RELATIONSHIP BETWEEN VALUE THEORY AND PRICE THEORY

1. Our problems awaiting solution

Around labour value theory, there are many problems and they have been  debated for a long time. We can arrange them as follows.=81@=81iFig.1=81j

On the assumption that structure of production is showed in Fig. 1, we  can describe our problems as follows.=81@(Fig.2)

First, there is a basic problem that (1), that is, relations of value  can exist or not. Adding that, how can be proved this relation? Second, there is a big problem,  what is called 'transformation problem'. How do we think about this? Third, the main  problem for us, is the relation between (1) and (2). In other words, what does it mean  'Value controls production price', and how does it be accomplished?

If we want to remain as Marxian economists, we have to make answers to  these three questions.

2. How can we demonstrate labour value theory?

When Marx wrote "Das Kapital"(1sted=81D1867, 2nd ed.=81D1873), the  popular value theory was, of course, labour value theory. What he did was how labour value theory  had to be in the preposition that labour theory is true.  But our situation is in very  different circumstances. Nowadays we have to demonstrate that labour value theory  is true.   Many disputants express their opinions about how to demonstrate the  truth of this theory. Some people say that it is necessary to change the definition of  value from Marx's so as to help from falling in false. Others say that Marx's value  theory is wrong or useless. My assertion is as follows.

(1) Labour value theory in chapter 1 of 'Das Kapital' is a hypothesis as  the start point of any other theories. This hypothesis can not be proved as truth within  the theory itself. What Marx did was which conditions labour value theory has to  fulfil to maintain consistency in itself and to be able to explain inner  relationships of capitalist society.

(2) What I think as hypothesis is the preposition of same quality or  homogeneity of labour. Real labour, of course, are different each other. But not only  Marx but also every economists based on labour value theory, agreed that labour is  homogeneous in some sense. As every commodity is estimated by money, and can be  distinguished from each other only by quantity, we must find some homogeneity. I think  only three answers can be, labour (as Marx, who analyzed commodity to value in use  and value in exchange), money (like realists about money and advocates of abstract  labour) and utility in general (like neo-classical theorists and Boehm-Bawerk).

(3) The reason why I choose labour and do not choose other two elements  is to distinguish many sorts of prices as I will analyze afterwards. And my  attitude that I assume labour is homogeneous in a sense means that labour value theory  can not be proved in Chapter 1 of 'Das Kapital'.

(4) How can we prove that labour value theory is true, then? Labour  value theory is, as is always regarded, necessary to prove (a) that value regulates price  level and (2) that the origin of profit of capitalists is surplus value. The second  point is easy to prove if labour value theory is true and the standard of wage is value  of labour power. The main problem is to prove the first point. We will come back  to this point later.

3. How to deal with 'transformation problem'?

Through the controversy on 'transformation problem', we got the  conclusion that the two preposition that total value equals to total production price and  total surplus value equals to total profit at the same time can not generally be maintained.  But Marx might also agree this conclusion. The main point is not there. Value system  can be calculated when coefficient of technique and coefficient of labour are decided. On  the other hand, we can say, about production price, that relative production price is  calculated when both the rates of real wage and profit are given adding above conditions  (we can give money wage rate instead). In another expression, there is one value that  we can decide freely within prices and profit rate (See Fig. 2).

This means there may be many production price levels corresponding with  different profit rates. If different profit rate can appear (we will argue about  the conditions of this point), we can get many different production price levels which do not  even fulfil the condition that total value equals to total production price.

This comes from two different calculations are achieved. What sort of  situation this is? It means production price as such is calculated to fulfil the equal  level of profit rate, and not to fulfil total production price equal to total value. And at the  same time, production price as such shows only necessary conditions to get equal profit rate,  but does not show sufficient conditions to get equal profit rate.

To solve this latter question, we need four levels of analysis from  value to market price. That is, (a) labour value, (b) production price, (c) market production  price, (d) market price.

We can only observe daily changing market price. Of course demand and  supply may be not equal. But we can suppose a balanced price, which means the  equivalence of demand and supply. This price is nearly equal to the equivalent price in  neo-classical theory. But this level of price can not be stable. Profit rate must be  equal through every industry. The price, which fulfils this condition, can be named market  production price. When market condition is under free competition, this price, market  production price, will be attained in many different levels.

But there is one market production price, which fulfils the condition  that total value equals to total market production price. I call this price as production  price to distinguish it from other market production prices. I think this  production price is the same as what Marx called production price, that is, true transformed  price from value.

Thus we can distinguish three different equilibrium, that is, (1)  equilibrium between supply and demand, which correspond with market price, (2) equilibrium  which achieves equal profit level through industries, which means market  production price, and (3) production price which realize value. But I do not say any words  until now about the conditions that realize different market production prices and how  these market production prices converge to production price. This point requires  further examination.

4. The role of moneyed capital to be lent.

Market price and market production price realizes through competition  among capitals. Demand and supply plays rolls in this matter. So we have to analyze this  point.

*M1: money as means of circulation, including means for payment; M2:  money as money, deposit to banks in practice; M3: advanced money from banks to  borrowers.

[Explanation of Fig. 3]

At the left hand of Fig. 3, flow of goods is shown. Oblique arrows show  the stream of goods from production to consumption, which is mediated by market, or  circulation. Money as means of circulation remains in market. Supply and demand meet  in the market, but the total amount of supply exceeds X (as for the existence  of intermediate trade). At the right hand of this figure, there shows complex trade of loan.  Through trade of goods, free money or unemployed capital springs from surplus value,  depreciation fund and reserve fund for fluctuation, which can be lent by banks. Banking  system can expand the sum of loan through its mechanism of credit creation. From  the viewpoint of banks, it is serious if they lend money or capital. They think they lend  money when money comes to banks through customers' deposit or clearance of payment.  They think they lend capital when money is drawn out from banks. In this case their  reserve fund fall off and banks have either to restrain from lending or to go the  Central Bank to borrow additional money. This means the limit of credit creation.

From the viewpoint of borrowers, if borrowed money is capital or money  is thought from different angles. When they can use borrowed money to expand their  business, that is, to expand reproduction, they think they borrowed capital. When they use  that money to clear old payment promise, they regard they borrowed just money, not  capital. This difference influences the scale of reproduction by borrowing (See  chapter 31 to 33 of 'Das Kapital', Book 3).

What we want to explain is how price level fluctuate from time to time  according with variation of expected profit rate and interest rate.

But I must tell before we go into detail that we abridge three points. First, we consider only two markets; commodity market and money  (capital) market, and omit labour market. So we suppose real wage rate is fixed (or money  wage rate is fixed). It is unreasonable to ignore wage variation to analyze business  fluctuation, I know, but it is only to simplify the analysis. Perhaps changes in wage  rate will delay compared with changes in price, and through the upswing stage of  business cycle, rising commodity prices can stand for relative change between wage and price  and rising profit rate.

Second, we consider only banking system, that is indirect finance, and  ignore security market. By this abridgement we are to ignore the important role of  security market to decide interest rate, which J. M. Keynes analyzed through speculative  motive to reserve money. Third, we do not think about technical innovation. This element is of  course very important and gives much influence to the level of expected profit rate  and the level of reproduction. But I think it is unnecessary to consider about it when we  concentrate our attention to the relation between value and price.

