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Book Reviews

Journal of Policy Analysis and Management, Vol. 17, No. 4, 721–748 (1998)© 1998 by the Association for Public Policy Analysis and ManagementPublished by John Wiley & Sons, Inc. CCC 0276-8739/98/04721-28

Note to Book Publishers: Please send all books for review directly to the BookReview Editor, Professor Laurence E. Lynn Jr., Harris Graduate School ofPublic Policy Studies, University of Chicago, 1155 E. 60th Street, Chicago,IL 60637.

Walter Williams

Why People Don’t Trust Government, edited by Joseph Nye, Philip Zelikow,and David King. Cambridge, MA: Harvard University Press, 1997, 339 pp.,NPA.

The University of Washington’s Graduate School of Public Affairs startedits Trust in Government Project in 1995 because of its disquiet over thepotentially adverse impact of rising distrust on a school committed toeducating high-level civil servants, on the governments its graduates serve,and on the nation itself. Although the Founding Fathers feared excessivefederal government power and saw citizens exerting a healthy skepticism asa central element of American governance, the nature and level of the distrustin the national government by the 1990s appeared to be out of hand. Ideologyand meanspiritedness dominated politics; the federal government had cometo be seen as the problem, never part of the solution, at least in domesticpolicy. Professors and media pundits set forth dire warnings of the dangers todemocracy of the rising government distrust. The damage, however, has notbecome evident. Despite campaign scandals, a plethora of special prosecutors,and alleged presidential indiscretions in Arkansas and the White House, theeconomy has reached levels not seen since the 1960s, and people have feltmore bullish on an America that stood again as the world’s economicpowerhouse. As the economy has soared, trust in the federal governmentrose from a low of 21 percent in 1994 to 38 percent in late 1997 and thendropped in early 1998 to 34 percent as accusations of the president’s allegedsexual affairs increased. These events have led to the “so what” question: Doesthe distrust in government really matter? No certain answer emerges. Whatis clear is the need for more reasoned debate and analysis on a question that

Laurence E. Lynn Jr.Editor

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is exceedingly complex.A problem in that regard has been the lack of a study that provides both a good

introduction to the distrust issue and an insightful analysis of it in broad perspective.Why People Don’t Trust Government, edited by Joseph Nye, Philip Zelikow, and DavidKing (all at Harvard University’s Kennedy School of Government), now fills this needwith a number of essays by the editors and an array of scholars, mainly from Harvard.Readers should appreciate the breadth of the essays and the divergence of views in aburgeoning new area of scholarship. Moreover, Nye and Zelikow in the final chapteraptly entitled “Conclusions: Reflections, Conjectures, and Puzzles” skillfully lay out aframework for considering the trust issue, indicate the disagreements among theauthors, and highlight the speculations and the many unknowns in the emergingstudy area. Moreover, for those like the reviewer who have been unable to offer agood answer to the often-asked question of where to find a relatively short introductionto the trust issue, the final chapter and Nye’s “Introduction: The Decline of Confidencein Government” do the job in a little under 50 pages.

The edited volume offers diverse, and at times conflicting, opinions about possiblecauses and the still undetermined consequences of the fall in trust in government.The greatest strength of Why People Don’t Trust Government is its healthy skepticismabout harm and its presentation of differing views about the potential dangers ofdistrust. This review essay first considers a number of the potential causes spelledout by the various authors and then assesses the prime suspects chosen by Nye andZelikow in the final chapter. Although their choices are reasonable as far as they go,this review essay goes a step beyond to discuss at some length key factors I believeare at least equally important in analyzing the trust in government issue. One finalintroductory comment needs making: My own bias is the strong belief that: (a) thecontinuing high levels of public distrust are harmful to effective governance; and (b)the disrespect for the government institutions crafted by the Founding Fathers andthe flight from responsible citizenship do threaten severe damage to Americandemocracy.

The Nye, Zelikow, and King edited volume is not the first book on trust ingovernment, but it is a particularly important one because of its already-mentionedbroad perspective that provides a base for research and discussion of the subject andits wide scope of coverage. Another virtue is balance. As to the latter, consider brieflytwo useful books, one by Michael Sandel [1996] that offers a conservativecommunitarian perspective and the other by Jacob Weisberg [1996] that gives a liberalslant. Both add to the trust in government debate and cover in-depth issues and pointstouched on only briefly at best by Nye, Zelikow, and King. Sandel [1996] emphasizescommunity institutions and civic virtue—what he labeled the “political economy ofcitizenship.” Weisberg [1996] provides an extended critique of partisan politics andthe trust question, and a useful discussion of what government should and shouldnot do. However valuable, neither of the books set the stage as Why People Don’t TrustGovernment does. I read the Sandel and Weisberg books that came out in 1996 beforethe edited volume but would recommend reading the latter first as a base for thesetwo books and others more narrowly focused and more partisan than Why PeopleDon’t Trust Government.

The Essays

Nye’s introductory essay begins with the often-noted points that trust in the federalgovernment to do the right thing has fallen from 75 to 25 percent since 1964 and thatgovernments are not alone, with almost all other major institutions, such as the media,

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suffering large declines since the 1960s. He then makes a central point that goes tothe heart of the distrust in government issue:

Whatever the symptoms, we should not overly worry about causes if the consequences do notmatter. The “So what?” question comes first. One possibility is that the current symptoms area sign of health. The United States was founded with a mistrust of government. The AmericanConstitution was deliberately set up in such a way that a King George could never rule over usagain. . . . A long Jeffersonian tradition says we should not worry too much about the level ofconfidence in government. If the polls reflect wariness rather than cynicism, the results maybe healthy.Second, if you look not at the way government works day to day but at the underlying consti-tutional framework, the public opinion polls are still positive. If you ask Americans what is thebest place in the world to live, 80 percent say the United States. If you ask them whether theylike their democratic system of government, 90 percent say yes. . . . Most people do not feel thesystem is rotten and has to be overthrown. . . . Something is steady, even though there is lessconfidence in governmental institutions than there was three or four decades ago. (pp. 2–3)

It is well to start with a healthy skepticism, but the advice—take two aspirin and callagain in the morning if pain persists—is hardly satisfying, nor does it seem sufficientin light of the deterioration in the political system in the last several decades.

Nye claims judiciously that the available evidence indicates “the sky is not falling,neither is all well with the world” (p. 5). More investigation is needed, and the essaysdo so by addressing three key aspects of government: its scope (what it does), itsactual performance, and its perceived performance. The last two underscore the pointthat how well people think the government is performing may be far more importantthan the actual outcomes. The essays consider why there has been so large a declinein trust over the previous three decades by looking at economic, political, andsociocultural hypotheses about causes. Nye indicates that “the purpose of this bookis not to provide solutions, but to clear the ground so that we may have a betterunderstanding of where we are in the evolution of democratic governance” (p. 5).That appears to be the purpose that now drives a number of researchers, includingthe reviewer in light of this uncomfortable circumstance: Some of us think the risingdistrust is hurting the political system and well may be a threat to American democracyover time, but do not understand its causes sufficiently either to be confident thatchanges are actually needed or to indicate with any degree of confidence what changeswill do less harm than good.

Harvard historian Ernest May’s essay sweeps from the 17th century to the presentin considering the scope of government. Before the 17th century in Europe, the scopeof government had almost no limits; it was “the individual’s only source of hope forprotection” (p 23). There followed three “technological-economic-social revolutions”with the first running from about 1760 to 1850 and involving major increases inagricultural productivity and a shift in manufacturing from human and animal energyto steam and waterpower. The second industrial revolution from 1850 to 1950 wasdriven by vast changes in transportation and communications and the advent of massproduction. The last revolution that is still in progress features information and itsrelated technologies. Each industrial revolution transforms culture and society, andputs different demands on governments. The scope of government that fits well withthe needs of one era may be—more accurately, almost certainly will be—harmful inthe next one. Professor May’s central point is that the critical systemic issue of the fitbetween the current scope of the American government and what the new industrialrevolution demands for effective governance hangs over the entire trust in government issue.

Former Harvard University president Derek Bok asks whether the harsh public

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judgment of federal government performance is reasonable or whether Washingtonis being made the scapegoat for America’s ills, many of which are beyond government’sreach (and should be). Bok considers over 60 “specific objectives of importance tomost Americans” (p. 61) to analyze how the federal government has done over threedecades by comparing the early 1960s with the 1990s and then over a shorter periodby comparing 1960–1975 with 1975–1990. He uses performance measures, such asper capita income, amount of water pollution, the percentage of various demographicgroups in poverty, and the percentage of the population owning homes, to arrive at anumber of important judgments. First, the United States has made “definite progress”(p. 61) over the three decades in the great majority of comparisons, leading Nye andZelikow to conclude: “If he is correct, then the straightforward explanation thatdiminished confidence in government reflects diminished performance by governmentis wrong” (p 256). Second, the evidence is mixed on whether performance hasdiminished over the last 20 years. Third, there is “little evidence to support thewidespread impression that government inefficiency squanders huge amounts ofmoney” (p. 62); moreover, when it does, the results generally come from weak policies,not inept management. Put differently, the usual government failure is not frommismanagement by the civil servants (the machinery of government), but from thepoorly designed or just plain bad policies of their political masters. Fourth, whencompared with Britain, Canada, France, Germany, Japan, and Sweden—all of whichhave had their own governance problems—Bok finds that “in roughly two-thirds ofthese cases, the United States has performed less well than most of the other nationssince 1960. In roughly half of the cases, our record is actually at or near the bottom ofthe list” (p. 63, emphasis in original). Bok’s analysis does not show that good of aperformance record either in more recent times or compared to a number of othernations. At best the record does suggest that the public’s perception of federalgovernment performance and the actual record could be out of kilter, although theNye and Zelikow statement appears to be too strong.

