A Seat at the Table

Organized medicine and psychiatry have a long tradition of governmental advocacy and public engagement. The American Academy of Psychiatry and the Law (AAPL), since its founding 50 years ago, has made some forays into these fields. However, its involvement has been less substantial than other similarly situated professional organizations. With its increasing membership and expertise, AAPL now possesses the capacity to dedicate some of its organizational attention, energy, and resources to educating policymakers and the public on current and future topics related to forensic mental health. In addition, an increasing number and type of professional activities related to this discipline are affected by governmental regulation and public opinion. Therefore, the need to become involved in shaping policy is more urgent, particularly in light of the fact that other forensic mental health organizations have been actively involved in governmental advocacy for decades. Finally, as a field and in the near future, we likely will deal with life-changing technological innovations related to the practice of forensic psychiatry. AAPL and its members are perhaps uniquely qualified and have a responsibility to help ensure that these innovations are developed, implemented, and utilized appropriately. This can only be accomplished by having a proverbial seat at the table in the process.

Concussions and Contracts: The National Football League's Limitations to Protecting Its Players from Chronic Traumatic Encephalopathy

Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative brain injury that has become prevalent among high-contact professional sports, especially American football. More and more retired players are exhibiting symptoms of CTE and being diagnosed with CTE post-mortem. While the neuroscience community constantly releases studies showing a causal connection between brain trauma and CTE, the National Football League (NFL) continues to deny that any brain injury can arise from playing football. The NFL must implement provisions in their contracts to fully inform and protect players from this lethal brain injury. This article examines the repercussions of CTE, how players' contracts do and do not provide protections, and the possible provisions the NFL can implement in its contracts to adequately protect players of repeated brain trauma.

Ensuring accountability through health professional regulatory bodies: the case of conflict of interest

How do self-regulated health professions' regulatory bodies address financial conflict of interest (coi) and ensure accountability to the public? using document analysis, we examined how four ontario regulatory colleges (physicians, nurses, physiotherapists, audiologists/speech-language pathologists) defined coi and the education, guidance and enforcement they provided for coi-related issues. These colleges are upholding the mandates to define, identify and address financial coi by providing regulations or standards and guidelines to their membership; they differed in the amount of educational materials provided to their registrants and in the possible coi scenarios they presented. Although there were few disciplinary hearings pertaining to financial coi, findings for the hearings that did occur were documented and posted on the college public registers (the listing of all registered college members along with all relevant practice information), informing the public of any limitations or restrictions placed on a member as a result of the hearing.

Going for the cure: patient interest groups and health advocacy in the United States

Citizen groups, though celebrated during their sudden arrival on the lobbying scene, are vastly outnumbered by groups representing elite, occupationally based interests. Sensitive to the odds that nonoccupational groups face, this study asks what factors have allowed patient groups to form and become active in federal politics. Using three distinct data sets--a survey of patient groups, content analysis of group websites, and in-depth interviews with group representatives and policy makers in Washington, DC--this study assesses the activities of patient groups in the United States and argues that patient advocacy organizations garner stability from the relatively easy provision of selective and solidary benefits. Larger patient groups are especially likely to make use of these structural advantages to pursue congressional lobbying strategies. However, even these groups seek out noncompetitive, distributive political environments. Moreover, the study finds that patient groups rarely form coalitions across diseases, forgoing the potential to collectively speak for shared patient interests.

Experience in implementing ICRP recommendations: IRPA's perspective on the role of the radiation protection professional

The International Radiation Protection Association (IRPA) has a membership of approximately 17,000 individuals who are members of 48 national societies in 60 countries worldwide. As such, IRPA's vision is to be recognised as the international voice of the radiation protection professional. This article will discuss elements of the outcome of the 12th International Congress of IRPA ('Focus on the future'), objectives and current activities of IRPA, criteria and priorities for the engagement of IRPA with international organisations, current IRPA initiatives in the areas of radiation protection culture and certification/qualification of radiation protection experts, planning for the 13th International Congress of IRPA, comments on the implementation of recent recommendations of the International Commission on Radiological Protection (ICRP), and suggestions about IRPA and ICRP collaboration in their implementation. IRPA recognises that ICRP is the international body to determine policy and to make recommendations for protection against ionising radiation, and IRPA is in a position to participate in and facilitate the implementation of those recommendations.

Creating cohesion from diversity: the challenge of collective identity formation in the global justice movement

Collective identity formation is important because it plays a crucial role in sustaining movements over time. Studying collective identity formation in autonomous groups in the Global Justice Movement poses a challenge because they encompass a multiplicity of identities, ideologies, issues, frames, collective action repertoires, and organizational forms. This article analyzes the process of collective identity formation in three anti-capitalist globalization groups in Madrid, Spain, based on 3 years of ethnographic fieldwork. The author argues that for new groups practicing participatory democracy the regular face-to-face assemblies are the crucial arena in which collective identity can form and must be both effective and participatory in order to foster a sense of commitment and belonging. The article raises the possibility that scholars should consider what seems to be an oxymoron: the possible benefits of "failure" for social movements.

A total extinction confidently hoped for: the destruction of Cape San society under Dutch colonial rule, 1700-1795

San (Bushman) society in the Cape Colony was almost completely annihilated during the eighteenth and nineteenth centuries as a result of land confiscation, massacre, forced labour and cultural suppression that accompanied colonial rule. Whereas similar obliterations of indigenous peoples in other parts of the world have resulted in major public controversies and heated debate amongst academics about the genocidal nature of these episodes, in South Africa the issue has effectively been ignored aside from passing, often polemical, references to it as genocide. Even recent studies that have approached the mass killing of the Cape San with sensitivity and insight do not address it as a case of genocide. This article sets out to redress this imbalance in part by analysing the dynamic of frontier conflict between San and settler under Dutch colonial rule as genocide. It demonstrates both the exterminatory intent underlying settler violence as well as the complicity of a weak colonial state in these depredations, including its sanctioning of the root-and-branch eradication of the San.