5. The role of moneyed capital to be lent (continued)=81\=81\why we deny  neo-classical theory

Warlas' law indicates that economic activity can arrive at general  equilibrium under complete competition. This theme premises both diminishing marginal  product and Say's law. We deny both of these premises. The first premise may be true  in a short run, in another word during existing fixed capital does not change. When we  think about profit equilibrium, we have to think of the long term during which fixed  capital can change. Then we will get a more flat cost curve. But we do not say  further about this point. What I want to put emphasis now is the mistake of Say's law. This law  means that function of money is limited to a tool for circulation. Of course  sometimes Marx himself premises Say's law.

For instance famous reproduction formula that Marx analyzed in book 2 of  ' Das Kapital', money works only as a tool for circulation (when he  exceptionally mentions about cash savings, he supposes cash savings are equal to real  investment).

But as we already suggested, money works sometimes as currency,  sometimes as money as money, and sometimes as moneyed capital.

Now we are going to analyze business cycle, we support the premise of  effective demand, established by Keynes (but we do not agree with his premise of fixed  price and adjustment by supply)=81D

5. Business cycle and change of prices, profit rate, interest rate

We can distinguish four stages of business cycle after Marx. They are  (1) dullness after crisis, (2) moderate briskness, (3) apex, and (4) crisis or general  overproduction. Adding this, we suppose the system is working under free competition and gold  standard.

At stage (1), profit rate is low, so business activity is dull. Although  moneyed capital for lends is plenty, as the result of dullness of business activity, seldom  wants to borrow money because of low profit rate. Investment is almost for renewal.  Economy is almost in the condition of simple reproduction. I think market production price  in this stage is nearly equal to production price At stage (2), new investment begins, and business activity begins  upward. In this stage moneyed capital is also plenty and interest rate is low, so many  enterprises begin to expand their business. Demand leads economy. Price begins to rise, the  level of profit rate going upward. But this stage is taken place of by stage (3). Business activity reaches  its top, and a new state begins in the backward. Enterprises feel short, so they begin to  borrow money as they can. This time money is not borrowed for expansion, but for  maintain cash flow. From this reason, interest rate swings upward.  Suddenly begins crisis.  Many dishonored bills appear, bankruptcy, unemployment increases. It becomes  open that too much value produced. Through such destruction of value, a new condition  for reproduction is constructed. Then repeats stage (1).

This is how value controls the fluctuation of price. Through  overproduction and destruction of too much produced value, economic equilibrium is  attained. Although this state is economic equilibrium, social strain increases. In capitalist  society, the last word of it is exploit and the social state of laborers getting worse compared  with capitalists.

6. Conclusion

I assisted that labour value theory is a hypothesis at the beginning of  economic analysis. If it is right, this theory can not be proved directly. How can it be  assured that it is true? I think the best hypothesis may goodly explain and analyze the facts. My  idea to explain the facts is separation of production price and market production price.  Here production price has the character same to value. In the other hand, market  production price is price that makes an economic equilibrium. But this equilibrium is  conditioned by the stage of business cycle. Through one business cycle the system of value  equilibrium occupies and regulates the system. And we also add that system works  fairly good, under the condition in 19th century system. In our century, the state of  affairs has changed because of monopoly, bigger roles of states, and the infest of  speculation. But another essay has to be prepared for this theme.

The Relationship between Design For Environment (DFE) and Design For Cost (DFC)