Both Gary Orren and Robert Blendon et al. offer separate but closely relatedchapters that provide an extended portrait over the last three-plus decades of thedecline in public trust. The latter chapter is written by a group of people from Harvard,the Henry J. Kaiser Foundation, and the Washington Post, and draws from an extendedsurvey effort by the three institutions. In only 10 pages (the chapter might be addedto the brief packet of background reading on trust), Blendon et al. provide an excellentoverview of the dimensions of the fall in public trust and the broad reasons for it,including perceived government failures and the loss of confidence in political leaders.Orren makes the basic argument that factors outside of government, such as rapidinformation and technology transformations, are powerful factors affecting trustbut that “the steady descent of trust is intimately tied to the government itself, andnot simply a by-product of external trends” (p. 93). He considers the hypothesis thatthe media are the prime cause of the rising distrust but rejects the thesis because itgrants too much independent influence to the media. He argues that the media oftenare just doing their job, such as reporting on setbacks in Vietnam or on the savingsand loan crisis. In these two cases, governments directly committed egregious errors,and it cannot be claimed legitimately that the media misshaped public perceptionby distorting actual performance. But having defended the media, Orren thenobserved: “Government bashing has become a powerful stream of dissatisfaction inits own right. . . . [T]he denunciation of government by political leaders and thepress. . . . is now a dependable and constant feature of the contemporary politicalculture” (p. 95).

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Orren’s thesis seems to say government in and of itself at times performs badly; themedia are not the driving factor in making government look bad—but governmentbashing by the media and politicians as reported by the media is a constant factorfueling public mistrust. That the argument does at times seem in conflict reaffirmsour present lack of understanding of the distrust issue. But both essays do make onecritical point: Confidence plummeted after America became heavily involved inVietnam and the nation learned of Watergate in 1972. Public distrust varies after thissharp drop but always at much lower levels. The early 1970s opened a Pandora’s boxthat has yet to be shut.

Robert Lawrence offers a rich analysis of whether the economy is the main culpritin the declining trust in government that will be summarized only briefly. Mostimportantly, his digging into the economic data, however, reveals no straightforwardrelationships. As Nye and Zelikow noted: “Lawrence pointed out that any simpleeconomic hypothesis is undermined by two problems: (1) trust in government startsfalling in the mid-1960s, while economic performance is still strong, and (2) trust ingovernment falls among rich and poor citizens alike. . . . Confidence in governmentdeclines for winners and losers alike” (p. 258). This startling outcome suggests largerforces at work but not which ones.

Jane Mansbridge’s comprehensive and provocative essay considers the impact ofbroad social and cultural changes on the increasing distrust in government. She seessociocultural changes, such as the fast-growing elderly population and the increasein female-headed families, leading to rising expectations and “government overload,”where the public wants the government to solve problems beyond its powers or elseseeks government solutions but is unwilling to pay taxes sufficient to treat them.Further, Professor Mansbridge argues: “Another part of the explanation surely derivesdirectly from a combination of social and cultural causes: a decline from a post–World War II high, mounting cynicism about authority, increased negativism in themedia, and growing normative divisions within the country” (p. 152). Mansbridgeends her essay with an apt warning: “When a major economic crisis next emerges, ashistory suggests it will, the governments of the major democracies will be far betteroff if they have found ways to become sufficiently resilient, competent, and just torespond in ways the public will trust” (p. 153).

David King sees deleterious changes in the Democratic and Republican parties as akey aspect of the falling trust in government. The two parties have shifted to the rightand the left much more than the electorate, and the party leaders have becomeincreasingly ideological. King’s main thesis can be summed up as follows: “The politicsof polarization is the politics of mistrust. . . . [T]he declining fidelity to party labels. . . [and] the rising partisanship among political elites in Congress . . . point to agrowing gap between the interests of political elites and the preferences of averageAmericans. . . . The growing gap . . . is being filled with cynicism, mistrust, andfrustration that our leaders do not care about 'our’ problems” (pp. 156, 178). Thissound and fury of polarized partisanship may bring far less harm than political analystssuch as King think they do. The American political process may be ugly to view andat times look to be out of control, but the counterargument is not to be dismissedlightly that the mysterious workings of the American political system will save theday. However, King is persuasive that the political elites less and less reflect citizens’views, and I find that disturbing.

Political scientist Richard Neustadt analyzes the capacity of the American politicalsystem to perform effectively in the face of rampant distrust. He argued thatgovernments in selling programs have often overpromised and thus have undermined

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even moderate success. The perceived failure comes about because the actual resultsare measured against the unrealistic expectations born of too rosy a picture beingpainted at the outset. Neustadt lamented: “The consequences I conceive as truly andcontinually damaging for timely innovation in governmental programs, forthoroughgoing implementation of them, and for realistic expectations about them—hence for media approval and citizen satisfaction” (pp. 180–181). Neustadt goes onto point out that mistrust has it uses in undercutting programs and in diverting thepublic’s concern about unmet needs. Claiming that the federal government is ineffectiveand not trustworthy becomes a powerful weapon against needed programs, bothnew and existing ones. Just so.

Neustadt considers a number of causes already discussed, but one is worth delvinginto because unlike Lawrence, he sees a critical economic impact that has sweepingpolitical implications. Neustadt singled out the group “we once called the blue-collarmiddle class, now joined by various white-collar counterparts, more white than black,and mostly males, whose fathers were prime beneficiaries of post–World War IIprosperity” (p. 197). This “anxious class” is made up of “mainly heads of householdin the family income bracket of $30,000 to $50,000 but with ranks now swelled byfears of downsizing to brackets below and above, and to those with white-collars aswell as blue” (p. 197). Neustadt specifies one bracket as central and then proceeds togo above and below it but is not precise about how far. The problem is that we do notknow enough to be more specific. Recall that economic winners and losers are bothincreasingly distrustful. Nye and Zelikow in their discussion of the Neustadt essaytry to explain the winners’ distrust as follows: “Wealthier voters have always mistrustedgovernment more, and their ideological preferences may have increasingly outweighedtheir pocketbook experience in the aftermath of Vietnam and Watergate” (p. 261).They also think that wealthier and better-educated citizens may be more sophisticatedand hence increasingly distrustful over time but add that “there is no received wisdom,and the puzzle persists” (p. 261). Is there an anxious class of citizens fearful for theirown future and that of their children unless their offspring can be highly educated,perhaps a dim prospect as the parents lose out economically? Looking at the totalincome distribution may well be misleading because something important ishappening in the middle of it that increases distrust, but how to disaggregate thedistribution, as Rogers and Hammerstein wrote in The King and I, “is a puzzlement.”

University of Michigan political scientist Ronald Inglehart focuses on culturalchanges in a large number of nations by employing the World Values and Euro-Barometer surveys. One factor occurring in advanced industrial nations isimportant for the analysis of rising distrust in America: “[The] conditions ofprosperity and security are conducive to 'postmaterialist’ values of individualautonomy and diminished deference to authority, but that does not meandiminished political participation or alienation” (pp. 262–263). For example, Nyeand Zelikow indicate that such activities as writing letters to government officials,attending meetings, and engaging in protests continue to be “more robust thanvoting behavior” (p. 277). Inglehart points out that the issue of whether politicalparticipation is going up or down comes about because of two opposite forces:“[E]lite-driven participation is eroding, but more autonomous and active formsof participation are rising” (p. 233). These two forces complicate analysis, butthe increased individualism moving toward libertarianism and the decline indeference are particularly important in the United States in part because theConstitution still rests so heavily on the notion of citizens’ rights being bound upwith citizens’ responsibilities.

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The Prime Suspects

Beyond their excellent review of the book’s essays, Nye and Zelikow seek to synthesizethe hypotheses set out by the individual authors about the causes and the impact ofhigh distrust in government. The effort yields 17 hypotheses on falling trust fromwhich they eliminate several. The most likely factors are “illusory expectations ofwhat government can do (particularly for the World War II generation),” the media’sharsh criticism of government, libertarian or postmaterialist values that spurnauthority, and the wide split between political elites and ordinary citizens (p. 268).They also set out two deep structural changes: the third industrial revolution and thesociocultural shift toward the individual that has reduced the authority of allinstitutions. Nye and Zelikow’s combination of some of the most promising factorsfrom the long list and the structural changes provides their “short form of this story”(p. 275) of declining trust in America:

[H]istorical events in the 1960s and early 1970s (Vietnam and Watergate) precipitateda drop in confidence in the U.S. government, but the effects . . . have been broader and longer-lasting because of (1) long-term secular changes in sociocultural attitudes towards authorityand traditional social order that came to a head in the 1960s; (2) profound economic changescaused by the information revolution and globalization; (3) changes in the political processthat increased the distance between the political activists and the public; and (4) a more con-sistently negative approach by the press to government and other institutions. Together, thesechanges have reinforced a popular culture of bad government. (pp 275–276)

Nye and Zelikow’s “story” is an impressive one. I would include the aforementionedfactors on the short list of primary suspects causing the fall of trust in governmentand other institutions. My problem is that Nye and Zelikov exclude two of the factorsthat appeared on their first list that I think are equally, if not more, important thanthose they single out: (a) expectations and what the authors label as the “World WarII effect” (p 269); and (b) the rise of libertarianism and the subsequent hard-coreantigovernmentalism.

