Title: Intensive care: a doctor's journal
Author: Murray, John F. (John Frederic) 1927-
Published: University of California Press,  2000
Subjects: Medicine | Aging
Publisher's Description: Intensive Care is an affecting view from the trenches, a seasoned doctor's minute-by-minute and day-by-day account of life in the Intensive Care Unit (ICU) of a major inner-city hospital, San Francisco General. John F. Murray, for many years Chief of the Pulmonary and Critical Care Division of the hospital and a Professor at the University of California, San Francisco, takes readers on his daily ward rounds, introducing them to the desperately ill patients he treats as well as to the young physicians and medical students who accompany him. Writing with compassion and knowledge accumulated over a long career, Murray presents the true stories of patients who show up with myriad disorders: asthma, cardiac failure, gastrointestinal diseases, complications due to AIDS, the effects of drug and alcohol abuse, emphysema. Readers will come away from this book with a comprehensive understanding of what an ICU is, what it does, who gets admitted, and how doctors and nurses make decisions concerning life-threatening medical problems. Intensive care for critically ill patients is a new but well-established and growing branch of medicine. Estimates suggest that 15 to 20 percent of all hospitalized patients in the United States are treated in an intensive or coronary care unit during each hospital stay, so there is a real possibility that the reader will either be admitted to an ICU himself or herself or knows someone who will be. Murray not only offers a real-time account of the diagnosis, treatment, and progress of his patients over the course of one month but also conveys a wealth of information about various diseases and medical procedures in succinct and easy-to-understand terms. In addition, he elaborates on ethical dilemmas that he confronts on an almost daily basis: the extent of patient autonomy, the denial of ICU care, the withdrawal of life support, and physician-assisted suicide. Murray concludes that ICUs are doing their job, but they could be even better, cheaper, and--most important--more humane. His chronicle brings substance to a world known to most of us only through the fiction of television.   [brief]
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Title: Life without disease: the pursuit of medical utopia 
Author: Schwartz, William B 1922-
Published: University of California Press,  1998
Subjects: Science | Medicine | Economics and Business | History and Philosophy of Science | Public Policy
Publisher's Description: The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to preventing the onset of disease. Understanding the role of genes in human health, says Dr. William B. Schwartz, is the driving force that will change the direction of medical care, and the age-old dream of life without disease may come close to realization by the middle of the next century. Medical care in 2050 will be vastly more effective, Schwartz maintains, and it may also be less expensive than the resource-intensive procedures such as coronary bypass surgery that medicine relies on today.Schwartz's alluring prospect of a medical utopia raises urgent questions, however. What are the scientific and public policy obstacles that must be overcome if such a goal is to become a reality? Restrictions on access imposed by managed care plans, the corporatization of charitable health care institutions, the increasing numbers of citizens without health insurance, the problems with malpractice insurance, and the threatened Medicare bankruptcy - all are the legacy of medicine's great progress in mastering the human body and society's inability to assimilate that mastery into existing economic, ethical, and legal structures. And if the average American life span is 130 years, a genuine possibility by 2050, what social and economic problems will result?Schwartz examines the forces that have brought us to the current health care state and shows how those same forces will exert themselves in the decades ahead. Focusing on the inextricable link between scientific progress and health policy, he encourages a careful examination of these two forces in order to determine the kind of medical utopia that awaits us. The decisions we make will affect not only our own care, but also the system of care we bequeath to our children.   [brief]
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Title: Just doctoring: medical ethics in the liberal state 
Author: Brennan, Troyen A
Published: University of California Press,  1991
Subjects: Philosophy | Ethics | Medicine
Publisher's Description: Just Doctoring draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way to a new, more aware and engaged medical ethics.The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems - from informed consent to care rationing and the repercussions of the HIV epidemic - and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century.   [brief]
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Title: Big doctoring in America: profiles in primary care 
Author: Mullan, Fitzhugh
Published: University of California Press,  2002
Subjects: Medicine | Health Care | Sociology