1. Introduction
With the development of concurrent engineering, a lot of
DFX tools have been appeared. For example, they include
design for assembly (DFA), design for manufacturing
(DFM), design for quality (DFQ) and so on.  Design for
environment (DFE)  or Design For Cost (DFC) is one of
the branches in DFX
 [1]
 Some papers have been published .
about DFC
 [2] [3] [4]
 And DFE have been included in a lot of .
papers
 [5] [6] [7] [8]
But the relationship between DFE  and .
DFC is absent.
In this paper, we provide some characters between DFE
and DFC. Then we point out how to use DFE in DFC  or
use DFC in DFE. By analysis of the relationship between
DFE and DFC, we can find the  method that integrated
them. Namely, LCC estimation methods can be used in
DFE; Life Cycle Assessment (LCA) can be used in DFC;
the other way is that design is evaluated using Design
Compatibility Analysis (DCA) fuzzy theory.
2. Design For Cost (DFC) and its Research Areas
Design For Cost (DFC) is a design method which
analyzed and evaluated the product’s life cycle cost
(include manufacturing cost, sale cost, use cost,
maintenance cost, recycle cost, etc.), then modified the
design to reduce the life cycle cost. Its characters can be
concluded as followed:
1) In tradition, designers attached importance to the
other parameters, but not cost. In product design process of
DFC, the LCC must be an equivalent parameter as
performance, schedule and reliability.
2) Product designers consider reducing product cost in
the whole life cycle.
3) DFC need confirming parameters of manufacturing,
usage, maintenance phases, for example, assembly cost
percent unit, usage cost percent unit. Designer should
balance performance, schedule, reliability, LCC and so on.
4) It makes sure that designers and their related
personnel communicate and feedback cost information in
time each other. So they can use some effective methods to
control product LCC.
The research areas in DFC proposed are the following:
1) Cost features are extracted using LCC analysis. Then
LCC database and LCC estimation methods base were
established.
2) In order to provide design information in cost
estimation, we must analyze design stages and models and
then extract some design features that are related with
LCC in different design models.
3) The research and development of software tools in
DFC: DFC is a design method to face designers. To
improve design efficiency and design quality, it is
important to use DFC software tools in product design
process.
4) According to market states, the balance between
design and LCC must be found. Under increasingly furious
market competition, the lowest product cost did not
enough defeat other competitors. Product must be the best
performance/price, namely provide the best functions in
the suitable price that can be accepted by users. Because
the price mostly depends on product cost and designers
decide product functions, it is essential to balance between
design and cost.
5) DFC must be integrated with the other DFX tools:
Because DFC is faced the whole life cycle, it requests that
DFC must harmonize the other DFX (DFM, DFA, etc. )
tools to work. Therefore, we should establish an evaluation
criterion to do it.
In addition, the other key technologies included how to
confirm target cost, how to select the methods of
manufacturing according to the project investment, etc.
Especially we point out that DFC is different from Design
to Cost (DTC). DFC is the conscious use of engineering
process technology to reduce LCC while DTC obtains a
design satisfying the functional requirements for a given
cost target
 [9]
 Further detailed distinction between the two) .
approaches can be found in the reference)
3. Design For Environment (DFE) and its Benefits
Design For Environment (DFE), also known as eco-design,
recognizes that environmental impacts must be considered
during the new product design process, along with all of
the usual design criteria. It is defined as systemic
consideration of design performance with respect to
environmental, health, and safety objectives over the full
product life cycle. There are three unique characteristics of
DFE
 [10]
:
(1) The entire life cycle of a product is considered.
(2) Point of application is early in the product realization
process.
(3) Decisions are made using a set of values consistent
with industrial ecology, integrative systems thinking
or another framework.
(ISTP indexed this article)World Engineers' Convention 2004,November 2-6, 2004 Shanghai, China, Vol G, 293-296
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DFE considers the potential environmental impacts of a
product throughout its life cycle. A product's potential
environmental impacts range from the release of toxic
chemicals into the environment to consumption of
nonrenewable resources and excessive energy use. Life
stages of a product include the time from the extraction of
resources needed to make the product to its disposal.
In effect, designers design a product life cycle, not just the
product. An awareness of a product's life cycle will help
the company avoid environmental surprises and liabilities.
Ideally, the design team will seek to reduce these
environmental impacts to the lowest level possible.
DFE benefits:
DFE offers businesses opportunity to improve
environmental performance, while simultaneously
improving their profits. Companies that implement DFE
find that it:
l Reduces environmental impact of products/processes.
l Optimizes raw material consumption and energy use.
l Improves waste management/pollution prevention
systems.
l Encourages good design and drives innovation.
l Reduces costs.
l Meets user needs/wants by exceeding current
expectations for price, performance and quality.
l Increases product marketability.
DFE can also provide a means for establishing a long-term
strategic vision of a company's future products and
operations. In general, DFE is an enabling force to shape
more sustainable patterns of production and consumption.
4.The Relationship between DFE and DFC
The relationship between DFE and DFC  is given in Fig 1.
Both of them belong to DFX field together. There are
some sameness and differences.
DFX
DFE
DFC
Fig1 Relationship between DFC and DFE
LCC  and
Greenness
The differences:DFC is a design methodology that uses all
kind of ways to cut down production's LCC; DFE
facilitates systematic evaluation of a product and
continuous improvement goals for the entire product life
cycle. LCC  is  one of the design factors in DFE, it  also
includes reducing  environmental impact, energy supply,
raw materials and so on. Namely DFC evaluates a design
from LCC, but DFE evaluates a design from greenness.
DFC use LCC analysis methods, but DFE use life cycle
assessment (LCA) methodology.
The sameness: both of them consider the  production life
cycle cost in design.  And they evaluate a design from life
cycle. In DFC greenness is also considered.
4.1 The Application of LCC in DFE
The life cycle cost of a product is made of the cost to
the manufacturer, user, and society
 [11]
 The total cost of .
any product from its earliest concept through its retirement
will eventually be borne by the user and will have a direct
bearing on the marketability of that product.
The LCC concept was initially  applied by the US
Department of Defense (DoD). Its importance in defense
was stimulated by findings that operation and support costs
for typical weapon systems accounted for as much as 75%
of the total cost
 [12]
 However, most of the methodologies .
developed by the DoD were not intended for use for design
but for procurement purposes.
While the life cycle cost is the aggregate of all the
costs incurred in the product’s life, it must be point out that
there are differences between the cost issue that will be of
interest to the person designing the product and the firm
developing the product in a life cycle cost analysis. While
the firm must know the total cost of the product, the
designer is only interested in the costs that he/she can
control. Some of the costs incurred in the life of the
product are not as a result of the design. These costs are
related to the way we do things. Life cycle cost can thus be
classified into management related costs and design related
costs. It is latter component that the designer is interested
in. In this paper, we mainly discussed it in DFC. One cost
category that may not be of interest to the designer is the
research and development cost. This cost is not related to
the actual design of the product but rather to the kind of
product we are developing, the resources we commit to the
process and the manner in which we use these resources to
arrive at a design solution.
TABLE I  MAINLY COST ESTIMATION MTHODS [15]
Properties
Cost estimation
methods Uncertainty
Phase of
design process
Precision
Parametric Cost Method Low Early Middle
Analogy Cost Method High Late Middle
ANN Cost Method Middle Early High
ABC Method High Late High
Engineering Cost Method Low Late High
We must estimate LCC in DFE because customers can’t
purchase a product that is greenness but that they can’t
afford. There are a lot of cost estimation methods in DFC.
We can use them to estimate LCC in DFE. Table  I shows
five familiar methods. In our opinion, the different
estimation methods are selected at the different design World Engineers' Convention 2004,November 2-6, 2004 Shanghai, China, Vol G, 293-296
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stages. Generally, ANN cost method can be used at the
conceptual design stage; ANN and parameter cost method
can be selected at the earlier overall (general) design stage;
Then parameter cost method can be used at the general
design stage; Finally, engineering cost method can be
selected at the detail design stage. For more detail see
Chen Ke-zhang, Feng Xin-an and Chen Xiao-chuan[13] in
English or Chen Xiao-Chuan, Liu Xiao-Bing and Feng
Xin-An [14] in Chinese.
4.2 The Application of LCA in DFC
LCA is a technique for assessing the environmental
impacts associated with a product or service
[16]
 It was .
developed as an environmental policy support measure in
the past decade. LCA’s goal is to compare the
environmental impacts of different products and services
that satisfy comparable needs. To do so, all stages of the
life cycles of goods and services have to be considered, i.e.
resource extraction, production, utilization, and disposal.
So we can use LCA in DFC in order to improve
production’s  greenness. For example,  from  life cycle
phases, the factors that can be considered as followed:
l Manufacturing: In this phase, we consider materials ,
process  and product packing from greenness. We
select a design that must reduce the  influence  of
environment. For example, we select  recycling
material
l Transportation: In transportation phase, conveyance
and handling tool can be selected from environmental
protection  point.  And optimization sale channel is
needed. That can  decrease  transportation  cost and
energy supply.
l Store: Mechanical manufacturing production will not
influence the environment normally in store.
l Maintenance: In maintenance, we need notice
whether produce the trash and waste gas etc. that
pollute environment.
l Product  use: In  this phase, the production  does not
produce waste gas and trash that pollute environment.
l Disposal: In this phase, material recycle and function
reuse are the key technologies.
In DFX, we can use Design Compatibility Analysis (DCA)
in order to evaluate a  design
 [17]
 DCA method does not .
only include LCC but also include greenness. And it
includes manufacturing, assembly, disassembly,
serviceability and so on. How use DCA does not repeat
again in this paper. For more details please  see  the
reference [18].
5.Conclusions
DFE is the most effective method of improving product
environmental propert ies. From theories and  facts, DFE’s
development is very quickly. In order to realize DFE’s
goals, there are not a unified technology and method. But
the substances of DFE already reach extensive common
recognitions. Now there are a lot of  applications in the
world.
In this paper, the relationship between DFE and DFC is
given. Then the methods of using LCC  in DFE  and using
LCA in DFC are proposed. Namely, LCC estimation
methods can be used in DFE;  Life Cycle  Assessment
(LCA) can be used in DFC; the other way is that design is
evaluated using Design Compatibility Analysis (DCA) in
DFX.
Acknowledgement
The author gratefully acknowledges the support of
Donghua University fund and National Natural Science
Foundation of China.
References
1. Liu Jihong, DFX: design for product life cycle, CAD &
CAM, 9(1998), 34-36. ( in Chinese)
2. E. R. Dean and R. Unal, Designing for Cost, Trans. of
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Annual Meeting, June 23-26, Seattle WA, 1991, pp.
D.4.1-D.4.6.
3. Chen Xiaochuan, Fang Minglun, Feng Xinan.
Application of multiple domain feature mapping in
Design For Cost(DFC), Concurrent Engineering  2002,
Cranfield University, U.K. July, 27-31, 2002, pp. 12-16.
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an. Methodology and technology of design for cost
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14-18, 2004, pp. 3129-3134.
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45(1)(1996), 109-114.
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Scheller, Herbert; Hoffman, William,  Green Design
Advisor': A tool for design for environment, Journal of
Electronics Manufacturing, 9(1)(2000),17-28.
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Inaba, Atsushi,  Quality Function Deployment for
Environment(QFDE) to support design for environment
(DFE),  7th Design for Manufacturing Conference,
Montreal, Que., Canada, September 29-October  2,
(3)2002,. pp 415-423.
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Proceedings of AIAA 1992 Aerospace Design
Conference, February, 1992, Irvine,CA.
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opportunity for manufacturing enterprises”, Concurrent
Engineering: Automation, Tools, and Techniques. A.
Kusiak Eds. NewYork: Wiley.1993,pp.1-17.
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uncertainties”, Electronics Systems Effectiveness andLife Cycle  Costing, NATO ASI Series ,Vol. F. J. K.
Skwirzynski(ed.),1983, pp.535-549.
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framework of design for life -cycle cost”, Proceedings
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an. Methodology and technology of design for cost
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Hangzhou, China
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DFC(Design for Cost) and the other DFX, Machine
Design and Research, 20(3) (2004),18-23. ( in Chinese)

