Survey research was for a long time thought of primarily as a sociological tool. It is relatively recently that this research method has been adopted by other social sciences and related professional disciplines. The amount and quality of its use, however, vary considerably from field to field. This volume describes the elementary logic of survey design and analysis and provides, for each discipline, an evaluation of how survey research has been used and conceivably may be used to deal with the central problems of each field.

CHARLES Y. GLOCK is director of the Survey Research Center at the University of California, Berkeley.

"Company Doctor is a distressing cautionary tale that should be read by anyone professional or otherwise- employed by a large complex organization. On one hand, it alerts us to the ways in which the fundamental tenets of modern medicine, and by implication of other professions, can, in a corporate environment, mutate to serve employers' overridding interest in controlling workers and maximizing profits. On the other hand, the book also indirectly offers hope: if the social and legal context of professional work is responsible for the breakdown of professional ethical codes, then reform may be possible by changing that context."
-WILLIAM J. SONNENSTUHL, Industrial and Labor Relations Review

"Elaine Draper delivers a timely and probing examination of the conflicting interests of physicians who serve two masters: their patients and their employers. Her interviews reveal that fidelity, privacy, and trust are not just abstract principles, but deeply felt (though imperfectly realized) obligations. Draper's cross-disciplinary background lets her weave in-depth social science with careful legal analysis to provide an arresting picture of a topic-professional conflicts of interest-that has emerged as one of the most troubling issues of our time, not just for doctors but for all professionals ... and their clients."
-ALEXANDER M. CAPRON, University Professor, Henry W. Bruce Professor of Equity, and Professor of Law and Medicine, University of Southern California

"Given that today's world is one of increasing professionalization, but also of increasing corporate/bureaucratic conformity, there is much to be learned from the professional physicians who work for large corporations, or 'company doctors.' Professor Draper has done an impressive job of doing that learning and of sharing the relevant lessons with the rest of us. Her book provides insights not just into the doctors' own perceptions doing so in rich and well-written ways-but also into the deeper power of structural and organizational factors that the doctors often fail to recognize or acknowledge. As a result, the book is valuable not just for what it tells us about this important group of doctors but for what it tells us about the challenges of trust, expertise, and professional responsibility, and about the nature of the increasingly interdependent society we all seem destined to inhabit."
-WILLIAM R. FREUDENBURG, Dehlsen Professor of Environment and Society and Professor of Sociology, Environmental Studies Program, University of California, Santa Barbara

"Professor Draper has provided an in-depth, thoroughly researched and engaging look into a central issue of our times-can physicians maintain medical professionalism as employees of rich and powerful corporations? While this book specifically examines the field of contemporary U.S. occupational medicine in an increasingly corporatized overall American medical system, the book, through the example of this bellwether specialty, really applies to and informs the debates about the entire U.S. health care enterprise. If you are involved in that debate or affected by it-read this book."
-RICHARD A. LIPPIN, M.D., FACOEM, Former Corporate Medical Director, ARCO Chemical Company

To limit the skyrocketing costs of their employees' health insurance, companies such as Dow, Chevron, and IBM, as well as many large HMOs, have increasingly hired physicians to supervise the medical care they provide. As Elaine Draper argues in The Company Doctor, company doctors are bound by two conflicting ideals: serving the medical needs of their patients while protecting the company's bottom line. Draper analyzes the advent of the corporate physician both as an independent phenomenon, and as an index of contemporary culture, reaching startling conclusions about the intersection of corporate culture with professional autonomy.

Drawing on over 100 interviews with company physicians, scientists, and government and labor officials, as well as historical, legal, and statistical sources and medical trade association data, Draper presents an illuminating overview of the social context and meaning of professional work in corporations. Draper finds that while medical journals, speeches, and ethical codes proclaim the independent professional judgment of corporate physicians, the company doctors she interviewed often expressed anguish over the tightrope they must walk between their patients' health and the corporate oversight they face at every turn. Draper dissects the complex position occupied by company doctors to explore broad themes of doctor-patient trust, employee loyalty, privacy issues, and the future direction of medicine. She addresses such controversial topics as drug screening and the difficult position of company doctors when employees sue companies for health hazards in the workplace.

Company doctors are but one example of professionals who have at times ceded their autonomy to corporate management. Physicians provide the prototypical professional case for exploring this phenomenon, due to their traditional independence, extensive training, and high levels of prestige. But Draper expands the scope of the book—tracing parallel developments in the law, science, and technology—to draw insightful conclusions about changing conditions in the professional workplace, as corporate cultures everywhere adapt to the new realities of the global economy. The Company Doctor provides a compelling examination of the corporatization of American medicine with far-reaching implications for professionals in many other fields.

