMceEnDtlIyCuINnE fcroovmertehde lfoifhtniess-Mreavnevailllaebinroteardnaplatdtoecrnumofenctosr porate medical abuse. 3 Vital Signs 23 The 1981 Health Budget: CTaRrOteUr'Bs L1E98A1HbEuAdgDe,t,TpRlOusUBinLflEatBioEnH, IpNrDom. ises deep cuts in health services. 15 Columns WUROBRAKN/E: NPVhiIlRadOeNlp:hRiaetSuarnnsoPf GthHe OSHA WOMCEaNnc:eHr yPdoelicAymendment Overturned: THETFhIiFnTgHs MCOayLUGMetNM: oNrYe FNauirrses Hit the Bricks 32 Media Scan The Therapeutic Touch by Dolores Krieger Losing Patience ATACLOOROPKOBRAACTKE MEDICINE IN i"t?W" Thhaestedtiedrshee gkunoeswti?oAnsndbywSheennadtiodr hHeokwnaorwd THE IANSDBUESSTTROYS Bona'ksecruclpuat bstilriatiyghint tthoethWe ahteeargrtaotef Pscreasniddaeln.tTNhiexy are no less apt in establishing the culpability of tdheeatahssbeasmtoosnigndaussbtersytoins twheorskcearnsd. aWl ohfaetpdididemthiec kconorpworaabtoeumt athneagceemrteanint odfetahdelainsbesesstoofs ainsdbuessttorys exposure to its workers, and when did they knMowediti?cal studies for over half a century have skiinllgelre.d(Soeuet aHsebaeslttho/sPaAsCaBmUaLjLoEr ToIcNc,upNaoti.on61a,l NMoavnv.-iDllee,c.g, ian1t97o4f.)theYeUtS faosrbeysteoasrsindJuoshtnrys-, wpliathntsovearcr$o1ssbitlhlieonUinS,sapleusblaincnlyualdleynaiendd 2o1r mamininimatiizoend rietvsealelsthaolverrowleh.elRmeintrgoscpiercctuivmestaexn thiaasl aecvtieddenwciethththaet ffuolrl dkencoawdleesdgJeohonfsd-aMmaangviinllge Wmeadteicraglatceo,ncsiercquumensctaenstitaol ietsviwdeonrkceer,s.noYmetaltitkeer ehsotwabloisvherwchuellpmabinigli,ty,is einitshueffriciaemntontog filnaarlglye Wseghmetehnetrs tohfepeupbildicemopicinoiofnasobresintoms adneyatchosuwrtass. othfeigunnofroarntut,nawteel,l-bmuetaunninfogrecsoerepnorcaotensdeeqcuiseinocne cmaarekfeursllyocraltchuelanteedcecsosarpryorahtuemdaenciscioonst, roefstas useplof-ninfcinridminingatthineg"semviodkeinncgegtuhant"--thoirsreeifnutqaubeles, tqiuonencaecsteodf tihneirfuallctikonnosw. ledge of the conse disFcoorvePrryesiodfentht eNiWxoant,ertghaetesmtoakpiensg. gFuonr wthaes Jaorehnjsu-stMcoamnvinilgletocolimghptaansyt,hethreessumltookfinleggaglurnes qwuaegsetsd inagliateinrasltly tthheousaasnbdesstoofs laiwnsduuiststrybeinbgy woTrkheersfo, lcloownsinugmseerrsieasndoftmheeidrifcaaml iclioensf.erences oMnanwvoilrlkeercso' rhpeoarlathtewmereediccoanl dsutacftfeddubryinJgohnthsepreecroiogdnize1d95b7y-5i8n,dulsotrnyg toabfteeranaosbcecsutpoastiownaasl wheaasltbhrohuagzhatrdto, pbuubt lsictilalnsdevberroaaldyeerarmsebdeicfoarleatit tenTtihoenseasraepsoerritosuswheerealthinhtraozdaurdc.ed into the Jpouhbnlsic-Mraencvoirldle acnodmpvaenryifieodfficaisalsaudthuernintigc tbhye wnoowrk-fearmroeucseicvaesde $o3f6V5,e0la00vsi.n Wa issuec,ciensswfuhlicshuiat ahgimainosfthaiscaosrbpeosrtaotse-rpehlyatseicdiailnlnfeosrs.noTthienfroercmorindgs wleenrweaotebrt,ainaedKnfrooxmvitllhee actotmorpnaenyy rbeyprPeasuelnGtinilgacsebnetstsousitsw,orwkheors haansd musaedres itnheamnuamvabielarbolfereto HeTahlteh/rPepAoCrt.s are especially illuminating of the mcourlptioprlaeteroplehsyspilcaiyanesd --byroJolehsnsa-sMdaoncvtiolrles, (Jl-aMw)2 yers and managerial officials. They show in cthaesier awftoerrkecra/sepadtieelnatyss oafnkdnofawilnuroers stuospinefcotremd mgloedssicaolvecrontdhietiosenrsioaunsdneasttsemofpttshetoirdsisiggnusiseanodr scyomnfplitcotmosf. iTnhteerseestrewphoircths hciogmhlpiagnhyt tphheycsricitiiacnasl fparcoete--ctoarres othfetyhepirrimcoarrpiolyralteegaelmapdlvoiyseorrss, tooraanrde ethre/pyaptireinmtsa?rilOyrmcaenditchaelyabdevibsootrhs stoimthueltiarnweoourks- olythweri?thout compromising one interest or the What They Don't Know Won't Hurt Us not Iton stoelml ewcoarskeesrsphoyfsickinaonwsnsimorplysudsepceicdteedd mingedtiwcaol ccaosnedsitidooncst.orFsoroebxsaemrvpelde,pionstshibelfeollluonwg tnuomt toorsteilnl tthheeaXff-eracytesdawndorykeetrsd.eIcnidthede feixrsptlcicaistely, t"hNiso iHs .iCnd."icoarteNdooHnetahlethrCecoourndseblylinthge. (nAoltlateimon qpuhoasteess aarned thinesearutitohnosr'si.n) tThhise afnirdst fcoallsoewoincg c1u0,rr1e9d57d:uring the medical conference of July P"MatiineinmtaAl": Mexaploe,su5r0e yteoarssilioclad,. aHsibreesdtoisn f1i9b3re2,. XPo-rratlya:ndEqCueimvoecnatl--a1re2ayeoafrs.increased density Drigiahgtnaopseisx:.M. .ight be infection or tumor. No oc ckunopwatnioonrailgidni.sease or TB. X-ray changes of un Dr. Z:21.. NNooAtaHbS (Air Hygiene Survey) 34.. NDoo Hno.tCn. o(tNifoyHpleaanltthmCaonuangseerlling). 19I5n8:another case, at the conference of April 9, NPautriseenWt B::OMna3le/2, 6n/o58ag--e [gDivr.enA., a physician af cfiulilaotseids AwsitshoctihaetioSno]mreeprsoertteCdo--un'tPyr,esNeJncTeubofera sinotleitrasrpyaclees,ioisn caotntfhiermriegdh.tI5athmaunntearbiloer troibidaennd tyifeyaritaingoeabryliear mfilumcsh, aslmthaolluegrhsliitgihstsudgegnesisttye.dAa qtyuelisetsiopnerisiprhaeisreadllyastotoitw. hIewthoeurldaasdimviislaertdhiesnlsei sgiuoenstbioeningofevnaeloupatlaedsm. SoalsitawreyllnoadsulTeBs rawihsiecha should not be ignored. Continued on Page 7 GAOLIENAGDOBVAELRLLOIOKNE abLuseea,d ispomisoonviinngg, oluikt eofdrtuhge gcehnetttosuarnvdeyinstointhBeaslutibmuorbres. aRned Pthheilraedpeolprtheida chaasvees foofucnhdildhhalofoodf lceaaldledpoi"sloenadingbeolut"tsidoer t"hiennseorcaintdy."uppCehrilmdriedndlefrcolmass mhoidmdeles Yinorrku,ralanDdutcLhietcshsfiCelodunCtyo,uNnteyw, Cexocnensesicvtiecutl,eawd erleevfeolus.ndMwoirthe ttehsatned 40in peCrcheanrltesotof n,chiNldorretnh Cleaardollienvae,lsh. aEdveenxcteenssiyveearbsloagodo cinlagsessitciaolnsooufrcleeaodf lepaadinpto,isothne finorg ionnlcyhitlhdrreeen, ocfoufolduracccaosuens.t pNaoiwn,t oacldcocuranctskifnogr aabnoducthhiaplpfeodf tehpeidedmetiecctgerdowcsa.seBse,twweheinle19th7e3 faonudn1d97w8i,th16u3n,0d0u0e clheialddreanbswoerrpe ttiroenat,m2e1n,0t0. 0 reguiring intensive miOninmizseomleeadfroenxtpsoseufrfeorthsavtoe bcaelelnedsu"clceeasdsf"ul.peInnci1ls971wesroefpoeurncedntto lheaavde oans mthuecirh paasin1t2e.d5 sinurtfhaeciers g(raanpdh,itoef "cloeuardsse",).nTonhee standards, self-imposed by the Vital Signs tmhiasnunfoawctutorernsothmemorseeltvheasn, liomniet pweivrcees'nwt alrenaidngspawinert.e p(rTuhdeenot!ld) fUonlldoewrinpgresussruvereysforofmevathpeorFaDteAd dmoiulks slheoawdincgonptoetnetnst,iatlhlye hianzfaanrt feovrimdeunlaceinodnusthtrey ihmapsapcrteosfenletaedd bsoalbdyerinfogoduss.ed Tthoeseianl dcuasntrnye'ds rsetpurdeiseesntativsehsohwaivnegpresleinttteled cmoenatseunrtadbuleringintchreeacsaenniinng lperaod cceasnsneodf itnhfeainrt efovrampuolraast,edcanmnilekd, Canhdildthreonseol!ivleinadg wneoarrkers slehaodwsnmtoelbteerspharatviceublaerelny svounlninegra.b.le. .tMo eleaandwphoilie, PinrgesriedsetrnitctCioanrtseronistrheelax use oi leaded gasoline fgrluaists-apnadckveedgebtaabbylefojuoidcse.s, and chDairr.perHsoenrboefrttheNeCeednletemr afno,r mDiistteeaesefCoor nttrhoel'spardevviesnotriyocnomof crehcieldnthlyoopdublleisahded paoisstoundiyngo,f oCvheerlse2a,00a0ndchiSldormenervfirlolem, Mclaasssssaucbhuursbesttos,f Botwstoon.wPolarkyiinngg tNheeedrloelme anof atnhde hTisooatshsoFciaairteys, fciorsltleacntdedsethceonddecgirdaudoeurss atenedthexof taemnitn. edCthoenmtrofollrinthgeirfloeradtchoenir pecaorneonmtsi'c setdatuucs,atainodn,I.Qs.o,ctihoe fseturednycdeesmobnetswtreaetend mhiagrhk-edadnifd bloewha-lveiaodraelxproastuinrgess inantedachinersa' banrodadpebrafottremryancofe itnetsetlsl.igeTnhcies hcoanvfeirfmousndothhiegrhesrtuindcieisdenwcheicohf girrroitsasbailnitdy,fiinmepmaiorteodr cporogbnlietimons,, aexnpdohseydpecrhaicltdivreitnywahmicohngaplpeeaadr tpooibnetcowmitehopuetrmtarenaetnmteantt.soAmlel tlheaersneedp,rowbleerme s,doNsee-erdelleamteadn, buenldieefrmtihnaitngbtlhoeodlonlega-dstanledvienlgs b"sealofew." aFewce,rtaifinanvya, luoef twheesree clehaidldpreaninth.ad been exposed to shoInwcnrethaastinthge meavjiodresnocuercehsaosf tliecaldes toidnahyaleadre anaidrbofarnlleoutpairn cstorneteetndt uinst oannedgsroaiml. (Trhoeuglhelayd, sVt2reteetasspwooenep)inofgsNeowr Ydiorrtk fCroitmy M(reamcAemrthbuerr,Par"kAilnl LtohseAnsgweeleest gcorenetaninsictienngtimfloews itnhge pdeormwnis"s?i) bchleildrdeani.lyOnilnytsamkeall afomrousnmtsaollf wsuocuhlddirptroivnigdeestedpotreengutilaalrllyy Adanndgjeursotutshisahmapoupnetnss. oAf relceaedn.t Nsteuwdy Yoforckh, ildderemnoninstRraotcehdeshtoerw, ohfousleeahdoldcodrursetlacteodncewntitrhatiothnes ccohmildmreonn'shbalboiotsd laesvedlsirat-nedatsiuncgh, tohbujemcbts-.sucking, and mouthing thiTsheaisrboourrcnee olfea98d pfearlcloeuntt oisf athuitsocmoombeilsefreoxmhathuestc. omMbuucshtioonf eofnleeragdyed gcarsiosliisn,es,inbuctrweaitshitnhge amounts are coming from diesel 3 ftiuceulslatewithemitshseiiornsh. eaTvhye pEanr vreircoongmnieznetdal tPhrios,tecatniodn iAnge1n9c7y8 dmiorencittoerdingstpartoegsramtos dfoerveleloapd cleovnetlrsoiln mtheecahiarnaisnmdstowbheegrine sletavnedlsardwse. reTheabEoPvAe tahcecnepptreod pfoorseadirmloeraedstlreinvgelesn,t ostraignidnaarldlys yscehare.duled to go into effect last hoSwienvceer,thethlaetesDt eepnaerrtgmyecnrtisiso,f Erenlaexrginyghthase caudrvreonctatreedstrfiuctritohnesr donenttheCaursteero,f pleearsdiesdtinggasw. iPthrehsiis "hme oraacl teugaullivyalehnatsofownaer," uhnatisl polredmereendtinthgethEePlAowteor dstealnadyarimds pfoerrmtheittleedgal aimn oungtas sooflilneaed. 2K0n,0o0w0ledpgaerticaublaotuet ctohmeposuonmdes esumcihtteadprinimditiievseelsteaxtehathuastt sistanin daTrdhserepmroabilnemyeaorfs alewaady.pollu tgiuoint,oushowweitvher,thereminatienlslecutubai-l dcheivlderleonpmatensttakeo.f Cchoiludnretlnesosf nleeaadr lweaodrksemrselatenrds htahvoesealrlievaidnyg bvueelnnersahbolwe.n Rtoecbeentlpya,rtaicnuallayrsliys o"fgrveeegnetianbgle"s ggraorwdnenisn uhrabvane cshoonwtenntusn. acRceepsteaabrlcyhehrisgh flreoamd Hstiatruvtearodf aTnedchtnhoeloCgaylifhoardnitao Igno tuonetahrethar1i,d600deyseearrtsolodfbPoderieus ttoo fsiingdnifihcuamntanamreomunatisns ofwiltehaodu.t bTyheDirr. cloonncaltuhsainonE,ricsusomnm, iasripzeerd thienaelntht ctoonttrhoevercsuyr,re"nBtaspeudbloinc 4 wlehaadtpwoiesoanlirnegadayndkintsoweffeacbtoount Health/PAC Bulletin TPaomnyelBaaBlerier RMoibchbaBeluErl.aCgelark Jaime Inclan Board of Editors Hal Strelnick DavGidleKnonteJlecnhkuicnks RondaAKrthotuerlcLheuvcikn David Rosner DMeasdCgealClaonhen Associates JoannPeetLeurkMomednoifkf KDaotuhgyDCoornnwanay DoreeRnoRbianpOpampaotrat CDianndFyeDshribvaecrh SuLseannRRoedvberebrgy MLoaurashnaneHKuresntnedy KenARloesxeRnboesergn MThaormk aKsleLiemvaennthal GeRl iSctkevSeunrspoinn Alan Levine Richard Younge Ann Umemoto SMtafafn: aKgaintegPEfdoirtdorre: sMhearr,ilLyonrnetNtaorWinasvkyra MshAouNlUd SbCeRaIdPdTrSe,ssCeOdMtoMHEeNaTltSh/,PLAECT,TE17RSMTurOrayTHSEtreEeDt,ITNOewR York, N.Y. 10007. aSnudbsc$r2ip8tiofonrraitnesstiaturetio$n1s4. foSruinbdscivriipdtuiaolns, $o1rd1e.2r0s foshrosutulddenbtes addressed to thAevPenuubeli,shNeerw: YHourmk,aNn.YSc. i1e0n0c1e1s. Press, 72 Fifth HSceiaelnthc/ePsAPCresBs.ullSeeticnonids-cplausbslisphoesdtagbeimpoanidthlyat bNyewHuYmorakn, N.Y. and at additional mailing offices. 