The social transformation of american medicine.

The Social Transformation of American Medicine is one of the most comprehensive studies on the rise of the medical profession and the development of the health care industry published to date, Starr is able to span the fields of medicine so that he discusses intelligently the economic, political, and historical developments in medical care. His wri ting is clear and succinct, his arguments are copiously footnoted, and the inferences he draws are sound. In Book I, he covers "the rise of medical authority and the shaping of the medical system"; in Book II, "doctors, the State, and the coming of the corporation." Reviews by Daniel Bell of Harvard and George Silver of Yale call Starr's work brilliant-I would agree. I would recommend this book to anyone who wants to understand the current health care system. Starr describes the movement of the medical profession from one that was initially viewed skeptically to one that was later embraced; and now, coming full circle, to one that is viewed critically. Starr maintains that the current status of American medicine is the result of our history of accommodating professional interests while failing to exercise control over health programs, and then needing to adopt piecemeal regulations and cut-backs on programs that become too inflationary, One of the primary messages I take from this book is the importance of a com bination of forces: a profession's authority, the political climate, and the current philosophy about health care. Starr illustrates how these forces coalesce to defeat or achieve medical improvements. As occupational therapists, we are dependent on the development of the health care industry. It is wise for us to understand the forces that have an impact on medical care and what they could mean for our profession, Kay Barbara Schwartz, M.S., OTR