An acquaintance who works with street teens once said to me, “They live in a completely different world.” She did not mean only that they lived downtown and not in the suburbs, slept under bridges and not in beds, ate in soup kitchens instead of restaurants. She meant that street teens experienced a social reality radically different from the reality of those who have lived most of life in a relatively sheltered and stable middle-class environment. They have a different view (...) of other people, of social authority, of human nature, of political and social institutions. As my acquaintance understood it, this difference resulted from experiences at home and school, experiences with adults who were at best negligent, at worst abusive and hostile. Children were not cared for at home, fared poorly at school, then ran from home to the street. The street teens she knew were hostile and despairing and expected others to be the same. A fundamental difference was in the area of trust: these teens lacked trust in family, teachers, peers, police, even those who sought to help them. And apparently for good reason, given the circumstances from which many of them emerged. (shrink)

Based on two years’ ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients’ mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients’ mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians’ income structures are the most crucial (...) factors in inducing patients’ mistrust. Hospitals’ heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians’ reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians’ attitudes toward and interaction with patients may also affect patients’ sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem. (shrink)

My paper proposes the concept of relational work to explain economic activity. In all economic action, I argue, people engage in the process of differentiating meaningful social relations. For each distinct category of social relations, people erect a boundary, mark the boundary by means of names and practices, establish a set of distinctive understandings that operate within that boundary, designate certain sorts of economic transactions as appropriate for the relation, bar other transactions as inappropriate, and adopt certain media for reckoning (...) and facilitating economic transactions within the relation. I call that process relational work. After identifying specific elements of a relational work approach, the paper focuses on the case of monetary differentiation. It compares a relational work theory of earmarking money with behavioral economics’ individually based mental accounting approach. (shrink)

The Protestant ethic — a moral code stressing hard work, rigorous self-discipline, and the organization of one's life in the service of God — was made famous by sociologist and political economist Max Weber. In this brilliant study (his best-known and most controversial), he opposes the Marxist concept of dialectical materialism and its view that change takes place through "the struggle of opposites." Instead, he relates the rise of a capitalist economy to the Puritan determination to work out anxiety over (...) salvation or damnation by performing good deeds — an effort that ultimately discouraged belief in predestination and encouraged capitalism. Weber's classic study has long been required reading in college and advanced high school social studies classrooms. (shrink)

Both experimental and ethnographic studies show that reciprocal exchanges (in which actors unilaterally provide benefits to each other without formal agreements) produce stronger trust than negotiated exchanges secured by binding agreements. We develop the theoretical role of risk and uncertainty as causal mechanisms that potentially explain these results, and then test their effects in two laboratory experiments that vary risk and uncertainty within negotiated and reciprocal forms of exchange. We increase risk in negotiated exchanges by making agreements nonbinding and decrease (...) uncertainty in reciprocal exchanges by having actors communicate their intentions. Our findings support three main theoretical conclusions. (1) Increasing risk in negotiated exchange produces levels of trust comparable to those in reciprocal exchange only if the partner's trustworthiness is near-absolute. (2) Decreasing uncertainty in reciprocal exchange either increases or decreases trust, depending on network structure. (3) Even when reciprocal and negotiated exchanges produce comparable levels of trust, their trust differs in kind, with reciprocal exchange partners developing trust that is more resilient and affect-based. (shrink)

Combining principles of individual rational choice with a sociological conception of collective action, James Coleman recasts social theory in a bold new way. The result is a landmark in sociological theory, capable of describing both stability and change in social systems. This book provides for the first time a sound theoretical foundation for linking the behavior of individuals to organizational behavior and then to society as a whole. The power of the theory is especially apparent when Coleman analyzes corporate actors, (...) such as large corporations and trade unions. He examines the creation of these institutions, collective decision making, and the processes through which authority is revoked in revolts and revolutions. Coleman discusses the problems of holding institutions responsible for their actions as well as their incompatibility with the family. He also provides a simple mathematical analysis corresponding to and carrying further the verbal formulations of the theory. Finally, he generates research techniques that will permit quantitative testing of the theory. From a simple, unified conceptual structure Coleman derives, through elegant chains of reasoning, an encompassing theory of society. It promises to be the most important contribution to social theory since the publication of Talcott Parsons' Structure of Social Action in 1936. (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)