1980 Human Sciences Press Illustrations by David(pCpe. l1si6,(p1p7.,212,,273, )3.3) and Bill Plympton ntreeumroellyogiimcaplofrutanncttifoonrs,usit tios erxe eofvaleluadatpeenrmowissthibelecriintiocuarl sleovceiels tEyn."ergFyorandthePreDseidpeanrttmCenarttero,f soovefar r,litkheis acolnecaldusiboanllohoans .goSnoe, mbyanthyesEtaPtAes,tothdoeuvgehlopmsatnadnadtaerd dceizdeudresl,eaarde smtilolnwitaoitriinngg topsreoe wlehaidchbawlloayont.he w--iHndalbSlotrweslntihcke CSohuarrcneesy:, E., etal., "Increased LCehailddrAenb:soWrphtieorne DinoeIsntnheerLCeiatdy C22o6m-3e1, FFreobm. ?1"98P0.ediatrics 65: "LFeoardm-FurleaeMCakaenrss,"MCovoemTmouwnairtdy NReuptroirttio1n0:7,Inlasntiutaurtye 24W, 1e9e8k0l.y Hleaardriosu, t:MTihceheaenle,rg"yGcertitsiinsgcotmhe pheoaulnthd,s" aThethrPeraotgretossivpeub4li3c: 2L7in, -OFuc,tobJaenre19S79.,. "Preventing LCehaidldrPeonisonTinogdaiyn, CJhainlduraerny,"FDeHbErWuaPryubli1c9a7ti3on (Nreop. r(iHnSteAd) 7N8e-e5d1l4e3m).an, H.L., etal., ''Defi cCiltasssrionomP s yPcehrfoolromgainc cea nodf CL ehailddreLn ewviethlsE,"levNatEedJMDen3t0in0e: 689-95, March 29, 1979. CTHHIACTKAENINF'TEEIUDST thaFtorthtehosmeawjohro mhaisvuesebeolifevaend tpihbyiostiiccisancsamperefsrcormibinprgofliingaapte pcoroldprainatdeloythefor rvirtahleincfeocmtimonosn, tthois tihse"chviacsktenamfeoedu"ntcsomofparaend ptiabriot toifcsstannowdarfeddfeteodlsi.veAsbtoocukt 4a0s poferacnetnibt ioofttihcse 2p0romdiullcioendpionunthdes tUoniatneidmSatlatfeeseedasc,haycecaorrgdoinegs into AthsesesOsmffeincte. of Technology anLtiobwiotdicossawgee,renofnir-sttheardadpeedutitco flieveedsstoicnk thperoedaurclyers19b5e0gs,anwhaedn danintigbitohteicnsutarrieenmt bardoethtoinawnihmicahl fbeeeedns. reTghaerdberdothu,ntwilhitchhenhaads wanatsitbei,otciocnstaiannedd lowwaslevaelsbyof pTrhoedulicvtesotfoctkheiprromdauncuerfasctsuoroen. breecinoggnfiezdedthtehbatrotthheiwr elrievegsrtoowck imnganldarfgoerraanntidbiofatisctesr.inTahneimdeal fpeaendiesLoqoumicekdly. tTurhneeddrtuhigs wcoasmte pdurostdruyc.t into a $50 million in kepLtivseestttoicnkgskegprtowin ctoleaonp,timweulmlweight without the use of an tcihbiicoktiecnss.,Oonr lpyigasn--imraaliss--edcianttulne, tshaenitaarnytibcoiontdicit-iionndsubceendefwit efirgohmt gteaninds.thLaivt etshtoecklaptrtoerduccoeursrsceonis dchinegapteor.OTTAhisesrteismualttse,s, aicnco9r0 p60erpceerncteonftpoigf salalncdatvtelea,l acanldveasl,l tpiobuiolttricysriencethiveiirngfeelodws. level an theTwwoeigthhetograiiens inaraentoibffieorteicd-ffeodr athnaimt atlhse. Oannetibairogtuicms enhtelapssetrhtes tainoiumsadlsisedaesfeesndanadgakienespts itnhfeemc htieoanlthisyw--oratnh oaupnocuenodf opfrebveeenf. tThhaet sethceondanatrigbuiomtiecnst malateinrtatihnes balance of bacteria which nor- Tanhteibwioitdiecssphraeasdleudsetoof bcoamctmeroianllyreussisetdandcreugtos, such as penicillin mtesatlilnyallivteraicnts,thereadnuicminagl's tihne acnomd pbeatcitteiorina fboretvwiteaelnnutarnieimntas,l fatTtehneinwgitdhee-scparlefafdorulseesso.f anti bspiorteiacds dheavselolepdmetnot othfebawctiedrei aulserdesisdtraungcse, topethneiccilolminmoannldy tseutrrvaicvyacllinaen.dThtrraonusgmhissseiloenctivoef froesrmistaatinocne ptharsoseudghingepnlaestimcidins, ainrceregarsoiwnginngumimbmerusneof tboacmtearni'as aSrtmraainmseonftagriounmorrohfeaa,nttiybpiohtoicids., abnled tomepneinnigciitlilsin, ,ohnacveesbuescceopmtie rtreesaitsmtaenntts. tOo necosnpveceinatliisotnainl resistant bacteria research pthreedviacstet dmthajaotr"itiyn 2o5f oarn5ti0biyoetaicrss whuilml abnethreernadpeyrebdy thueseslepsrse"adfoorf tdhifisficruelstisttoanecseta.blAislhthothueghdiirtecist clianuksibnegtwheuemnanresdiissteaanstebaancdtetrhiae u(essepoefciaanltlyibiwoittihc-epnhryiscihceiadnfeaendds elapyidemmiisoulosgeicaolf eavnidtiebnicoeticesx), mistasn. y,SevtheeralNyeethaersrlaangdos, Gaenrd otrtiheesr bCaonmnmedonpeMnaicrkileltincoaunnd atentdrahcyavcleinseinucseefionuanndima amlafrekeedds breydubcatciotenriian riensfiescttainotnstocatuhseesde druIngs.1977 the Food and Drug AthdemCinoimstmraotinonMmaorkveetd etoxafomllpolwe aontidcs rienstarnicimt athl efeuedseinoforadnetribtio traendtucbeatchteerpiaopuinlatitohne ofwroerslids. Pgiraenstssed--bAymtheericpahnarmCyaacneaumticida,l PDfoizhemr,ea--ndCMonergcrke,ssShpaorsptep,oannedd acnoyuldFDbeAcaocmtipolneteudntbily athestuNday ptihoanraml Aacceaudteimcayl ofinSdcuiesntrcye. aTlhsoe cstornicvtiinocned ofnarmpeernsictihllaitn a arned toentraaclylclainnetibwiootuilcds mienananaimbaanl fneaetdivse,s isnucglguedsitnegd bthyotshee FalDteAr, baraecirtararecliyn uasnedd itnylhousimn,anwthhiecrh taapnyt apnladsmdoidnso.t give rise to resis fesDsor.r oSftamnleedyicFinaelkoawnd, amipcrroo bWioalsohgiyngtaotn,thheas Ucnlaivimeresditythaotf pthreodouncleyrsrehaasvoennwothsywliitvcehsetdoctko t"hfaersmeersalhtaevrenbaetievnegsettiisngtbhaadt pinafnoirems.a"tioHnefrobmelitehveesdruthgatcotmhe 5 dmreuagt acnodmppoaunliterys phraovdeucmerissliend troectehiivnekitnhge sthaamtethyeiyeldwforuolmd nthoet NalAteSrnraetpivoertdirsungost. dAulethuonutgilhtthhies sleparrinnegd, ethaartly threepostrutdsy hawvilel recSoomthmeennedxmt toimreesytuoduiehse.ar the doenteailabomuatnthaendtravtheellinfagrmdreur'gs hdeaugwhatsers,elylionug wtihlle kfnaormwewr.haItt aseinrv'tejuhsitmchriigchktenif fheiesdd!oIstewwouerlde resistant to penic--ilHlina!l Strelnick tSiboiuortcices: iTnomFeeMdonBtee,com"Ainng NUusetlreistsioinn HAucmtiaonn T7h:era3p-y6,," February 1980. "EUnrjooyloagbyleTaondda y " Profitable sioTnhNe eNtwoorrwki,cha d-ivEiastioonn oTfeNleovri wwihcihch- iEs aitnontuPrnharamdaicveiusitoicnalso,f MbaosretdonNcoomrwpiacnhy, thaat Cmhaincuafgaoc- truermesemanbders?e)l,ls saplth(aMrmoratcoenustaiclta--l, hchoeumseihcoalld,produanctds thrsopuegchiaolutyt tfhirestwoofrlda, rseecreinetslyorfeletealseevdisitohne cshaosswesttefosrhodwoscwtoirlsl.beTohfefevreiddeoon a"fofrreecolonavnenbiaesnits toviepwhyinsgiciaonns hacocmoerdoinr gofftiocethpelayprbeascsk ruenleiatss,e" a"ansnouwneclilngasthetoshopwr'osfereslseioansea,l gtiroonuapllsy, aNnEdTVhNoswpiitlallsb.e dAidstdrii btruatiendinagutpormoagtriacmalslyatto rseosmideen1c6y9 maWjohrytedaicdhni'nt gthiisnrsatitthuetiroonbsv."ious imnendoivcaatliosnchocoolmoer otohuetr poafrt oaf tlheme niosnt-hpartofthitesepcrotofrit?sTehcetoprrcoabn binencoovuatniotends,obnutot tphreond--ucaenudsethfuisl wbuilflfsbeasretchoegcnoinzetrdadbiycttihoenorwetitihcainl ppreirvvaetret thseemct.or innovations -- "UTrohleogyfiTrsotdays,h"owwas prreoledausceedd, wthieth theAhmelepriocfan15 advUisroorlsogfriocaml Awsesigochieadtionand whdoecid"ecdareufuplolny tuirmoelolygytopiscesriteosb."e coItverperdobinabthlye wdioffuelrdenntoltyhianvethbeeeSnovdioent eUmniuocnh, eaxpcperopvt eitdwboyusldevtehreanl mhaovree tcoombe tmhirteteeems.oTrehisshwowillsboenfvolalroiwouesdabsy ypeeacrts, oafllutroolboegyporevseernthteedco"imninagn intSeorefsatirnsgoagnododen. jBoyuatbthleewinanyo." vloantigon'tsopearpvpeersairo.n Odoneesn'ftuttaukree c"huosswr-tuonnNiEnTgVaNcosshto-wef"fewctiilvledoisf- fhiacvee pprraocdtuiccee.d "AUnrdoloagfyteTrodthaeyy" tsyppeecialsthieosw,stheiny waillll htahvee tootheexr ptiaonndal sthhoewirs monarekaect hinstpoeciaadltdyi. Acofmterpanayll, canno lestelaf-rpersopfeictatibnlge panrotidcuipcattelinteitlleaspseli.keS:o Uwreolocagny aTnod KYnoouw; AAllbYouotu EUvreorloWgyanBteudt WScehroeolA; fTrahied tCooAmsikngInCMriesidsicianl FUrroomlogyth; e anCdomHinowg CTorisiPsrofiint Urology. --George Lowrey 6 Losing Patience DCro.nXti:nWuehdefnrowmePraegceei2ved this report, we had mnoatnH.Cw.erthee mnoatn. There might be a case if the Hne.Ced. edand twhee tfahmoiulyghdtoctorw. eI tshheouldmarne-Xa-rnady tphreonpgeor thropurgoh tcuendautreel.y Forit Hd ies ahpapde a br eeedn. itsoldanoftlheinxgib. leIt Dsitru. atSiomn.ith: No Otio.Dna.l (DOicsecauspea), nToB. cRaen-Xce-rr,ay nion six months. PaItnientht e Aca, sethoef dsuoscptoercstedacatinveinly fyeecttidonidorntoutmtoerl,l oththeepr astpieenctiaolfacthtieoinr.sIunsptihceiocnass--e oofrPtaatkieentanBy, tthhee pdooscstiobrislietylimoficnaantecdert,obtuhteidridownontstaetlilstfhaectpioan tsiuernet, otfhethseeimr oebdsicearvl adteiocinssioonrsswusepreicmioandse. Tinotbhee cdoenctaedxetsoafgpoh.yNsiocidanou- bptatsioemnte rdeolacttioornsshevipesntwtoo dsiaoynswnooutltdo ainrfgourem,foersptheceiawlliysdionmtheoflathtteerdceacsie waboorvkee.r kBnuotwionf hniesitphoetrenctiaaslelydgirdavtehecoanfdfietciotend, msoigthhat thahveempeigrhfot rcmoendsualdt doitthioenraslpteesctisa,lipsetsrhwaphos mmoadreeaaggdrieffsesrievnetmdeiadgicnaolsiasctaionnd spuocshsiabsl,yfotarkeexn admocptoler,s deixdplnoortationrfyormsutrhgeerwy.orkAenrsd, isninnceeiththeer tcoassetocposumldokthinegy ochrotooseexetorcliesaevaentyheoitrhdeursltiymjiotebd, porbesveervnetirveismleeaftsuwreit.hTthhreoungahgoguitn, gtheguoeusttisoidne: Wmaonunlderthweisthe rpehsypseicctiatonsthheasveepaactiteendtsiniftthheesyadmide lnoohtnasl-sMo hanavvielloebCliogarptioornastitoont?heir employer, the UUnwnehaelatlhtyhya,nd Unadvised c u pTahtei o noacl dthiseesaesedowchtoicrhs me nosctooufntetne rweads adissbaeblsitnogs,iso,ftena fdaisteaalse simluinlagr t"oBlcaocakl Lmuinnegr.s"' Amasrbkeesdt,o s ims aniys yweoarkresrs' firastfteexr pbeosstuosre dutost absy cboreuagthhilensgsneasnsd, slucanrgring t iosfs uthee, wseheinchoncXan-raybse. dAussbtedstiosesiasseissaclasloleodne"ponfeaumlarogceorngiorsoeusp,"oaf tleurnmg the I-M doctors often used in their diagnoses. sisT, hase tchoerspeomraetdeicmaeldciocnaflesrternacteegsyinfdoircaasteb,ewstaos diniisteiaalsley. nBoutttaostethllewdoisrekaesres tphraotgrtheessyedha(duptohne dcoisnatbinleude,dtheexpcoosmuprea)nyanpdhytshieciawnowrkoeurldberceavmeael thoisthoervhicetrimtr--ueslocwonlydiatinodn.inTghuisarsdteradtetgerymws--as sSummitmhetdo huips cinorpaonraotwe sfuapmeoruiosrsmienmFoebbryuaDryr,. 1949: theItsemmusetn bheavreemtheemxb-rearyedevthidaet naclethoofuagsh bdeesftionsiitse, lytheayrearenowtordkiinsgabtloeddayfraonmd asbestosis. They have not been told of this 7 kInnoswomneocrassuessp,ecctoemd pmaendyicpahlycsoicnidaintisosnism. pWlyordkeecrisdtehteontceallnwnootrkcehrosoosie to lmeaevaseutrhees.ir dusty job, quit smoking or exercise any other limited preventive dmiaangnfoeseilss fworelilt, iiss fhealtppthyatatasholomneg aansdthaet wgooorkd,, annodthhinisgpshhyosuicladl bceonsdaiitdio. nWrehmenaihnes bdieacgonmoesiss sdhisoaubldledbeamndadesiacnk,d tthheenclatihme psuhbamsiist--tedDb.Ky.]thTehCe ofimbrpoasnisy.of[Sthmisitdhi'sseeamse eisveinrtrueavlelrysicbolempaenndsatpioernmwainllenbte spoaidthatot eisanchotodfitshaebsleedmietni.sBfeultt athsaltonhge ashsothueldmnaont banedtowldorokf ihnispceoanced,itaionndstohethCaot mhepcanany lciavne benefit by his many years of experience. firsItn dtahtee fionldloicwaitninggmseodmicealchceassteXr-erpayortasb,ntohre mcoanlicteyrninisthinedpicaattieedntbtyhaant t"rNig.gDe.r,"eda "pNhoysDicuisatn" aredsvtirsicetdiotnh,ebcyommpeaannys omfawnhaigcehmtheenstetophpylasciceiathnes wcoournkseerlilninag nsoens-sdiounsty("eHnv.Cir.o"n) mweanst. cTlehaerlhyeatlhthe tiinmgewwithhetnhethweoprkhyers/ipcaiatinenhtatdoarepveierwsonhaisl omr eheetr dmiaegdnicoaslis saintudataidovni,setoon pjorebsoerntpetrhsoenaml emdeicdail cseavl eprraelcayuetaiorsnse(laep.gs.e,dgibveetwupeesnmothkiisngN).oODftuesnt rSeosmtreictitmioens,anadsthteheHeraelcthorCdoubnelsoewllinigndsiecsastieodn,. scoomndeitmioenntisohnorwtaosfmaadfuelolfcthoeunpseerlsloinng's mseesdsiiocna.l C19o5n8simdeerditchael fcoollnofwerienngccea:se from the March 5, DPar.tiZe:nHtiCre:dMinal1e9,2550. Pyeipaersmoaldch. ine operator. 22 yineatrrasnesxitpeopsuipree.toCasirlpicean,tecremfoern4t,yaenadrs.asbestos Ntiounrseed Win:1N95.D4.. Hin. C1.94in8.1P95n6euomfXoc-roanyiocshiasnmgeens. Dpnieaugmnoocsoinsi:osiEs.ar.l.y. to moderate mixed Dr. Z: 21.. NTaobtify plant manager Nurse3V.:CShheocukldwthitehs_e_m__e_n__b_e_a_d_vised? 8 Dr. Z: We can put transite pipe out ofbusiness from this list alone. ciaTnhsu' sNosixDuysetaardsveisloapryserdesbtreictwtioeenninth1e94p8haynsid Athneot"hmerentwtioony"earosf eplanpesuemdobceofnoiroesias fuilnl h1e9a5lt4h. wcoouunlsdehllainrgdlysesseseimoninwtahse pgiavteienn. t'sSuinchterdeeslta--y ainntderwesot.uld mos't assuredly be in the company's phAyssiciinadniscawteedreinwDelrl. aZw'sarleasot fctohmemeexntet,ntthaensde tsheevetrriatnysoitfethpeipdeudstivdisisioeans(ewphreorbeleamsbeasttolesasdtuisnt sistraodndgedtyptoe aofcewmaetnert mpiipxetu).reYtoet mtharkeeeayveearrys tbiecfipoaren,tsi,n s1a9id55,inDtrh. eSmAMithA, oAnrechofivtehsesoefpEanr evxirpoonsmedenttoalthHe efaibltehrs(,pv. e2ry03f)e,w"dOefvealllopwaosrbkeesr-s ttohseisd."ocBtourtsinwceerertaaiwnadreeptahrattmtehnetss,itiutaatipopneawrass, annoyt wsoherroesyin. tThheisSpmeirthceppatipoenr. does not appear 23,C1o9n5s7id: er another patient conference on luly PNautriseentWD:: 5M'9a"le,ta5l8l, yweaerisghosld2. 68 lbs. N.D. in D19r4. 