ELAINE DRAPER is a visiting scholar at the Institute for the Study of Social Change, University of California, Berkeley, and assistant professor of sociology at California State University, Los Angeles.

"Friedman brings a broad social and historical perspective to bear on the conventional wisdom that America is an increasingly litigious society .... The author cogently examines several aspects of both private and public law without resorting to legal jargon. This volume deals with a vital issue in contemporary society and does so with style, humor, and insight."
-Choice

"Provides a much needed perspective on an issue of paramount concern .... Total Justice leaves the reader with important insights into the liability crisis."
-Contemporary Psychiatry

"Skeptics should spend two hours with this book; they will come away convinced that the law-drenched age in which we live can be interpreted only in the light of this sophisticated argument."
-ABA Journal. The Lawyer's Magazine

It is a widely held belief today that there are too many lawsuits, too many lawyers, too much law. As readers of this engaging and provocative essay will discover, the evidence for a "litigation explosion" is actually quite ambiguous. But the American legal profession has become extremely large, and it seems clear that the scope and reach of legal process have indeed increased greatly.

How can we best understand these changes? Lawrence Friedman focuses on transformations in American legal culture—that is, people's beliefs and expectations with regard to law. In the early nineteenth century, people were accustomed to facing sudden disasters (disease, accidents, joblessness) without the protection of social and private insurance. The uncertainty of life and the unavailability of compensation for loss were mirrored in a culture of low legal expectations.

Medical, technical, and social developments during our own century have created a very different set of expectations about life, again reflected in our legal culture. Friedman argues that we are moving toward a general expectation of total justice, of recompense for all injuries and losses that are not the victim's fault. And the expansion of legal rights and protections in turn creates fresh expectations, a cycle of demand and response.

This timely and important book articulates clearly, and in nontechnical language, the recent changes that many have sensed in the American legal system but that few have discussed in so powerful and sensible a way.

Total Justice is the third of five special volumes commissioned by the Russell Sage Foundation to mark its seventy-fifth anniversary.

LAWRENCE M. FRIEDMAN is Marion Rice Kirkwood Professor of Law at Stanford University.

Evaluates a technological approach to social change which seeks to cure society's ills by dealing with its symptoms, rather than root causes. It examines four such technological shortcuts in terms of their relevance to specific social problems: methadone in controlling heroin addiction; antabuse in treating alcoholism; the breath analyzer in highway safety; and gun control in reducing crime. The authors seek solutions which do not require large amounts of new resources or planning, and will accelerate the pace of social change. They indicate that technological handling of such problems may be the answer.

AMITAI ETZIONI is professor of sociology at Columbia University and director of the Center for Policy Research.

RICHARD REMP is a doctoral candidate in sociology at Columbia University and research associate at the Center for Policy Research.

"This pathbreaking interdisciplinary collection of essays challenges many of our preconceptions about addiction and offers researchers productive new paradigms for studying and treating self-defeating behavior."
-DAVID LAIBSON, Harvard University

"This book is on the cutting edge of thought about the phenomenon of addiction. The chapters cover all aspects of addiction, from philosophical, to physiological, to psychological, to social. The common notion that addicts are helpless and hopeless prisoners of their habit is effectively rejected by these authors. Anyone involved in the study of addictive behavior or anyone interested in the phenomenon of addiction will find Addiction a valuable resource."
-HOWARD RACHLIN, State University of New York at Stony Brook

Addiction focuses on the emergence, nature, and persistence of addictive behavior, as well as the efforts of addicts to overcome their condition. Do addicts act of their own free will, or are they driven by forces beyond their control? Do structured treatment programs offer more hope for recovery? What causes relapses to occur? Recent scholarship has focused attention on the voluntary aspects of addiction, particularly the role played by choice. Addiction draws upon this new research and the investigations of economists, psychiatrists, philosophers, neuropharmacologists, historians, and sociologists to offer an important new approach to our understanding of addictive behavior.

The notion that addicts favor present rewards over future gains or penalties echoes throughout the chapters in Addiction. The effect of cultural values and beliefs on addicts, and on those who treat them, is also explored, particularly in chapters by Elster on alcoholism and by Acker on American heroin addicts in the 1920s and 1930s. Essays by Gardner and by Waal and Mørland discuss the neurobiological roots of addiction Among their findings are evidence that addictive drugs also have an important effect on areas of the central nervous system unrelated to euphoria or dysphoria, and that tolerance and withdrawal phenomena vary greatly from drug to drug.