A Bigger Picture

Professor May took a long historical view and usefully moved across more than twocenturies to look at three industrial revolutions. In addition, an intermediateperspective of nearly 70 years starting with the Great Depression is needed in analyzingtrust in government and the public expectations that are related to it. Three keyeconomic periods are important for our purposes: the scarcity years of the GreatDepression and the war itself, the abnormally high-growth years after Americademobilized from the war, and the period of weak productivity that started with thefirst Organization of Petroleum Exporting Countries (OPEC) price hike in 1973 andthat appears to have ended in the 1990s, a point returned to later. The middle periodof American economic hegemony that unexpectedly did not last—what I have labeled“the Truncated American Century” [Williams, 1997]—is the pivotal time shaping theexpectations of the prewar generations and the Baby Boomers. The war effortrevitalized American business, and the nation’s people came to peacetime withoptimism about the future, available funds to spend, and a strong faith in the capacityof the country and its government to perform effectively. As the Brown Universityhistorian James Brown observed: “No comparable period of United States historywitnesses so much economic and civic progress. In this golden age it often seemed

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that there were no limits to what the United States could do both at home and abroad.. . . With 7 percent of the world’s population in the late 1940s, America possessed 42percent of the world’s income and accounted for half the world’s manufacturing output”[Patterson, 1996, pp. vii–viii, 61]. Per capita income far exceeded that of other nations.America, like Rome, stood as an economic colossus astride the world.

How people assess their experiences in one period much depends on the immediatepast. Critically important for how the parents of the Baby Boomers came to seethemselves in the postwar era was the combination of the terrible economic hardshipsof the 1930s, the efforts of the federal government to cope with the worst depressionin the nation’s history and win World War II, the war-induced scarcity, and theemergence of the nation as the world’s economic and geopolitical hegemon. Thosewho lived through the prewar and war years experienced a level of well-being duringthe Truncated American Century undreamed of in the Great Depression. The BabyBoomers—born and raised in the abnormally prosperous times of the early postwaryears—took the bounty of that later period as their birthright. Doing better than theirparents seemed a realistic expectation in light of their childhood experiences. Hence,they held tightly to the core belief of the postwar era in ever-expanding economicprogress by families and their children. Families from the Great Depression yearssaw their income and assets (especially homes) rise far beyond what they imaginedin the grim 1930s. They were able to send their children to prestigious universitiesand colleges, and see them become esteemed professionals. But for many of thesechildren, the promise went unfulfilled as the abnormally high productivity growthrate fell precipitously. The Baby Boomers prospered, but not at the expected levels.Call them whiners, call them unrealistic, but for the purpose of analysis their perceivedplight is the operative factor.

The importance of the first years after World War II in shaping how Americansthink of their country and themselves today cannot be overemphasized. It matterslittle that Americans in the late 1990s have higher real incomes than the early postwarAmerican families. Then, the United States faced no strong economic rivals, and itscitizens had far more income than persons from other nations. Productivity wasgrowing at nearly 3 percent. Incomes were leaping higher and higher, and those atthe bottom and in the middle were gaining on the wealthy. Today several countrieshave higher per capita income or are close to the U.S. income level, depending on theincome definition used. Add in the biggest income gap since statistics in that areahave been kept, and it is small wonder that Americans perceive that early postwarperiod of American hegemony as far superior to today. This monumental differencein comparative bases is central to understanding postwar America and the currentmind-set and behavior of those born in the first two decades after World War II.

As libertarianism has grown, government-bashing has become increasingly harsh.Antigovernment true believers view government as bad except in a restricted numberof areas, such as defense, safety, and infrastructure, that would have been acceptableto Adam Smith in 1776. They hold that individuals should have no restrictions ontheir rights, save not to harm others. This set of beliefs undercuts any notions ofcitizen responsibilities and civic virtue. Those who crafted the American Constitutiongenerally feared too much federal government power yet saw a critical place for suchpower if reasonably contained. The foremost proponent of this public philosophy,James Madison, helped develop checks and balances in the federal structure so thatinstitutions and procedures could block individual and institutional excesses. Yet,Madison’s ultimate safeguard for protecting American democracy was the expectationthat the people themselves would be responsible, skeptical, watchful citizens; he poseda question still relevant today:

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Is there no virtue among us? If there be not, we are in a wretched situation. No theoreticalchecks, no form of government, can render us secure. To suppose that any form of governmentwill secure liberty or happiness without any virtue in the people is a chimerical idea. If there besufficient virtue and intelligence in the community, it will be exercised in the selection of thesemen; so that we do not depend on their virtue, or put confidence in our rulers, but in thepeople who are to choose them. (Storing, 1981, p. 72)

The essays in Why People Don’t Trust Government pay little attention to the flightfrom responsible citizenship, but the Founders would not have let the public off soeasily. However difficult the task, however high the level of citizen competence requiredfrom the governors and the governed, the Constitution still demands citizens withsufficient “virtue and intelligence” to pick wise, political leaders.

The unfulfilled expectations flowing from the Truncated American Centuryexperience and the flight from civic virtue fed by extreme individualism have interactedto heighten the mistrust of government. The wondrous early postwar governmentthat won the war and helped veterans with education and housing had ceased toproduce the expected income levels that had been based on extrapolating the abnormalproductivity growth of the Truncated American Century. When government no longerappeared to work and sufficient income did not flow, people demanded more rights,fought taxes, and spurned citizenship because it took time from trying to earn aliving. The income and wealth expectations born in that middle period between theGreat Depression and the first OPEC price hike in 1973, when not realized, fueledindividualism and the belief that government was always the problem, never thesolution. The now-unrealistic expectations generated in the Truncated AmericanCentury still haunt the nation and foster distrust of government.

So What?

Toward the end of the final essay in Why People Don’t Trust Government, Nye andZelikow make this key statement:

Confidence in democracy as a form of government seems to remain strong in the United States.. . . Why, then should there be any concern? The honest answer is that we are uncomfortablewith uncertainty about something that matters so much—the health of our institutions ofdemocratic governance as we enter the new century. Perhaps the American system is goingthrough an adaptive cycle akin to that experienced at the end of the last century. We are un-sure. (pp. 277–278)

So we are. But some are less unsure than others. For instance, Mansbridge andNeustadt took Cassandra-like positions in warning of likely dangers. I confess to beingof that school too, although recognizing full well that pessimistic professors andpundits have established a cottage industry. Recall the gloom of the “America inDecline” debate that followed Paul Kennedy’s The Rise and Fall of the Great Powers[Kennedy, 1987]. What has happened instead is that the United States has returnedto its position of unchallenged economic hegemony towering over its competitors.Indeed, it well may be that America, after 20 or so years of suffering one economicproblem after another, may be entering a new period of sustained economic growth,which will be lower than that of the Truncated American Century but much higherthan that of the two decades or so after 1973. If so, the distrust in government issuetakes on even greater importance in finding new policies to meet future demands ina changing setting, where again there is a fast-growing economic pie.

Even if America is entering an era of sustained, relatively high economic growth,

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it will be distinctly different from the previous one. The current economy widens theincome gap, while the earlier one benefited the poor and the middle class more thanthe top of the income distribution and did so without significant political redistributionefforts. The former economic outcome fueled the American Dream while the currentone thwarts it. The irony is that just as the nation has recovered its economic vigor,the collapsing political system inhibits reasoned debate and sensible compromise.There is a dangerous disconnect between the economy and politics. The public hascome to see the federal government either as irrelevant in their lives or more likely ascorruptly controlled through huge political contributions by business and interestgroups who call the shots, not ordinary citizens. People now question why they shouldexpend the effort to be responsible citizens or even to vote, and instead seek to acquirethe cornucopia of wondrous goods and services that leap from our television screens.

Problems, however, abound even in the economic expansion, ones that aremost unlikely to be solved by the super economy alone in this globalized worldthat disproportionately rewards the well-educated. The income gap between thewealthy and the broad middle class is the widest since such data have beencollected. Americans are not saving enough for retirement. Good blue-collar jobsare rapidly disappearing, and low-income wage earners will not benefit that muchfrom the boom until the federal government funds major investments in raisingtheir skills. To tackle these problems, the nation must have a strong economy.But the economy cannot do it alone. It is in the political arena that the criticalpolicies must be made that mitigate the harsh economic distribution that threatensmiddle class prosperity. But whether the political system will be healthy enoughto support reasoned deliberations and hard decisions is unclear. That health maywell depend on the level of citizens’ trust in government. The essays provide asound base for pursuing salient research and the analysis needed to answer the“so what” question and to seek appropriate policies if the current level of distrustin government does threaten the American political system and ultimatelydemocracy itself.

WALTER WILLIAMS is Professor Emeritus of Public Affairs and Codirector of theTrust in Government Project at the University of Washington.

REFERENCES

Kennedy, Paul (1987), The Rise and Fall of the Great Powers (New York: Random House).

Patterson, James T. (1996), Grand Expectations (New York: Oxford University Press).

Sandel, Michael J. (1996), Democracy’s Discontents (Cambridge, MA: Belknap Press of theHarvard University Press).

Storing, Herbert J. (1981), What the Anti-Federalists Were For (Chicago: Chicago UniversityPress).

Weisberg, Jacob (1996), In Defense of Government (New York: Scribner).

Williams, Walter (1997), “U.S. Looks Good, But Hold the Applause,” Seattle Times, July 13, p. B5.

Peter Reuter

World Drug Report, by United Nations International Drug Control Program. Oxford,England: Oxford University Press, 1997, 332 pp., $29.95 paper.

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The United Nations International Drug Control Program (UNDCP) is a small,specialized United Nations (UN) agency whose principal funder over the last 15 yearshas been the government of Italy, producing a string of Italian directors. This book isa surprisingly strong effort to give the agency an identity as something more than thesetting for lengthy international fora of legendary dullness and the operator of ascattershot of small programs in a large number of developing and transitional nations.The book surveys the global drug problem, presenting new statistics on worldproduction and consumption (of which much more later); summarizing theories ofwhy people use drugs; discussing alternative drug control strategies; and offeringprofiles of drug problems in eight nations. Despite being produced by a team ofauthors, it is readable and mostly nonofficial, even ignoring a lovely four-page essayon corruption and organized crime by Amartya Sen.

