Cost Effectiveness of Trust

In general practice, we work on the innocent assumption that we can reverse the trend by using trust, a broader view or long-term deeper relationships to make sense of symptoms and understand the meaning of what’s going on. This can save money and can enable us to talk to families, not just individuals. A beautiful essay by Howard Brody gives this more substance and presents the evidence that a primary care type of encounter, wherever in the health system you are, really can be cost effective as well as morally satisfactory.

Family practice: http://fampra.oxfordjournals.org/cgi/content/full/20/2/225




.......but the CPU is a human being: old, weak, vulnerable, pitifully limited, possibly senile. (p. 116)
This kind of fear is rooted …in a fundamentally misconceived vision of our own humanity; a vision that depicts us as “locked-in agents”—as beings whose minds and physical abilities are fixed quantities, apt (at best) for mere support and scaffolding by their best technologies. In contrast to this view, Clark (1997, 2003) argues that human minds and bodies are essentially open to episodes of deep and transformative restructuring, in which new equipment (both physical and “mental”) can become quite literally incorporated into the thinking and acting systems that we identify as minds and persons.

Re-Inventing Ourselves: The Plasticity of Embodiment, Sensing, and Mind Journal of Medicine and Philosophy, 32:263–282, 2007




........Whether or not the controversial idea of a ‘risk society’ is theoretically coherent or accurate as a historical generalization is much debated, but there has undoubtedly been an avalanche of discussion and literature on risk, hazard, and blame in recent times, and that phenomenon needs some explanation. As well as a ‘risk society’, we are also said to live in a ‘regulatory state’. The idea of the ‘regulatory state’ is that a new institutional and policy style has emerged, in which government's role as regulator advances while its role as a direct employer or property-owner may decline through privatization and bureaucratic downsizing. The two ideas of ‘risk society’ and ‘regulatory state’ could, indeed, be linked in so far as risk and safety is often held to be one of the major drivers of contemporary regulatory growth, for example in the development of EU regulation (see Royal Society 1992). In turn, development of risk regulation is interpreted by many to reflect broader political and cultural change. Building on a ‘grid-group’ analysis of culture that highlights a dynamic of conflict among four fundamentally different sets of beliefs and attitudes, risk is seen as a political weapon used by a society poised between the cultures of individualism and egalitarianism, to blame those who wield power in the state and big corporations for what happens to the rest of us. From this perspective the increased salience of risk and regulation reflects a cultural shift away from ‘hierarchist’ world-views over matters of trust and blame.

Christopher Hood (All Souls College, Oxford), 2003, The Government of Risk:Understanding Risk Regulation Regimes; OUP






Our DNA contains much evidence about our lives, including our vulnerability to specific diseases, and even aspects of personality…..Adamsmith.org/blog








The Office of Research Integrity in the USA investigated 127 serious allegations of scientific fraud last year. The reasons for conducting fraudulent research and misrepresenting research in scientific publications are complex. The pressures to publish and to achieve career progression and promotion and the lure of fame and money may all play a part, but deeper forces often seem to be at work. Fraud and misconduct in medical research; 3rd edition; Family Practice Vol. 20, No. 2, 225; Oxford Journals