BOOKS

...Absent the sort of attitude change for which False Hopes calls--one that will allow us to change our expectations and name our priorities--it is a distinct possibility...

...Callahan draws the concept of a sustainable medicine from the environmental movement...

...Although he spends considerable time differentiating between rights-based health systems such as that of the United States and solidarity-based health systems such as those found in Europe, Callahan concludes that all are in equal trouble...

...On its face, this seems hard to square with the notion of inviolability...

...Far better, the poem suggests, to stick with a tight container, a form that acts as a windbreak and preserves home and family, averting "the worst cold...

...Callahan begins with a fundamental observation: all systems of health-care delivery and financing are under duress...

...Similarly, many technological advances in diagnosis and treatment are driven not by patient care but by investor-owned companies...

...Certainly there are elements of non-Western and alternative medicine traditions which are sympathetic to a more limited medicine...

...Yet there is never anything pat about the thinking or phrasing even in the most rigorously formal of the verses...

...In The Idea of Human Rights, Perry's aim is even more ambitious: Instead of arguing simply that religious beliefs merit serious attention from theorists, his claim here is that the very idea of human rights--the idea, as he puts it, "that certain things ought not to be done to any human being and certain other things ought to be done for every human being'--simply makes no sense outside a religious framework...

...Laputa syndrome has struck when the individuals who populate the world of political philosophy have become so denuded that they forfeit any genuine connection to the real people whose conflicts the theorists aim to resolve...

...Since then the national government and the provinces have continued to tweak the program, but its five underlying principles of portability, comprehensiveness, access, universality, and public administration have remained untouched...

...In forestalling the objection that he has simply begged the question, Perry says quickly that one could just as well replace the idea of being sacred with being inviolable, or having inherent worth...

...Christopher F. Koller is the chief executive officer of Neighborhood Health Plan of Rhode Island, an HMO focusing on publicly insured populations, in Providence...

...In the end, this type of medicine must be one which is comfortable in saying--in its research and its patient care~"enough already...

...This malady threatens all political theorists who, in striving to articulate principles rationally persuasive to all, proceed from an idea of the person that intentionally abstracts from any particularities that might block agreement to those principles...

...This chapter, where he applies the concept of equity to themes previously discussed, is an elegant overview of his work and should be required reading for any would-be reformer...

...For Hugh and Pat Armstrong, both of Carleton University in Ottawa, who co-authored Universal Health Care, the answer is crystal clear: Head North...

...While False Hopes is an important extension of Callahan's previous work, it has some conceptual weaknesses...

...Suzanne Keen teaches English literature at Washington and Lee University in Lexington, Virginia...

...The Armstrongs do their best responsibly to debunk the traditional criticisms of the system--long queues, government bureaucracy, heavy taxes, and dissatisfied providers...

...Universal hospital insurance was established in Canada in 1957 and physician insurance came nine years later...

...Michael Perry, who holds a distinguished chair in law at Wake Forest, has long waged a persuasive campaign against Laputa syndrome...

...In the end, Canadians can boast of lower per capita costs than the United States, higher satisfaction ratings, equal or superior public-health outcomes, and, of course, universal coverage...

...False Hopes builds on his past work and extends his reach across all national systems of health-care delivery and financing to consider what attitudinal changes are necessary for modern medicine to survive...

...I am after a change in the hopes and ideals of medicine," he proclaims, "not simply in the way we organize and deploy the provision of care to sick people...

...Callahan's proposal is suitably grand--a new concept of a "sustainable medicine" for a new era...

...With anti-Romantic sentiment, this poem casually props no wind harp (Aeolian lyre) to await inspiration and let in the destructive wet...

...This brief collection of essays summarizes the implementation of universal health insurance in Canada and then catalogues the Canadian system's virtues...

...As a tract, Universal Health Care has the cheerleader tones and one-sided naCre one would expect...

...If the Viagras and new Alzheimer drugs don't bankrupt it, invasive surgeries on eightyfive-year-olds will...

...Callahan is at his strongest toward the end of False Hopes when he considers these equity issues...