7Z.: H19iryedeairns 1in94th1e.6cyoeaalrms pinoetse.ntial exposure stoilicPao. r.t.lIannd194C7e, mheenwt,entastobeRs.toGs. afsibsrwee,epaenrd. lDyiaagdnvaonsicse:dM. i.x.e.d Pneumoconiosis, moderate Dr. Z: 21.. ATadbvise the plant manager 3. NoH.C. DSous1t0reysetarricstiaofnter--thwehdicohctocrosulpdroepxopseladina tNheo awodriakgenr'os stirsanosffaer"tmo osdweereapteelryinad1v9a4n7c--eda"ndpnweiuth wmaosconnoiotsisre, atdhye ctoompoaffneyr mtheedicmalandepaarhtmeaelntht creoausnosnesllinfgor sensositonr.ecAomcmlueendtoingthea dohcetaolrtsh' oconutnhsiesllsianmgesepssaitoiennits bgyiveDnr.inSamliathte,r"cIomseme ennot reason to bring a man in like this, it is dpaannyg,ernooutst.h"eTmhaend. aAnsgiefrtoisucnldeearrslycotroetthheisc,oDmr. _X__i_m__m_e_d_i_at_ewlyomraensp, osnhdes,is v"Neroywnetravkoeus.thIaft ssuhereisyocualwleidllihna,vsehea wcliallimgeotnhyysotuerrihcaanl dasn.d" AI asma pwroemviaonursefecrornefdertoenwcaes drieacgonrodsedshboywtehde, cotmhe pvaannycedphAyssbiceisatnossisa.s" Bhaavseindgon"MthoedseerdatiealgynoAseds atinmde,mbosotthstawteowrkoerrks,erocfocmopuersnes,atwioonulladwaspapt ethaer eilnlntietslesedst.o compensation for these work-related Dust to Dust nioTuhsesweitshamtheeidr oacdtvoricsewtoeretraengsufaelrlywoprakresirms oto fneorne-ndcuestoyf aAreparisl. 9T, h1u9s58in, tthheeifrolmloewdiincgalinctoenr change took place: PDar.tiZe:nRteEc:oMrdaslien,d5i3cayteeaArssboelsdt.osis in 2-51. Man wA]asreapdovristeedd aobno2u/t1d/5u7st'Oinrhigisinluanl gusnidna1te-5d5X. [-Drary. schlionwicsalnoor oacbcnuopramtiaolnitayl.d..a.taI,nitthisenoatbmseynbceelieoff tdhoaetstnuobterrceuselomsbisleisanayfasciltiocrosiins twhiitshswituhiacthioIn.amIt pfalemuirliaalr.iIntvsoelevmems teonmt eyotoubekeoenpe osfetnhdeicnagsemseo,f tmeeannifeysetairnsg. pIarwenocuhldymsatillleleadmveinsets oafctcearseioignahl sinptuetruvmalse.x' aminations and X-rays at six month DX-iRagany:osTish:eErairglyhttoampeoxdesrhaotewsPnaenumaorecaonoiof siins. Dcrre.aZs:ed1. dTeanbsity present in previous X-rays. . . 23.. DNootinfyotptlraanntsfmeranager 4. tPheenMdinedgicfaultuDreepcahratmngeenst.indicated by paSrtomfeonutrdyieaagrnsoasfetderatshbeesctoomsips,anthyemweodrikcearl wdaes apdevrsiosendhaabsouptro"gdruesstsiendhitso l"uenagrsly." tBoym19o5d8ertahties amsebdeisctoaslis.c"onTfheerne,ncwei'tsh nfiormreaasodnvsicgeiveisn, "tnhoe ttircaensofferth"eatctohmatptaimnye'.sTdhoicstsoor,unndost ltihkeepthaetiepnrta'sc. vatTiohne olofnXg-rdaeylacyhabnegtweseeanndthneotmifeicdaitciaolnoobfstehre pwroarckteicrse.wDasurniontg exthceepftoiounralr,epitorwteads cmomedmicoanl cboonthferoefntchees,NaotoDtaul sotf 2r0eswtroicrtkieorns haanddthoef dtahteeisr HmeeadlitchalCroepuonrste.llIinngonslyestswioonofrethceor2d0ecdasoens wtheerier wtioonrkebresfocroeuntsheelleddoacbtoorust trheecirommmedeincdaledconthdait masaonnaegewmouenldt htraavnesfeexrptehcetmedtotoabneodno-ndeu.stIynjfoivbe, osefltlheed a2t0thcaesseasmtheetiwmoerokrerwsiwtheinrethheeaslatmh ecoyueanr Cinotrhpeormatueltpihpylesircoilaenssooffpteenrsfounnacltidoonc tmora,naleggearl--aadnvdisothreadnedmcaonrpdosroaftethese roles are routinely in conflict t(hSaetethTeayblwe)e.reBuptlaince1d3ocnasaesn,ot-hdautstisrefostrriacltmioons.t tswesos-itohnirdtosookf pthlaecgeroyueapr,sthaeftehreathlteh dcoocutnosresllhinadg froercothmemseen1d3ecdaasenso-rdaunsgterdesftrroicmtio2n.toTh10e dyeelaarys!s Ahenadlthin csoomunesienllsetadncbeystthhee ptiemrseoonfhtahde nmotebdieceanl ccoonnffeerreennccee tahnadt thitewy asshofuulrdthneortdtheceindbede haetatlhthe ctioeunnt sDe)l.leFdor(stehee,sefo1r3ecxaasmesp,leth, ethaevecraasgeeodfePlaay fmorencdoeudntshealltitnhge wafoterkretrhsebedotrcatnosrsferhraedd wreacso3m.6 yeaArfsf.ected workers, moreover, were not told tphlaatcethde odnoctaorNsohaDdursetcoremstmriecntidoend. tIhnatptahretywbee mknaonwuftahcistufrrionmg iwntoerrkveiersw,s wwhitoh Jtoohldns-oMf abneviinllge wtraasnsdfoenrreedbyanthdeocnolymypeaanrys lfaotrermfeinddicinalgroeuatsothniss --197s3e,epH. e6a.lAthl/sPoAifCthBeUcLoLmEpTaInNy, pNhoy.s5ic0i,anMsahracdh pormommepntldyintogldtrtahnesfwerosr,ketrhseythaotbtvhieoyuswlyerwe oruelcd thhaivse--hiandwtohitcehllcwaoserktehresythweomuleddnicoatlhraevaesohnasdfotor r"edcuosrtdinyethaers lulantgesr"th(Patatitehnety Et)o,ld"mweonrtkioernsedo"f psenleleudmoofcoXn-iroaysisch(aPnagtieesn"t (CP)a,tioernt"shCeaaltnhdcIo).un 9 A Rose by Any Other Name asbWeshteons-rceolmatpedanyhepahltyhsicpiraonbsletmolsd wthoerykewrseroef Fcoonrsecxiaomusplyle,gtuhaerydeadvoiindethdesuwcohrdlistigthioeuyscwhoorsdes. adsisc'u'pssnieounmaotctohneioJsuilsy/' 10a,s 1i9n57thmeedficoalllowcoinng ference: PNautriseentWF:: NM.aDle. ,(N46oyDeaursst oreldst.riction) in 1954, DHr..CZ.:(HHieraeldthinCo8u/1n2s/e2l9le.d2)8inye1a9r5s6p.o.t.ential ex p(coaslucrienetdoaansdbensatotusrafli)b.re, diatomaceous earth DNru.rYse: WWh: eAndrveicseodrdosfsXa-yraXy-rcahyacnhgaens.ges due to PPnneeuummooccoonniioossiiss, towpeatwieonut.ld not use the term Dchra. nXg:eIssipnokheistlounthgiss. mHaensaanidd htoeldis hinima ocfletahne Darre.aZ.: ... He says it is a clean area, I disagree Dwiitahghniomsi--s:itEiasrldyusmtyix. ed Pneumoconiosis, plus old arrested TB in the right mid-lung field. infTohrme adtoioctnorosuwt oefrethaelsmo ecdariceaful lfitloesk.eFeporceexratamin- OWnh-atht ec-hjoabngseadfewtyahs andotncoot rcphoarnagteedin. stetaregsetsobnuwt hthicehmtheedsiecawl earnedascotecdialout pthiee,Juaflyter10a, b1r9i5e7f,dcisocnufsesrieonnceabthoeutfoallpoawtiinengtinat terchange took place: PDar.tiZe:n1t.GT:abMale, 41 years old. 32.. ANoHtSify(ApliarnHtymgaiennaegeSrurvey) 3. WItehdaso tnoobt ehawveormkeadnyonn.on-dusty areas. Nreuprosret cWo:mWe tooutlhdeyMouedcilcaarilfyD--epadrotmesentht?e AHS 10 Dr. Z: I trust you do notput anything about the ANHurSseinVt:hDeomyeoduicraelcafollldaetrtsh.e first meeting, we ddoenceid. edWteo unseeeidnitsiaolmsetothdinegnottoe wshhoawt hawsebedeind snoomteedt.hing about the changes when they were DNru.rZse: SVa:yThreisfeisrraecdhtaontgheefSroamfetwyhDatewpaerdtmeceindte.d aDtr.thSemfiitrhst: cIfonwfeerpeuntcien. AHS, it means we have aredavsiosneds ayroeuretcoorhdaevde ian tshuervfeilyes.dAonneatbtuotrnenyo rmeigguhetsstaeydwshtuadtideisd aynoud dthoe. yThcaeynctahnenanssawyetrhweye Ddor.nXo:tBknuto.wif itthies rreesguuletsstoefdthaensdeysotuuddieos.not get Dsart.isSfamctiitohn:?That is not your responsibility. I tthhiendkuisttgcoooudntfsoraryeobuuttwIoddooncotot rtshitnokkwneowshwouhladt gcuivrerenant.y Aadnvdicwe iothn othuart. pDreussetnctouenntgsinaereerinnogt cchhaannggeess., Ifyaonuyowneouisldwonrroitedhaabvoeut tthheeirlwatoerskt athrienag,. ___________ will handle the whole Doctor/Lawyer? extTrhicraobulgyhionutetrtwheosveenrewpoitrhtsmleedgiaclailsosuneess.aSreomine pmhaylspircaicatnicceonsucietsr,nsarseuctho assomaveoeidxitnegntmpeadritcaolf mceorsnt fdoorcptororst'epctriancgticthee. Bcoumt optahneyrsf,rosumchcoams cpoenn psalaticoentshueitsdoacntdortsheinir tahteteanddvaenrtscaorsiatsl,rionleevoitfaabdly wviosirnkgertsh' eclcaoimmsp.anTyheanndthietscloanwfyliecrtsbheotwwetoenfitghhet pdaotciteonrtss' a(snudppthoesierdalyll)epgriaimncaeryacnodnicdeernntiffoicrathtieoinr witChotnhseidceormthpeancyasberoefaPkastiienntot Hth,eaowpoemn.an of 49 ymeeadriscawl hdoepawratms ednitagasnohsaevdingby"mtohdeercaotemlypaandy vfeacntcioend.''asDber.stoSsmisi,thprseaciidpitaattetdhabtytiemaerl:ie"rSihne sshhoouulldd nhoatvwe onrok dinusdtuestx.pSohseurise.m" oving fast. She disYceutssaitotnheabJuoluyt 2h3e, r1c9a5s7emfoedcuicsasledcoonnfehreonwceto, whehlipcha,voonide ahsesrufmileinsg, sahecowmaspeennstiattlieodn, bclaasiemd (otno the doctors' diagnosis): Disrv. eXr:yNnoewrvtoaukse.tIhfasth_e__is_c_a_l_l_ed__i_n,wsohmeawni,llsgheet hoynsyteoruicrahlaanndds.I am sure you will have a claim yDoru. Sdmo iXth-:raIyws,ildlogoa palhoynsgicawlitahs twhaetll,. but when wNouursldenV't:thIfatshaelsoisptrreacnispfietarrteedsotomeatnhointhge.r job, Dcorm. Xpl:aMintrss.. I_t_i_s_o_n_e_y_e_a_r_siinscweosrhkeinwgaswHith.Cn.o Dwrh.eSremsihthe:iAs stoadadyo.ctor, you cannot leave her NshuersisetVo:bIef tthraenresfearrreedbatdhewn?orking conditions, Dbyr.tSramnsitfhe:rrYinogu. are precipitating the situation to aDnesopni-tdeutshteydjoobctwoar'ssuorwgnenbtelylienfesctehsastartrya,ntshfeeyr dcaidtesnoftorsetreanthsfeeirr wroiltehinasthsetrocnogmppaantiye.ntOandvthoe tcoonthtrearsyickthweyomdiasncuifsssehde hwoaws tnootsotrfatennsftehrerebdlo: w DDrr.. ZX::EWitihlleryIouoretxhpelapilnantthemtarnaangsfeerrwtoillhdeirs?cuss trheiassownithwehearr.e Itrtahninsfkerwriengshtooupldlacteellhheerrinthea cnoomn-edubsatcykartoeat.heIfcwoencfaenrennoctetraanndsfesrayh--er,'WI whialtl Dshra.lSl mI ditoh?:'We were going to explore, with the tmraannsafgeer,r,ththeen pwheaswesillofcotrmanesbfearc.kIftowethceancnoont fDerr.eXn:cIewainllddsiesceuwsshtahtisiswwithhaht.e.r.and soften this feotcr.her. I will say--we have recommended-- Drerc.oZm: mNoe,ndIeddo. Snoayt wthaanttwitethoabvee dsaisicdutshsaetdytohue phoesrsiabbiloiutyt otfhaistriannstfheer afuntdur[eD.r.IfZ]ymouayscaoyntyaocut ruepcsoemt. mend and it is not done, she would get Similarly for: PNautriseenWt I::NF.eDm. a(lNeo, D49usyteraersstroicldti.on) in 1952 and DHr..CZ.:(HHieraeldthinCo1u92n9s.elPlerdio)r7t-o55JM. employment, dshaetewshoerkheads ibneeancaigsaprinfancetroriny.AFBroumild1in94g1. 1to7 yHe.aCr.s wphoatetnwtiaasl sehxeptoosludr?e to asbestos fibre. In Nniousrisse. W: X-ray changes showing Pneumoco Diagnosis: First stage asbestosis. . . Dcarl.liXn:gYofotuhempaaytiepnretcfioprietaxtaemsionmatieothni.nAgftienr athlle, tphaeyy, yaoreu mpraoydbuecicnrgeaatnindg taakcirnisgish. oWmeemaaygoaogd gravate this into something decisive. creWathinatge"v,erit tdhoees"cnriostisa"pipsetahratin"ythoeu dmoacytobr'es mhaidndattothbaetatsimbees.tosis, which the person already Or, in the April 9, 1958 conference: PpoastiuernettoJ:aMsbaelest,o5s5duyseta.rs old, 18 years of ex jDorb.?Z: The guestion is, third shift or come off the Dhirm. Sfmorithth:iWrdeshhaifvt,e htoebiespinracatincoanl.-dIuwsotyuladrOeaK. Oclathimerwainsde heveemryabyobdeyoiustionfvaoljvoebd, parnedciipnittartoeua bDliea.gnosis: Early Asbestosis and arrested TB. ceTrnhewiatpholtehgeaolsmisaottfetrhs--e dhoecatdoirn'sg coeffnltirtailgactoionn afrgoaminsta thmealcpormacptaicney, spuriot teacntidng stuhbejmugsaeltvinegs mtoepdaictiaelnpt'rsa--cticcoemtoescoinmpaarneyvenaeleidnsgadsioscpupsossioedn during the March 5, 1958 medical conference: DPar.tiZe:nHteKi:sMwoarlek,in5g2nyoewa.rsWoalds.at Glen Gardner D(TrB. XS:aNnaotocrhiuanmg]einba1s9ic5a0llfyo.r SaCboTuBtAlid[Soymeaerrss.et XCo-ruanyteyd ThBimAisnsoFceiabtriuoanr]y.isTwhaeytchininfogrmhiemd ahnimd tthherouSgahnahtoisrifuamm.ilyHdeocstaoidr thwaet htoeokhasX-troaygso itno cDheacnegmebseirn a2n-2d5-d5i8d. n[Dotr.teAll] haigmretehderoenathreis.mTohree termyipnlgoytoeehiwdaesthuipnsgestfraonmd himimp.liHede cthamatewine tahries oMuornXd-aryayasnodfghaivme. uIsraeqfouremstleedttehrergeigvueeustsinagutahll oserinzdatihoinmatnhde tXha-rtaywse. wWoeuldhatvheentobesehnadppthyesteo fciolmnfsertoenGcel.en Gardner but I wanted them for Dhars. Zb: Ietehninktatlhkeinrge wliiltligbaetiloitnigafotirona. Hwihsibler.othHeisr tbhreorteheisr wa athsiirndvoplavretyd ainctaiobno.x.c.ar accident and Dcrri.tiXc:izIewd oanbdoeurtifouprrohcaenddulrien-gwiosfethwies ccoaureld, hbee knew we took X-rays and he was not told 0/ 11 cwhhaenngTeBs.isSihnovuolldvewde. nWotecchoaunldgeteollutrhpermocaendtuhraet wtheemarefoslleonwditnhgrotuhgohse. X-rays to SCTBA and let Dspru.tuSrmnsi.thW: eTdhoeynost.hoItuilsdthfeoilrlorwespuopn.siTbihlietyy. d.o. Dagre. Z. :W28hyaetariss ethmeplaonysmweenrt--anDdihseabiisli5t2yyReaertisreof TmBen.t.?.IHfeoirsegseeettin1g00VApebrceneneftitstootanl thdeisbaabsiliistyo.f oTuhtegyuehsasvteheusse opveeorplae abtarthreisl p.o..inWt, ewehadvoenotot NknuorwsewVh:eIndoornoifttthheinykwiitlilsftioleo. wild a guess. His bBruoitlhdeinrgsawidit,hThitsolcdhehsimt, intewviellr ktoillghoimba.'ck to H Dwirl.lSbmreiathk:dEovwenn