Relationship between manufacturing and design departments: an empirical validation of a theoretical framework

ABSTRACT

Dean and Susman (1989) give four arrangements (design having a veto, manufacturing having a veto, use of integrators to co-ordinate activities of design and manufacturing, use of matrix structure) that define relationship of design and manufacturing functions. In this paper we relate these to the strategy of the firm (Miles and Snow et. al, 1978). This relationship is given in the form of hypotheses. We argue that in 'defenders' manufacturing will have the 'veto' over design; in 'prospectors' design will have the 'veto' over manufacturing; where as 'analyzers' will use 'integrators' to co-ordinate activities of design and manufacturing. This framework was supported by a sample data of twenty firms having design and manufacturing departments.

Keywords: relationship of design and manufacturing functions, veto with design, veto with manufacturing, integrators for design and manufacturing functions

1. INTRODUCTION

Different business strategies require different organizational configurations to be successful. There needs to be a good fit and appropriate match between the competitive strategy of an organization and its internal processes. A lot of work has been done relating competitive strategy to managerial characteristics (Gupta and Govindrajan, 1984); (Slater, 1989), strategic planning system characteristics (Veliyath, 1993), human resource management practices(Balkin and Gomez-Mejia, 1990);Rajagopalan, 1997), technology strategy (Dvir, Sagev, and Shenar, 1993), organizational structure (Powell, 1992), control systems (Govindarajan and Fisher, 1990), corporate SBU relations (Golden, 1992), middle management involvement (Floyd and Wooldridge, 1992), managerial consensus (Homburg, Krohmer and Workman, 1999) and marketing policy (Slater and Olson, 2000). In this paper we relate generic strategy types used by firms (Porter, 1985), (Miles and Snow et al., 1978) to different structures (Dean and Susman, 1989) that define the relationship between design and manufacturing departments.

Our focus is on relationship between design and manufacturing as the performance of these two departments is critical to the overall performance of the organization. Moreover these are two departments which are always in a state of conflict over product issues. Whitney (1988) recognized design as a strategic activity, which required inputs from many parties, including manufacturing. Concurrent or simultaneous engineering was employed to gather inputs and integrate them into design. Gupta and Somers (1996) analyses the importance of manufacturing flexibility and it being influenced by business strategy.

We give a framework in this paper that first identifies strategy of the firm and then recommends a suitable working that ensures desired co-operation between design and manufacturing departments.

2. BACKGROUND

We begin with an overview of past literature on strategy typologies and organizational structure (i.e. relationship between design and manufacturing). Porter (1985) listed three generic competitive strategies, namely (a) 'low cost position' (where company competed primarily on cost); (b) 'differentiation' (here company competed primarily on features other than cost); (c) focus (where a firm concentrates on a given segment. Miles and Snow et al. al. (1978) talked about three business strategies- defenders, analyzers and prospectors. Defenders seek to seal off a portion of the total market to create a stable domain. They achieve this by standard economic actions like competitive pricing or high quality products. Prospectors on the other hand try to locate and develop product and market opportunities, they compete on product novelty. Analyzers follow an intermediate strategy between defenders and prospectors. Walker and Ruekert (1987) came up with a hybrid topology which discriminated between low cost defenders and differentiated defenders. But he dropped the concept of analyzers. But as cited by Slater and Olson (2000) the alteration is not warranted. Hence for the rest of the paper we will be concerned with 4 strategy types: prospectors, low cost defenders, differentiated defenders and analyzers.

Dean and Susman (1989) listed alternative organization structures that could be employed by organizations to encourage co-operation between design and manufacturing. They identified four organization structure types prevalent in practice: (1) Manufacturing gets the veto (2) Use of integrators (3) Manufacturing and design reporting to a common boss (4) Use of matrix structure. However Dean and Susman (1989) do not tell how to choose among these different alternative structures to relate design and manufacturing departments.

3. INTEGRATIVE FRAMEWORK

Here we give a framework defining the desired relationship between design and manufacturing departments of a firm given its strategy.

If a firm chooses to be a low cost defender (Walker et. al., 1987) then it seeks to seal of a portion of the total market in order to create a stable domain by competitive pricing (Miles and Snow et al., 1978).For a low cost defender the manufacturing cost is kept low as possible. This tends to give more power to the manufacturing department forcing frequent redesigns.

Relationship between manufacturing and design departments: an empirical validation of a theoretical framework

Dean and Susman (1989) give four arrangements (design having a veto, manufacturing having a veto, use of integrators to co-ordinate activities of design and manufacturing, use of matrix structure) that define relationship of design and manufacturing functions. In this paper we relate these to the strategy of the firm (Miles and Snow et. al, 1978). This relationship is given in the form of hypotheses. We argue that in 'defenders' manufacturing will have the 'veto' over design; in 'prospectors' design will have the 'veto' over manufacturing; where as 'analyzers' will use 'integrators' to co-ordinate activities of design and manufacturing. This framework was supported by a sample data of twenty firms having design and manufacturing departments.
Keywords: relationship of design and manufacturing functions, veto with design, veto with manufacturing, integrators for design and manufacturing functions
1. INTRODUCTION

Communication & Media

Youth Consumption: Towards an Integration of Structure, Culture and Agency

By Andy R. Brown, Bath Spa University (March 2008)

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Section: Communication & Media
Subjects: Sociology of Culture and Media, Cultural Studies, Sociology, Consumption.
People: Frankfurt School , Bourdieu, Pierre.
Key Topics: agency, identity, entertainment.

Abstract

Youth, media and popular music studies have developed in separate fields of research, resulting in a lack of integration of key areas of enquiry, such as the relationship between the cultural and structural in youth music consumption and the role of media industries in ‘framing’ such a process. A more recent focus on popular music as a media culture suggest a way forward in exploring links between production, mediation and consumption of music and youth consumer practices. This article reviews three such frameworks: (i) the production of consumption, (ii) production of culture/cultures of production and (iii) cultures of consumption, evaluating their contribution to a more integrated understanding of how youth consume music as a structurally and culturally mediated process. Controversies over youth ‘download culture’ and evidence of regulatory changes in the global music industry and its impact on how youth consumers can access music media, underlines the need to pursue a research integration agenda, drawing popular music and youth consumption research closer together. Yet it remains the case that both approaches exhibit a structural vs. cultural divide over youth consumption and its relationship to the global music industry, offering optimism and pessimism in equal measure.
DOI: 10.1111/j.1751-9020.2008.00103.x