Moreover, apart from Paul Stares’s [1995] recent brief survey, there is no otherscholarly effort to provide such broad coverage of world drug issues. The availableAmerican drug policy literature is parochial, in part reflecting the fact that the U.S.drug problem is both uniquely large and well documented; not only is the lampposthere but so are the keys. Latin America gets some attention but primarily as a sourceregion for the United States [compare Smith, 1992].

The World Drug Report devotes almost 20 pages to “The Regulation-LegalizationDebate” (pp. 184–201). As evidence of its evenhandedness one need only note that itrefers approvingly to Kleiman’s [1992] insight that the issue is “more a question ofchoosing among problems than choosing among solutions” (p. 198). Being aninternational agency with a particular responsibility for poorer countries that benefitin direct financial ways from exporting drugs, it does a good job of analyzing howlegalization may threaten those export markets. “Under a legal regime regulated byan international control mechanism, more efficient, streamlined and cost-effectivemethods would be introduced, either by synthesis of the traditional plant materials,or else by relocation of some cultivation to geographically more convenient centerswhere standard quality could be assured. . . . In this scenario the peasant farmerswould be the prime losers” (p. 191).

The Report does little to tout UNDCP’s own programs. It even beats the drum ofinternational cooperation surprisingly softly. It only occasionally utters the shibboleththat we are all producer and consumer countries now, which ignores the fact thatsome major producer/transshipment countries (like Mexico and Nigeria) have verymodest user problems, while many consumer countries (like Italy and Spain) haveno significant production activities. Indeed, the Report itself gives data from aColombian population survey that shows only 1.5 percent of the population reportingever having used cocaine, compared to a figure of about 12 percent for the UnitedStates. The tone is generally dispassionate about success and failure of existing policies.This might indeed be a useful source book for a course on drug policy.

With the success of the UNDCP’s Human Development Index (HDI) in mind, theReport introduces two new indexes of its own, the Drug Abuse Index (DAI) and DrugAbuse Trend Index (DATI). Interestingly, these aim only to rank the seriousness ofeach of a selected set of drugs in terms of its contribution to the nation’s drug problem.Unlike the HDI, they do not allow comparisons across countries. This is a recognitionof just how difficult it is to find consistent and reliable problem measures amongeven developed countries. For example, Italy has never conducted a national prevalencesurvey of the kind that has been routine in the United States and the Netherlands for20 years. On the other hand, Italy has more credible and comprehensive overdoseand treatment data than most other Western European nations. It has been said of

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the French overdose recording system that the subject has to die in a doorway with aneedle in his arm before he will be counted as a drug overdose, while the Germanswill include the once-treated marijuana user who dies as a passenger in an autoaccident. Both statements caricature but have enough truth to make the PompidouGroup (a Council of Europe entity) print on the tables of its most recent report onEuropean cities: Warning! These data are not directly comparable [Hartnoll et al., 1994].Throw in countries such as Pakistan, without much infrastructure of public healthdata collection, and the enterprise does indeed seem hopeless. The Report’s appendixstatistical summaries are interesting in themselves but do not invite comparison.

Precisely because the Report is a compendium, a review must be selective. I havechosen the one area in which the UNDCP might reasonably claim to have brokennew ground, namely estimating and describing the world drug trade.

Numbers

The Report serves as the origin of a widely cited estimate of the size of the internationaldrug trade, $300 to 500 billion (p. 124). This number is already tossed around withthe same ease as census estimates of London’s population; even the Economist, themost skeptical and sophisticated of media on official estimates, routinely cites it. Yet,the figures have the murkiest of origins, evidenced by the footnote pull to a forthcomingdocument, which only appeared much later. Though the estimate is only twice thesize of a reasonable estimate of total retail expenditures on drugs, it is probably 20times the international trade flow related to drugs.

Fortunately, the Report itself contains a set of figures that point to the implausibility

Table 1. Estimated drug expenditures by nation.

Nation Dependent users (Per Per capita Drug ($ perin thousands 100,000 income expenditures dependent

population) (ca. 1994) in $billions user)

Italy 170–420 (515) $18,160 7–13 (33,898)

Sweden 17 (194) $17,900 0.4 (23,529)

United States 2700 (1037) $24,680 48.7 (18,037)

Australia 100–300 (1121) $18,530 2.0–4.4 (16,000)

Thailand 1300 (2203) $6350 1.1–1.9 (1154)

Pakistan 3000 (234) $2160 1.5 (500)

of the grand total. Table 1 is a compilation of national drug expenditure estimatespresented in chapter 7, along with per capita GNP figures.

These nations are not a random selection; except for Sweden, these are amongthe purported leaders in their continents in terms of the severity of their drug problem.Pakistan and Thailand are routinely cited for the large size of their heroin addictpopulations. Yet, Pakistan’s addicts spend about $500 per capita on drugs, while inThailand, with a higher GDP per capita, they manage to spend about $1000. Italy andAustralia have very large heroin-dependent populations compared to other developednations, while the United States has demonstrated its leading-edge capacities by havingthe first and largest epidemic of cocaine dependence.

Roughly these figures suggest that dependent users (who account for the vast bulk

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of total expenditures) in rich nations each spend about $20,000 per annum on drugs(mostly heroin and cocaine). The total for the United States and Western Europe isprobably $100 billion, twice the official estimate for the United States [Office of NationalDrug Control Policy (ONDCP), 1997]. Now assume that the drug dependents in the restof the world manage to spend $1000 each, the Thai figure; that is generous indeed, giventhat Thailand is substantially wealthier than most other Asian nations with large opiate-dependent populations, such as Afghanistan, Burma, and Iran. Then we would needliterally hundreds of millions of such addicts to reach the global figure of $400 million.Yet, the numbers suggested in this report are about 20 million (including the UnitedStates and Western Europe) for heroin and cocaine, the only very expensive drugs inmass consumption. A total for the developing world of $50 billion would seem extremelygenerous, giving a total of about $150 billion in consumer expenditures.

The error is even more egregious than this because the Report considers $400billion an international trade number. For example, it is “equivalent to eight percentof total international trade. . . . and [is] larger than the international trade in iron andsteel, and motor vehicles” (p. 124). Clearly, the international trade component of drugsales is quite small; on the same page the Report refers to the fact that gross profitmargins at the retail level are about 100 percent for heroin, and sharply higher forother drugs. For the United States it seems likely that the landed price, relevant forthe international trade calculation, is only about 15 percent of the retail price.

Thus, even if retail sales totaled $400 billion, the international trade figure wouldbe about $60 billion. If, in fact, the sales figure is only about $150 billion, then thetrade flow is down to a mere $20 to $25 billion, a very small share of total trade,currently estimated at $5,000 billion.

This is not merely pedantry about measurement. A certain amount of seriouspolicymaking is dependent on the froth of international drug trade estimates. If $400billion in illegal drug revenues is flowing across borders, then the justification forstringent money-laundering regulations is clear. At $25 billion, one needs to look alot more carefully as to whether the resulting impediments to the easy flow of capitalare worthwhile.

These are fairly fundamental flaws in the estimates and their interpretation. Nogreat sophistication or technical expertise is required to detect the flaws. Yet, agenciescontinue to propagate gross exaggerated figures. It is fair to inquire as to theirmotivations, which may not be much different from those of Mitch Snyder, the firstnational advocate for dealing with homelessness in the United States. When heannounced that there were 1 million homeless in the early 1980s, he was frank inresponding to questions about the source of the figure; it was the smallest numberwhich he could be sure would attract national attention [Jencks, 1994]. In the late1990s for a global phenomenon, $300 to $500 billion may be the smallest numberthat will galvanize the attentions of major governments.

It would be unfortunate if the Report were remembered only for its propagationof another mythical number. It contains a great deal more that is both useful andotherwise hard to find.

PETER REUTER is Professor in the School of Public Affairs and the Department ofCriminology at the University of Maryland.

REFERENCES

Hartnoll, Richard et al. (1994), Multi-City Study of Drug Misuse (Strasbourg, France: Councilof Europe).

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Jencks, Christopher (1994), The Homeless (Cambridge, MA: Harvard University Press).

Kleiman, Mark (1992), Against Excess: Drug Policy for Results (New York: Basic Books).

Office of National Drug Control Policy (ONDCP) (1997), What America’s Users Spend on IllicitDrugs. 1988–1995 (Washington, DC: Office of National Drug Control Policy).

Smith, Peter (ed.) (1992), Drug Policy in the Americas (Boulder, CO: Westview Press).

Stares, Paul (1995), Global Habit (Washington, DC: Brookings Institution).

John E. Brandl

Pasteur’s Quadrant: Basic Science and Technological Innovation, by Donald E. Stokes.Washington, DC: Brookings Institution Press, 1997, 196 pp., $38.95 cloth, $14.95paper.

In Pasteur’s Quadrant the late Don Stokes, longtime Association for Public PolicyAnalysis and Management (APPAM) leader and dean of Princeton’s Woodrow WilsonSchool of Public and International Affairs, argues for a way of understanding therelationship between basic and applied research, a way at odds with the perceptiondominant in this country for the past half century. Though not specifically devoted topublic policy research, the book has much to teach readers of this journal.

Vannevar Bush, Franklin Delano Roosevelt’s science adviser, taught Americans tosee basic and applied research as belonging to different categories. In his mind,research was one or the other. Bush’s notion that applied research should be thoughtof as not only different from but inferior to basic research is summed up in hisaphorism “applied research invariably drives out pure.” After Bush [1945] publishedhis influential Science, the Endless Frontier, researchers in the United States came allthe more than they had previously to view research in that way. Stokes’s firstcontribution is to remind us that Bush’s idea is a construct, hardly an immutable law.