ibfehfeorgeehtsetihsro65ugyheathrsisooldn.e, he DDrr.. ZX::WI hthatinakbowuet psrhoocuelddugreo?back to our old bsyles.teSmC.TMBeAdiwcaolulyld, acsararydoocntofrro,mI athmerree.sponsi DSCr.TZB:AI dbount 'ot ntlhyinakftwerecroanisfeerdenacney. objection to DDrr.. XA: Bount parirooruttointehabt,aswise. wTohuisldissenpdrofcilemdsurteo astraotuensdalhareyr.e.TThweyogdooctotovrsar--ioAusainndstiBtu--tioanrse. on Dharv. eZ:toIf athssaut miseththeiersefurnecstpioonn,sisbhioliutileds.inWduosutrlyd Dthre.ySmnoitthb:eWDer.taAk'es fthuencXti-oranys?s for our own pro tpercotbiolenm, nsoetnfdoirngsocthiaelmoboluigt,atbiount. aTfthererecoinsfenro ence. Strictly a Management Decision mediNcaolt doinslcyussdioonslegdaelscirsisbueeds ipnertmheesaetecothne fceloresenlcye wrietphormtsa,natgheemseendt.ocItnorssoadlsooingid,enthtiefyy mwhaikceh mseaenkagtoerdiaelf-letyctpe(judsetcifiiseido)nws--ordkeercissuiospnis wcioornkserosf nhoetalbteh thraanzsafredrsreadn.dThaedsveiselatttheratdseiccik msioannsa,geesrpiaelciianltleyr,esatrse, bculetafrllyy iinn tthhee fcaocme poafntyh'es awsobreksetorss' exhpeaolstuhren. eeds to limit or eliminate From a conference on luly 23, 1957: PDautsitenretsLt:riMctaiolen, 3a0dvyiesaerds oilnd.1H95ir4e.dPinre1s9e4n3tl,yNao pyeaacrkserofanpdotiennstpiaelcteoxrpionsausrbeestotosa.sb1e3s-taonsd, -ac-ehlaitlef Danidagsniloicsais.: Early Pneumoconiosis, mixed. DNru.rZs:eHWa:sNhoe.been health counselled? DDrr.. SXm: Githet: dDeoenpoitndsopiarantyiothninognfRore-6Xm-raoyn.ths and Dbrri.nXg:uDpofworecdoonfAeHreSnc(eAitrheHny.giene Survey) Dhirs. jZo:bA, sthaebreloicskdpuasct.ker and every time he does Danro. tXhe: rIfmyaonuontatkhee sthaimsemjoabn. Tofhf,e ayroeua wmiullstpbuet Dclre.aSnmedithu:p.That is a long-range idea. Dr. Z: 21.. ATaHbA are3a.. Advise plant manager, to clean up 4. BterrinXg-ruapysi.n 3 months to conference af Dshro. uSldmbiteha:dIvidsoed.noTthethreinmkatyhebepclhanant gmesaninagtheer picture. We can give a better decision after a Time IntervalasnBdetHweeaelnthRCeocoumnsmelelinndged(HN.Co.)DSuessts(iNon.Ds.) Restrictions Counselling before Ctoimunesoerlliwnigthaint soanmee oCneouynesaerlloinrgmdoerelaayfetder lob Restriction year after lob Restriction lob Restriction Restriction NPeurmcebnetr ooffCCaasseess - 120% 255% 6153% Average Delay between N.D. and H.C. = 3.6 years; Range of delays = 2 to 10 years. Dshro. rZt:pIetrhioindkotfhteimpela. nt manager should be told tthhaetresihsoaulpdotebnetiaclleliaanbeidlityu.pA. lsIo,whoerrke iaslla jtohbe building in the AHS not to make it too obvious. maTnhaigsercioavl,ernuopt maenddicaclo.nNceervnertfhoerlelsisabiitlsitcyoni-s hseugmuaenncdeesvapsataletioinn ocfotmhepadroiscotonrst'orethceompmoteenntdiaal atisobnesstnosoits toor torathnesrfeprnweuomrkoecrosnikonsoews.nIttotohoakvea borniethf efedwocmtoorms'epnatrst,satnoddencoidaeppinaroennet saugcohncizaisneg, printed in full below, on July 10, 1957: PDar.tiZe:nHt iMre:dMinale1,91593. yWeaarssionldS.ervice. Has been dinuTste.xtiles 39 years and had exposure to asbestos ANduvrsiseeWd o:fMtheinstiinon19o5f4P.neumoconiosis in 1952. DX-iRagany:osPisr:esEeanrltyfailsmbe,stcoosims.pared with film of d1i-a1c7-s5h7a,dtohwer.eRisignhotwhialanrisnhcardeoawseailnsoriabpapnedarcsatro Dber.eZn:la1.rgTeadb. Otherwise there is no change. 23.. NDootinfyotptlraanntsfmera.nager kepStimonilaarlvye,rybdruussgtyuejolyb,foarnsoetvheenr milol rpeemrsoonnthsis, apfnteeurmohcaovniniogsisbfeoeunr yedairasgenaorlsieedr: as having PDar.tieZn: tHNi:reMdalien, 41894y0e.ar3s oyleda.rs in the Army. yPereasrsenptloyteantciaral neexpoopseuraretotroinsilTicraa,nscietemPeinpte.an1d4 aNsubressetoWs. : H.C. about chest changes. Records DinidaigcnatoesiPsn: eEuamrloycmonixioesdisPinneu1m95o4c.oniosis. Xch-aRnagye: siDncifefupsreeviloinuseafrilme. xaggeration. . . No Dr. Z: 21.. TNaobtify plant manager 34.. MLeaanveisoinn whiosrsjtobjoubnitnilIrBevuiielwdinagfter his Dr. Z: I hnateexttophthyisnikcaolf. him on his job. Dr. Smith: Leave him there until October. 5, A19n5o8th, earndserreiosuoslvceadsieniws hdaistccuasnseodnloynbMe caarcllh ed cold-blooded terms. It is presented in full below: DPar.tieZn: tHOir:eMd ailne, 15923y3e. ar2s3oylde.ars potential ex pPoipseu.reIstoprSeisleicnat,lyCsehmiftenfot raenmdaAn.sbestos-Transite NMuernsteionWo:fWPnoerukmedocaosnitorusicskindr1iv9e52r. 1W92a1s-1H9.3C3.. winer1e2n-5e4g.. P&S (Patch and Sputum tests--DK) DDrr.. SZ:mSihtho:uAlddwvaenccheadnPgneehuimmo?coniosis. DDrr.. XSm: Iifthh:eWhiotsn'6t5mIawkeillabney sduirfpferriesendce. . Dr. Z:oHnediissatboilbitey,wifatncehceedsscaaryre.fully and retire 21.. TNaobtify plant manager 34.. DWoantcoht ctraarnefsufelrly 5. Retire if necessary. praTchteicaeboovfeccoarpseosrarteevepahlyasigcoiaondsdienaltahbeoduot mthie yneaanrts caogmo.pBanuyt wohfaot nlieghltadrgoethiensdeumstreydicoavlecro2n0 tfiecreedncteosdasyh?ed on corporate medicine as prac phFyisriscti,antsheoyftenclefuanrlcytiornevineatlhethmatultcipolrepororaletes opforpaetersomnaalnapgheyrsi--ciaann,dletghaalt atdhveisdoermaannddscoorf theTsheerovlaersioaures rroouletsinecloymipnacnoynfplihcyt.sicians play atincdulathreinredaivsoidnusatlhsatthceoyrpdoorahtiaovnes nhoirtecthhaenpgaerd fpoorradteecaindteesr.estWs,habtuthathsechmaendgiecdal iasnndotsoccoiarl pstaasgseaguepoofnthewOhiSchHAthAescet teanreyeaacrtseadgoouatn.dTthhee gcuropwatiinognawl ohrkeearlthanhdazpaurbdlsichaawvearesnigenssifiocfanotlcy pshoirfateted tahnisdfimeldedoifcaml eodfifcicinees,ouotntoof pthrievaftaecctoorry floAorsaandresinutlot tohfethpeusbelicchhaenagreisn,gocnheamwboeurl.d not etoxpspeceat kphasystihceiadnosctionrslaorfgJeohcnosr-pMoraantvioilnlse stpodokaye cinianthsetoldataey 1c9a5rr0ys.wBituht tmheamnyascodripreocrat tpeerpshoynsail vexalpueersienacneds roerlattihornosuhgihps sodceirailvetdradfirtoimon ththaet pcoenrifolidc.t Abnedtwoeneen stpilaltiseenets qmueidteiccalleanrleyedthseaonldd tchoerypohraavtee lbeegeanl adnodingmfaonragdeerciaadlepsr,iomriatnieys.coArs porate physicians continue to "resolve" this 13 cboenfoflriectthboyseopotfintghetior sweorvrkeerco/mppataineyntsi.nteSriensctes oguutns"idtehrast troevtehaislsdthaye draorcetloyrs'secehotihcees"sbmetowkeineng sceolrdpoomratceonasnidderpathtieendtetianitleerdesitms p--licaatniodnsthfuosr their medical practice of such choices--these Jaoghen,sg-Miveanuvsilalen immepdoicrtaalntregpliomrtpss,edinestopittheistpheairrt of Tthheecboarspicordaitleemwmoraldo.f corporate medicine re imsathinesptoadtiaeyntw--hathteitchoams pbaeneyn oforrthdeecwaodrekse:rW? ho --David Kotelchuck Names and Abbreviations Used in this Text artIinclteh,epraetpieonrtts'sgaunodteddoicntotrh'se nteaxmt eosf tahries npoutbuliscedr.eWcohridle, ththeedoucusemeonftsianrdeivoinduthael ncaasmee. sIndopeasrtincoutlasre,emthewaafrfreacnteteddwionrktehriss athnedirthemiredfaicmailliecsohnadviteioanrsighdtisncoutstsoedhavoer rneevceeaslseadry pinubthliecllyegaalnsyuitms oforrewthhiacnh twheays ewveerrethoerirgeinpaolrltys rgeavtehaelrmede.diBceaclaaunsdeshoociwal aittstitucdoerspoornattehe pphayrtsiocfiatnhse ctohmatpanaryeanodf bferroeandceer dinistceuressstionasndariempreoprtraondcuec,edconin tdheilseteadrticsole thwaitthotthheers wcoarnkneorts' idneanmtiefys cthiaenms.aTrehealnsaomneost porfetsheentceodr,ponroattbeepchayussie wtheoupgahrtitchuelalralwy dwoisehs ttoo psoromteecetxttheenmt p(raol treeclatttihoneschoipnsf)idbenuttiasliimtyployf dboeccatours-epaptuibenlit cseartivoen aonfythebirronaadmerespduorpesosneothaeprpe.eaTr htoe sDinr.glKe eenxnceetphtioWn.isSomurithu,sewohfothewansamCeoorf pviollreataet MtheedtiicmaleDofirtehcetocroonffleorehnncse-sM. aDnr-. rSempiothrt,edwchoonfperaernticceips,atsepdokienwaitlhl sopfectihael aauntdhodriidtynoats aapnpoeaffricienr tohfetrheepocortrsptoorahtaiovne poferthsoenaaflfleycteexdawmoinrkeedrso.rTshpeoskaemnewsiitxhdaoncy etoarcshanodf nthuersefsouwrermeeldisitceadl acsopnrfeesreenntceast arerepocrotendsisatnedntltyhorseefeortrheedr ttohaans DNru. rSsemsitVh anTdhWe ,reapnodrtsDoofcttohresmXe, dYicaanldcoZn.ferences had a standard format: After reading the pagatei,enot'snenammeed, icdaelpasrttamffenptenrsuomnbewr oaunldd pdiosscuursesttohpeoptaetniteinaltl'sywhaorrmk fruelcodrudstsa.ndTheexn athsewwasorhkiesr'sorXh-rearydfiialmgnsowsiesrebydetshcericboemd, pthaenycomnefdericeanlcde.epTahretmceonltleacsteodf thsteaftfimtheeonf danisdcuwsosrekdintghecopnadtiietinotn'ss,mtheednicoanl esiotfutahtieomn emnacdee rwechoicmhmeinndcalutidonesd fofrlagthgeincgonftehre pTearbs"o)n, 'snmoteifdyicinagl rethcoerdpsla(n"Tt abm"aonrag"eNro, whoolrdkienrg("aHm.Ce.d"icoarl "cNoonfHer.eCn.c"e--wtihthatthise, "CHoeuanltshellCinogun"s)e, llicnogn"duocrtin"Ngo aHneaaltihr h("yAg.iHen.Se."suorrve"Ny owAhe.Hre.St.h"e), paenrdsotnranwsofrekrs jroinbgs.thTehewoinrkdeursttroialleshsydguisetnyeorsunrovne-yduasntdy jroebporttrsa,nscfleerasrlyweardev, isaocrycorrdecinogmmtoendthae ttiioonn,s twohoitchhermdiegphatrotmr menitgshotfnthote accotrpuoproan trheecmor.ds,Thneotiffyirisntg tthherepela--nt mtaabnbaignegr atnhde hthoeldwinogrkaerhse--altrhepcroeusnesnetleldinagcstieosnsisonwhwiicthh wmeernet uitnsedlef.rtaken by the medical depart recMoradnsy, asbubchreavsia"tOio.nDs."arfeoruoscecdupinattihoensael adbisberaesveiaatniodn"sTa.rBe."prfeosreTnutebderacsuplorsinist.edThine ttrhaenstelaxttioonf t(haeccroeprdoirntsg, tfoolltohweeadubthyort)heiinr bourasciknettsh.eMcoonstteaxbtborfevthiaetifoenws dwoezreenocbavsie traeipnotyrtspeprrseissetsn,teedsp, eaclitahlolyugihn tshoemaebubnrceevri ations of department names. PSAHNILSAPDGEHLPHIA cia"lTlyennseeodf ythoanudsa/onrdsmoefdfiicnaallny udinddneorst ehravveedthPeihr ihlaedaletlhphneiaendss vmiectesby othfe pcoumblbicineadnhdeapltrhivsaetre fPahciillaitdieeslphbeiafoGreentheeralcloHsoinspgitaolf n(PoGt bHe)inagndmtehtetiordnaeye."ds are still 19T79huspbreesgsinsrethleeasOectoobferth4e, Fcleuldloiwngshiitps thCroeme myeisasrioenffocrtonto dcooncusemgeunetncaensdouf nthdeercsltoasnidngthoef PstGatHem. eAnts issignfiofricanat paesoptlhei-s ophriieanhteedaltvhieswcenofe,thite, oPf hcioluadrseel, beTgshethPeGPHGHguqeusetisotnionh.as been aDruoruinngd thfeorfirssetvhearlaflofdtheicsacdeens. PtuGryH, whoaws euvnegru,etshtieonkeedy. rIotlperoof vseidrveidceas guuannmtiatytchaendd rbayngeanoyf omtehtreorpolihtaonspairteaal wihnich thine clalrugdeesst ctihtye. nAastiownit'hs sfiomuirltahr alorceaals puwbitlhic hdoissppriotaplosrtiinonuartbealyn ilnacrgoemenupmeobpelres, oPfGnoH- parnodvildowedbpoattihenotrdisnearrvyicienspatainendt aannd oiumt epxretrsasoivredinnuarmybesreravnicdesquwaliitthyouoft hwaasssloinnge poaftitehnetsnfaotriopna'ysmlaerngte. sItt hwoesllpoitvaelsr,2,h0a0v0inbgedsin. Iitstsreppriumtae tcieolnlenint, maettdriaccatlincgirtcoleistswinasteernx qshuiaplisfieadngdradreusaitdeesnocfiethse wbeesllt mcoeudnitcrayl. schools throughout the goIvnerthnem1e9n5t0sspaonndso'6r0esd, tsheevecritayl mpearjorrosletudiines tohfe thheeaclitthy'sfiperldo. 