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ethical odyssey

scientists are up to and what they have already got lurking in test tubes in the lab'. So wrote one correspondent to the Scotsman in response to a report that three teams of British scientists are seeking to create 'hybrid' embryos for medical research. The scientists want to transfer a human cell nucleus into an animal egg from which the nucleus has been removed. The resulting embryo would then be harvested for stem cells, to aid research into possible cures for conditions such as Alzheimers' and motor neurone disease. Scientists are keen to implant the human nucleus into an animal egg because human eggs are in short supply.
The hybrid cells would, as scientists point out, be 99.9 per cent human and 0.1 per cent cow or rabbit. But the very thought of such cells created fantastic visions of half-man, half-rabbit monsters - and not just among correspondents to the Scotsman. ‘There is a lot of innate wisdom in the yuk factor’, observed Josephine Quintavalle of the lobby group Comment on Reproductive Ethics. ‘My question is: what will the scientists actually create?’ The government seems to feel the same. It is committed to banning the creation of hybrid embryos (though it has not yet got round to drawing up the legislation) and has called on funding bodies 'to make clear that they will not fund or support research involving the creation of such hybrids'. In January the Human Fertilisation and Embryology Authority (HFEA) - the body that regulates embryological research in this country - postponed until autumn any decision on whether to license the procedure.
A sense of 'yuk'. And a fear of rampant science unrestrained by ethical concerns. These have becoming over-riding responses of many people to advances in biotechnology. Politicians and policy makers on both sides of the Atlantic have, at best. pandered to such emotions and, at worst, encouraged them. The philosopher Dame Mary Warnock, who chaired the committee that in 1984 drew up early guidelines on embryological research, suggests that policy makers should take gut feelings seriously. For 'morality to exist at all', she argues, 'there must be some things that, regardless of consequences, should not be done' because crossing such barriers generates 'a sense of outrage... a feeling that to permit a practice would be indecent or part of the collapse of civilisation'. When President George Bush last year vetoed legislation that would have provided public funding for stem cell research he warned that there can be no 'crossing the line' that 'would needlessly encourage conflict between science and ethics'.
Many people recognise the medical benefits that biotechnologies may bring. But many also fear that such benefits may be purchased at too great a price. The image we have is of an unending conflict between an amoral science, hellbent on progress at any cost, and those who seek to restrain scientific advancement and place it within a moral framework. How can we defend the dignity of human beings from being eroded by techniques such as cloning? Is it possible to stop science treating human beings as mere objects? Questions such as these bet

Medicine

Statue of Asclepius, the Greek God of medicine, holding the symbolic Rod of Asclepius with its coiled serpent

Medicine is the science and art (ars medicina) of healing humans. It includes a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Before scientific medicine, healing arts were practiced along with "Eastern medicine" — which are typically based in traditional, story-told, or otherwise non-scientific practices.
Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication, surgery, or some other form of therapy. The word medicine is derived from the Latin ars medicina, meaning the art of healing.^[1][2]
Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual suffering continues to require the application of ordinary human feeling and compassion, known in English as bedside manner.^[3]

Contents [hide] 1 History 2 Clinical practice 3 Institutions 3.1 Delivery 4 Branches 4.1 Basic sciences 4.2 Specialties 4.2.1 Surgery 4.2.2 'Medicine' as a specialty 4.2.3 Diagnostic specialties 4.2.4 Other major specialties 4.3 Interdisciplinary fields 5 Education 6 Legal controls 7 Controversy 8 Honors and awards 9 See also 10 References 11 External links

[edit] History

Main article: History of medicine

The ancient Sumerian god Ningishzida, the patron of medicine, accompanied by two gryphons

Prehistoric medicine incorporated plants (herbalism), animal parts and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (magically obtaining the truth). The field of medical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

Statuette of ancient Egyptian physician Imhotep, the first physician from antiquity known by name.

An ancient Greek patient gets medical treatment: this aryballos (circa 480-470 BCE, now in Paris's Louvre Museum) probably contained healing oil

Early records on medicine have been discovered from ancient Egyptian medicine, Babylonian medicine, Ayurvedic medicine (in the Indian subcontinent), classical Chinese medicine (predecessor to the modern traditional Chinese Medicine), and ancient Greek medicine and Roman medicine. The Egyptian Imhotep (3rd millennium BC) is the first physician in history known by name. Earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found.^[4][5] The Indian surgeon Sushruta described numerous surgical operations, including the earliest forms of plastic surgery.^{[6][dubious – discuss][7]}

The Greek physician Hippocrates (ca. 460 BCE – ca. 370 BCE), considered the father of Western medicine.^[8][9]

The Greek physician Hippocrates, considered the "father of medicine",^[9][10] laid the foundation for a rational approach to medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence".^[11][12]
The Greek physician Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the Western Roman Empire and the onset of the Dark Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.
After 750 CE, the Muslim Arab world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine".^[13][14] He wrote The Canon of Medicine, considered one of the most famous books in the history of medicine.^[15] Others include Abulcasis,^[16] Avenzoar,^[17] Ibn al-Nafis,^[18] and Averroes.^[19] Rhazes ^[20] was one of first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine.^[21] The Islamic Bimaristan hospitals were an early example of public hospitals.^[22][23]
However, the fourteenth and fifteenth century Black Death was just as devastating to the Middle East as to Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East.^[24] In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey.
The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general - see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Ibn al-Nafis and Vesalius improved upon or disproved some of the theories from the past.
Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century (inspired by the method of inoculation earlier practiced in Asia), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900.
The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austrian doctors (such as Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner, and Otto Loewi) made contributions. In the United Kingdom Alexander Fleming, Joseph Lister, Francis Crick, and Florence Nightingale are considered important. From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet).
In the United States William Williams Keen, Harvey Cushing, William Coley, James D. Watson, Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan (Kitasato Shibasaburō), and France (Jean-Martin Charcot, Claude Bernard, Paul Broca and others did significant work). Russian Nikolai Korotkov also did significant work, as did Sir William Osler and Harvey Cushing.
As science and technology developed, medicine became more reliant upon medications. Throughout history and in Europe right until the late 18th century not only animal and plant products were used as medicine, but also human body parts and fluids.^[25] Pharmacology developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc.). Vaccines were discovered by Edward Jenner and Louis Pasteur.
The first antibiotic was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes.
Pharmacology has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce side-effects. Genomics and knowledge of human genetics is having some influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology and genetics are influencing medical technology, practice and decision-making.
Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment^{[citation needed]}. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.^[26]

[edit] Clinical practice

The Doctor, by Sir Luke Fildes (1891)

In clinical practice doctors personally assess patients in order to diagnose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's medical history and medical record, followed a medical interview^[27] and a physical examination. Basic diagnostic medical devices (e.g. stethoscope, tongue depressor) are typically used. After examination for signs and interviewing for symptoms, the doctor may order medical tests (e.g. blood tests), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions.^[28] Followups may be shorter but follow the same general procedure.
The components of the medical interview^[27] and encounter are:

• Chief complaint (cc): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
• History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
• Current activity: occupation, hobbies, what the patient actually does.
• Medications (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
• Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
• Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
• Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.

• Review of systems (ROS) or systems inquiry: a set of additional questions to ask which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc.).