Publisher's Description: The general practitioner was once America's doctor. The GP delivered babies, removed gallbladders, and sat by the bedsides of the dying. But as the twentieth century progressed, the pattern of medical care in the United States changed dramatically. By the 1960s, the GP was almost extinct. The later part of the twentieth century, however, saw a rebirth of the idea of the GP in the form of primary care practitioners. In this engrossing collection of oral histories and provocative essays about the past and future of generalism in health care, Fitzhugh Mullan - a pediatrician, writer, and historian - argues that primary care is a fascinating, important, and still endangered calling. In conveying the personal voices of primary care practitioners, Mullan sheds light on the political and economic contradictions that confront American medicine. Mullan interviewed dozens of primary care practitioners - family physicians, internists, pediatricians, nurse practitioners, and physician assistants - asking them about their lives and their work. He explains how, during the last forty years, the primary care movement has emerged built on the principles of "big doctoring"--coordinated, comprehensive care over time. This book is essential reading for understanding core issues of the current health care dilemma. As our country struggles with managed care, market reforms, and cost containment strategies in medicine, Big Doctoring in America provides an engrossing and illuminating look at those in the trenches of the profession.   [brief]
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Title: American medicine: the quest for competence
Author: Good, Mary-Jo DelVecchio
Published: University of California Press,  1995
Subjects: Medicine | Science | Medical Anthropology | Public Policy
Publisher's Description: What does it mean to be a good doctor in America today? How do such challenges as new biotechnologies, the threat of malpractice suits, and proposed health-care reform affect physicians' ability to provide quality care?These and many other crucial questions are examined in this book, the first to fully explore the meaning and politics of competence in modern American medicine. Based on Mary-Jo DelVecchio Good's recent ethnographic studies of three distinct medical communities - physicians in rural California, academics and students involved in Harvard Medical School's innovative "New Pathway" curriculum, and oncologists working on breast cancer treatment - the book demonstrates the centrality of the issue of competence throughout the medical world. Competence, it shows, provides the framework for discussing the power struggles between rural general practitioners and specialists, organizational changes in medical education, and the clinical narratives of high-technology oncologists. In their own words, practitioners, students, and academics describe what competence means to them and reveal their frustration with medical-legal institutions, malpractice, and the limitations of peer review and medical training.Timely and provocative, this study is essential reading for medical professionals, academics, anthropologists, and sociologists, as well as health-care policymakers.   [brief]
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Title: Managing the medical arms race: public policy and medical device innovation 
Author: Foote, Susan Bartlett
Published: University of California Press,  1992
Subjects: Politics | Medicine | Public Policy | Economics and Business
Publisher's Description: The allure of medical innovation is powerful - it holds out the promise of perfect health, the end of pain, the deferral of death. Our insatiable appetite for costly new technologies, fed by a profusion of innovations and the profits they generate, has led to what has been dubbed the medical arms race. During the last several decades government has been called upon to manage the escalation of this race.Foote has written the first comprehensive examination of the profound influence of government policies on medical innovation. She explains how these policies have proliferated to affect every stage of the innovative process in medical device technology - from the first research idea to the patient's bedside. Drawing on case studies of technologies as diverse as lasers, cardiac pacemakers, CT scanners, and IUDs, she traces the interaction between the industry and government institutions, including the National Institutes of Health, the FDA, and the Medicare and Medicaid programs.Public policies during the 1950s and 1960s, Foote discovers, tended to promote innovation, while the regulation and cost controls of the 1970s and 1980s began to inhibit it. For the 1990s and beyond she proposes incremental policy improvements that will rationalize and streamline government intervention. She cautions that we must recognize the limits of medical technology and public policy to cure all ills.Medical innovation is a crucial part of health care reform, a subject of increasing complexity and controversy. Written clearly and accessibly, Managing the Medical Arms Race is an invaluable source for medical, industry, and policy professionals, but it also has much to say to anybody concerned with how we as a society choose to take care of our health.   [brief]
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Title: From the fat of our souls: social change, political process, and medical pluralism in Bolivia
Author: Crandon-Malamud, Libbet
Published: University of California Press,  1991
Subjects: Anthropology | Latin American Studies | Politics | Medical Anthropology | Medicine