...This bias toward the conservationist stance is reflected, he maintains, in the historical hegemony in Western medicine of aesculapius-the belief that only medical intervention can cure a body's ills---over hygeia--the notion that a well-tended body can cure itself...

...What makes a poem in so tight and elaborate a form transcend the sense of exercise...

...Meanwhile, almost 15 percent--over 40 million people---of the U.S...

...Here he maintains that, given the technological, market, and ethos-of-progress imperatives dominant in contemporary medicine, an equitable health system is only possible if informed by a notion of a sustainable medicine...

...That to which political philosophers are especially susceptible we might call Laputa syndrome, after Swift's description in Gulliver's Travels of a floating island whose residents are so absorbed by abstract speculations that they barely acknowledge the world around them...

...Hygeia does not deny the pain nature inflicts upon us, nor our need to conquer or mitigate that suffering...

...For Perry will later assert that the idea of human rights does not impose any absolute constraints on what one may do to others, and that such rights may always in theory be outweighed by other concerns...

...There may be other rules I have not discerned...

...Perry argues, in the first chapter, that the idea of human rights amounts to a claim that all human beings are sacred and that no nonreligious account can adequately account for the sacred...

...False Hopes is Daniel Callahan's canary-in-a-coal mine message about the plight of Western health-care systems...

...Absent regulatory restraints, the profit motive continues to fuel a ravenous pharmaceutical industry, which takes wants, turns them into needs, and then enshrines them as health-care rights...

...Medicine, he maintains, has much to learn from this more modest, less instrumental view of how humanity interacts with nature...

...The bulk of False Hopes is a series of independent but connected essays in which the concept of a "sustainable medicine" is applied to themes important to medical philosophy...

...Like Elizabeth Bishop, another poet who conjured up the elemental from the homeliest of subjects, Marie Ponsot uses demanding forms without making the reader feel the strain of artfulness...

...LEANING ON RELIGION David McCabe ll occupations have their hazards...

...More generally, in a market-driven culture individual want trumps collective need, and all bow to the altar of autonomy and choice, growth and expansion...

...The themes of medicine's current era--domination of nature, unlimited capacity for improvement and social expansionism-ensure its demise...

...Perhaps also the intimation that a lapse in the performance, like the imagined crack in the pane, would "buckle every saving frame," adds to the urgency of the wordsmith's work...

...The possibility--and in some cases the reality----of managed-care companies inserting themselves clumsily into treatment decisions between patients and providers has created ground for outrage...

...Politicians have seized upon managed care as a political horse to whip in the coming elections, and the pharmaceutical industry continues to prepare a boutique of designer drugs to accommodate the inexorable aging of a selfobsessed generation of baby-boomers...

...Will we all be done in by a plethora of Viagras and gene therapies, the burdens of an aging society, and our own furious needs...

...One also wonders if Callahan paints with too broad a brush and fails to acknowledge differing cultural attitudes that might make a sustainable medicine more likely...

...PubCommonweal 2 5 September 25, 1998 lic health priorities lose out to individual medical treatment and research...

...A sustainable medicine, he maintains, is "a medicine that, in both research and health-care delivery, aims for a steady-state plateau, at a level that is economically affordable and equitably available, and also at a level that is no less psychologically sustainable, satisfying most--but, of necessity, not all--reasonable health needs and expectations...

...For example, when he looks at how a notion of sustainability would influence the concept of progress, which occasionally supplants the patient's own well-being as a goal of contemporary medicine, he comes to a not surprising conclusion: "sustainable medicine requires the acceptance of an idea of progress that sets finite goals, that is willing to accept adequacy rather than perfection...

...Living room" The window's old & paint-stuck in its frame...

...It averts the worst cold...

...Callahan spends much time assessing humanity's attitudes toward nature...

...Anecdotes of needed care denied or delayed as a result of managed-care companies have driven public perception and public policy...

...health system is its inability to guarantee universal access...

...This structure is characteristic of much of Callahan's writing in the book--to work from principles and fundamental experiences, to think analogically and syncretically, and to hew a middle path when the going gets tough, explicitly acknowledging the limits of individual and community resources...

...Nor does "having Commonweal 2 6 September25, 1998...

...The fundamental scandal of the U.S...

