For two decades, Dr. Danielle Ofri has cared for patients at Bellevue, the oldest public hospital in the country and a crossroads for the world's cultures. In Medicine in Translation , she introduces us, in vivid, moving portraits, to the patients she has known. They have braved language barriers, religious and racial divides, and the emotional and practical difficulties of exile in order to access quality health care. Sharing their journeys with them over the years, Danielle has witnessed some of their best and worst moments, and come to admire their resilience and courageous spirit. Danielle introduces us to her patients: Samuel Nwanko, who was brutally attacked by a Nigerian cult in his homeland and is attempting to create a new life in America; Jade Collier, an Aussie who refuses to let a small thing like a wheelchair keep her from being a homegrown ambassador to New York City; Julia Barquero, a Guatemalan woman who migrated to the States to save her disabled son but cannot obtain the lifesaving heart transplant she needs because she is undocumented. We meet a young Muslim woman threatened at knifepoint for wearing her veil, and the spitfire Señora Estrella, one of Danielle's many Spanish-speaking patients, whose torrent of words helps seal Danielle's resolve to improve her own Spanish, an essential skill in today's urban hospitals. And so she, her husband, and their two young children and seventy-five-pound dog relocate to Costa Rica, where they discover potholes the size of their New York City apartment, a casual absence of street signs or even street names, tangy green-skinned limon dulce dangling in the playground, and sudden rains surging over the craggy edges of roadside ditches. Ultimately, Danielle experiences being a patient in a foreign country when she gives birth to their third child, a "Costarricense" girl. With controversy over immigrants in our society escalating, and debate surrounding health-care reform becoming increasingly urgent, Ofri's riveting stories about her patients could not be more timely. Living and dying in the foreign country we call home, they have much to teach us about the American way, in sickness and in health.

"The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for physician, and genesis, meaning origin. Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness take up increasing space in medical dope-sheets ... The public has been alerted to the perplexity and uncertainty of the best among its hygienic caretakers ... This book argues that panic is out of place. Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal."--Introduction.

Reform of the welfare sector is an important yet difficult challenge for all countries in transition from socialist central planning to market-oriented democracies. Here a scholar of the economics of socialism and post-socialist transition and a health economist take on this challenge. This 2001 book offers health sector reform recommendations for ten countries of Eastern Europe, drawn consistently from a set of explicit guiding principles. After discussing sector-specific characteristics, lessons of international experience, and the main set of initial conditions, the authors advocate reforms based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition. Policymakers need to achieve a balance, both assuring social solidarity through universal access to basic health services and expanding individual choice and responsibility through voluntary supplemental insurance. The authors also consider the problems that undermine effectiveness of market-based competition in the health sector.

In recent decades, American medicine has become increasingly politicized and politics has become increasingly medicalized. Behaviors previously seen as virtuous or wicked, wise or unwise are now dealt with as healthy or sick--unwanted behaviors to be controlled as if they were health issues. The modern penchant for transforming human problems into diseases and judicial sanctions into treatments, replacing the rule of law with the rule of medical discretion, leads to the creation of a type of government social critic Thomas Szasz calls pharmacracy. Medicalizing troublesome behaviors and social problems is tempting to voters and politicians alike: it panders to the people by promising to satisfy their needs for dependence on medical authority and offers easy self-aggrandizement to politicians as the dispensers of more and better health care. Thus, the people gain a convenient scapegoat, enabling them to avoid personal responsibility for their behavior. The government gains a rationale for endless and politically expedient wars against social problems defined as public health emergencies. The health care system gains prestige, funding, and bureaucratic power that only an alliance with the political system can provide. However, Szasz warns, the creeping substitution of pharmacracy for democracy--private medical concerns increasingly perceived as requiring a political response--inexorably erodes personal freedom and dignity. Pharmacracy: Medicine and Politics in America is a clear and convincing presentation of this hidden danger, all too often ignored in our health care debates and avoided in our political contests.