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Ianbofartcito,nbsyinrecsatsreicstoinf gknMowednifceatiadl dcreefaectet,s tahesitHuaytdioenAemveenndmmoernet risetsetdricptriivoer ttoha1n97t3h.at which ex theTMhecReaveidceansceealpsorosdhuocwesdthaint tdhaerd"ldifoeesennodtanwgoerrkmtoenste"pasrtaante t"htehrearpaeputeiuc"tica"borftrioomns i"nnothne vreidalerswworhldo.teTsthifeiemd eadgirceaeld pthroat esuvfefneriendcafsreosmwhaerdeistheeasme otthheart mmeignhttstmaneedtartdh,e tlhifeeoeuntcdoamngeeorf tlhye preognnancythdeependweodmgraena'ts pvsiryocnhmoleongtiaclal, anpdhyseiccoaln,omenic tshitrueaattieonni.nMgosctosnedviteiroensanddo linfoe-t bperecgonmaencoybwvihoeuns thuenthileallathterisikn of Tabhoertieovnidiesnhciegheinst. the case acacreerfbualtliyngdeofcfeucmtseonftspovtheertyeoxn pthoeoralwreoamdeyn:lohwighhemalathtersntaatluasnodf ainmfaonntg maodrotalelistycen(tess)p,ecpiaololyr pnruetrniatitoanl caanrde. lack of access to wiWthdhreanwnM, epdoiocaridwofmunedninhgavies angoewphriecree oeflsaen taobogrot.ioTnhies eagvuearl 19 wtoeltfhaereabveenreafgite foerntairtehrmeeonptehr's scohnoicehsofuosreahwolodm. anT, htheen,onalrye ctoyctaorrtyertmhe, usnewekanatnedupnsreafgen,ainl hleegrsaellf aanbdorhtieornc,hilodrrendoefpwrihvaet fliottrle mthoeneyprtohecyeddourhea.veTtohpeasye ereqsutarilcittyiobnestwreeecnrepaotoer atnhdenoinn pleogoarl wabomoretino'snsacwcehsicshtowassafea, cSounpsriedmereatioCnouirnt tdheecis1i9o7n3 rliebaesroanlisz,ingDoaboolirntgionc. oFnocrluthdeesde vthioaltatetshetheHpyodoer wAommaenn'dsmrigenhtt tuonedqeuratlheprFoitfethctiAomn eannddmpernivt.acy fanOantilcys btheleievsetatuhnacthaestwofmetaanl wcehsot sishothueldvbicetifmorcoefdratopecaorrryina rGeisvueltnintghepgreegnnearanlcyprotobletmermo.f ucensdt,erthreepo1r9t7a7geanodf ra1p9e78anHdyidne Aatmedendthmeentssuffhearvinegnootf atlhleevsie wshoomweedn,. vicAtismsthoferaepveiadnednicne cMeestdicaaried amboorsttionosftebnecaduesneieodf tmheent6.0 day reporting require a JwuodmgeanD'soolriingghtalstoo foreulnigditohuast fHreyeddeoAmmeisndrmeestnrti.ctTehde lbeygistlhae taimveenindimtiaetnivtegrfeowr poaustsaofgea mofotrhael cmounrvdiecrti--ona ctohnavticatiboonrthieolnd biys rseelvigerioaln,s b(fuotr ceexratmainpllye, nRoetfoarlml, aUnnditeCdonMseerthvoadtiivsetsJaunddaisAmm, ethrie DcaonolBinagptifsotuCndhuarschfeasc)t. tThhaot utghhe CinavthoolvliecdChiunrchthewasPrdoir-eLcitflye pshoolirtticoafl rmuolivnegmtehnet,ahmeesntdomppeendt aulnocnoen.stiHtuetionfoaul nfdor tthhies reHaysodne bAemcaeunsdemeitntpreuvnecnotsnstaituwtioomnaanl fcroormdanchcoeowsiitnhghearboorwtinopnerisnonaacl relTighieousDboeolileinfsg. decision in MdeccRisaioenv.. HWahrarits eismaerlgaensdmisarka cshleipasr apmicotnugrepoovfertthye, irllelhaetiaoltnh aBnyd wthiethdheoclidsiinogn toabboeratrioanchfiuldn. ddeinngiesuntdheer Mrigehdticaoidf , asocpioeotyr wanodmbaondyto, fcoornctirnogl hheerrinotwonmalinfe dinagto, rywicthhoiludt baellaorwinignganhderrathise mit.eaPnsrotpoodneeanltssucocfessthfuellyHwyidthe Atiomnsendhmaveentnaontd esixmpirleasrsreedstrtihce spalomyemeenntt,huasiagsumarafnotreefdullmeimni mchuimld ancnaruea,l idnceocmenet, ahdoeuqsuinagte, ectocm., ptrheahtetnhseiyvehavheeaflotrh recsatrriec, atinriggahbt otortliiofen,.oAnlethhoausgnhooringehhtatos exSpehcotualdsetchuereS, uhpurmemanee Clifoeu.rt MagcrReeaewitahntdhe Zdebcairsaioznsciansethse, tMioendsicwaiildl bfeinfaunllcyinrgestfoorredabasora wmiethdoicuatllfyurthneerceressstarriyctiosne.rvTichee aonntliy-aabvoerntiuoen tlhoebnbyopwenoutlod tbhee Athme enpdrmopenotsetdo RthieghCt-oton-sLtiitfue ttoiobne. 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Tbhefeotraecttihces o(ffirheabraosmsmbeinntgsandofdesctlriuncitciosn, aennotsn,ymsiot-uinss,pheotnce.) cathllast tohacvlie btheeenreecmepnltoypeadstsoweifllfecptriovbealybliyn coAntbinourteio. n. .ainsdaescfuanladtaem. ental cfroemedpoomn.enStincoefthaenrye arweonmoa1n0'0s ptieorncseanfte)emffeetchtiovdes o(nfoctontotramceepn t"icoanr,efeuvl"enwtohmeamn ocsatndibliegceonmtlye pabreilgitnyanotf. sWafeithaonudt athcecesasviabille atobocrotimonpsu,lswoormy emn oatrheefrohrocoedd ionr wgeenllu-bineeinrgis.k Ttohtehedirechiesaioltnhsanidn MQucRerane avr.eHaarhriospaenfudl Zsbiganratzhav.t btheerreiaglhiztetdo afobroartiilownofmineanll.y will --MariiyKnanteNoPrfoinrsdkryesahnedr 20 wem w mmm NHYITNTUHRESES BRICKS maInnythNeYlaCstvtwolounmtaornythhs,osRpNitsaalst hTahveeconnetgeonttiaotfetdhenneewwccoonntrtraacctsts. hofasthbeeennegaostivaatrioiends awshthicehnlaetdurteo tvhoelunftianrayl hossepttilteamlsewntesr:e stthrurecke --and MCaoilmuomnbidieas-,PrKesibngystberroiaonk MIsreadeilcasl uCcceenstsefrul(lCy PMneCg)o;tiBateetdh after posting a strike notice; Mt. Steirneasit RarNbsitrwaetiroen.forced into in reaMdianrcghi"nNgurwseitsh opnicSktertikesigfnosr B"Neuttresers hPaavteieRnitghtCs aTroeo"," oavnedr 2ty,0v0o0luRntNasryaththorsepeitaNleswwYeonrtkoCni sFteribkreuardyur1intog 8t.heTheweneukrseso,f rSetparteesenNteudrsebsy' thAesNsoecwiaYtioornk a(NnYdSmNAil)it,amntaipnrteasineendcea udnuirfiinegd uthneiteds:trwikee'reafcetdiounps,. an"dWwee'r'lel cbeenot uctonhterraectu,"ntsitlatwede ogneet naudrsee MonaimtohneidespHicokspeittal. line at ranItkwaans donfliyletwporeysesaurrseagfoortcheadt NclYauSsNeAfrtoomreimts ogvoevearn"ninog-srturilkees". fTirhsetsien NreYcSeNntAshtrisiktoersywanedrecathmee aist faactiimnge wa hseenriothues ochrgaallneinzgateiotno iHtsosrpeiptraelsennutrasteiosn forfom6,00D0isCtriitcyt N11u9r9s'ess aLnedagtuhee UonfiteRdegFiestdeerread tsitorinkeosf aTndeacthheersc.onTtrhaucsts ththeesye pprroovdiuncgedgrwouerned afnor imNpYoSrNtaAn.t PcoenrhsaidpesretdheaseNsYtSriNkeAs wcaarnmubpe fwohritchhe wuipllcodmecinidgeciwtyhoelewcitlliobnes tfhoer tchoellceicttyivneurbsaersg.aining agent weArelthimoupgohrtanwt aigneallinthcreeacsoens tirnaccrteasstriunggglerastedueoftointhfelateiovner, cnoonnd-eitcioonnosmiacnidssupeastoiefnwtorckainreg wimepreoratsanicmep. orTtahnetseor iosfsugerseatienr schluifdt ero: tatmioann,dwaetoerkyendovscehrteidmuel, dinugti,ees,limainndatiojonbofsencounr-intyu.rsiAnlg ptheoruiegnhceniunrstuersnihnagvtehelsiettliessueexs pinrtoogrceossntrwacats lamnagdueagien, tshoemsee coRntercaecntst.ly, Beth Israel nurses htraavcet, awlshoicnheghoastidatreadwan nmeuwchcoant tneunrtsieosnhaavse bmeogruen taoncdommpoarree bcoanrgtraaicntisnagndaeltxeprnloarteivceosl.lecBtievthe rIesrcaeenlt'sly 6j0o0ineRdNDs,istwrichto 11h9a9v'es Science SCIENCE AND LIBERATION is a collection of essays on the role of science and scientists in the modem world. Grouped into four sections, the more than 20 articles cover the important issues of: the myth of the neutrality of science, science and social control, working in science, and new approaches to science teaching and working. and Liberation Edited by 398 pp. $15.00 hardback; $6.50 paperback Rita Arditti, Pat Brennan, Steve Cavrak Send check or money order to South End Press Box 68, Astor Station Boston, MA 02123 35% discount for an order of five or more, plus 75<t postage for first book and 20<t for each additional book. pLoesatgeudeaotfenRedgaiystsetrreikde Nnuortsicees., Ttohestnriukres,esbwutertehifsullpyropvreedparuend ntheeceRsNsasrya,nddutheetosutphpeorutnoitfythoef aoltshoerrheopsrpeisteanltwedorkbeyrs 1w1h9o9.arAe ncaewnt cownatrgaect apnrodvidbienngefsiitgniifni cofrfeaasneds,a edveecrryeaosethienr swhieftekroetnad wtioirne nweagsotwiaotninginsedsosiwonns-.to-thethoTuhseandsdoefteRrNms ionnatthioe npickoeft tlainbeless alendd toatsotmhee gnaeignostibaetiinngg wbeonnefitwsithandimwproorvkeinmgenctosndiin teinofnosr.ciNnogwthtehsee cdoifnfticrauclttstaosnkthoef jwoibthboengliyns1.1Incothlleecptaivste, bNaYrgSNaiAn, ihnags rheapds atorseearlvpicroeb3l0emhoespniftoarlcs, ginrgievcaonnctersa.ctNsurasneds wpilrlobceeslosionkg cinogmmtoittmseeentwthoetthheer sNtrYikSeNaAc's toifonthsewseillprloeabdlemtost.he correction theItsies alcsoondtirfaficctultntoegaossteiasstihoonws thaagvoeniasfmfesctebdettwheeehnistoRrNicsal aannd poathset,rRhNossphiatvael bweoernkeinrst.heInpothsie tfiuonnctioofniknegepdinugrintghesthrioksepsitablys tshaemirefetilmloewbweonrekfeitrisnwghfirloemat tthhee ostgryikeosf. "Cproonffeussseiodnbalyistmhe'', idofetoeln umnootirvgataendizbeyd coanncdernfefaorrfupal, htioenutrss, onfurosveesrthimaveeawnodrkaecdtulaolnlyg pthreolovnagrieodusstriinksetitsuittiuoantsionwsh. eAret tshtreikree wcoemremNitYteSeNs Aspostkreikoefs,hathve ointhgerthewosrukpeprsortanodf scoommemMunDitsy, 22 omregmanbiezrast.ioHnaolwseuvpepr,orntofrofomrmthael doethnet.r uOnniontsheinvoothlveerdhwanasd,evait tBheethsIasmraeel,uwnihoenreansurtshees aorteheinr chroestpeitalmwuoturkaelrs,supplapnosrftorwcoerne mneagdoet.iaDtiuorninsg, thweorlaksetrswewekoroef b1a19d9geRsNssta,"tianngd"Wtheeysuvpispitoerdt othuer dHiorespctitoarl'soffeatrhoef choonscpuitrarle.ntTjohbe afacctitoonr sinmaavyoihdainvge abseternikea amt athjoart insNtituurtsieosn.must not wait for their tcaotlilveecstivtoe bleaargdaitnhiengwraeyp.reTsheeny tbheegminselbvreisdgcianngtatkheethgeapstsepasntdo bthueimldsienlgvestheandunitthye bheotswpeiteanl wleoardketors.anTihnicsreawsiell inulstitmreantgetlhy fthore ahlolsipnivtaollvaeddmiinnidsteraaltiinogn.with proAblltehmousgrhemtahiens,etheanudnityotahnedr wacatyivitsom aof pthoetennutiraslescphoainngtse thine Nmuorrseinagct.ivNeutrhsaens inhatvhee pbaesctoamnde mtivuestbdaregmaainnidngfroumnittshaenirocroglalenci ezantcioonurawgheischpaprrtoicviipdaetsiofnorfraonmd mtheinimstermatboersrshaipn.d Theoduugchatoards wlaobuellds lwikiethouust tochacnhgainngge tthhee bnuarssiecs aproewseeerkirneglarteiaolncsohnitpros,l aonvder ththeeiarbiwlitoyrktiongaffceocnt daitiroenasl tciheannt gecairne.theAsdelaivcetirvye ofppaar toircgipananiztastioinns,ouwr hautneivoenrs tahnedy mdeamyobcer,aitnizceontshteamntlyasnedekimngaktoe tnheeemds,mwoerecarenspgoonsaivleontgo woauyr btoewttaerrd paacthiieenvtincgartheosaendgoamlsoroef tcioonntsr.ol over--ouNruwroserksi'nNgectwoonrdki TARHOEUABDLE, TRBOEUHBINLDE The 1981 Health Budget aTnhdepCroagrrtaemr aadtimcainlliystrcaotinosnersveanttivaeto$u6g1h,billeliaonn, b$5udbgilelitotno Cinocnrgearesses.ovAelrth1o9u8g0h, tthhiesrraetpereosfeinntfslaa trieopnreinsetnhtes eaco3n.2ompyermceenatnscutht einbuhdegaletthaecxtupaelnly dloiotumreinsgoevceorntohmeiccucrrriesinstmyaeyarw. eWlloforsreceyfeutr,ththeer trheetrebnucdhgmeetntw. hTehne tihnek hAaddmsincaisrtcrealtyiondribeedgaonn taalllkaignegnocfyabu10dgpeetrsc--enetxaccerpotssthteheDebpoaarrtdmceuntt ionf mDeefaennsse".mTohdeeCstaritnecrrveaesrseiso"nwofh"icfihscfaalilretsotrakienetp" pneawceawreiaths oinffilnatvieosntmfoerntm, aannyd parfoegwradmese,pacufetsw, scuapchitaatsiotnhegpraronpt ofosredmeeldimicianlastciohnooolfsthanedfeademraal jorTchuet iCnamrtoenreybufodrgneturisse tbroaiunnidnged. by three demanding and egually contradictory political aanndd tehceonreogmuiicremreeanlittsieos:f ainpfolaltiitoicna,l mcaimlitpaariisgmn,. Ctioanrtaelr Risepreusbploicnadninsgtrtaoteignyflaotifon"cwoiothlinag"tratdhie saplreenaddiynpga--raelsypzeecdiaelclyonionmthyebayrecaurobfinsogcfiaeldearnadl hcluinmeadn, sheervisicbeesi.nEgvpeunsihfeCdairntetrhwatedreirencottioson ibny bCeoenngirnetsrsoiodnuacled pinretshseuHreo.useRaensodluthtieoSnsenahtaevteo tlhimeitGthreofsesdeNraaltiboundagl ePt troodaufcixt.edIpfertcheentHagoeusoef trheseo1lu9t8io2nbiusdpgaesstetdo,2C0opnegrrceesnstwoifllthhaevGe NtoPh--olda vcuertsoifonat leinastrto$d5u7cbeidlliobny. IrWonaicrraellny, tMheagSneunsaotne b(Dil-liWonashin) wthoeuld19f8o2rcebuedvgeent.deTehpeesrecpurtsopoofs$a7l5s astmraotuegnitsttsohaopfeedtoerahleaJdarovfifs siuncihtiamtiveea.suCreasrtbeyr demonstrating restraint in their own budget re- 23 Health Care Financing Administration (in millions of dollars) MMeeddiiccaairde.................................................................................... ........ QReusaeliatrycAh assnudraDnecme o.n..s..t.r..a..t.i.o..n...................... ........ All other HCFA................................ .... TOTAL...................................... .... 1979 $2192,,144078 2196 55 $41,655 1980 $3134,,514620 2340 65 $47,821 1981 $3175,,374698 2384 71 $53,250 % Changet ++ 1111..44 ++ 1163..73 + 9.2 + 11.4 qcuutesotfs.$2M0-a4n0ybainllailoyns.ts expect a federal budget socTihaalt stehrevi"creess,traainndt" disoelismnitoetd etoxtheunmd atno atnhde omnielitaanryymbuodreg.etT,hiisssios cthoem"mpoansstihvaeteitusthhaonckassinao" mapipssrioleacsyhsttoemfesd, eraraplidhedaelpthlopyrmogenratmsysstwemhisl,eaMnXd aobthoeurnmd.echanisms of international intervention theHfeaacltththaadtvtohceatuepscmomayintgakeelescotmioenscommefaonrtwine wcoilml fboert ssphaorueldd btheesmwaolrlsitndofeetdhe. Ccaurtste, rbcuatnnthoet alafbfoorrd-ctiovirlisrkigahntgs-elriibnegratlhecoreamlitnioanntssooflothnegoalds tshoerleonisgthaesthhreeatseoefsa Kaenstnreodnygcannedeiddatcoy,raalnldy lDenemgeoctrhaisticfatlrlo. oWpseamgaaiynsttheareRfeopreubelxicpaenctchthaalt tahwisayyeparro'sgrsatrmatefguyndosf awlliollwbineg rienpfllaatcioend tobyeaat "msalajoshr aatntadcgkosuogne"imappporrotaancthpirnog1r9a8m2 tsh.at effects Food and Drag Administration (in thousands of dollars) BBuurreeaauu ooff FDoruogdss.a..n..d...D...e..v..i..c..e..s..................................... NBautrle. aCueonftRerafdoirolToogxicicaol lHogeiacaltlhR..e.s..e..a..r.c..h..... PBruoigldrianmg aMnadnFagaecmilietniet s........................................................ TOTAL.............................................. 1979 $ 18379,,900478 2104,,901649 3190,,742599 $312,126 1980 $ 19530,,729816 2124,,772739 424,,338712 $328,332 1981 $ 19564,,590672 2135,,217538 4229,,686939 $362,462 % Change' ++ 23..19 ++ 22..64 ++ 5851..424 + 10.4 *DNeewparntammeentfoofr Ewdhuactartieomnawinass ocfretahteedD. epartment of Health, Education and Welfare since the ptTerhceepnet.rcTehnet achctaunagleinfrcormeas1e98o0rtode1c9r8e1asdeoeiss nthoetrienfcolruedeunadneardstjautsetdmeinntteformr tsheofin1f9l8a1tiodnorlalatreso. f 14 24 Source: ACornusntceiiln,,JSanhuerarryy, 2E8d,it1o9r8,0G. overnment Relations Note, Vol. VI, No. 2, National Health woWrthitheixnamthiensienglimasitaatisotnaste, mtheentboufdfgeedteriasl sitnill tmenint.istIrtattieolnls fseoemlsetshoimnge ocfomprmogitrmamenst tthoe aandd wbuhdicghet parlsoogrtaemllssusarweheirne idneethpe htreoaultbhles.ysTtehme s(Someeeboofxtohne BmuodsgtectarirtyicHaligshtrleigshsetssbwyilAl gbeencfeyl.t). Budgetary Overview lab"lAeseinntfitllaetimonenftoprcreosgreaxmpsa,nsthioenhoefalutnhcboundtrgoelt bsaeycsomSehsermryorAe rlniksteeian hoofrsteheanNdatriaobnbalit Hsteeawlt,h" Cstroautniocnil.(HTChFeAH)eiasltthheChaorreseF, iannadnaclilntgheAddimscirnei Mtioendaircyarpeubalnidc hMeaeldthicapirdogarcacmousnatrefotrhesormabeb8it6. psoemrceensmt oaflltihnecrfeeadseersalinhePaulbthlicbuHdegaeltth. SDeersvpiictee pshroougtrianmgs",hoAlddtmhaint ilsitnrea"tiownhenburedvgieetweienrgs maorset dliigshctrleytisoenaasroynepdrowgirthamjuss.t eTnhoeugshtewincirseabseesintgo gkreaemp sthheabpepnyefuicnitailriethseofyseoamr'se ceantde.goTrhicearleparroe twhhreiceh mtealejogrranpehws tohuetlAaydsm, iannisdtraotnioenmstarjaotregcyu.t CHAP mentTohfetAhedmCihniilsdtrHateioanlthisApsrseusrsainngcefoPrroegnraacmt O(CvHeAr P$)40e0armlyilleionnouhgahs btoeelnausnecthasitidtehifsorJutlhye. ptarlo,gvriasimon, ,whheiacrhinwgo,uplhdamrmanadceautetimcaeld, iacnadl, mdeenn atanldhenaelathrlybentwefoitsmfiollrio1n00l,o0w00-ipncreogmneancthwildormeenn. Yinet tlhasetpriosgsuraem's itWselafsihsiningttoronubcleo,luams rne.poFrtaerdrseoaucrehdinmganaynwti-oambeonr'tsiognrouapmseonndtmheenbtisll, hleaavve tihneg laowfe-winwcoommeena'dsvaoncdatcehsitlodrgeon'ist aglroonuep.s, and Primary Care priRmeagruyirceadrestianteclicnoivcserwagoeuldofacdodmapnroethheenrs$iv52e malsilolipolnantosMtoecdoincastirdu.cTt hfoeuPrutebelnicnHeweacltohmSmeruvniictye ahneoaltthhercenfitfetyrs-o(nCeHCCHs)Casn.d Texhepanodvesrearlvl icCesHaCt bofudthgeetfewwillfebdeeruaplghreaadlethd pbyrog14ra.3mpsetroceanctt,uaolnlye keep pace with inflation. NHSC CoTrhpes b(NesHt SnCew) sbuisdtgheet.NNatHioSnCaliHs beaelitnhgSselrovttiecde fporrovaem$5e2ntmovileliron198in0c, reevaesne,taakin43g ipneflracteionnt iinmto aincccroeuanste. iCn uthrreepnrtepselanntscoinrpcslu, dtoe ianc6l1udpee4rc,5e0n0t Mheaanltahgemcaernet apnrdofBeussdigoentaslstr.onTglhyeopOpfofsicees thoef sCuobrspisd'iegsrotowtthhe, pprrivefaeterrsinecgtotroviinacMreeadsiecaferedearnadl Mheeadltihcaiadd.voIcnattehsisaaprpeeaa,r atto lheaavste, btheeatepnubtlhice budgeteers --at least for this year. Professional Education eliTmhienaAtedmcaipniitsattriaotniongroanntcse toagmaiendiwcailll ssceheokotlos ecnentitr.elTyh.eNsuurpspeltyraoifnipnhgyswicililaanlssoanbde cnuutrs7e6sphears tdhoeurbelaerde sminocree th19a6n0e,naonudghHpEroWfesbseiloinevalesstothgaot acarol uanndd. sTpheicsi,aolftycomuarsldei,sitgrinbourteiosnthoefgpehoygsricaipahnis ainngd ptrhoefersestieonnt.ioHnEpWrobalpepmaraefnftlliyctibneglitehveesnuthrast anseiathsetreoafdythesstreepamrobolfemfesdwerialll bdeoslloalrvsedprsoovliodnegs osypmpopstoedmabtyicthreelAiefm. eTrhiceasne Mcuetsdiwcailll Abesssotcroiantigolny AanMd Ath'se hAemaevryicancamNupraseigs'nAscsooncitartiiboun.tioTnhse gCuaartrearn-tpereopsotsoermd ycutw. eather for at least this AMOAth,earndcuwtsillwsiullrvliivkeelyCobnegrteoslseiroanteadl rbevyietwhe. NwHhiScCh wsiclhl boleasrsuhbisptsanwtiiallllbyelehssiktehdan9a.3ntpiceirpcaetnetd, tSupiteicoinal isncchroelaasresshipast fmorosetxcmepetdioicnaalllyscnhoeeodlsy. mtoepduict aolnstthuedetnabtsle()i.aer.,e abneyinognehwelidthaotutth$e2ir5p,0r0e0 sinefnltatlieovne,lsi,s wthheicehg,ugivivaelenntthoef 1a41p4eprceerncetnrat tceuot.f Specific Programs coTnthienuHeseatlothsiCt aatroepFainsapnicrainligngAbdumdigneisttriatthioans dtoonhoellditttlheetolicnoenotrnoml. aCjourrriennctreHaCseFsAbystrpauteshgyinigs creosgtucloantotariynmaenptparnodacihncerse.asiTnghley aAgglircees-siinvepWoolincyd-emrlaaknidngmceanntalbitey sweehnichin pHeCrvFaAd'ess litshteoirf 25 Center lor Disease Control (in millions of dollars) HPreeavlethntPiornomFootrimonu:la G rants.......... Risk Reduction/Health Education . PrevTenottiavel..S..e..r..v.i..c..e.s..:........................ VImemneurneiazlaDtioisnea.s..e..s..................................................... Chronic Diseases............................ HealTthoPtarol.t.e..c..t.i.o..n..:............................ EFnluvoirroidnamtieonnta..l..H...a..z..a..r.d..s.................................... OEpcicduepmaitcioSnearlvSiacfeest.y..a..n...d...H...e..a..l.t.h......... aTnedchAnpoplolgicyatDioenv.e..l.o..p..m...e..n..t............... OtheTr oCtDalC..:...................................... BHueailldthinIgnscaenndtivFeacGilritaiensts................................ Program Management .................. Total........................................ TOTAL.................................... 1979 1980 1981 % Change! --10 --14 1170 + 21.1 $ 10 $ 14 $ 27 + 92.9 4379 3408 3408 -- 15 18 19 + -- 5.6 $101 $ 96 $ 97 + 1.0 282 307 3110 ++ 432..39 2672 8218 8330 ++ 27..15 25 27 27 -- $144 $173 $181 + 4.6 902 6118 3502 ++ 12732..57 4 4 4 -- $ 96 $ 83 $ 86 + 3.6 $351 $366 $391 + 6.8 ptorobpeosesadvseadvinthgrso,uwghhicthheincplausdseasg$e78o0f mailclioosnt dcoenfetaaitnedmebnytmboilrle--thathnea s2a-1mevobteillinwthheicHh owusaes tohfeRteruperessoeunrtcateisveosf!mHedCicFaAl'isnfinlaatbioilnithyatsoleadttatocka pwreoagkreasmt howsphiitcahls isntrtihkeessysthteem--haprudbelsitc aantdtihne nerDceistpyitceomCmounngirteysshioosnpailtalhs.earings into the pmluignhittieosf.dHisCtreFsAsehdahsorsepfiutsaelsdsteorvdienvgeplooporacpormo gbrealimevetos sthaavteptrhievsaetehhoospspitiatlasl.s HwiCllFpAicokffuicpiatlhlye sClahcicka, goQ'suebnetlienagYuoeurendg, CMooekdiCcaolunDtyirHecotsopritaolf Thahseordye,"craisehde cHalClsFiAt.'sIn r"eMceanrtieconAgnretossinioenttael pteosotirmpoantiye,ntYs ouunnagblewtroyleynjsopyetchuelastiemdplwe fhaerteheorf 26 pesucbalrigcoht eaat lvtohlucnatraerywhoousplditamlsa.gHicCaFllAy'sdtirnuee aotn- titistucdheiewf,asLreeovneaarldedScinhaaefpfreirv,atreepmoerteetdinlyg wbehleitnatinedd duenndieodcutmhaetnttheedilr wcaorrekeprosseads a"pwreotbblaecmk.s," looTsheeirne,HaCt FleAas,t,anisdagthraetemsoemnet(tfhoartmscorfewscsreawretuipghittsenRinegseaisrcmhaannddatDoreym. oHnsCtFraAtiopnlapnrsojteoctsstetpo $ce5n8t,miellvioenn, atnakainbgsoluintfelaitniocnreaisnetoof a8c.c3opunetr. AHlCthFoAu'gshR$1&4 mDilpliroongwraemntstoarbeaial omutixbeedsiebgaegd. BsirvoeoklypnoJleiwtiicshkiHnogspitaalnldast yWeahrit(eafterHionutesne finortesryvsetnemtiosnr)a,timonoasltizoafttihoen--moonfteeyn iisnethaermfoarrmkeodf cuOtbtahcekrssacnredwc-ltoigsuhrteesn.ing will be taking place ainttethmepltoendgt-otehrmoldcaarllesataretea.nHurCsiFnAg hhaosmaelrreeaimdy bliushrseedmmenetdiapnro. gTrahmissmteoat-aaxneataipopnraollayc-hestwabill Health Services Administration (in millions of dollars) 1979 1980 1981 NCoatmiomnaulnHityeaHltehaSltehrCviceenCteorsrp...s..................... .. .. .. $27673 $34822 $319314 IInnddiiaann HHeeaalltthh FSaecrviliictiee.s............................................. ...... 49727 54794 60727 MPHigSrHanotsHpeitaalltsh...................................................................... .. .. .. 13742 14703 14655 MFaamteilrynaPllaanndnCinhgil.d...H...e..a...l.t.h.................................. .. .. .. 318315 318605 319747 EHmypeergrteenncsyioMne..d..i.c..a..l..S..e..r..v..i.c...e..s......................... .. .. .. 4101 4200 2260 Other HSA.......................................... . . . 64 77 85 TOTAL.............................................. $1,746 $1,942 $2,116 % Change f +-t-6134..43 ++ 49..17 + 142..65 +-+ 37..73 +- --3150..04 + 9.0 awbroevake thhaevnoactiionnasltaatevserwagiteh, csouscths assigNniefwicaYnotrlky nanovdatiMveasrseafocrhmussesttusc.h Iats tahlesoWausnhdinegrctountsstainte befrfionrgtintog wuapggeraledveelsnfuorrsinnugrsihnogmheomgeuaaliidteys ubpy tWo a9s0hinpgetrocne'nst ionfcrpeaarsietyd wreiitmh bhuorsspeimtaelnat idaensd. rbeequuirneddepracsust-thbryougthheosfewangeewincrreeagsuelsatwioonusld. Arelstthroauingehd Ha CfFeAdefrraolmcaopuprltyihnagsthteesmeproergaurillay trieomnsaitnos sutnatceerMtaeind.icaid programs the outcome a nHaCtioFnA-'ws igdeenreurlael, sgtrraatceeglyesrselyliecsononceiimvepdosainndg wmiitnleisstsrlaytiveexleycutseimd.plTerhisthaapnpetahres tpoolbiteicaalldy ptoruocvhidyertsa,skasowf acsrarcekceinngtlydodwonneoinn NfreawudYuolernk,t wdihceterde,NteriwedY,oarnk'ds DcoenpvuitcytAedttoovrneeryonGeehnuernadlriend nuArsinfegwhommoedeospterimatoprrosvaenmdeandtsmiinnisltorantgo-rtse.rm cparoreviadree ahnotmiceipahteedaltfhromaidHeCsF, At'so efpfroortvsidteo ehloimmienmataiknegr thseervreicgeusi,reamnednttothaset eMk eldeigciasrleatpioan tbieecnotsmbineg heolisgpibitlaelifzoerdnuforrsinthgreheomdeaycsareb.efore HCLFoAngt-atceirtmlyccaornediosnneostptrhoevoidnelyr aabreuasei.nHwChFicAh wishpolpanpniningg31topbeorocsetnPtS--ROaftaeprpirnofplartiiaotnio. nIst cboyna- tsiinouneasl StotadnedfaernddstRheeveifefwecOtivrgeanneiszsaotifotnhsedPersopfeitse satnudditehse GbyentehrealCAocncgoruenstsiinognaOlffBicuedwgehticOh fsfuicge pgoesstsibthlyatmPoSrRe,Otshasnpetnhdeyatsalveea.st as much, and anMd HeaunmwahnilSe,erinvitcheeso(HthHerS)m, aPjuobrlaicreHaeoaflHtheSaeltrh vFiocoedparnodgrDamrusgdAodhmotinfiasrteratnieoanrliys baseiwngells.laTtehde fcolurdoendl)y ina i2ts.3prpoegrrcaemntoipnecrraetaiosnes,(iwnfiltahtiaonn aidn dSiitginoinfaiclan$t2ly5, tmheillmioondesfot r2.6nepwercleanbtoirnactorreiaesse. fcoarnnthoet pFoDsAsib'slyBualrleoawu iotftoDreusgtasblainshd iDtsevpiocsets tmouartkedetiansga srueprvlaecilelamnecnet fsoyrsteexmtenbseiivnegcownitdreollys mpraiorkrettointghesymstaermkectianllgedoffonrewbydSrueng.s.KTehnenepdoys'ts t(rDo.l-sMfaosrsa) w"doouwldnssturebasmtit"utaepmpraonaychcutrhraetnwt coounld plermessuamsatbhleyy iddeevnetilfoyp.dNruogocnoemisplciecrattaioinn wphroerbe the mTohneeHy eisalstuhpSpeorsveidcetoAcdommineifsrtoramti.on (HSA) dreepvraessteantitnsgacuvtesr.yTmheixCeHd AbaPg, NofHiSnCc,reaansdesCaHnCd potrhoegrrapmrosghraamves aflarreeaddypoboerelyn. described. Many PHTSh'se meoigsthtalagrmenienrgalcuthsoaspreitables.ingTfhaecedPHbSy h1o97sp0sitatolsdreevbeoloupndweadysfroofmmaoNreixfuolnlyatitnatcekgriantitnhge 27 National Institutes o! Health (in millions of dollars) 1979 1980 1981 NNaattiioonnaall CHaenarcte,rLIunnsgti,taunted..B..l.o..o..d...I..n..s.t.i.t..u..t.e $953066 $1,050218 $1,050488 NNaattiioonnaall IInnssttiittuutteeooffDAernthtarlitRise,search .... 65 69 70 NaMtioentaabloIlnissmtituatnedoDf iNgeesutriovleoDgiicsaelasaensd. . . 303 342 366 NaCtioomnaml uInnsitciatutitveeoDf iAsollredregrys aanndd Stroke . 