Publisher's Description: From the Fat of Our Souls offers a revealing new perspective on medicine, and the reasons for choosing or combining indigenous and cosmopolitan medical systems, in the Andean highlands. Closely observing the dialogue that surrounds medicine and medical care among Indians and Mestizos, Catholics and Protestants, peasants and professionals in the rural town of Kachitu, Libbet Crandon-Malamud finds that medical choice is based not on medical efficacy but on political concerns. Through the primary resource of medicine, people have access to secondary resources, the principal one being social mobility. This investigation of medical pluralism is also a history of class formation and the fluidity of both medical theory and social identity in highland Bolivia, and it is told through the often heartrending, often hilarious stories of the people who live there.   [brief]
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Title: What I learned in medical school: personal stories of young doctors
Author: Takakuwa, Kevin M
Published: University of California Press,  2004
Subjects: Medicine | Sociology | Ethnic Studies | Gender Studies | Anthropology | Health Care
Publisher's Description: Like many an exclusive club, the medical profession subjects its prospective members to rigorous indoctrination: medical students are overloaded with work, deprived of sleep and normal human contact, drilled and tested and scheduled down to the last minute. Difficult as the regimen may be, for those who don't fit the traditional mold - white, male, middle-to-upper class, and heterosexual - medical school can be that much more harrowing. This riveting book tells the tales of a new generation of medical students - students whose varied backgrounds are far from traditional. Their stories will forever alter the way we see tomorrow's doctors. In these pages, a black teenage mother overcomes seemingly insurmountable odds, an observant Muslim dons the hijab during training, an alcoholic hides her addiction. We hear the stories of an Asian refugee, a Mexican immigrant, a closeted Christian, an oversized woman - these once unlikely students are among those who describe their medical school experiences with uncommon candor, giving a close-up look at the inflexible curriculum, the pervasive competitive culture, and the daunting obstacles that come with being "different" in medical school. Their tales of courage are by turns poignant, amusing, eye-opening - and altogether unforgettable.   [brief]
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Title: Genethics: moral issues in the creation of people 
Author: Heyd, David
Published: University of California Press,  1992
Subjects: Philosophy | Ethics
Publisher's Description: Unprecedented advances in medicine, genetic engineering, and demographic forecasting raise new questions that strain the categories and assumptions of traditional ethical theories. Heyd's approach resolves many paradoxes in intergenerational justice, while offering a major test case for the profound . . . [more]
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Title: Gypsy law: Romani legal traditions and culture
Author: Weyrauch, Walter O. (Walter Otto) 1919-
Published: University of California Press,  2001
Subjects: Law | Cultural Anthropology | Ethnic Studies | Sociology | European Studies | Political Theory
Publisher's Description: Approximately one thousand years ago Gypsies, or Roma, left their native India. Today Gypsies can be found in countries throughout the world, their distinct culture still intact in spite of the intense persecution they have endured. This authoritative collection brings together leading Gypsy and non-Gypsy scholars to examine the Romani legal system, an autonomous body of law based on an oral tradition and existing alongside dominant national legal networks. For centuries the Roma have survived by using defensive strategies, especially the absolute exclusion of gadje (non-Gypsies) from their private lives, their values, and information about Romani language and social institutions. Sexuality, gender, and the body are fundamental to Gypsy law, with rules that govern being pure (vujo) or impure (marime) . Women play an important role in maintaining legal customs, having the power to sanction and to contaminate, but they are not directly involved in legal proceedings. These essays offer a comparative perspective on Romani legal procedures and identity, including topics such as the United States' criminalization of many aspects of Gypsy law, parallels between Jewish and Gypsy law, and legal distinctions between Romani communities. The contributors raise broad theoretical questions that transcend the specific Gypsy context and offer important insights into understanding oral legal traditions. Together they suggest a theoretical framework for explaining the coexistence of formal and informal law within a single legal system. They also highlight the ethical dilemmas encountered in comparative law research and definitions of "human rights."   [brief]
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Title: The corporate practice of medicine: competition and innovation in health care
Author: Robinson, James C 1953-
Published: University of California Press,  1999
Subjects: Politics | Public Policy | Medicine | Economics and Business