Stokes writes that Bush and others led us to think of basic and applied research aspolar phenomena depictable as diametrical points on a line segment, basic on theleft, applied on the right. Basic research might lead to applied, but they are not to bemixed.

Stokes wants us to think differently. He sees the assignment of basic and appliedresearch to opposing ends of a line as limited and limiting. He asks us to rotate theleft part of the line upward 90° around the midpoint, then to extend the two linesthus formed to create four quadrants.

The northwest quadrant (basic, not applied) he names for the theoretical physicistNiels Bohr. The southeast quadrant (applied, not basic) honors the tinkering geniusThomas Edison. But Stokes is mostly interested in the northeast sector. Researchthere is both basic and applied, motivated by concern both to understand and toimprove the world—thus named Pasteur’s Quadrant. For Louis Pasteur, basic andapplied research were not separate activities. Again and again, whether “pasteurizing”milk, devising the germ theory of disease, or coming to an understanding of the biologyof fermentation, he devised whole new fields of study as he simultaneously inventedimprovements in health and commerce.

Stokes laments the persistent influence on the U.S. government of the Bushianviewpoint, citing especially the National Science Foundation. His favorite federalresearch agency is the National Institutes of Health, which has long fostered the kindof use-inspired basic research Stokes admires in Pasteur. He urges the design of fundingarrangements that carefully assess research proposals for both scientific worth and

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usefulness. Anticipating Bush-like rejoinders, Stokes makes a practical claim thatmight be persuasive even to those dubious of his call for including the prospect of usein the allocation of basic research monies. He contends that under his approachbasic research would be better funded because those conducting it would be viewedby politicians and other citizens as less arrogant and isolated.

References to America’s lagging economy, an apparent Japanese superiority intechnology transfer, and a persistent and crushing federal budget deficit already datethe book—but only in trivial ways. Its central message has lasting capacity to informand to prod. The book is a lovely gift from Don Stokes to all who ponder the influenceof ideas on events.

Pasteur’s Quadrant discusses basic and applied research in the natural and physicalsciences. In homage to Dean Stokes I will devote the remainder of this review todrawing from his argument some implications for public policy research andeducation, the field to which he contributed so much in the last several decades of hisvaried and productive life.

Stokes aligns himself with the (remarkably almost 400-year-old) insight of FrancisBacon that “knowledge and human power are synonymous, since the ignorance ofthe cause frustrates the effect.” A policy requires a theory, Stokes might say. A policyembodies a theory: if x then y. If government takes a prescribed action x, then adesired outcome y can be expected.

With Pasteur, Don Stokes knows that oftentimes creation of a theory is inspired bya desire to influence the world of public affairs. He gives Keynes as an example. Inorder to influence the Great Depression, Keynes needed a theory of what caused it, ofhow an economy works.

For policy researchers, public service is not merely attending meetings of civicorganizations but devising and applying understandings of how the world works.Thirty years ago an idea very like this inspired Don Stokes and other founders oftoday’s policy schools. But today, when we claim to be preparing managers, analysts,planners, and politicians by providing them with some theories of economics,organization theory, and political science, we might not be thinking hard enough.

Pasteur’s Quadrant inspires us to ask what theory supports the institutions ofgovernance that we study and into which we send budding public servants. Implicitin our curricula and in the way we conduct much policy research is an assumptionthat the institutions of government will put our analyses and graduates to good use.Informing politicians of market failures will be sufficient to get them to implementcorrections. Exhorting public employees to adopt the latest budgeting system willcause them to do so. Public policy school graduates will devote their skills to advancingthe public interest. One need not ponder the last three sentences for long to recognizetheir implausibility. The governance question remains: How does a free people induceits members to act in ways that accomplish public purposes? Answers to thatquestion—theories of the operation of the institutions of governance—are prior tothe techniques of analysis, planning, and management that we use in our researchand teaching.

For policy researchers in America, Pasteur’s Quadrant is Madison’s Quadrant. JamesMadison, the main designer of our governmental system, theorized as he applied. Heasked under what circumstances citizens and politicians might be expected to act inways that accomplish public purposes. And he built a governmental system that insome circumstances orients people to do that. The elegant colleague who wrotePasteur’s Quadrant nudges us to do similarly. We are in his debt for giving us Pasteur’sQuadrant, Madison’s quadrant—Stokes’s quadrant.

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JOHN E. BRANDL is Dean of Public Affairs at the Hubert H. Humphrey Institute ofPublic Affairs, University of Minnesota.

REFERENCES

Bush, Vannevar (1945), Science, the Endless Frontier (Washington, DC: U.S. Government Print-ing Office).

Patricia W. Ingraham

Governments, Parties, and Public Sector Employees: Canada, the United States, Britain,and France, by André Blais, Donald E. Blake, and Stéphane Dion. Kingston, Ontario,Canada: McGill-Queen’s University Press: 1997, 189 pp., $49.95 cloth, $22.95 paper.

Governments, Parties, and Public Sector Employees poses a simple, but infrequentlyasked question: Are parties and governments of the left more generous toward publicsector employees than those of the right? André Blais, Donald E. Blake, and StéphaneDion explore the question in a comparative and historical context, examining theexperience of Canada, the United States, Britain, and France for the period 1950–1990. The authors rely on a combination of methodologies, utilizing time-seriesanalysis for the longitudinal data; qualitative analysis for legislative debates, partyplatforms, and political speeches; and personal interviews for additional clarificationabout the role of political parties.

In an important sense, this research builds on and adds to the rich and remarkablycumulative comparative policy literature published in the 1970s and early 1980s.Although that literature analyzed broad socioeconomic and political influences onpublic policy, it was notable for its general exclusion of issues related to publicbureaucracy. Guy Peters and others included the size and cost of the national publicservice as one variable in the overall policy equation; beyond that, discussion wasvery limited. One of the contributions of this work is that it defines the nature of thepublic workforce as a policy worth analyzing in its own right. It also squarely connectsthe characteristics—and the rights—of that workforce to politics and elections. Thisis very useful. Although the United States has been most adamant in placing theinstitution of the public service in a neutral “black box,” the other nations studiedhere have generally been noted for considering only the higher civil service in policyand politics discussions and analyses. The discussions that Blais, Blake, and Dionprovide regarding public sector unions and their complicated relationships with partiesand elected leaders demonstrate the utility of considering the public service in itsentirety. This is not to suggest that others have not considered the role of unions; it isonly to say that the treatment here is rich and complex, and contributes substantiallyto understanding the interactive relationships between the public bureaucracy andpolitics.

Blais, Blake, and Dion argue that four dimensions of public bureaucracy areimportant: size, compensation, collective bargaining rights, and political rights. Theirfundamental hypothesis is that governments of the left are more generous towardpublic employees on all of these dimensions than are governments of the right. Inchapters dealing separately with each of the four nations studied, the authors devise34 tests of the hypothesis. In the final chapter they argue that, in 20 of the 34 tests,the Left was, indeed, more generous. In their carefully phrased conclusion, the authorsalso observe that, while the pattern they found is consistent over time:

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Public employees’ issues have emerged as more important on the political agenda, especiallyin Britain and in France. Increasing debts and deficits have made those issues more salientand have highlighted the differences of the left and of the right . . . the differences have alwaysbeen there, but they have become more visible. (p. 160)

The authors attribute these differences to two factors: the public sector is betterrepresented in the parties and politics of the left, and the left is more “sanguine”about the role of the state. In an argument that seems somewhat dated in terms of“New Public Management” and politics of the 1990s—and perhaps the 1980s as well—the authors note that “parties and governments of the left increase public employment,first and foremost, because it is required to expand the role of the state, a role theybelieve to be essential” (p. 162). Yet, the authors note in chapter 4 that, in Britainboth parties have been historically willing to target public compensation to combatinflation. Further, in those actions most directly having an impact on the size of thecivil service—nationalization and privatization—there was “little direct partisanconcern for employment effects” (p. 102). It must also be noted that, even though thecases fall after the period examined in the study, the parties and politics of Clinton,Blair, and Chrétien would seem to be exceptions to the general link of the left andgrowth—at least if growth is defined as occurring at the national level of government.

Indeed, if there is a quibble with the book, it must be that the authors appear to bea bit eager to glean generalizations from a very nuanced analysis. In the U.S. case, forexample, the authors write: “Our findings lead to a general conclusion. The partyorientation of the President has little effect on federal employees' conditions, butparty balance in Congress matters a great deal” (p. 85). In a detailed footnote discussionof the Hatch Act—surely a defining characteristic of the American bureaucracy—theauthors note, however, that “the attempted updating of the Hatch Act shows howmuch difference it makes having a Democrat in the White House” (p. 166). In theFrench and Canadian discussions the authors attenuate their conclusions by moreclearly noting exceptions and, in the case of France, observing that support of thebook’s general hypothesis varies from indicator to indicator. In the concluding chapter,the broad generalizations reemerge.

Having said that, however, this book is important for several reasons. First, it isvery successful in placing the public bureaucracy in the political arena, not just as aninanimate object that is acted upon, but as an important actor with an influence onpartisan agendas. Public employees vote, join unions, and strike. Their compensationis a sizable part of public budgets. Efforts to change the number of public employees,where they work, and how they work are important public policy—and political—questions. Blais, Blake, and Dion make this case clearly and well.

Second, the descriptive material contained in each national chapter is invaluable.Major developments in each of the national bureaucracies for the 40-year period aresuccinctly summarized; the opportunities for comparison go far beyond both theauthors’ hypothesis and the role of political parties. The descriptive base provided bythis book, for example, lends itself very nicely to the current interest in comparativeadministrative reform. Analysis of the similarity of reform efforts in many differentnations begs for a strong comparative starting point, and the descriptive researchthat Blais, Blake, and Dion provide is a strong candidate.