212 242 250 NaItniofencatlioIunsstDituisteeaofseGse..n..e..r..a..l..M....e..d..i.c..a.l...... 191 216 228 NaSticoineanlcIenss.t.i.t..u..t.e...o..f..C...h..i.l.d....H...e.a..l.t..h...a..n..d...... 278 313 332 NaHtiuomnaalnEDyeevInelsotpitmueten.t....................................................... 119058 211103 211186 NaHtieoanlathl ISncsitietnutceeso.f..E...n..v..i.r.o..n..m...e..n..t.a..l.......... 78 84 97 ONathtieornNalIIHns.t.i.t.u..t.e...o..n...A...g..i..n..g.............................................. 25577 25750 27745 TOTAL............................................. $3,186 $3,443 $3,582 % Chang ++ 03 + 1 + 7 + 3 + 5 + 6.1 ++ 32..78 ++ 175..15 + 7.4 + 4.0 vthideminsgelvsuesppinotrot lfoocralpdriemlivareyry csayrsetemprsobgyrapmros. Dcuets.piWtehtehnis,inthfleatihoons'spittaollsl fiasceadade$d12inm,illtihoins trheeprPeHseSnthsoasp1i6taplse.rcent decrease in support for graFmedseirsaallssoupinpdoortufbotr. AotlhtheorupgrhimthaeryCcoamrempurnoi ty Health Centers are getting budget increases wtiohnic, hthweillMalaltoewrntahlemandto CkeheilpdpHaceealwthith(MinCfHla) g"irnacnrtesatsoes,"tawtehsiacrhearmecoeuinvtisngtooan9lypaer$c1e5nmt cilultioinn wthiellfsaucsetaoifnianfsliamtiiolna.r 5Fapmericlyenptlacnunt,indgesppriotegrtahmeisr sElvigehntlytheincdreesapseerdatealpypruonpdrieartfiuonndeodvemr i1g9ra8n0.t health program is receiving only a $5 million Alcohol, Drag Abuse, and Mental Health Administration (in millions of dollars) 1979 National Institute ofMental Health........ . $570 1980 $620 1981 $671 % C+ha8n.2ge! NaatniodnAallIcnoshtiotulitsemo.n...A...l.c..o..h..o..l..A...b..u..s..e....... . 175 190 201 + 5.8 NSta.tEiolnizaalbIentshtsitHutoesopnitaDlru.g...A....b..u..s..e...................... .. 27729 27849 27948 + --10.1 O ther...................................................... . 9 12 17 + 41.7 TOTAL............................................ . $1,105 $1,185 $1,261 + 6.4 binofolastti,onr.epresenting a 1.5 percent loss to HSIAnf'lsahtiyopnewrtiellnsailoson msceraenenain1g4, ptreeractemnetnctu, tafnodr wreofenrraalbipgrobgartatlme sw. iTthhepuabclaicdehmeaiclthreasdeavrocchaeterss wthheeHnetahrety, Lwuonng,ananadddBiltoioondaIln$st1i1tu.2teminilltihoenNfoar tairoenatlarIgnestteitdutfeosr odfeHmeoanltshtr.aAtioltnhoaungdh etdhuecfautniodns pcoromjepclatsinoinnghitghhatblmooadnyproefssNuIrHe,'sadpvroogcraatmessarine tshcehsoeola"raetams omspahinetraeinthaatcpormeffeorrstaabclaed"eomldicbcooyn's fgerraemnciensGteoorsgeiraviicsespdeenldivinergyo. vOernhealsfuacmh ilpliroon gdroalmlarss wonith"ocuotormdainkaintigona"nyof ehfyfopretsrtetonsiinocnreparsoe psorouvrcideeorf ppaarytimciepnattifoonr minanMyebdliaccakidG, ethoergoiannlys whTohseufCfeernftreormfohrypDeirsteenasseionC.ontrol (CDC) is schhirfotinnigc dmiseoanseeys, aawndayvenfreormeal idmismeausneizsa(tiinofnlsa, tion is accomplishing an 11 percent cut) to hgreaamlths, wprheivchenatrieonbeianngdstreipskpedreudpucfrtoiomn$1p4roto $ta2r7getmeidllfioonr .woMrkupclhaceo,fscthhoisol,maonndeoythwerilcl ombe mmiulnliiotyn tsoetetinnlgasr.geCiDtsCApispaallsaochrieaqnuLesatbinorgat$o2ry5 tfoowr On,cWcuepsattiVoinraglinSiaaf.ety and Health in Morgan of NHeeaarlltyharllecperoivgerdammsoodfetshte"NinactiroenaaslesIn"stwithuitcehs wsiigllniffaicilantot iknefleaptiounp-inwdituhceidnflcautitosn.hitThtheemNoast ptieorncaelnCt acnuct)e,rNInastitoitnuatleH($e1armt,ilLliuonngi,nacnredasBel,oo1d2 cInust)tituatned($t2h0e mNialltiioonnailncIrnesatisteu,tenionfe Gpeenrceernatl pMeerdceicnatl cSucti)e.nTcheses(e$1th9rmeeilliinosntitiuntcerseaascec,ousenvteedn fthores5e3cpuetsrcseunpterofficthiaellNyIsHugbguedsgt eatwinea1k9e8n0i,nagnodf tohnelyinwshtietuntitohneasle rsemseaallrcrhetreesntacbhlmisehnmtsenat.reItexis aomthienrehdeainlththaendcohnetaelxtht -oreflamteadjopr rocugtrbaamcsksthiant the staying power of NIH becomes clear. Health Resources Administration (in millions of dollars) 1979 1980 1981 CHoeanlvtherPsliaonnn/iCnlgos.u..r.e.................................................................. $152 $167 $17100 HCeaaplitthaPtiroonfe..s..s.i.o..n..s...E..d..u..c..a..t.i..o..n..:.................. -- 116 -- PSrtiamrta-ruypC..a..r.e../.F..a..m....i.l.y...M....e..d..i..c..i.n..e.............................. 585 --653 -- --83 ANaretla. HHeeaalltthh SEedruvciacteioCnoCrpesnStcehrosl..a.r..s.h..i..p..s... 2705 8216 2914 ELxocanepRtieopnaalyNmeeendtsS..c..h..o..l.a..r..s..h..i.p...s............................. 27 120 1102 DFiinsaandcviaanltDagiesdtrAessss..i.s..t.a..n..c..e.............................................. 159 207 229 PNuubrlsicinHge..a..l.t.h.......................................................................................... 10167 10167 2197 Other Health Professions........................ 74 61 29 MediScualbFtoatcailli.t.i.e..s...G...u..a..r..a..n..t.e..e...a..n..d............. $656 $565 $506 OtLhoeranHFRuAn..d.......................................................................................... 4632 2435 2--4 TOTAL.............................................. $761 $633 $530 % +Cha1n.g8e! -+1--0207..07 + 9.3 + 5--00.0 ++ --2180..60 - 72.6 - --52.5 - 10.4 +-1004..03 - 16.3 Alcohol,AdDmraigniAstrbautsioe,n (aAnDdAMMeHnAta)l Health stiTtuhtee oAfDMAeMntHalAHbeauldthgestuswtaitihnetdhea Nfivaetiopnearcl eInnt cinrfelaastieo''n. -Aboltrhnoucguht tdheespAitdemaini$s5tr1atmioinllihoans a''lisno prergouperisatteidon ato t$h5e019m8i0llbioundgseutptoplienmcreenatsael caarpe ttohismrinegoruietisetsmanayd ftahree cphoroornliycaalslythmeeCntoanllgyreilsls, apTphroeacHheeasltihts sReelfs-oiumrpceossedAbdumdigniesttrcaetiiloinng.has btheeenagteanrgceietsedinfoHrHthSe. Imnoasdtdeixtitoennstioveelcimutisnaotfioalnl ocfutcsaipnitsautipopnorgtrfaonrtsnu(r$s1e16traminililniogn()$7a7ndmdilrlaiosnti)c, gHrRaAm ftaocegsuaterarmntieneatliooannsoftoitsm$e4d5icmalilflaiocnilitpireos, tghreamveswtihgiicahl sfuurevlievdorsoof tmheucohlduHninlle-cBeusrstaornyperox paragnusmioenn. tsAlftohroeuagchhthoefrteheasree csutrtisk,inthgelyosvoeuranldl tihmepsaectcuotns HaRreAaidtsdelefdmtaoyibneflaatliaornm'sintgo.ll,Wthheeny repCruetssenint aH2e7apltehrcPernotfecsustiboancskEfdourcthaitsioangemnackye. Athsehheeaalltthhpplalannnniningg'spsrhoagrreaomf HfaRrAm'sodrewvinisdilbilneg. bceundtgeint g1r9o8w1s, fHroRmA26mpaeyrcbeenctoimne19i8n0crtoea3s3inpgelry tnhinregapternoegdrabmy uHnCdFeAr i'stseofwfonrtscotontbroriln, geftfheectpivlaenly vbuivreisaeucctriantigc inHfiRgAhtinigtshealsf.alaTrmhiisngoibmspcluicrae tmioendsicafollry tuhnedefrasteervoefd ianrneears. cAitlythoaungdh oHthReAr htoasigonftoerneinceivpitllyriagllhotws eadnidts apclacnesnsinigssaugeesn, ctihees atigoenntcoysaetrlveiacset hcaustsanwehxeprelictihteproeliacryeonfoopaplotesri nHaRtiAveCshoiuefrceHsenorfycaFroeleyfo'sr sthenesiutinvditeyrsteorvtehdis. hisossuteilisttyanHdsCiFnAsh'sarLpecoonnatrrdastStcohtaheeffuenrrehmasittienxg hibTihteedretoiswliatrtdlemjoiynoinriMtieusdavnildletthoelepaovoern. HRA's finessstiitountaiolneadluwcoaetsio. nIn, athdedithieoanlttho tphleacnuntisnign pprroo gInrfalmatiiosnslwaitleldeffofercat ma neaetge1r1$p3emrciellniot nbuindcgreetacseu.t foonrcet-haempbliatinonuisngpraoggeranmciesto. Sheimlpilafrilnya,ncHeRtAh'es choonspvietarslsiohnas abneden cwlhoistutlreed dcoowstns toofa mexeacgesesr $te1r0mmdiellbiotna,t sacasirncgellye feancoiluitgyh. HtoRrAet'isreinttheentlioonngs gtoloosmlicyevitrhtuise opfiedis"aepgpuoiitnatbilnyg"evweirllyohnaevfeairtlhye. wilTlhderavsitritcuaalllyenrdedtuocneurthsee efdlouwcaotifonnewsupRpNosr.t Nfruusmtreartoiuosn staundides jhoabvedpiossinattiesdfatcotipornofeasssiotnhael pofrfimthaeryRNpraosbsleemmbslyinlrienteasinwiinllgfnourcresehso. sSphituatltsintgo sseeeekk stohleumtioants tporethciesseelyprothbelepmosi.ntYewththeenyfmiscuaslt pfarceislsituierseswaitrhevtehrey lmitotlset rionotemnsfeoredviescr,relteioanvainryg innovation. Although throwing money at the Office of Assistance Secretary for Health (in millions of dollars) 1979 1980 1981 NaRtioensaelaCrcehn.t.e..r...f.o..r...H...e..a.l..t.h...S..e..r..v..i.c..e.s........ . $ 36 $ 33 $ 35 NNaattiioonnaall CCeenntteerrffoorrHHeeaaltlhthSCtaatirsetics . . . . 38 45 42 HeTaletchhMnoailnotgeyn.a..n..c..e..O...r..g..a..n..i..z..a..t.i.o..n...s................... 33.3 593 698 ASmdoolkeisncgeannt dHHeaeltahl.t.h.................................................................... 31 1138 1138 OHetahlethr.P..r..o..m....o..t.i..o..n..........................................................................,, 1043 1103 1206 TOTAL.............................................. $218 $284 $311 % Change! +- 66..17 ++ 16166..97 -- ++ 1--090..10 + 9.5 psereomblsemeqoufanlluyrsceleraertenthtiaotn bwainllkrnuopttsinoglvenuitr,siet traiTnhinegOpfrfoigceramofs wthilel oAnlsysiwstoarnstenStehcerpetraorbylemfo.r gHreaamltsh'sh(eOavAiSlyH)dbeupdegnedtenist seotnasiindteerfaogrepnrcoy HcoeoapltehratSitoantis(tsicuschorasththee NNaatitoionnaall CCeenntteerr ffoorr HSeecarlettharySeorfviHceEsW'sRe"ssehaorwchp)iecae"ndprofogrramthse. AfocrmcoerrdHinEgWly,Sencoretoanrye Cwaalisfasnuor'sprainsteid-smtookisnege pofroHgeraalmth fMroaziennteantaintscecuOrrrgeanntilzeavteiol.nTs h(Oe HOMffiOce) oreuctsetirvipepdinga inhfelfattyionapapnrdoparllioawtiionngs forreqau2e.s6t dpeemrcoennsttraitniocnreparsoegrianmsO. HOMHMOOsmtaafyfinngeedanaldl ttwheo hreelpporittscaHnCgFeAt wsohuegnhtputobliscuitpypriessgsivwehnictho ccohnasrgume tehra-otwevneendtGherobuepstHHeMalOths,Cionocpluedraintigvethoef PveungtetpoSoorunand,d "eslkdiemrl"yppaetiresnotnssafnrdomseeenkrotollpinrge. NThaetioonnalyl Cotehnetrer"wfoinrnHere"alwthasCthareenTeweclyhnfoolromgeyd, fcehcatirvgeendeswsitohfthinenmovisastiivone omfeedviaclaulattiencghntoheloegfy rmeolarteivtheatnodiotsubcloesdt,s.f.rTohmis$3oftfoic$e8'smbilulidogne,tenwvais tsiioonnsinogf taecghronwolionggyfeadsseersaml iennvt.olvement in ques Health-Related Programs eqMuaallnyy phoeoarlltyh.-reTlahteedCparrotegrramAsdmairneistfraartiinong panladnsfotoodcaarvsseis$t8a1n7cemipllrioognrfarmoms cbhyildtignhutternitiinogn esildigizibeidlityscshtoaonldalurdnschfoers.freTeheasned cpuatrstiasltlayndsubin pstraormk isceonotfrathset CtoHtAhPe bAildl.mTinhiestAradtimonin'sistbraritgiohnt bisenaelfsiots fpolrandnisinagbletdo wcourrktaeirls, saoncdialis sleocoukriintyg fSoercwuarirtdy ptorogevraemn adfeteerpethriscfuatlsl'sienletchtieonSso. cial Summary voTllheye i1n98t1heheAadltmhibniusdtrgaetitorne'sprwesaernotsf aattmritaijoonr faagialuinresst mtoacnoynptruobllitcheheMaletdhicparroegraanmdsM. Feeddiceariadl binutdhgeectsomviirntguaylelyargs.uTarhaenotenelymdiofrfeeroefnctheewsilalmbee tlhitatltethtoe eslteacntdionbsewtwilelebne noveeerd,eadndputhbelirce wheilallbthe caUrenplirkoegrahmiss laansdt dDeevmasotactriantgiccuptrse.decessor, PprreetseidnesentoLf ybnedinogn aJbolhenstoonp, uCrcahratesre mguanksesannod bhuettweirl.l dLoikuebtCleasrstesra'sy oththaetrtheecomnoomunitcinpgoltioclileso,f fdiinsee.a"se, degradation, and dis--abMiliatyrk"Ksuleitismmane Rockefeller Medicine Men Medicine and Capitalism in America by E. Richard Brown Originally $12.95. Now Only $10.45! Send orders to: Health/PAC 17 Murray Street New York, N.Y. 10007 "This book tells us what health care in the United States is really all about. . . . No one can or should ignore this book. It's an eloquent, well-documented damning appraisal of the historical marriage between medicine and capitalism and its impact today." on shaping the kind of health-care systWemaswhienghtaovne Post Price includes postange and handling. Allow at least six weeks for delivery. 