Publisher's Description: One of the country's leading health economists presents a provocative analysis of the transformation of American medicine from a system of professional dominance to an industry under corporate control. James Robinson examines the economic and political forces that have eroded the traditional medical system of solo practice and fee-for-service insurance, hindered governmental regulation, and invited the market competition and organizational innovations that now are under way. The trend toward health care corporatization is irreversible, he says, and it parallels analogous trends toward privatization in the world economy.The physician is the key figure in health care, and how physicians are organized is central to the health care system, says Robinson. He focuses on four forms of physician organization to illustrate how external pressures have led to health care innovations: multispecialty medical groups, Independent Practice Associations (IPAs), physician practice management firms, and physician-hospital organizations. These physician organizations have evolved in the past two decades by adopting from the larger corporate sector similar forms of ownership, governance, finance, compensation, and marketing.In applying economic principles to the maelstrom of health care, Robinson highlights the similarities between competition and consolidation in medicine and in other sectors of the economy. He points to hidden costs in fee-for-service medicine - overtreatment, rampant inflation, uncritical professional dominance regarding treatment decisions - factors often overlooked when newer organizational models are criticized.Not everyone will share Robinson's appreciation for market competition and corporate organization in American health care, but he challenges those who would return to the inefficient and inequitable era of medicine from which we've just emerged. Forcefully written and thoroughly documented, The Corporate Practice of Medicine presents a thoughtful - and optimistic - view of a future health care system, one in which physician entrepreneurship is a dynamic component.   [brief]
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Title: Healing the masses: Cuban health politics at home and abroad
Author: Feinsilver, Julie Margot
Published: University of California Press,  1993
Subjects: Latin American Studies | Politics | Medicine | Public Policy
Publisher's Description: How has Cuba, a small, developing country, achieved its stunning medical breakthroughs? Hampered by scarce resources and a long-standing U.S. embargo, Cuba nevertheless has managed to provide universal access to health care, comprehensive health education, and advanced technology, even amid desperate economic conditions. Moreover, Cuba has sent disaster relief, donations of medical supplies and technology, and cadres of volunteer doctors throughout the world, emerging, in Castro's phrase, as a "world medical power."In her significant and timely study, Julie Feinsilver explores the Cuban medical phenomenon, examining how a governmental obsession with health has reaped medical and political benefits at home and abroad. As a result of Cuba's forward strides in health care, infant mortality rates are low even by First World standards. Cuba has successfully dealt with the AIDS epidemic in a manner that has aroused controversy and that some claim has infringed on individual liberties - issues that Feinsilver succinctly evaluates.Feinsilver's research and travel in Cuba over many years give her a unique perspective on the challenges Cuba faces in this time of unprecedented economic and political uncertainty. Her book is a must-read for everyone concerned with health policy, international relations, and Third World societies.   [brief]
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Title: Public health law and ethics: a reader
Author: Gostin, Larry O. (Larry Ogalthorpe)
Published: University of California Press,  2002
Subjects: Law | Medicine | Health Care
Publisher's Description: This incisive selection of government reports, scholarly articles, and court cases is designed to illuminate the ethical, legal, and political issues in the theory and practice of public health. A companion to the internationally acclaimed Public Health Law: Power, Duty, Restraint, this collection encourages debate and discourse about how courts, scholars, and policy makers respond to the salient legal and ethical dilemmas. The excerpts and commentaries in the reader analyze the legal and constitutional foundations of public health, juxtaposing them with the emerging importance of public health ethics and human rights. The book offers a systematic account of public health law, ethics, and human rights in promoting the common good. Gostin provides thoughtful commentary on the field of public health and carefully explains the meaning and importance of each selection. Scholars, legislators, and public health professionals, as well as faculty and students in schools of law, public health, medicine, nursing, government, and health administration, will benefit from the contemporary case studies covering a wide range of topics from bioterrorism to public health genetics.   [brief]
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Title: Power and illness: the failure and future of American health policy 
Author: Fox, Daniel M
Published: University of California Press,  1993
Subjects: Sociology | Medicine | History | American Studies | United States History