Association Health Plans: What’s All The Fuss About?

Policymakers have tried to address the problem of the uninsured and to help small businesses with rising premiums by encouraging associations to offer coverage. Although supporters and opponents have made claims about the potential impact of this strategy, the association market has not been studied in depth. Examining current standards might explain why proponents seek changes. This paper discusses states' approaches to regulating health insurance offered by associations, including "self-insurance," as well as existing state exemptions from state insurance laws that otherwise would apply to coverage sold to small businesses, self-employed people, and individual purchasers. We also examine market problems such as insolvency and fraud.

[Legal action instituted by an association to protect animals--a pleading]

Initiated by the development of the European Law inside Germany a debate has started to implement legal actions instituted by associations. In this connection Schleswig-Holstein drafted a legislative initiative for voting at the Federal Council. This initiative contains a brought legal action instituted by accepted associations, the participation of these associations in specific administrative proceedings, and a wide title to disclose. This legal suggestion includes a determination of the mandate given by the constitution (para. 20a GG) to protect animals.

[Legal framework of the medical profession and of the neurology speciality]

The law on the general organization of Health Care Professionals (GOHCP) and the Framework Statute make up a new regulatory framework for the practice of medicine, which is completed with the legal debate on the obligatory association to the medical college, pending in the Constitutional Court based on certain regional legal developments. The GOHCP defines the functions of the different professions according to degree, establishes a public registry of physicians, converts the obligation of practicing according to the state of the art into law and updates the training, introduces the Resident core training program and opens the door to superspecialities. It also regulates the professional career, in order to establish a common body of four grades to which the health services can add a fifth one with previous character. Among the novelties of the Framework Statute, there is extensive updating of the offences and sanctions -- that include aspects such as work harassment and adaptation of the workday to the European guidelines, so that the maximum workday is established in 48 hours per week and the complementary (having a voluntary character) cannot exceed 150 hours per year. Lowering retirement age to 65 years foreseen in this guideline will require planning of human resources and has already generated suits in the courts. The obligatory nature of belonging to the medical college has also been modified, this time by some guidelines on the regional level. They would require a decision by the Constitutional Court on whether the college members can be exempted in some cases.

A gower maneuver: the American Society for Bioethics and Humanities' resolution of the "Taking Stands" debate

The American Society for Bioethics and Humanities debated for several years about whether it should adopt positions and, if so, on what range of issues. The membership recently approved an amendment to its bylaws permitting the Society to adopt positions on matters related to academic freedom and professionalism but not on substantive moral and policy issues. This resolution is problematic for a number of reasons, including the lack of a categorical difference between these types of claims and the Society's inability to speak on behalf of patients and research subjects. The implementation of the amendment also raises several issues. The Society will need to refrain from speaking too specifically and to articulate the responsibilities of its members. If the Society fails to address these concerns, it runs the risk of denigrating its public image and that of the profession.

[Limited relevance of veterinary disciplinary regulations]

After several years of pressure on the part of the KNMvD to establish disciplinary regulations for veterinarians, these were at last incorporated in the Veterinary Practice Act of 1992. This article discusses the extent to which veterinary disciplinary regulations actually meet the expectations of legislators. On the basis of an investigation of the parliamentary passage of the Act, the flood of complaints before disciplinary judges, the nature and magnitude of jurisprudence of the veterinary disciplinary committee, and interviews with those involved, it would appear that results are disappointing. These disappointing results, in particular the one-sided emphasis on companion animals and the continuing misunderstanding about the prescription of veterinary medicines, lead to the conclusion that veterinary disciplinary regulations are currently of limited relevance. The authors consider that insufficient use is made of the potential of disciplinary measures to contribute to the monitoring of the quality of veterinary practice and give recommendations about this.

Coordination among health care stakeholders: effects on state health policy choices

This article proposes that coordination among health stakeholders is reflected in the structural relations within state health care lobbies and treats lobbies as a mechanism of social control over the industry. This article compares the effects of structural relations of lobbies and also professional associations and economic conditions upon a regulatory typology of health policy outcomes. Results of network analysis show that special interest structures exert social control, regulatory policy reflects choices between markets and regulation and vertical industry relations, and network analysis is useful for studying these complex ideas.

Antitrust enforcement encourages health care providers to cooperate procompetitively

A review of significant administrative and judicial rulings in antitrust law during 1993 shows that the antitrust laws should not impede innovative, cost-cutting cooperative arrangements among providers, so long as their actual or potential procompetitive benefits are not outweighed by their anticompetitive effects.

Wives and mothers like ourselves? Exploring white women's intervention in the politics of race, 1920s-1940s

This paper takes the issue of the removal of Aboriginal children, and the broader white anxiety over the 'half-caste problem' which underpinned the policy, to explore white women reformers' intervention in the politics of race in the years 1920-40. In these years middle-class women's citizenship was based on maternalism and the defence of motherhood. At the same time the national feminist lobby, the Australian Federation of Women Voters, joined the public debate about the 'Aboriginal problem'. In this context it is necessary to ask: What was the feminist view of Aboriginal women's status? Were they considered 'wives and mothers' like themselves, as Louisa Lawson suggested in the 1890s? What was their view of the 'half-caste problem' and the 'absorption proposal' formulated to solve it? By asking such questions I hope to modify the current feminist historiographical view of white women reformers as 'pro-Aboriginal' and 'radical' and their policies as challenging White Australia in these years.