31 Media Scan pnluarisninEgngtlhiseho.reticians to use theIn qtuhaelityinstoiftutinounraslingsettcinarge, gdiivreecntlyto ppartoipenotrstioisnaflreqtuoentthlye Bmoyrsrtoicwisimng, ThTeamvialyinftraoinms Ethaasttethrne mlevaenlagoefmsteanffti.nNgudresitnegrmisinaeldabboyr ahufmoramn oorfga"neinsmergisya"noimr aptreadnbay. einntteanilssivaehefiaevldy.ouGtloaoydofntuimrseintgo Tspheiscifeicnepragtyhwiasyosrogranfoicziedcalilnetdo tarnydtposymceheotlobgoicthal tnheeedpshyofsipcaal cahpapkeraars. wShyemnpttohmes "offlowill"nesosf tsiheonutlsd. sIenrveadadsitaiomn,odenruartsinegs pinrainmabiasldainscreup--teda, sdoempaletitcedv,eorr froigricde bdeetmwaenednspaotfieinntsstiatuntdiotnhae DThoelroarpeesutic KTroiuecgh,er,PrentTichee- sioTnhoefhtehaeleern,ebrygya "ckrinsiosw. ledge tlhizeedcehnetarlatlhitycaroef. tBheecasutasfefinogf H19a7ll9,. PEanpgelrebwaocokd, $C5.l9if5fs., N.J., saubplep"opseladcteombeentaobflehetor htraanndssfeirs guestion, rank-and-file or union voOcanteesofotfheprporfoebslseimonsaltihsamt adin hpaetrieonwt,noer n"eurngryufftole"a adneyp"lceotend gestion" in the chakras. Know By her silence on the tnhuerssipnegcimficusctofnatceentisofttohadtepfirnoe fessionalism. While there has lleesdsgae pornotdhuecptaorftsocfiethnetifhiecaslteurdiys than an inner almost volun mqueedsitcioanl aolfloteccahtinoonloagnyd, aplrwofaeysssiobneaelnisma vinagnuuersisnegn,seanodf toafritshteic,hkeanloewr leadsgaen. "iCndoinvcideuivael pceripotrsittihees,prKesreiengtearrac tihneiftosrmupopfenr uercshinegloins,chthaenrgeinigs twohaonseohveearlatbhugnidvaenscheimofapcrcaensas rangement as given sthtiellorneoticualniffoieudndaantidonefxocrlunsuirvse manidtmwehnot saendstrinotnegntsieonnsteoohfeclopmill ingM. any nursing academics un ptaeionpcloengtriovlesovheimr thoer phreorjeacctieorn iisnputht eintomdoestciseioxnpsloisnivtheis naorena cdieernsctayndandthifsirmthleyorbeetliiceavle dtehfait of this vital energy" (1). fercoonnteodmbicy uinsisouneizebdeinnugrsecs.on ansurasilnegarwnielldnpevroefrebsseiornesupnetcitledit The "Energy" of Nurses shaHroesptihtaels,saomf ecoupresres,pedcotivneo.t citasnhfaitndona.n Jeumstptwyhpaetgistoithtahnagt new"Trtaenrmsfeorfoafret nienrgnyu"rsiisngn.otAat Tsohmeyehoonwlyasbelee tthoattankuersueps athree pnruarcsetistiodnoertshactannodoo?ther health cleaamste teinntoyevaorgsueagion trheelatpihornastoe slaIcnk wrehaelniteyv,er hwiht abty chuatbpapceknss. NeOwnYe oarnkswUenrivhearssitcyom--eoonuet ooff tfhroemcdaerebiloitfatpinagtiednitsseassuefsfesruinchg wthhaetnpnautiresnetss arreecesipveeedleedss-uapnids tdheevelvoapnmgeunatr.dsTaokfingtheooffreftricoaml ansarychdriosneiacseo. bOstnruccltoisvee apnuallymsois tlhesast pdairtieecnttscatarek.e Tlohnegerrestuoltgeist rnoulres,ingD'sohliosrteosricaKl r"ineugretrurinhgas" i"ttrbaencsofemreosfaepnpearrgeyn"t mtheaatnwshiant mbeetttser(,exacnedptsptaefrfhamposrathleatpolfutmhe dtieevnet locpaered acdailsletidnctTfhoerrmapoefuptiac tohragtancizoendte, xtpaitsienitn,telplhigyesnictlayl hreoaslpsittarul gcgolme pfotrrotlhleer").enTehrugsy"thoef Touch (TT). tciaernet'swnheicehdsanatnidcipimatepsrotvhees phais qnuurastees sitsaffiinnggewttiitnhg wthheichadeto CKorniecgenertr'satTiohneoorfyEonfetrhgey qofuamliatnyyopfhlyifseicbayl breulrideevninsg. him shpaevnedoptthime unmeceeffsescatr.y time to This, of course, is nothing Where does Krieger fit into 32 ThTehraepeubtaicsiTcoupchreamreisseims ploe.f enxewemoprlimfiyesstertihoeus,inaanbdilmityereloyf tchairsefutlulyg-aovf-owidasr?anyWdhisicleusssiohne oinfswtihtuattioTnTawl osueldttilnogo,k liitkewinouthlde alapbpoerairntetonsbivee wophpoolissetidc vtioewthoef pnautriseinntgc. aTreheca"nenbeerrgeyd"upcuetditnotoa swimhipchle cmanecbheanpicearflortmecehdniiqnuea tmioanttiestrvoiefwmoifnnuuterss.inTghmisayrecdoumc fmorint ibsotrtahtothre fainscdalltyh-emihnadreadssaedd and overworked staff nurse. "Science" TanoudcThherapeutic heKr trhieegoreyr ofbheegaalningdbeyvethloeplianyg uinngdeornlaoyfhheaanledrss. bAyt fsitrusdt,ysinhge tvreiendeetro. gBiveteweTeTn a19s7c1ientainfidc o1f97s4m,aslhl estcuodniedsucwtehdicha npuumrpboerrt ttohedehmemonosgtlroabteinanleevleelvsatoiof npian t(i2e)n. tNs otrseiamteildarbayttethmeptteecdhsnciiqeune thifeirc baopopkro. aEchvidisentocebeoffotuhnedeifn fcelcutssiovfeTlTy onlitmheipteadtienntoawre exto atesptirmacotniciaels wanhdichcasietsesltfudriaeiss--es suesreiobuysqquuaecsktiso.ns because of its tifiKcrfioecguesrthoatshsehsifatfeedr hgerorusncidenof hthaes eifnfectutsrnonstihgenahleleadlera, swuhbitclhe sinhtieftrntoawlizaardtioann eomf pthhaesishoeanlitnhge rolTe.he turn toward focusing on othne tehfefechtesaolfeTr hhearsapaepuptiecaTreoductho amcycsetliceirsamte. KInriheegrebr'osoakd,osphteionnoowf advocates the use of dream aynoaglaysains,d msyamndbaollaisc. Tlahneghueaagleer, kisnotowleadttgaein. some ideal inner KrIinegear hmaosredesmcioennsttirfaictedvetihne, gtheenuEiEneG satantde, EaMs Gme(a3s).urWedhiblye tthhies"shteaated"moafythedohewaloenrd, ewrse afroer ecxotnesrtnraailnizeeddt?o Kasrkiehgoewr'salal nthswiseisr --ene"rKgiyrivliearni"tabplhyotloeagpraspfhroym. Thheer fingertips (4). One on One to Inacvroeiddibtlhye, Kdreibeagteersmaarnoaugneds theecahlntholcoagrye. aSnhde rperfiroariintsiesfromin eTxheprlaipceiutltyic TcouocuhnttoeSrpcioenstiinfigc aMdejudniccitnteo, torradpirteiosennatlimngediticaisnaen. 33 hasThbeeeanpptorocarcithicoifzeHtehaeltmh/iPsAusCe ooff terecshonuorlcoegsy,, tahnedmtihsaellsokceawtioend pmreiodricitiinees. oHfeadlitsheaasned-treilalntiensgs aanredfruenfduasmaletnotaalclycespotcitahlatisbsuaesisc; panreamlyizseethmeapkreosbiltemimspionstshibelesytso tgermes,sivleetchaalonngees.suggest pro ToBuych cisonintrdaisvti,duaTlhisetircaptoeutthice acporper.oaTchheesinthdeiviidnudaivlid"uhaelal(eilrl") epiatthieernt fwitisthinntoothtohueghsyt sotfewmheforer btheettqerueosrtwioonrsseo.fBteycihtsnsoilloegnyc,e aoln: cloecpattsiotnh,e apnredsepnrtioarirtriaensg, eimt eanct atrsieas gtoivbeen.apTohlietricaaple.utic Touch nicTehlyerianptoeuatihceaTltohuccharedosyesstefmit wityhifcohr rheejeacltths.soCcuiatbl arecskpsoinnsisbeirl voigcyes baencdomapeproirprerilaetveantet.chnTohle bsuecccoemssesor dfaeipluernedoefnttheosnysttehme athbeimlitsyelvoesf bnoduyrsaensd,tomotrheriomw pInortthainstwlya,y,sonuulrsinestoartheesiert-wuoprkto. shheoalutlhdecrarethseystfeamil.ures of the Technology and Health Care tioTnhtehraet isthae glartoewstintgecrhencoolgongiy mcaasyes.noFtorbeexeafmfipclaec,iomusanyin tearll mbyinsaulpppaotriteinvtes, arraethbeertttehrantrecautread tDivoeinogr ev"eevneprayltlhiaintigve,ptohsesriabpley". ccearntaaicntluyailnlycrheaassteesnthdeeaptaht,ieannt'ds siautfrofegreinnigc daisnodrdercsh. ances of bidKrfioergethr,e huoswe eovferT,hmeraakpeesutnioc 34 Tinoeuffcehctwivhee.n hInighfatcetc,hnnoolwoghyeries dqoueesstisohne oefxpwlihciicthlypaadtdiernetsscathree TsiTtuaantidonwshiacrhe maapyprboeplreiasstesof.or whPicahtietnetchcnaorleogysitiusatiinoanpsproin plartiea,teabreecparuesceisiteliys totaoilloitrt-lem,atdooe ftioornainl tennusrisvien,g wchaoreli.stiTch, etrhaodsi-, preiccoegnmiotivoenmoefntht eisvaalune oefxpnluicrsit tiencghncoalroegyovienr ctehrattainof shitiugah toifonTsT. iAs s1im0-pmlyinaubtesu"rtdreaatnmdepnat" thetic by comparison. Counter-Culture and Health fonAdmoefriccraancskspeoetmscphaermticeusla(r5l)y. Nmeoxdtetoofgthenoeurgahlt"fliinfde-ssittyslset,r"otnhgis ehsetaltehx.pDreosessioTnT pinlugmiatstteelrfsintoof ahneyaltohf? these undercurrents in proAamchoensgtothseicpkonpesscualntudrhaleaaltph acarel recluigltiuorne, h(ejaolgthgifnogod,apghaiynssit cliacnhcisemr),, anmdacohuitnrieg-hbtreqaukaicnkgeryII.aOlobjnegctitvheislyc,onTtTinusmho,ulifd fofirt nion motyhsetricirsema.soAnll,thwainth tithse belxacteanpt tdiiovniduoafl rreelliigainocne, apnrdearcehspoinn psiebniluitlytimfoartheea"ltmh.eTTgemnaeyrabteiotnh"e vthieew"poofwheera"ltohf tbhye einmdpivhiadsuizailn. g plaKcreieitgtehrerme,aokresto nidoenetfiffyorwt ittho atonyfryo.f tThheemr.apSehuetihcasTbouigcgheirsfnisoht hinetaelnthdecdratzoeb. e merely the latest Content and Context upThaesraptheautticuTnioquuceh isboodffyereodf nkunorswinlegd. gAe mwohnigchudniisqtuinegbuoisdhieess of knowledge, the selection is liinmg,itesdc.ieUncneforistuanlarteealdyyfosrpnoukresn forl.ust how different is Thera pMeeudtiiccinTe?oucInh tferromms Sofcieancttiufaicl oknpopwoslietdegs;e bbasuet, tihneytaerrempsolaorf tiidceaol.logByo,ththpeyroaproeuanldmoasnt iidnedni vsiicdkunaelsrsatahnedr thheaanltsho.ciBaoltvhiecwonof craetnhterartethathneirpreevffeonrttsionin. Bcuorthe povreesrerv"heeaalth"moinnoptohley hpeoawleerr m(aaltyhoduogthhisTmheorraepesturtoincglTy)o,ubcyh mothyesrtwifyisieng,plarciitnugalikzninogwleadngde binedyiovniddutahle. rTehaechhoefatlhere arevmeraaignes theAddiosppteinosner ooff mthageic.medical mhootdteesltisisnsouemsisftoarket.hOe nneuorfsitnhge enluitresesis. pWrivhailtee mpraanctyicesufcohr sincghesmuebsorindvinoalvtee ntourmseesdriceimneainto Tsoomuceh pdreogvirdeees, thTehwehrearpeewuitthicallTtohecutpthriecceordo.f such in dtoepmeankdeenncuer,sihnogwethveer,lamugahyinbge pstroicvkateofptrhaecthiceealtfhorscdioenctcoerss. iIsf tnruargseedsy, ,bapsreivdatoen pTrhacertiacpeeuftoicr Touch, is farce (6). TT and Nurse Practitioners proOmnieseosf athfearm-roevaecmhienngtsimwhpiaccht isnpethciealdizealitvioenryaonfdhneuarlsthe pcararectiis tsioomneersn.urAssesnautrtsaeinparamcteitaisounreerso,f rinecdoegpneintidoenncdeueannudrsriencge.ivWe htihlee tahcecreessaarnedseelriitoisums apmroobnlgemnusrsoef pnrinacgtittoiofnilelrsa, nteheedy faorrechbeeagpienr middle-level health providers sForcuisatlrarteiaolnitywiotfhwthheicahtthemeapltthtocadreeliivsear qpuaratl.itWy hnautrsisinngeecdaered iisspnaortttool the 'hbiaelraanrcchey' .the inequities of the health care hierarchy but to destroy that amnadideton rreephuatbaitliiotanteoftnhuersheas.nd beNenurasbele ptoragcatiintioanmeresasuhreavoef msuecdciecsisneo'snlpyrivbaytepopraecsheirnvge.oInt sistrautnelgikyelwyotuhladt baenyatatrlatecrtnivaetivtoe amsotshtenuerpsiecepnratecrtitoifonheerasltsho lcoanrge ritesmeaminpshascsiiesnotinfidcimagendoisctiinces.anBdy Tc ooumchp airsi saonn ,eclTechteicr afpoermu t iocf ttihcesr.apMeuotsitcsnuwrsiethopurtacdtiitaiognneorss fcraonm baenyesxupcehctaetdtemtoptsthoyfuanwnaeyl theTmheoruatpeofuttihce Tmoauicnhstrceaanmo. nly ainpgp.eIatlatpopaeatlhsinmolasyt esrtroinngnlyurtso gthuossteed wwhitoh, hoarvneevgerroiwntnenddeisd tsotitubteioconamlenuinrsvionlgve(d7).wBituht, thinis disivaenrsioinnd, icvoidmuianlg jcuospt-aosunturasneds alercetibveegminunsicnlges.to flex their col Strategy lor Change woTrkheinhgunnudrrseedsshoafvtehonuosnaenedds ooff Therapeutic Touch. The prob fleromms thdeyeffiaccieednaciileysdoinnottahreisier n"huersaidnsg,"toordeifninteheitsienlafbbieliytyonodf theFrbuosrtdraetrisonoforfeatlhiety.attempt to pdaelritveorf guthaelitysoncuiarlsinrgealciatyre oisf wMhuicchh ohfeawlthhat ciasredoinseainpatrhte. htheraolutghh cnaurreses.syNstuermsingcolambeosr tiisonceinngtr.aNl utorsethsearseyisnteamp'sosfiutinocn tcoierseaolfizuentdheersotabfvfiionugs adnedficsiuebn mroelersoiofnnoufrsthinegimtoptohretaonpceeroaftitohne ocfenthtrealsityys,tenmu.rsBeseccaaunseboefgitnhetior caofflelecct ticvheasntgreengbtyh. using their noWt thoa"tbiaslnaneecde"edthies ainsetgruugitgieles olifttltehemohreeaaltththceamreidhdileeralervcehlybya amdydsitnifgyianngoth"escrieinndciev"idubaulitsticto, dchesatlrloeyngethdamt uhstiebraercthhey.hieArlasro wchhyic'sh psryevsteenmtsiceguditoyminineaftfieocn ttiovtaelcpaureblfiocrhaellalathndapopbrsotraucchtstoa the social causes of illness. divRidatuhaelr stohlauntionlosokaimngongforcoinn sotrrguacntsi,zendursstersensghtohultdo udseemthaenidr daneciesgiounal-maankdincgolilnegaiarel apliagrnt eodf health care sys--temG.lenn Jenkins References 1. D. Krieger, The T herapeu tic Touch, 1979, Prentice-Hall, Englewood Cliffs, N.J., page 13. 2. D. Krieger, "Therapeutic Touch: The Imprimatur of Nursing," Am erican Journal of Nursing, May 1975, pp. 784-87. 3. D. K rieger, "Searching for E vidence of P hysiological Change," Am erican Journal of Nursing, April 1979, pp. 660-62; The Therapeutic Touch, Appen dix II, pp. 153-63. 4. D. K rieger, " A ltern ativ e Medicine: Therapeutic Touch," N ursing Times, April 15, 1976, pp. 572-74; The Therapeutic Touch, p. 11. 5. C. Sogan, "Astral Projection and the House That Could Count," Playboy, July 1978, pp. 82-86, 226 -32. 6. P. McCarty, "Energy: Tapping the Body's Natural Resources," The Am erican Nurse, June 20, 1979, pp. 8 and 23. 7. J.F. Quinn, "One Nurse's Evalua tion As a Healer," A m erican Jour nal of Nursing, April 1979, pp. 662-64. 35 H72umFiafnthSAciveenncuees Press New York, N.Y. 10011