Finally, the book is a fine bridge from the concerns of policy and policy analysis tothose of public management. Whether or not it was the authors’ intent, the bookprovides an excellent context for a discussion of the constraints on the reform ofpublic bureaucracies. This is an important discussion and one that is empirically

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engaged much too infrequently. Into the sometimes turgid debate over managementstrategies and techniques, Blais, Blake, and Dion inject this bit of advice: Politicsmatters. A lot. Good for them!

PATRICIA W. INGRAHAM is Professor and Director of the Alan K. Campbell PublicAffairs Institute at Syracuse University.

Robert Hunt Sprinkle

Managed Care: Made in America, by Arnold Birenbaum. Westport, CT: Praeger, 1997,193 pp., $39.95 cloth.

Assessing Medical Rehabilitation Practices: The Promise of Outcomes Research, editedby Marcus J. Fuhrer. Baltimore: Paul H. Brookes Publishing, 1997, 469 pp., $67.00cloth.

Gatekeeping in the Intensive Care Unit, by Martin A. Strosberg and Daniel Teres.Chicago: Health Administration Press, 1997, 263 pp., NPA.

Any lexicon of contemporary American euphemisms would offer among its longerentries the meanings of a two-word term resonant with progressivistic concern:managed care. The import and importance of this term vary less by formal statementthan by personal experience. For some, managed care means order and affordability,for others, complexity and callousness. For most Americans, though, it must meannothing much, because most Americans are among the working well, for whommanaged care works well enough. Of all that has been and will be said about thissingular piece of privatized social engineering, one fact prevails. Accepting managedcare in the 1990s was easier than understanding the problems it promised to solve.

Three new books illuminate this topic, one straight on, the other two with a glancinglight. The first, by a medical sociologist and veteran health services researcher, ArnoldBirenbaum, is Managed Care: Made in America. This is a helpful synthesis of evidenceand argument, all or almost all from a point of view unflattering to managed care andpolitely resentful of what it has done to the genuinely not-for-profit health maintenanceorganization (HMO) model the reader suspects Birenbaum long favored and nowmourns. “We are in the middle of a vast reconstruction of the American health-caresystem,” he writes. “Whether this process will yield benefits for ordinary Americansdepends on who shapes its future and for what end.”

Birenbaum opens with a brief review of the origins and recent history of managedcare. A reader new to the subject might find the thread of this opening section elusive;a reader more familiar might find it mislaid here and there. The brief celebrity of“Harry and Louise” during the Health Security Act fiasco seems attributed by anaccident of editing to the National Federation of Independent Businesses rather thanthe Health Insurance Association of America. In the same Health Task Force period,“[t]he fear of [employer] mandates,” we are told, “was based on American capital’sunwillingness to be saddled with a social responsibility in an age of downsizing toface worldwide competition. Moreover, once the government established thisresponsibility, what would come next? The fear of precedents kept the largecorporations away from the table.” Yet, virtually all large American corporations werealready sponsoring health insurance for almost all their full-time employees. If otheremployers—that is, small business owners—were forced to increase the compensation

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they offered their full-time employees, then fewer costs, such as hospital costs, would“shift up” from the small to the large—from the petty bourgeoisie, as it were, to thecapitalist class. To the extent that small businesses supplied products and services tolarge businesses, then some adverse effect on “worldwide competition” might havebeen seen with employer mandates but, again, decreased cost-shifting could havecompensated to a degree. Employer mandates failed because small business ownersoffering jobs at or near the minimum legal wage could not transform “extra” wagecompensation into sufficient benefit compensation, even if the latter were tax-exempt.They faced changing not just how they compensated their workers but also, andsubstantially, how much. The problem here was less philosophical than the authorsuggests.

An oddity of America’s health care history is the rhetorical dual personality of “cost-shifting,” upon which mechanism all insurance, whether social or commercial, isbased. Every citizen, surely, deserved the chance to enter a risk pool, and the biggerthe better. However, long before Harry and Louise, there arose the contrary notionthat systemwide financial efficiency, and, with it, the general welfare, would beenhanced if cost-shifting between risk pools were minimized and low-cost risk pools,as many as possible, were encouraged to form. An early artifact of this idea was astipulation of the 1974 Employee Retirement Income Security Act (ERISA) thatexempted “self-insuring” groups from state regulation and, thus, from requirementsthat they contribute to the all-payer risk pools established to fund otherwiseuncompensated care. Self-insurers could profitably hold the health care capital theywould otherwise have “lent” to one or more insurance companies and then hire amanaged care organization simply to “manage.” The financial advantages of self-insuring must be considerable but are difficult to study. The operational advantages,Birenbaum reports, have been nil to modest. The societal effect, arguably, has beenatomization just where consolidation might have been preferred.

Birenbaum finds the core of managed care to be explicit rationing. He finds thesubstitution of prevention for treatment to be a lighter, less explicit form of rationing,but no less real. Physicians and patients alike might object to the second part of thisfinding. As to the whole, one might propose instead that the core element of managedcare is less socialistic than corporate: profit maximization (or, in the not-for-profitcase, residual revenue maximization) through risk avoidance in recruitment, riskmanagement in practice, and risk taking in investment. The first form of this elementis always, and the second form is potentially, toxic. The third form may at first seeminert, but it stimulates a provocative question: To whom would the fiscal proceeds ofpatient care capital most usefully—and to whom should they most fairly—accrue?Advocates of the medical savings account, the MSA, speak forcefully to this question,and in a way unfriendly to managed care. The MSAs are not discussed in this volume(though Golden Rule, their chief purveyor, is mentioned in an unrelated context).

The author gets to surer ground with an operational exposition of managed careorganizations. What do most of us know about them, really? We have quickly becomeaccustomed to the “care-speak” they use—neofunctionalist words like “provider” anda raft of three-letter acronymic nouns, such as PPO, IPA, PSO, and, of course, HMOand MCO. We have also come to expect new kinds of inconvenience, a new hired-helpimage of physicians, a lowered likelihood of professional candor, a greater chancethat “scarcity” will be described in the midst of obvious systemic surplus. We furtherknow that managed care savings have been modest and to a worrying degree artifactualand unsustainable, that managed care prices are now set rapidly to rise, that manypatients have been incensed and many reformers alienated by managed care tactics,

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that managed care has tended perversely to increase rather than decrease the absolutenumbers of uninsured and underinsured Americans, that managed care organizationshave begun to lose their malpractice immunity, that managed care leaders say effortsto regulate their behavior will push the country back toward the runaway healthsector inflation of the indemnity-insurance era, and that managed care profits andshare values have fallen and are not soon expected to regain their recent heights.

Can managed care organizations manage themselves? Can they measure their ownquality, raise it, and maintain it? Are they any good at this? Do they actually try? Orare they too strongly tempted to slant their self-questioning, to let their budgets leadand their behavior follow? Birenbaum is hopeful here, but wary. One serious difficulty,an ironic one given the health maintenance provenance of managed care, isdiscontinuity. Turnover rates for physicians and patients are high and likely to remainso. After all, it is through “deselection” of physicians and physician groups that amanaged care organization debrides its professional workforce and disciplines theresiduum.

Birenbaum has less to say about another type of turnover, patient “churning.” Newmanaged care patients tend to arrive in blocks of employed workers and their families.At the start of enrollment, they are as a cohort, then, relatively young and healthy.The capitation holder’s ratio of money-out to money-in—the “medical loss ratio”—should thus be quite low initially, yielding strongly positive cash flow, but the ratioshould immediately start rising slowly, month by month. If a high rate of year-end“same-store cancellations,” as they are unblushingly called by for-profit firms in reportsto stockholders [Humana, 1996], can be made up by a high rate of next-yearenrollments, enticed by direct-to-employer marketing and direct-to-patient advertising,then the medical loss ratio can be kept fairly low, especially because high-demandpatients are likely to be overrepresented among same-store cancellations. Of course,many high-demand patients do not disenroll; many are not dissatisfied, and some,having developed “preexisting” problems, fear reentry into the insurance market. Whenchurning fails, as it did for Humana in the Washington, DC, area in 1996, then officescan be shut (or, in this case, sold to nominally not-for-profit Kaiser Permanente) andnew offices can then be opened elsewhere, as in Humana’s overtly businesslike searchfor “younger, healthier patients” [Evans and Auerbach, 1996]. When churning“succeeds” or, at any rate, when patient turnover is high—the Commonwealth Fundis cited as reporting that 53 percent of managed care survey respondents had amembership duration under three years—then the preventive care, the “healthmaintenance,” that managed care promises not only becomes harder to perform butalso becomes economically less attractive to perform, because its payoff—such ascarcinoma in situ instead of cancer at an invasive stage—is less likely to be realizedby the “preventing” firm.

The leading popular explanation for managed care’s recently observed fall of profitsand share prices and its new upward slope of premium charges is the closing of thisindustry’s “frontier” phase, the oversettlement of its prime territory, the aging-in-place of its patients. Birenbaum notes that for-profit managed care organizationsregister much lower medical loss ratios on average than do their not-for-profit—andincreasingly not-so-common—counterparts. Will physician-owned managed careorganizations, now allowed under relaxed Federal Trade Commission rulings, behavedifferently? They may be less likely to move but may in other respects come to resemblethe competitors they are now trying to outdo.

Birenbaum is particularly concerned for the seriously sick, the chronicallydebilitated, the poor, and the young, and he is forthright in his judgment that they

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have not done, nor are likely to do, particularly well in managed care. That said, inthe case of nondebilitated Medicaid patients, such as poor mothers and their children,he fairly discusses evidence suggesting that managed care may on balance improvetheir lot. He is especially pessimistic, though, about patients in long-term care,Medicaid’s dominant expense, because this category is so prone to service substitution,so suited to “a race to the bottom.” In Birenbaum’s judgment, managed care cannotreliably serve these patients.