The physical examination is the examination of the patient looking for signs of disease ('Symptoms' are what the patient volunteers, 'Signs' are what the healthcare provider detects by examination). The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g. in infection, uremia, diabetic ketoacidosis). Taste has been made redundant by the availability of modern lab tests. Four actions are taught as the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen). This order may be modified depending on the main focus of the examination (e.g. a joint may be examined by simply "look, feel, move". Having this set order is an educational tool that encourages the practitioner to be systematic in their approach and refrain from using tools such as the stethoscope before they have fully evaluated the other modalities.
The clinical examination involves study of:

• Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
• General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
• Skin
• Head, eye, ear, nose, and throat (HEENT)
• Cardiovascular (heart and blood vessels)
• Respiratory (large airways and lungs)
• Abdomen and rectum
• Genitalia (and pregnancy if the patient is or could be pregnant)
• Musculoskeletal (including spine and extremities)
• Neurological (consciousness, awareness, brain, vision, cranial nerves, spinal cord and peripheral nerves)
• Psychiatric (orientation, mental state, evidence of abnormal perception or thought).

It is likely to be focussed on areas of interest highlighted in the medical history and may not include everything listed above.
Laboratory and imaging studies results may be obtained, if necessary.
The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.
The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.
This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.
On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

[edit] Institutions

Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.
Advanced industrial countries (with the exception of the United States) ^[29][30] and many developing countries provide medical services through a system of universal health care which aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities; most commonly by a combination of all three.
Most tribal societies, but also some communist countries (e.g. China) and the United States,^[29][30] provide no guarantee of health care for the population as a whole. In such societies, health care is available to those that can afford to pay for it or have self insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

Modern drug ampoules

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality and pricing greatly affects the choice by patients / consumers and therefore the incentives of medical professionals. While the US health care system has come under fire for lack of openness,^[31] new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

[edit] Delivery

See also: clinic, hospital, and hospice

Provision of medical care is classified into primary, secondary and tertiary care categories.
Primary care medical services are provided by physicians, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.
Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.

[edit] Branches

Working together as an interdisciplinary team, many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses, emergency medical technicians and paramedics, laboratory scientists, pharmacists, physiotherapists, respiratory therapists, speech therapists, occupational therapists, radiographers, dietitians and bioengineers.
The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while a separate discipline from medicine, is considered a medical field.
A patient admitted to hospital is usually under the care of a specific team based on their main presenting problem, e.g. the Cardiology team, who then may interact with other specialties, e.g. surgical, radiology, to help diagnose or treat the main problem or any subsequent complications / developments.
Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.
The main branches of medicine used in Wikipedia are:

• Basic sciences of medicine; this is what every physician is educated in, and some return to in biomedical research.
• Medical specialties
• Interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.

[edit] Basic sciences

• Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
• Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
• Biomechanics is the study of the structure and function of biological systems by means of the methods of Mechanics.
• Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine.
• Biophysics is an interdisciplinary science that uses the methods of physics and physical chemistry to study biological systems.
• Cytology is the microscopic study of individual cells.
• Embryology is the study of the early development of organisms.
• Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
• Genetics is the study of genes, and their role in biological inheritance.
• Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and immunohistochemistry.
• Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
• Medical physics is the study of the applications of physics principles in medicine.
• Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
• Molecular biology is the study of molecular underpinnings of the process of replication, transcription and translation of the genetic material.
• Neuroscience includes those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain and spinal cord.
• Nutrition science (theoretical focus) and dietetics (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition, and neoplastic diseases.
• Pathology as a science is the study of disease—the causes, course, progression and resolution thereof.
• Pharmacology is the study of drugs and their actions.
• Photobiology is the study of the interactions between non-ionizing radiation and living organisms.
• Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
• Radiobiology is the study of the interactions between ionizing radiation and living organisms.
• Toxicology is the study of hazardous effects of drugs and poisons.

[edit] Specialties

Main article: Medical specialty

In the broadest meaning of "medicine", there are many different specialties. In the UK most specialities will have their own body or college (collectively known as the Royal Colleges, although currently not all use the term "Royal") which have their own entrance exam. The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (e.g. emergency departments) which leads to the desire to form a unifying body of doctors and thence the prestige of administering their own exam.
Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery." "Medicine" refers to the practice of non-operative medicine, and most subspecialties in this area require preliminary training in "Internal Medicine". In the UK this would traditionally have been evidenced by obtaining the MRCP (An exam allowing Membership of the Royal College of Physicians or the equivalent college in Scotland or Ireland). "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." (In the UK: Membership of the Royal College of Surgeons of England (MRCS).)There are some specialties of medicine that at the present time do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above - for example anaesthesia developed first as a faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the Royal College of Anaesthetists and membership of the college is by sitting the FRCA (Fellowship of the Royal College of Anesthetists).

[edit] Surgery

Main article: Surgery

Surgical specialties employ operative treatment. In addition, surgeons must decide when an operation is necessary, and also treat many non-surgical issues, particularly in the surgical intensive care unit (SICU), where a variety of critical issues arise. Surgery has many subspecialties, e.g. general surgery, cardiovascular surgery, colorectal surgery, neurosurgery, maxillofacial surgery, orthopedic surgery, otolaryngology, plastic surgery, oncologic surgery, transplant surgery, trauma surgery, urology, vascular surgery, and pediatric surgery. In some centers, anesthesiology is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline.
Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time consuming.

[edit] 'Medicine' as a specialty

Main article: Internal Medicine

Internal medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases, either of one particular organ system or of the body as a whole. According to some sources, an emphasis on internal structures is implied.^[32] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth nations, such specialists are often called physicians.^[33] These terms, internist or physician (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.
Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys.^[34]
In Commonwealth and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of Primary care.
There are many subspecialities (or subdisciplines) of internal medicine:

• Cardiology
• Critical care medicine
• Endocrinology
• Gastroenterology
• Geriatrics
• Haematology
• Hepatology
• Infectious diseases
• Nephrology
• Oncology
• Pediatrics
• Pulmonology/Pneumology/Respirology
• Rheumatology
• Sleep medicine

Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on Medical education and Physician for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one to three year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the USA. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.

[edit] Diagnostic specialties

• Clinical laboratory sciences are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services. Subspecialties include Transfusion medicine, Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology and Clinical immunology.
• Pathology as a medical specialty is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in evidence-based medicine. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearrangements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology.
• Radiology is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
• Nuclear medicine is concerned with studying human organ systems by administering radiolabelled substances (radiopharmaceuticals) to the body, which can then be imaged outside the body by a gamma camera or a PET scanner. Each radiopharmaceutical consists of two parts: a tracer which is specific for the function under study (e.g., neurotransmitter pathway, metabolic pathway, blood flow, or other), and a radionuclide (usually either a gamma-emitter, or a positron emitter). There is a degree of overlap between nuclear medicine and radiology, as evidenced by the emergence of combined devices such as the PET/CT scanner.
• Clinical neurophysiology is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include Electroencephalography, Electromyography, Evoked potential, Nerve conduction study and Polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.

[edit] Other major specialties

The followings are some major medical specialties that do not directly fit into any of the above mentioned groups.

• Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine.
• Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
• Family medicine, family practice, general practice or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems.
• Obstetrics and gynecology (often abbreviated as OB/GYN (American English) or Obs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
• Medical Genetics is concerned with the diagnosis and management of hereditary disorders.
• Neurology is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
• Ophthalmology exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy.
• Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
• Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
• Psychiatry is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
• Preventive medicine is the branch of medicine concerned with preventing disease.
  • Community health or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.
  • Occupational medicine's principal role is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
  • Aerospace medicine deals with medical problems related to flying and space travel.