Publisher's Description: During most of this century, American health policy has emphasized caring for acute conditions rather than preventing and managing chronic illness - even though chronic illness has caused most sickness and death since the 1920s. In this provocative and wide-ranging book, Daniel Fox explains why this has been so and offers a forceful argument for fundamental change in national health care priorities.Fox discusses how ideas about illness and health care, as well as the power of special interest groups, have shaped the ways in which Americans have treated illness. Those who make health policy decisions have increased support for hospitals, physicians, and medical research, believing that people then would become healthier. This position, implemented at considerable cost, has not adequately taken into account the growing burden of chronic disabling illness. While decision makers may have defined chronic disease as a high priority in research, they have not given it such a priority in the financing of health services.The increasing burden of chronic illness is critical. Fox suggests ways to solve this problem without increasing the already high cost of health care - but he does not underestimate the difficulties in such a strategy. Advocating the redistribution of resources within hospital and medical services, he targets those that are redundant or marginally effective.There could be no more timely subject today than American health care. And Daniel Fox is uniquely able to address its problems. A historian of medicine, with knowledge of how hospitals and physicians behave and how health policy is made at government levels, he has extensively researched published and unpublished documents on health care. What he proposes could profoundly affect all Americans.   [brief]
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Title: The worth of a child
Author: Murray, Thomas H 1946-
Published: University of California Press,  1996
Subjects: Philosophy | Ethics | Medicine | Social Problems | Public Policy
Publisher's Description: Thomas Murray's graceful and humane book illuminates one of the most morally complex areas of everyday life: the relationship between parents and children. What do children mean to their parents, and how far do parental obligations go? What, from the beginning of life to its end, is the worth of a child?Ethicist Murray leaves the rarefied air of abstract moral philosophy in order to reflect on the moral perplexities of ordinary life and ordinary people. Observing that abstract moral terms such as altruism and selfishness can be buried in the everyday doings of families, he maintains that ethical theory needs a richer description than it now has of the moral life of parents and children. How far should adults go in their quest for children? What options are available to women who do not want to bear a child now? Should couples be allowed to reject a child because of genetic disability or "wrong" gender? How can we weigh the competing claims of the genetic and the rearing parents to a particular child? The Worth of a Child couples impressive learning with a conversational style. Only by getting down to cases, Murray insists, can we reach moral conclusions that are unsentimental, farsighted, and just. In an era of intense public and private acrimony about the place and meaning of "family values," his practical wisdom about extraordinary difficult moral issues offers compelling reading for both experienced and prospective parents, as well as for ethicists, social and behavioral scientists, and legal theorists.   [brief]
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Title: Paths to Asian medical knowledge
Author: Leslie, Charles M 1923-
Published: University of California Press,  1992
Subjects: Anthropology | Medical Anthropology | Asian Studies
Publisher's Description: Like its classic predecessor, Asian Medical Systems , Paths to Asian Medical Knowledge significantly expands the study of Asian medicine. These essays ask how patients and practitioners know what they know - what evidence of disease or health they consider convincing and what cultural traditions and symbols guide their thinking. Whether discussing Japanese anatomy texts, Islamic humoralism, Ayurvedic clinical practice, or a variety of other subjects, the authors offer an exciting range of information and suggest new theoretical avenues for medical anthropology.   [brief]
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Title: Rethinking the borderlands: between Chicano culture and legal discourse 
Author: Gutiérrez-Jones, Carl Scott
Published: University of California Press,  1995
Subjects: American Studies | Chicano Studies | Literature | Language and Linguistics | Law | Social and Political Thought | Rhetoric | Postcolonial Studies | United States History | United States History
Publisher's Description: Challenging the long-cherished notion of legal objectivity in the United States, Carl Gutiérrez-Jones argues that Chicano history has been consistently shaped by racially biased, combative legal interactions. Rethinking the Borderlands is an insightful and provocative exploration of the ways Chicano and Chicana artists, writers, musicians, and filmmakers engage this history in order to resist the disenfranchising effects of legal institutions, including the prison and the court.Gutiérrez-Jones examines the process by which Chicanos have become associated with criminality in both our legal institutions and our mainstream popular culture and thereby offers a new way of understanding minority social experience. Drawing on gender studies and psychoanalysis, as well as critical legal and race studies, Gutiérrez-Jones's approach to the law and legal discourse reveals the high stakes involved when concepts of social justice are fought out in the home, in the workplace and in the streets.   [brief]
