Book Reviews 1751 impose responsibility on the worker~ rather than the employer, or the system in which we operate (p.74). Vines' argument demolishes the ideology of freedom of choice and individual responsibility in the management of life and health, along with the essentialist discourses around hormones, genes and brain chemistry. Raging Hormones is a remarkably informed analysis of the scientific literature which has dwelt on this topic for a century of experimental endeavour. It brings to that analysis a perspicacious understanding of the cultural and sociologi- cal parameters of human behaviour and the epistemological groundings of those understandings. I would recommend this eminently accessible book to a readership of the widest educational engagement--to devotees of both the natural and the social sciences and to all who would better under- stand the human conditions under which women and men live out their lives. School of Sociology University of New South Wales Sydney 2052. Australia Ann Daniel Setting Priorities in Health Care, edited by M. Malek. John Wiley & Sons, Chichester, 1994. 332 pp., ISBN 471 94394 0. There are some books that have automatic intrinsic value. At this point in time, any book on health care priorities, rationalization, and routes to budget cuts, will find a sure readership. Almost anywhere in the world public health leaders, politicians, health care managers and practitioners are confronted with the rhetoric that urges them to cut budgets, programmes and practices for health. Setting Priorities in Health Care is therefore a timely publication, published relatively soon after the meeting that constituted the source of its contributions, the Second S.vmposium in Health Care Strategy held at the University of St Andrews, Scotland, in March 1994. Mo Malek describes in the Editor's Preface how over 200 experts from 20 countries gathered at the meeting to discuss a wide variety of prioritization issues, be they ethical, technocratic, economic or policy inspired. Such an introduc- tion whets the appetite! Yet, the overall impression of the book is, as with any collection of conference papers, that on the one hand the quality of contributions varies hugely, whereas on the other hand the geographical distribution of the authors is limited. To start with the latter, of 53 contributors to the volume, 40 are from Britain, 9 from Quebec (Canada), 3 are from Limburg (The Netherlands), and one is from a place unfamiliar to me. What happened to the other 147 experts from 16 countries? Do we see some selection bias? Is that also the reason that there is no talk whatsoever of any U.S. experiences--outside the near- proverbial Oregon exercise that by now seems to have acquired a hors concours quality? The budgeting mechan- isms and diagnosis-related rationalization tools developed in the U.S. experimented with in many other countries, hardly find a place in the current volume. Most of the chapters in Setting Priorities in Health Care deal with dimensions of the purchaser~rovider split in the British National Health Service. Though politically a relevant research priority, in health terms this is not. Charles Normand, author of the last chapter of the book, says in wrapping up: "Priority setting should be based on health gain, measured by a combination of longer life and better health-related quality of life. (...) Constraints to prioritizing on this basis come mainly from poor evidence, weak policy levers and political opposition." The book neither emphasizes health gain, nor provides a consistent analysis of the "weak policy levers and political opposition" in health care prioritizing. The strength of the volume is in its collection of a variety of rather successful efforts demonstrating effectiveness, providing evidence, arguing for a specific rationalization tool. However, the feasibility of rationalization measures ultimately depends on appropriate policy levers and political support. A number of authors attempt to link these concepts. I was especially charmed by an excellent piece by the majority of Qu6becois mentioned above (Denis, Lemay, Contandropou- los, Champagne, Ducrot, Fournier and Avocksouma) who ask themselves in Chap. 20 why a relatively simple task of bringing order to things has not worked in the health care field. Halfway through a wonderful analysis they reach this conclusion: "[This makes] it clear that the regulatory prob- lem can be defined as the difficulty of finding proper mechanisms to move from macro technocratic regulation to micro regulation of a health system. The fundamental problem is to search for regulatory options that will create new dynamics in the public health care system, based on a broad technocratic framework." One tends to agree with that observation until you realize that previously, in Chap. 18, Szczepura, Sidhu, Cobb, Cooper and Geller investigated such micro regulation and came up with quite disturbing results: 81% of the general public found that preventive services should, in times of monetary scarcity, be defunded. That reinforces the idea that 'health' per se is not a value, but that the public prioritizes on the basis of level of techno-service. That indeed is bad news for public health! Does that mean that 'health' has to be marketed better (ideologically in line with the apparent market principles that seem to drive the rationalization argument)? Annabelle Mark, in another challenging chapter, argues the contrary: some health services should be de-marketed (where she distinguishes between general, selective, ostensible and unintentional demarketing). This discussion of a selection of chapters shows the strengths and weaknesses of the book: it provides a number of quite creative arguments for and against rationalization in health care; it does so from a rather ethnocentric (even anglocentric...) perspective. A proper discussion of the latest in global rationalization (the World Bank Report's DALYs, the Disability Adjusted Life Years) is absent. Further, the authors do not manage to step beyond the disease paradigm into a health and salutogenesis perspec- tive. But maybe health economists, like medical doctors, deal better with disease than they do with health. HEALTH, the Maastricht Evelyne de Leeuw Health Research Institute for Prevention and Care University of Limburg, Maastricht The Netherlands