...As an awareness of the earth's ecosystems has reshaped our view of economic growth toward the idea of sustainable development, so might a reacknowledgment of human limits change our expectations of medicine...

...If we force it open the glass may break...

...I think, though, the issue is more complex than he allows...

...While this is familiar ground for Callahan readers, he attempts to use the sustainable medicine concept to integrate and further his previous work...

...Having looked serious health-care reform in the eye four years ago and blinked, the United States is now receiving exactly what it asked for: healthsystem changes driven by the private sector...

...Framed, it's a wind-break...

...Delivery systems consist largely of private providers, and financing and administration is a combination of federal and provincial responsibility...

...Still, there is a balance to be achieved...

...His thesis: modern medicine has aspirations and practices which guarantee stress and collapse...

...They also admit a few faults: cost inflation, and lack of drug coverage primarily...

...Sustainable medicine, Callahan writes, must live within boundaries of nature, recognize human need to struggle against aspects of nature that cause suffering and premature death, and manage that struggle in some affordable way...

...Mainstream environmental thinking has slowly moved from a conservationist view, seeing nature as something to be managed and exploited for our use and enjoyment, to more of a preservationist stance, which views humanity as part of an ecosystem, rather than sitting at the controls...

...Depending on one's definition, over 80 percent of the population (or double the number five years earlier) now receive their care through some form of "managed-care system'--where choice of doctors and access to services are limited in exchange for reduced rates and a supposedly predictable budget...

...The resolute plainness of the language helps to justify the densely packed repetitions...

...Demands exceed resources in every case, Commonweal 2 4 September 25, 1998 not just in the United States...

...The self-professedly broad arc of Callahan's aspirations make for a good balance against the puffery that passes for reform these days in Washington...

...Callahan is also gentle in his treatment of the market economy, which exacerbates or even causes many of the woes he cites...

...Broken windows cut, and let in the cold to sharpen house-warm air with outside cold that aches to buckle every saving frame & let the wind drive ice in through the break till chair cupboard walls stormhit all goods break...

...These changes--in all their ragged, inequitable, and profit-driven trappings--have left many citizens uneasy...

...In a series of books over the last ten years, Callahan has poked at the foundation of Western medicine like a moral engineer, documenting its fragility as he examined attitudes toward death, our inability to set funding priorities, and our addiction to the notion of endless medical progress...

...Often lost in the debate are the facts that managed care has reduced health-care cost increases and can improve health indicators, that wide and unexplained variations in clinical practice do exist, and that no alternatives to private financing and delivery of health care are being considered in the United States...

...It does, however, also leave one wondering what interim steps can be taken toward his promised land...

...population have no insurance of any kind, and convenience stores brim with home-made posters announcing fundraisers for various victims of various maladies...

...The environmental analogy at the basis of the notion of sustainable medicine is informative but fundamentally limited by the very personal nature of health care...

...The family picture, wrecked, soaked in cold, would slip wet & dangling out of its frame...

...However, its underlying story--that broad-reaching activist public policy for the public good can be achieved--bears repeating...

...He is particularly concerned with political philosophers who undervalue the claims of religion, a failing all the more vexing given that these theorists often rely on moral presuppositions which are, for many men and women, inseparable from their religious beliefs...

...A tritina goes the troubadours one better, evidently requiring the recycling, in decasyllabic lines, of three end words in one-two-three, three-one-two, two-three-one order, with a concluding line that employs each end word in one-two-three order...

...In fact, the traditions of communal solidarity which made global health budgets and universal access realizable in those countries would appear to make them more amenable to the concepts of limits and sustainability that Callahan promotes...

...BETTER SOLUTIONS NEEDED Christopher F. Koller n just the time since this reI view was commissioned, Viagra has assaulted the nation, and the media have heralded a new generation of cancer drugs--smart bombs which only target cancer cells, based on genetic research...

...Limits and interconnectedness are much easier to accept when recycling than when rationing treatment decisions for myself and my family...

...Ponsot risks losing some readers when she returns again and again to elaborate Provenqal verse forms, sestinas and villanelles, and she ups the ante when she adds (arcanely) two "tritinas," one of which I quote below...