“Carving-out” is another issue. A holder of capitation contracts may subcontractfor standardized specialty care with, for example, a surgical institute or substance-abuse treatment facility, where certain procedures, operations, or complex therapiesmay be so routinized as to be high in quality, quick in execution, and low in price.Less desirably, a patient and patient’s family may be surprised to learn that theirmanaged care organization has negotiated a discounted rate for, say, bone marrowtransplantation not at the children’s hospital across town but at a general hospitalacross the country, that this procedure has been “carved out” of standard coverageand sold to a low bidder—with the patient left to take it or leave it.

In the balance of the book, Birenbaum discusses more or less explicitly the reforms,restrictions, and oversight enhancements that would be necessary to domesticatemanaged care, to make it a truly progressive institution, rather than just a successfulscavenger-predator on the clinical savannah and free rider on the bioscience express.Given the ambiguousness of the advantages it has so far displayed and the predictablyhigh reorganizational and regulatory costs that would be needed to drive its advantagessafely and securely ahead of its disadvantages, the reader can be excused for asking,why try? Why try to save managed care?

This last question may sound like one whose time has not nearly come. Birenbaumdoes not ask it. But his arguments elicit it. If it must continue to hollow itself out withneoindemnity features, like point-of-service options and noncapitated independentpractice association (IPA) contracting, while state after state “learns it some manners”and a thickening swarm of lawyers learns its vulnerabilities, managed care may becomea trend with more of a past than a future.

The second book, Gatekeeping in the Intensive Care Unit by Martin A. Strosberg, ahealth administration scholar, and Daniel Teres, an adult-intensivist physician, iswritten for the doctors, nurses, and administrative support staff who care for ourcountry’s sickest patients. The premise here is an old one: intensive care units,regardless of ownership, are community resources and must be run as such. Theirlocation, size, and specific capabilities are functions of projected local and regionalneed, and the optimum use of a particular bed or isolation room or ventilator orextracorporeal membrane oxygenator depends upon the number of critically illpatients at any particular hour; the available level of staffing; the proximity,competence, and census of alternative facilities; and the likelihood that the servicesto be rendered will prove to have been worth rendering. This is a carefully planned,well-executed book built around admirably accessible discussions of realisticallycomposed hypothetical dilemmas and classic cases.

Medicare’s adoption of “prospective” payment by “diagnosis-related groups” (DRGs)in the 1980s reversed the American hospital’s by-then institutionalized incentive totreat as expensively as possible for as long as plausible. The old incentive had beensynergistic with overcautiousness, an honored if dysfunctional trait. The newincentive—to treat less expensively than Medicare expected and apply the differenceto the hospital amenities fund—was to prove highly disruptive. Many intensive careunits saw fewer patients and saw them for smaller proportions of their hospital stays.

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Capacity did not then necessarily increase, since staffing, the real determinant ofunit capacity, also decreased. Some hospitals closed units—or the emergency roomsthat fed them—because the intensive care income generated by Medicare patientscould not cover the losses generated by younger patients, such as uninsuredmotorcyclists with head injuries. The combined effect was a constriction of fullystaffed intensive care beds per capita and a funneling of high-loss-or-low-profit patientsto public hospitals, whose units often had no prospect of enlargement. Managed careorganizations complicated this picture further, even though they typically enrolledlow-risk populations, because even a moderate surge in high-cost care could raisemedical loss ratios to unplanned-for levels and because a hospital stood to lose agreat block of income if a disgruntled plan moved its in-patient business, routinecare as well as intensive, to an eager competitor’s half-empty wards.

Strosberg and Teres apply the term “gatekeeping” to admission and dischargedecisionmaking in the intensive care unit. This usage is sensible enough but mayconfuse readers accustomed to generalist-physician gatekeeping in managed careorganizations. The authors also apply the old French army (and coffee-bean sorting)term “triage” to a mode of decisionmaking complicated by an absolute or relativeshortage of fully staffed beds; “nontriage” is applied in settings not complicated bysuch shortages. They recognize that their version of gatekeeping is also greatly affectedby uncertainties and disagreements about prognosis and the reliability of prognosticaids, such as computerized physiologic scoring systems; about longer term “outcomes”projections; and about litigation likelihood. Is triage-mode gatekeeping a form ofrationing? The answer, of course, depends on which definition of rationing—thereare many now from which to chose—appeals to a particular analyst or advocate. Callit what one will, the shuffling of the unstable sick does commonly happen and, theauthors argue, can be made to happen better—more sensitively, more safely, morefairly, less expensively—through studious preparation.

The authors, in closing, look down some of the rougher roads to conservation of“scarce resources.” Gatekeeping decisions resisted by patients or families or otherscould be imposed confidently if states passed and successfully defended liability-immunizing statutes. Proposals dependent on this sort of legislative innovation havetended to be called “Oregonian” ever since Oregon’s first famous Medicaid waiverapplication, rejected during the Bush administration [Sprinkle, 1994]. Analogously,managed care organizations could develop and market contracts, presumably at cut-rates, through which rights of resistance to certain gatekeeping decisions would beforfeited in advance. Proposals such as these, recent though they are, seem almostsurreal now, as if stuck in the amber of a health care “crisis” that was never quitewhat it appeared.

The third book is Assessing Medical Rehabilitation Practices: The Promise of OutcomesResearch, edited by Marcus J. Fuhrer, a medical rehabilitation expert and director ofthe National Center for Medical Rehabilitation Research at the National Institutes ofHealth. He has assembled papers from a 1994 conference called to advance the“outcomes movement” standard deep into his own field, long one of the foggier reachesof the biomedical research world.

All clinical therapeutic research programs deal with outcomes. However, many, ifnot most, individual clinical therapeutic research studies deal only with surrogateoutcomes. In the rehabilitation context, if a clinician’s goal is return of a patient tofull independence, then the achievement of intermediate goals, such as intelligiblespeech or unaided transfer from a bed to a chair, is well worth accelerating. But whatif such goals are reached sooner only at great cost and only by a few days, and whatif that small, though statistically significant, difference melts indistinguishably into

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the months that still must pass before full independence might be achieved? If manyrehabilitation workers must be paid to achieve a goal that, in the end, signifies little,then why pay them? Why employ them? Why train them?

Long courses of individualized therapies yielding equivocal results were early andeasy targets for managed care cost cutters and for critics of Medicare, Medicaid, andVeteran’s Administration “waste, fraud, and abuse.” Rehabilitation prospects were sovariable, the range of adequately powered and acceptably designed randomizedcontrolled trials so limited, and the quality of practice so hard to measure that“fundability” in this field began to suffer. A search for more credible researchmethodologies was undertaken, the strategy being to select or to develop de novorehabilitation practices for which funding arguments could reliably be sustained.The strategy was rooted simultaneously in clinical investigation and political economy,and so were the tactics. Methods of cost-effectiveness, cost-benefit, multiattributeutility analysis, and human capital valuation began to fix the attention of scholarsmore comfortable with grip strength, and hypotheses meant to engage the self-interestof funders began to be generated in increasing numbers.

This book, while written by and for rehabilitation professionals, shows the policyscholar what a sudden and jarring reorientation toward “outcomes”—toward a“bottom line” both clinical and financial—can mean. New understanding and newperspective, certainly, but also a new determination to produce what is measurable,however tenuous its correlation with what is desirable.

ROBERT HUNT SPRINKLE is Assistant Professor of Public Affairs at the School ofPublic Affairs, University of Maryland.

REFERENCES

Evans, Judith and Stuart Auerbach (1996), “Humana May Leave Washington Market: Contin-ued Losses Plague Managed-Care Firm,” Washington Post, June 8, pp. C1, C2.

Humana (1996), 1995 Humana Annual Report (Louisville, KY: Humana, Inc.).

Sprinkle, Robert H. (1994), Profession of Conscience: The Making and Meaning of Life-SciencesLiberalism (Princeton, NJ: Princeton University Press).

John Merrifield

The Teacher Unions, by Myron Lieberman. New York: The Free Press, 1997, 305 pp.,$25.00 cloth.

Myron Lieberman’s latest work is invaluable as a scholarly reference and for studentsof unions and the political process. The Teacher Unions is a must-read for advocatesof school reform. Our woeful K–12 education system has made virtually everyone anadvocate of some kind of reform. No one else combines Lieberman’s experience as anacademic scholar and proponent of market-driven education service delivery withextensive personal experience working in, working with, and working against both ofthe teacher unions.

Lieberman describes the structure and motives of the teacher unions, the NationalEducation Association (NEA), and the American Federation of Teachers (AFT) ingreat detail, including personal experiences and anecdotes. The description includesthe history of both unions, especially the events of the 1960s that led to the explosionin their size and political influence. Three chapters (3 through 5) describe the unions’

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objectives, bargaining practices, and political operations. State-level affiliates of thenational unions are discussed in Chapter 6.

Chapter 7 discusses the unions’ adamant opposition to competition for public schoolpersonnel in any form. They oppose contracting out of noninstructional services,even though the NEA and AFT offices themselves contract out extensively. Chapters 8through 10 describe union revenue sources, union officials’ salaries, and the assessmentof agency fees for representation of teachers that are not union members. Liebermandocuments the understatement of political spending and the difficulty of disputingor recouping excessive agency fees. The result is extensive nonmember funding ofunion political causes with which nonmembers disagree. Chapter 11 is about AlbertShanker, who was president of the AFT from 1974 until his recent death on 22 February1997. Lieberman explains why Shanker was especially effective, and he examines thecontradictions between Shanker’s public statements and his private actions. In theprocess, Lieberman exposes the naiveté of the conservatives (including PresidentRonald Reagan and Education Secretaries William Bennett and Lamar Alexander)that accorded Shanker unusual privileges and praised him for being an enlightenedand “different” union leader, even though there was no significant difference betweenthe substantive positions of the two teacher unions.