[edit] Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

• Addiction medicine deals with the treatment of addiction.
• Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
• Biomedical Engineering is a field dealing with the application of engineering principles to medical practice.
• Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
• Conservation medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology.
• Disaster medicine deals with medical aspects of emergency preparedness, disaster mitigation and management.
• Diving medicine (or hyperbaric medicine) is the prevention and treatment of diving-related problems.
• Evolutionary medicine is a perspective on medicine derived through applying evolutionary theory.
• Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death.
• Gender-based medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
• Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the USA.
• Laser medicine involves the use of lasers in the diagnostics and/or treatment of various conditions.
• Medical humanities includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.
• Medical informatics, medical computer science, medical information and eHealth are relatively recent fields that deal with the application of computers and information technology to medicine.
• Nosology is the classification of diseases for various purposes.
• Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems.
• Pain management (also called pain medicine, or algiatry) is the medical discipline concerned with the relief of pain.
• Palliative care is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
• Pharmacogenomics is a form of individualized medicine.
• Sexual medicine is concerned with diagnosing, assessing and treating all disorders related to sexuality.
• Sports medicine deals with the treatment and preventive care of athletes, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.
• Therapeutics is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health [1].
• Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
• Urgent care focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency room.
• Veterinary medicine; veterinarians apply similar techniques as physicians to the care of animals.
• Wilderness medicine entails the practice of medicine in the wild, where conventional medical facilities may not be available.
• Many other health science fields, e.g. dietetics

[edit] Education

Main articles: Medical education and Medical school

Painted by Toulouse-Lautrec in the year of his own death: an examination in the Paris faculty of medicine, 1901

Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by a period of supervised practice or internship, and/or residency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research.
Many regulatory authorities require continuing medical education, since knowledge, techniques and medical technology continue to evolve at a rapid rate.

[edit] Legal controls

In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health.
Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.

[edit] Controversy

The Catholic social theorist Ivan Illich subjected contemporary western medicine to detailed attack in his Medical Nemesis, first published in 1975. He argued that the medicalization in recent decades of so many of life's vicissitudes — birth and death, for example — frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced industrial society. He was the first to introduce to a wider public the notion of iatrogenesis.^[35] Others have since voiced similar views, but none so trenchantly, perhaps, as Illich.^[36]
Through the course of the twentieth century, healthcare providers focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendant loss of patient-focused care, known as the medical model of health, led to criticisms that medicine was neglecting a holistic model.^{[citation needed]} The inability of modern medicine to properly address some common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, some, notably acupuncture for some conditions and certain herbs, are backed by evidence.^[37]
Medical errors and overmedication are also the focus of complaints and negative coverage. Practitioners of human factors engineering believe that there is much that medicine may usefully gain by emulating concepts in aviation safety, where it is recognized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Clinical versus statistical, algorithmic diagnostic methods were famously examined in psychiatric practice in a 1954 book by Paul E. Meehl, which controversially found statistical methods superior.^[38] A 2000 meta-analysis comparing these methods in both psychology and medicine found that statistical or "mechanical" diagnostic methods were generally, although not always, superior.^[38]
Disparities in quality of care given are often an additional cause of controversy.^[39] For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study.^[40] Rural poor African-American men were used in a study of syphilis that denied them basic medical care.

[edit] Honors and awards

The highest honor awarded in medicine is the Nobel Prize in Medicine, awarded since 1901 by the Royal Swedish Academy of Sciences.

[show] v • d • e Nobel Laureates in Physiology or Medicine 1901 – 1925 Behring (1901) · Ross (1902) · Finsen (1903) · Pavlov (1904) · Koch (1905) · Golgi / Ramón y Cajal (1906) · Laveran (1907) · Metchnikoff / Ehrlich (1908) · Kocher (1909) · Kossel (1910) · Gullstrand (1911) · Carrel (1912) · Bárány (1913) · Bordet (1919) · Krogh (1920) · Hill / Meyerhof (1922) · Banting / Macleod (1923) · Einthoven (1924) 1926 – 1950 Fibiger (1926) · Wagner-Jauregg (1927) · Nicolle (1928) · Eijkman / Hopkins (1929) · Landsteiner (1930) · Warburg (1931) · Sherrington / Adrian (1932) · Morgan (1933) · Whipple / Minot / Murphy (1934) · Spemann (1935) · Dale / Loewi (1936) · Szent-Györgyi (1937) · Heymans (1938) · Domagk (1939) · Dam / Doisy (1943) · Erlanger / Gasser (1944) · Fleming / Chain / Florey (1945) · Muller (1946) · C.Cori / G.Cori / Houssay (1947) · Müller (1948) · Hess / Moniz (1949) · Kendall / Reichstein / Hench (1950) 1951 – 1975 Theiler (1951) · Waksman (1952) · Krebs / Lipmann (1953) · Enders / Weller / Robbins (1954) · Theorell (1955) · Cournand / Forssmann / Richards (1956) · Bovet (1957) · Beadle / Tatum / Lederberg (1958) · Ochoa / Kornberg (1959) · Burnet / Medawar (1960) · Békésy (1961) · Crick / Watson / Wilkins (1962) · Eccles / Hodgkin / Huxley (1963) · Bloch / Lynen (1964) · Jacob / Lwoff / Monod (1965) · Rous / Huggins (1966) · Granit / Hartline / Wald (1967) · Holley / Khorana / Nirenberg (1968) · Delbrück / Hershey / Luria (1969) · Katz / Euler / Axelrod (1970) · Sutherland (1971) · Edelman / Porter (1972) · Frisch / Lorenz / Tinbergen (1973) · Claude / Duve / Palade (1974) · Baltimore / Dulbecco / Temin (1975) 1976 – 2000 Blumberg / Gajdusek (1976) · Guillemin / Schally / Yalow (1977) · Arber / Nathans / Smith (1978) · Cormack / Hounsfield (1979) · Benacerraf / Dausset / Snell (1980) · Sperry / Hubel / Wiesel (1981) · Bergström / Samuelsson / Vane (1982) · McClintock (1983) · Jerne / Köhler / Milstein (1984) · Brown / Goldstein (1985) · Cohen / Levi-Montalcini (1986) · Tonegawa (1987) · Black / Elion / Hitchings (1988) · Bishop / Varmus (1989) · Murray / Thomas (1990) · Neher / Sakmann (1991) · Fischer / Krebs (1992) · Roberts / Sharp (1993) · Gilman / Rodbell (1994) · Lewis / Nüsslein-Volhard / Wieschaus (1995) · Doherty / Zinkernagel (1996) · Prusiner (1997) · Furchgott / Ignarro / Murad (1998) · Blobel (1999) · Carlsson / Greengard / Kandel (2000) 2001 – present Hartwell / Hunt / Nurse (2001) · Brenner / Horvitz / Sulston (2002) · Lauterbur / Mansfield (2003) · Axel / Buck (2004) · Marshall / Warren (2005) · Fire / Mello (2006) · Capecchi / Evans / Smithies (2007) · Barré-Sinoussi / Montagnier / zur Hausen (2008) · Blackburn / Greider / Szostak (2009) Complete roster · 1901–1925 · 1926–1950 · 1951–1975 · 1976–2000 · 2001–present

[edit] See also

Main article: Outline of medicine

Medicine portal

• Outline of health
• List of causes of death by rate
• List of diseases
• List of disorders
• List of important publications in medicine
• Medical Encyclopedia
• Medical equipment
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• Medical sociology
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• Timeline of medicine and medical technology