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Title: Starting at home: caring and social policy
Author: Noddings, Nel
Published: University of California Press,  2002
Subjects: Politics | American Studies | Anthropology | Social and Political Thought | Political Theory | Public Policy | Social Problems | Public Policy | Sociology | Sociology
Publisher's Description: Nel Noddings, one of the central figures in the contemporary discussion of ethics and moral education, argues that caring--a way of life learned at home--can be extended into a theory that guides social policy. Tackling issues such as capital punishment, drug treatment, homelessness, mental illness, and abortion, Noddings inverts traditional philosophical priorities to show how an ethic of care can have profound and compelling implications for social and political thought. Instead of beginning with an ideal state and then describing a role for home and family, this book starts with an ideal home and asks how what is learned there may be extended to the larger social domain. Noddings examines the tension between freedom and equality that characterized liberal thought in the twentieth century and finds that--for all its strengths--liberalism is still inadequate as social policy. She suggests instead that an attitude of attentive love in the home induces a corresponding responsiveness that can serve as a foundation for social policy. With her characteristic sensitivity to the individual and to the vulnerable in society, the author concludes that any corrective practice that does more harm than the behavior it is aimed at correcting should be abandoned. This suggests an end to the disastrous war on drugs. In addition, Noddings states that the caring professions that deal with the homeless should be guided by flexible policies that allow practitioners to respond adequately to the needs of very different clients. She recommends that the school curriculum should include serious preparation for home life as well as for professional and civic life. Emphasizing the importance of improving life in everyday homes and the possible role social policy might play in this improvement, Starting at Home highlights the inextricable link between the development of care in individual lives and any discussion of moral life and social policy.   [brief]
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Title: Lives at risk: public health in nineteenth-century Egypt 
Author: Kuhnke, LaVerne
Published: University of California Press,  1990
Subjects: Anthropology | Medical Anthropology
Publisher's Description: Lives at Risk describes the introduction of Western medicine into Egypt. The two major innovations undertaken by Muhammad Ali in the mid-nineteenth century were a Western-style school of medicine and an international Quarantine Board. The ways in which these institutions succeeded and failed will greatly interest historians of medicine and of modern Egypt. And because the author relates her narrative to twentieth-century health issues in developing countries, Lives at Risk will also interest medical and social anthropologists.The presence of the quarantine establishment and the medical school in Egypt resulted in a rudimentary public health service. Paramedical personnel were trained to provide primary health care for the peasant population. A vaccination program effectively freed the nation from smallpox. But the disease-oriented, individual-care practice of medicine derived from the urban hospital model of industrializing Europe was totally incompatible with the health care requirements of a largely rural, agrarian population.   [brief]
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Title: Practicing virtues: moral traditions at Quaker and military boarding schools 
Author: Hays, Kim
Published: University of California Press,  1994
Subjects: Sociology | Philosophy | Education
Publisher's Description: Practicing Virtues is about learning to be good in the distinct moral worlds of Quaker and military boarding schools. Both types of schools bind their communities with shared codes of conduct, the military schools' conservative tradition emphasizing discipline and hard work, the Quaker schools' liberal tradition favoring tolerance and togetherness. At the heart of this contrast are two sets of virtues: pride, loyalty, and leadership among the cadets; simplicity, equality, and concern among the students at Quaker schools.During the course of a year Kim Hays lived in six schools, attending classes and staff meetings, sharing meals and informal conversation, and participating in the nonacademic side of boarding-school life.Despite the outward contrast between the Quaker and military settings, Hays found surprising similarities. Both systems cherish individualism while encouraging group identification and service to the school community. Hays shows that orderliness, obedience, and harmony do not in themselves create a vital moral environment. To reach that goal, teachers, students, and administrators need to disagree, question rules, and fight for change.This book has much to say about the role of education in developing moral responsibility. Every educator, student, and parent who cares about the future of American schooling will find valuable lessons here.   [brief]
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