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SummaryPrevention has been underdeveloped in the public health arena, at least in France. It is a complex discipline, relying both on strong scientific methodology as well as social and economical considerations, which may be sometimes a source of conflicts.

This article, as part of a broader analysis of the fate of the Local Community Service Centres (CLSCs), documents the radically democratic conception of health, healthcare and its management put forth by the popular clinics that emerged in Quebec at the end of the 1960s and which directly inspired the creation of the CLSCs. A rediscovery of this radical model sheds light on current debates about the public healthcare system and the Reform of Social Affairs in which the latter is rooted.

Keywords: clinique communautaire de Pointe-Saint-Charles, démocratisation, conception de la santé, modèle de gestion, système de soins, Pointe-Saint-Charles Community Clinic, democratization, conception of health, management model, healthcare system

In France, palliative care should meet a “means obligation” in taking charge of people at the end of their life. Being part of social imaginary, it could seem adequate to the willingness of the majority of the carers to address as best as possible this ultimate period of life. However, this aspiration – that we absolutely not questioning here – could are meet many obstacles in practices. This distance between theory and practice need to be named and reflected in order to recognize in their suffering, address and sustain the carers engaged in this kind of care.

Keywords: soins palliatifs, souffrance morale, éthique, limite, palliative care, suffering, moral, ethics, limits

Background: Caribbean graduates contribute significantly to the US healthcare workforce. The accreditation requirements of local governments vary from one Caribbean island to another island. The Educational Commission for Foreign Medical Graduates (ECFMG) requirement that all future applicants be graduates from accredited medical schools drove Caribbean medical schools to seek accreditation. Accreditation has been found to significantly impact the educational processes of Canadian medical schools. Our study aims at investigating Caribbean medical school leaders’ perceptions of the impact of accreditation on their school’s processes. Methods: This qualitative study and data analysis were done using a framework analysis. Academic leaders and faculty members from three different types of Caribbean medical schools (accredited, denied-accreditation schools, never applied for accreditation) were interviewed using semi-structured interviews. Results: A total of 12 participants from six different Caribbean medical schools participated in the interview process. Themes of processes influenced by accreditation at Caribbean medical schools were similar to those found in the Canadian context and align with best practices of Continuous Quality Improvement (CQI). Conclusions: Caribbean medical schools are changing their educational processes as a result of accreditation requirements. Some processes are not maintained in a continuous manner, raising questions about the development of a true CQI culture.

Modern medicine's field of action has generally been defined as the modification of the space of the body itself, though it has been broadened to include social space, in which the body is disciplined. Current forms of medicalisation, which are based on an unprecedented temporal inscription of the body represent a paradigm shift. Concurrently, the regulation of bodies generally operates through the internalisation of a temporal norm (recourse to drugs). This article show how the current medicalisation of the social is shifting from a disciplinary logic (spatial investment of the body) to a transformation of its temporal structure.

SummaryAmong the key benchmarks in assessing research excellence is the production and recognition of scientific discoveries for innovation. Despite the growing use of bibliometric indicators for policy-making purposes, there is still no consensus concerning the appropriate measures of research excellence. In this study, we examine the performance of France in biomedical sciences using several ISI-based indicators. We focus on the results provided by these two selective indicators: the absolute numbers and proportion of papers published in the very high-impact journals (above 20) and in the 1 % of the most highly cited papers. Furthermore, we present the detailed analysis of the Top 1 % French biomedical articles. On this basis we identify the crucial fields, the most active centres per speciality and the networks and the degree of international collaboration resulting from different types of research. These results provide an objective demonstration that the French biomedical research meets with high international standards and contributes to the world core research.

The Belgian social security programme has never sought to go beyond its initial objective of covering the costs of medical treatment. The programme has never been an instrument of health policy and it has never sought to establish an organized health service.The result is, of course, to ensure the prosperity of liberal-type medical practice and a spectacular rise in costs.The socialist union, FGTB, demands first of all, that medical costs be financed through progressive income taxes and secondly, that a comprehensive programme of public health be defined and oriented towards the protection of collective health and preventive medicine. As well, the programme should include a network of user-controlled community health establishments with a social and community orientation.

SummaryAn analysis of the role of a professional corporation such as The College of Physicians and Surgeons of the Province of Quebec requires a certain analysis of the market for medical services.THE MARKET FOR MEDICAL SERVICESCan the market for medical services be analysed through the model of perfect competition? This question is an important one because if the answer is yes, the policy of the state should then be limited to an action which would permit the mechanisms of competition to function freely. The access to the market should be left entirely free and submitted only to the choice of the consumers.It does not seem however that the perfect competition model is very well adapted to an analysis of this market even if some of the observed phenomena on this market can be analysed with such a model. This opinion is based on the following considerations :Society considers access to medical services as a right for all.The character of emergency and absolute necessity of certain medical expense sometimes leaves no alternative to the consumer, whatever his financial means. The insurance mechanism aimed at easing such situation also alters the competitive nature of the market.The relative positions of the physician and his patient are not positions of equality. The ordinary patient evaluates imperfectly the efficiency of the treatment received and the quantity of care he buys is usually determined by the seller.Medical services engenders internal and external economics which are not always fully appreciated by the consumer.CONTROL OF MARKETThe particular structure of the market for medical care makes it necessary to have certain control established on this market e.g. compulsory vaccination, quarantine or confinement, and also quality control for the persons admitted to distribute the service.A corporation such as the College of Physicians and Surgeons of the Province of Quebec exists primarily to exercise such control on the quality of medical services; control which is necessary to maximise the social efficiency of the system. The efficient exercise of this control however is function of some very important powers which must be granted to the corporation; especially the power to control the access to the profession i.e. the licensing power.THE PHENOMENON OF SOCIALISATIONThe distribution of medical services is presently experiencing rapid changes. Medicine is now less and less an individual matter and more and more a question of collective or social organization.With the advent of insurance programs organized with or by the governments, the consumers of health services tend to be grouped in one or a few large organizations with definite monopsonistic features.The equilibrium of the market requires that the sellers of the services also get organized. The question then is: « Can the professional corporation, whose role and power we just defined, assume the responsibility of defending the doctors' interests vis-a-vis the buyer of services? »It does not seem possible to answer yes to this question without creating for the corporation a situation of conflict of interests. As a licensing body, the corporation controls to a certain extent the quantity of doctors and consequently has an indirect control over prices. On the other hand, the function of the structure responsible of defending the interests of the doctors would be to obtain the best possible working condition including remuneration.