The plight of addicts struggling to regain control of their lives receives important consideration in Addiction. Elster, Skog, and O'Donoghue and Rabin look at self-administered therapies ranging from behavioral modifications to cognitive techniques, and discuss conditions under which various treatment strategies work. Drug-based forms of treatment are discussed by Gardner, drawing on work that suggests that parts of the population have low levels of dopamine, inducing a tendency toward sensation-seeking.

There are many different explanations for the impulsive, self-destructive behavior that is addiction. By bringing the triple perspective of neurobiology, choice, and culture to bear on the phenomenon, Addiction offers a unique and valuable source of information and debate on a problem of world-wide proportions.

JON ELSTER is Edward L. Ryerson Distinguished Service Professor of Political Science and Philosophy at the University of Chicago.

CONTRIBUTORS: Caroline Jean Acker, George Ainslie, Jon Elster, Eliot L. Gardner, Olav Gjelsvik, Jørg Mørland, Ted O’Donoghue, Matthew Rabin, Ole-Jørgen Skog, Helge Waal, and Gary Watson
 

Notions of justice and fairness are central to the American belief that the pursuit of a healthy and productive life is the right of all citizens. Yet in the real world there are seldom sufficient resources to meet the needs of everyone, and institutions are routinely forced to make difficult decisions regarding who will be favored and who will not. Local Justice in America is an insightful look into how selections are made in four critical areas: college admissions, kidney transplants, employee layoffs, and legalized immigration.

This volume's case studies survey the history and modern rationale behind seemingly enigmatic allocation systems, chronicling the political and ethical debates, occasional scandals, and judicial battles that have shaped them. Though these selection processes differ significantly, each reflects a bitter struggle between opposing—and equally intense—principles of local justice. For example, are admissions officers who use special points to foster student diversity less fair than those who rely exclusively on scholastic achievement? How did the system of personal discretion among doctors selecting transplant patients come to be viewed by the public as more inequitable than compassionate? Does the use of seniority as a gauge in layoffs violate equal opportunity laws or provide employers with their only objective and neutral criterion? How have partisan interest groups repeatedly shifted immigration quotas between the extremes of xenophobia and altruism?

In framing chapters, editor Jon Elster draws upon these studies to speculate on the unique nature of the American value system. Arguing that race matters deeply in all considerations of local justice, he discusses how our society's assessment of neediness balances on the often uneasy compromises between the desire to reward deserving individuals and the call to strengthen opportunities for disadvantaged groups. Well informed and stimulating, Local Justice in America speaks directly to policy debates in the fields of health, education, work, and immigration, and makes an important contribution to our understanding of the fundamental social issues that affect our daily welfare.

JON ELSTER is Edward L. Ryerson Distinguished Service Professor of Political Science and Philosophy at the University of Chicago.

CONTRIBUTORS: Patricia Conley, J. Michael Dennis, Gerry Mackie, Stuart Romm.

Traces the development of the sanitary and health problems of New York City from earliest Dutch times to the culmination of a nineteenth-century reform movement that produced the Metropolitan Health Act of 1866, the forerunner of the present New York City Department of Health. Professor Duffy shows the city's transition from a clean and healthy colonial settlement to an epidemic-ridden community in the eighteenth century, as the city outgrew its health and sanitation facilities. He describes the slow growth of a demand for adequate health laws in the mid-nineteenth century, leading to the establishment of the first permanent health agency in 1866.

JOHN DUFFY is professor of history of medicine in the history department and School of Medicine at Tulane University.

Emphasizing the importance of the psychosocial and cultural background of the individual patient, the final study suggests methods of acquiring this information and the ways in which the staff can then utilize these findings to best advantage both in initial contact and in planning comprehensive patient care.

ESTHER L. BROWN joined the Russell Sage Foundation in Manhattan in 1930 as a research associate and at her retirement in 1963 was its director of executive program planning.

This study focuses on the staff who provide direct patient care, viewing hospital personnel in interaction with patients and in their own work groups. It examines the psychosocial needs characteristic of most workers and suggests ways to meet them to encourage increased staff motivation and competence.

ESTHER L. BROWN joined the Russell Sage Foundation in Manhattan in 1930 as a research associate and at her retirement in 1963 was its director of executive program planning.