Academic Medicine Under Economic Stress: A Case Study of the Institutional Change Transforming American Health Care

American Academic medicine--the system of education and research that trains the coming generations of physicians, produces new basic and clinical bio-medical research and provides the medical safety net in many U.S. urban areas--is in a funding crisis. This essay lays out an historical and analytical account of the institutions, functions and funding mechanisms of this enterprise. The objective is to interpret the forces that led to the current impasse in which the medical education establishment now finds itself, and what the future is likely to hold as the forces of budgetary stringency and market competition continue to accelerate. A comprehensive review of the cross-subsidy system, its intricate relationship to the federal financing of health care and its origin in the Vannevar-Bush-inspired post-war research establishment is offered. The standpoint of economic theory is then taken to suggest that the intertwined functions of academic medicine be viewed from two perspectives. One, it can be viewed as a financially unnecessary mix of public and private goods. Two, it is an institutional framework for joint production that evolved under the post-Flexner, post-Bush era reforms of scientific medicine, but which now may be in need of modifications to its mission.     

William James's psychological pragmatism: habit, belief and purposive human behaviour

Modern institutional economists look to pragmatism for: (1)an evolutionary philosophy of knowledge; and (2) a foundationof a theory of human nature. These two elements are combinedin William James, who was both a philosopher of pragmatism anda pioneering experimental psychologist. The author shows firsthow William James added psychological depth to the pragmatictradition as it was left by C. S. Peirce, and offers a reconciliationof their respective theories of truth. The second part of theessay explores James's views on psychology, concentrating onthe relation to pragmatic philosophy and the question of habit.The last section compares this to human nature as seen in modernevolutionary biology, in brain science and in the philosophyof rationality in the social sciences.     

Contemporary Spanish trade unions

This article traces the development of the Spanish Trade Union Movement in the decade since the death of Franco. It reviews the immediate historical context of the contemporary Spanish unions, places them in a legal/institutional context and discusses their organisational strength and their role in the new Spanish democracy.     

Spanish trade unions 1986–1994; life after national agreements

The article reviews the situation of the Spanish trade unions since 1986 concluding that despite the fragmentation of corporatism and their organisational weakness, the unions have been able to retain a significant role in Spanish society but now face a major challenge.     

Adapting a book to make a film: how strategy is adapted through professional practices of marketing middle managers

Abstract

For an organisation to be competitive its strategy must be highly responsive to both environmental challenges and customers continuously shifting demands. Yet many organisations treat strategy making as an exclusively top management concern, even though the top management team is often remote from the daily interactions and communications taking place at the organisation, market, and customer interface. We challenge the assumption that strategy making ‘belongs’ to top managers and argue that marketing middle managers, possessing expert market and customer knowledge and insights, adapt top manager’s strategy to shifting customer demands in a changing environment. We explore this argument by adopting a strategy-as-practice perspective and analysing marketing middle manager’s practices across three case companies operating in a dynamic retail environment. Our research enables two key contributions. Our primary confirmation is to demonstrate that marketers are not passive implementers, but active adapters of top management strategy through three critical practices of sensing, challenging, and transmitting. We use the novel analogy of how adapting a book to make a film involves minor changes to the story line and characters to suit the new medium and to illustrate the strategically relevant and influential role marketing plays in adapting the strategy developed by the top management team for implementation. By demonstrating the value of the strategic practices of functional middle managers we also contribute to the growing debate of the need for greater inclusion and transparency in strategy making.     

Pester power – A battle of wills between children and their parents

Abstract

A widespread concern in the child-marketing literature, and indeed at a societal level, is that of pester power. There is a prevailing school of thought that holds that where children pose purchasing requests to their parents, pestering and unhappiness may result if those requests are denied. This paper approaches this issue by accessing children's views on pester power, as opposed to previous research studies that have tended to prioritise parental perspectives. Findings are presented from an interpretive study involving children aged between seven and nine years. The study suggests that children understand the various responses that parents make to purchase requests, for example, agreement, refusal, procrastination, and negotiation, and their parents' rationale for such responses. Furthermore, the outcome of such interaction tends to constitute more of a good-natured ‘game’ between parent and child, as suggested by the children, as opposed to the negative overtones of conflict indicated in the literature. The paper concludes that this interaction can be more closely aligned with our expanding understanding of the process of consumer socialisation, rather than the negative connotations of pester power and conflict phenomena, as suggested in previous studies.