[edit] References

1. ^ Etymology: Latin: medicina, from ars medicina "the medical art," from medicus "physician."(Etym.Online) Cf. mederi "to heal," etym. "know the best course for," from PIE base *med- "to measure, limit. Cf. Greek medos "counsel, plan," Avestan vi-mad "physician")
2. ^ "Medicine" Online Etymology Dictionary
3. ^ Culliford Larry (December 2002). "Spirituality and clinical care (Editorial)". British Medical Journal 325 (7378): 1434–5. doi:10.1136/bmj.325.7378.1434. PMID 12493652. 
4. ^ Prof. Arjuna Aluvihare, "Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" Vidhusara Science Magazine, Nov. 1993.
5. ^ Resource Mobilization in Sri Lanka's Health Sector - Rannan-Eliya, Ravi P. & De Mel, Nishan, Harvard School of Public Health & Health Policy Programme, Institute of Policy Studies ^{[disambiguation needed]}, February 1997, Page 19. Accessed 2008-02-22.
6. ^ A. Singh and D. Sarangi (2003). "We need to think and act", Indian Journal of Plastic Surgery.
7. ^ H. W. Longfellow (2002). "History of Plastic Surgery in India", Journal of Postgraduate Medicine.
8. ^ Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus., U.S. National Library of Medicine
9. ^ ^{a b} The father of modern medicine: the first research of the physical factor of tetanus, European Society of Clinical Microbiology and Infectious Diseases
10. ^ Grammaticos P.C. & Diamantis A. (2008). "Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus". Hell J Nucl Med 11 (1): 2–4. PMID 18392218. 
11. ^ Garrison 1966, p. 97
12. ^ Martí-Ibáñez 1961, p. 90
13. ^ Becka J (1980). "The father of medicine, Avicenna, in our science and culture: Abu Ali ibn Sina (980-1037) (Czech title: Otec lékarů Avicenna v nasí vĕdĕ a kulture)" (in Czech). Cas Lek Cesk 119 (1): 17–23. PMID 6989499. 
14. ^ Medical Practitioners
15. ^ ""The Canon of Medicine" (work by Avicenna)". Encyclopædia Britannica. 2008. http://www.britannica.com/eb/topic-92902/The-Canon-of-Medicine. Retrieved 2008-06-11. 
16. ^ Ahmad, Z. (St Thomas' Hospital) (2007). "Al-Zahrawi - The Father of Surgery". ANZ Journal of Surgery 77 (Suppl. 1): A83. doi:10.1111/j.1445-2197.2007.04130_8.x 
17. ^ Rabie E. Abdel-Halim (2006), "Contributions of Muhadhdhab Al-Deen Al-Baghdadi to the progress of medicine and urology", Saudi Medical Journal 27 (11): 1631-1641.
18. ^ Chairman's Reflections (2004), "Traditional Medicine Among Gulf Arabs, Part II: Blood-letting", Heart Views 5 (2): 74-85 [80].
19. ^ Martín-Araguz A, Bustamante-Martínez C, Fernández-Armayor Ajo V, Moreno-Martínez JM (2002-05-01—15). "Neuroscience in al-Andalus and its influence on medieval scholastic medicine" (in Spanish). Revista de neurología 34 (9): 877–892. PMID 12134355. 
20. ^ David W. Tschanz, PhD (2003), "Arab(?) Roots of European Medicine", Heart Views 4 (2).
21. ^ On the dominance of the Greek humoral theory, which was the basis for the practice of bloodletting, in medieval Islamic medicine see Peter E. Pormann and E. Savage Smith,Medieval Islamic medicine, Georgetown University, Washington DC, 2007 p. 10, 43-45.
22. ^ Micheau, Françoise. "The Scientific Institutions in the Medieval Near East". pp. 991–2 , in (Morelon & Rashed 1996, pp. 985–1007)
23. ^ Peter Barrett (2004), Science and Theology Since Copernicus: The Search for Understanding, p. 18, Continuum International Publishing Group, ISBN 056708969X.
24. ^ Michael Dols has shown that the Black Death was much more commonly believed by European authorities than by Middle Eastern authorities to be contagious; as a result, flight was more commonly counseled, and in urban Italy quarantines were organized on a much wider level than in urban Egypt or Syria (The Black Death in the Middle East Princeton, 1977, p. 119; 285-290.
25. ^ Peter Cooper, "Medicinal properties of body parts", The Pharmaceutical Journal, 18/25 December 2004, Vol. 273 / No 7330, pp. 900-902 http://www.pharmj.com/editorial/20041218/christmas/p900bodyparts.html
26. ^ Ezzo J, Bausell B, Moerman DE, Berman B, Hadhazy V (2001). "Reviewing the reviews. How strong is the evidence? How clear are the conclusions?". Int J Technol Assess Health Care 17 (4): 457–466. PMID 11758290. 
27. ^ ^{a b} Coulehan JL, Block MR (2005). The Medical Interview: Mastering Skills for Clinical Practice (5th ed.). F. A. Davis. ISBN 0-8036-1246-X. OCLC 232304023. 
28. ^ Addison K, Braden JH, Cupp JE, Emmert D, et al. (AHIMA e-HIM Work Group on the Legal Health Record) (September 2005). "Update: Guidelines for Defining the Legal Health Record for Disclosure Purposes". Journal of AHIMA 78 (8): 64A–G. PMID 16245584. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027921.hcsp?dDocName=bok1_027921. 
29. ^ ^{a b} Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14
30. ^ ^{a b} "The Case For Single Payer, Universal Health Care For The United States". Cthealth.server101.com. http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm. Retrieved 2009-05-04. 
31. ^ Martin Sipkoff (January 2004). "Transparency called key to uniting cost control, quality improvement". Managed Care. http://www.managedcaremag.com/archives/0401/0401.forum.html. 
32. ^ internal medicine at Dorland's Medical Dictionary
33. ^ H.W. Fowler. (1994). A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection). NTC/Contemporary Publishing Company. ISBN 1853263184. 
34. ^ "The Royal Australasian College of Physicians: What are Physicians?". Royal Australasian College of Physicians. Archived from the original on 2008-03-06. http://web.archive.org/web/20080306053048/http://www.racp.edu.au/index.cfm?objectid=49EF1EB5-2A57-5487-D74DBAFBAE9143A3. Retrieved 2008-02-05. 
35. ^ Illich Ivan (1974). Medical Nemesis. London: Calder & Boyars. ISBN 0714510963. OCLC 224760852. 
36. ^ Postman Neil (1992). Technopoly: The Surrender of Culture to Technology. New York: Knopf. OCLC 24694343. 
37. ^ The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine: the good the bad and the ugly. Retrieved 5 August 2006.
38. ^ ^{a b} Grove WH, Zald DH, Lebow BS, Snitz BE, Nelson C. (2000). "Clinical versus mechanical prediction: A meta-analysis" (w). Psychological Assessment 12 (1): 19–30. doi:10.1037/1040-3590.12.1.19. PMID 10752360. http://www.psych.umn.edu/faculty/grove/096clinicalversusmechanicalprediction.pdf. 
39. ^ "Eliminating Health Disparities". American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities.shtml. 
40. ^ "Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure". http://archpsyc.ama-assn.org/cgi/content/abstract/65/12/1402. 

[edit] External links

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