Chapter 12 was my favorite. Lieberman compares the promises that produced theunions’ phenomenal growth since the early 1960s with what actually happened. Heexamines two questions: (a) Have AFT and NEA members fared better than teachersthat do not bargain collectively? and (b) Is collective bargaining good for K–12students? Lieberman points out why the body of empirical findings as a whole isinconclusive. Self-interest, poor research practices, and data limitations have producedsomething to cite to bolster any contention. For example, though salary analyseshave produced mixed findings, the data are too poor to determine if collectivebargaining produced relative gains in fringe benefits. The data also do not exist todetermine whether collective bargaining benefits, if any, exceed costs, such as dues,and the opportunity cost of time teachers spend on union activities.

Because the empirical findings do not unambiguously support any position, anddata limitations will probably prevent definitive findings, the theoretical argumentsare especially important. Lieberman identifies and convincingly explains severalavenues of probable harm to students and union teachers, especially students. Forexample, the unions’ opposition to merit pay and salary differentials on any basisother than seniority and academic credit has harmed both the most effective teachersand teachers in high-demand areas like math and science. In turn, resulting shortagesof math and science teachers have hurt students. Finally, Lieberman explains bothhow the NEA has come to dominate the Parent–Teacher Associations (PTAs) and theresulting negative impact on parents and children.

Chapter 13 describes the issues surrounding a probable NEA-AFT merger.Chapter 14, the final chapter, was based on the assumption that the teacher unions

were major barriers to needed reforms and asked what could be done to weaken thatopposition. Discussion of what could be done was actually only a small part of chapter14. Most of Chapter 14 was spent describing hopeful signs, trends that might weakenthe unions, and alternative forms of representation for teachers. The book wouldhave been an even more valuable reference had the latter part of Chapter 14 beenplaced in a separate chapter that described a strategy, including likely expenses, whichcould be proactively used to weaken the teacher unions’ opposition to needed reforms.

JOHN MERRIFIELD is Associate Professor of Economics at the University of Texas–San Antonio.

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Chris C. Demchak

Fundable Knowledge: The Marketing of Defense Technology, by A. D. van Nostrand.Mahwah, NJ: Lawrence Erlbaum Associates, 1997, 233 pp., $49.95 paper.

In Fundable Knowledge, van Nostrand uses linguistic analysis to painstakinglyexamine the character and transformation of knowledge in the exchangesunderpinning the contractual processes in the U.S. defense science and technology(S&T) community. He reviews the knowledge-defining roles of the multiplicity ofdocuments that mark the relationships between vendors and customers. He exploresvia these documents the manner in which marketing as a motif underlies suchdocuments but is not clearly transferable to a more explicit process, such as technologytransfer. The work concludes by suggesting the use of genre analysis as a way to trackthe emergence of a discourse community that can sustain technology transfer betweenfederal research and development (R&D) sites and the wider economy.

Over the discursive text, the author builds toward a final argument that transferringdefense R&D to the civilian world is hampered by the lack of a marketing mind-setamong the relevant federal actors. He argues that marketing in the form of creatingfundable knowledge has been going on unbeknownst to these institutions. It has beenburied in the various genres underpinning the wide variety of acquisition documents.In van Nostrand’s view, during the normal defense S&T acquisition process establishedduring the cold war era, the customer markets needs to vendors, while the vendormarkets potential products in the exchange of requests for proposals and responses.Passing these documents among actors iteratively whittles the set of conceivableproblems to solvable—therefore fundable—problems, making the final product“fundable knowledge.” In contrast, unlike this well-established acquisition process,the technology transfer process has not yet had this level of document developmentand is thus not being properly marketed for success. Furthermore, despite legalrequirements to transfer technologies, the players currently cannot clearly conceiveof how to perform more direct marketing because of cultural predilections againstselling one’s science or discoveries. Hence, van Nostrand argues, something must bedone to build explicitly a “marketing” mind-set among the defense R&D engineers.Finally, van Nostrand suggests that a small community of knowledge brokers isemerging to create this marketing mind-set but that this nascent development hasnot proceeded far.

Fundable Knowledge is a complicated work. So many ideas are raised in the initialchapters that the key concern—the faltering technology transfer process—is easilyoverlooked until the summary chapters. The book is written by an outsider to thedefense community, an English professor. It is about the role of language anddocuments, and the term “fundable knowledge” certainly can be conceptually powerfulwhen properly prefaced. Another contribution is the set of descriptions of documentsin the acquisition process that existed until 1994 and of the various organizations,known as “activities,” and their acronyms. Rarely in this field are these otherwisebewildering documents explained in so few words. Finally, it is intriguing to considerthe level of cognitive dissonance that must exist in a community that routinelyadvertises its needs and capabilities to one another cloaked in official documents andyet is unable to see that process as a marketing activity.

In the wake of the cold war, innovative approaches to the study of defense issuescan be extraordinarily useful. This book, however, poses problems. Three elements ofthe argument are particularly tenuous: the definition and use of “knowledge,” the

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understanding and application of economic terms such as marketing, and thecharacterization of the uniqueness of the defense acquisition community and its“mind-set.”

First, the concept of knowledge is explored across a variety of definitions but is notconcretely defined. Instead, after a lengthy comparison of different possibilities, theauthor settles on a description that hardly clarifies the later application of the term.To wit, “. . . the act of interpreting information formulates some particular significanceabout it. And that formulation is knowledge” (p. 34). The author’s usage then dilutesthe concept by assigning the creation of knowledge to nearly any exchange ofdocuments between vendor and customer. Furthermore, the focus of the book is onthe precontract negotiations, in which occur the distillation of possible hurdles intodoable problems with appropriate significance attached to the solutions that need tobe established. Given this focus, creating fundable knowledge could more properlybe called “Cooperative 'Doable’ Problem Identification.” Much later in the book, theauthor asserts that this precontract process is “stabilizing” knowledge up to theawarding of a contract. Thereafter, knowledge is “destabilized” as actors publish injournals, give talks, and participate in other such activities. At this point, it is difficultto understand what exactly comprises knowledge. Missing from this discussion arereferences to works by authors in physics, engineering, computer science, economics,complexity theory, and the nascent surprise theory. Here knowledge is more thaninformation, and it is contextually defined by its relative value to the level of uncertaintyin a given situation [Casti, 1994; Demchak, 1991; Gleick, 1987; Gomory, 1995; Horgan,1995; Roe, 1998; Waldrop, 1992]. With a more expansive view of the literatures toconsult, van Nostrand could have altered his definition to accommodate these otherapproaches and, in the process, would have created a more consistent application ofthe term.

Second, the author’s notions of the market are unfortunately simplistic and appearprotomercantilistic at their base. Early in the book, the concepts of a market in theirmost elementary level are introduced, and this language is used for much of theremaining work. The author discloses that he went to marketing textbooks for anunderstanding of marketing as a process and seemingly came away with an idea ofproduct exchange that is tied to a fixed-pie barter system of nonshared, nonrenewablegoods. In particular, he declares the production of knowledge prior to the culminationof a research contract as a “paradox” because the contract to produce the product—the final knowledge to be created—is not yet signed. It is in the contract that the final“knowledge creation” parameters are formally agreed upon. Van Nostrand views asparadoxical that the actors should learn something important and new prior to formalagreement. Furthermore, that both parties to a contract should then acquire thisknowledge before contract monies are exchanged is presented as uniquely inherentin the U.S. defense S&T community. But this characterization borders on naïveté. Incorporate planning and advertising and marketing, the potential consumers routinelycollect significant information prior to paying for a product. As either side acquiresthis knowledge, it is also retained by the other. There is no paradox here unless themarket is a zero-sum transfer of single-user goods. In such a system, there can be nonegotiating in advance that informs both the seller and the buyer that an object issold, and even the facts of the sale present no new knowledge to the seller. This ishardly a nuanced understanding of the kind of information exchange that occursnormally between large institutional bodies.

Here the author neglects the truly interesting aspect of his work—the possibility ofwidespread institutional cognitive dissonance on the subject of marketing. Ratherthan emphasizing a paradox that may not exist, van Nostrand is on firmer ground

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showing how these documents are, in reality, marketing tools clothed as neutralexchanges of information. Admission that both parties increase their stock ofknowledge by exchange is itself trivial, but showing how these documents become anaccepted elaborately masked set of promises that winnow into a consensus on possiblerealities is more interesting and more useful as a conceptual framework. Relatingthose documents and processes to the actual processes of multinational corporationswould have been an advancement in this area.

Third, the book needs comparative insight beyond this set of institutions and thisparticular S&T venue. Van Nostrand argues that the federal actors in defense S&Tacquisition lack a mind-set in favor of marketing. He uses as evidence this veiledmarketing through acquisition documents and blames this lack in part on the inwardfocus of engineers who are not interested in social interactions. In recountingindividual interviews not apparently controlled for the individual’s location orexperiences, he uses the expressions of frustration by officials in technology transferjobs as confirmation of the wider mind-set. Furthermore, his assertion that this mind-set is peculiarly an attribute of defense acquisition in R&D was especially dubious tothis reader, a former defense analyst who worked in Washington for a nonprofit firmduring the 1980s. It was always clear to the largely engineering nonprofit employeesand to our “employers” in the Department of Defense that we were marketing ourcapabilities, albeit less extravagantly than the for-profit firms. In any case, the normalcorporate processes of finding what the client needs and attempting to respond tothat need were not considered repugnant or unthinkable. Indeed, it has been theargument of antidefense scholars for years that this marketing of large defensetechnologies was cynically pursued [see, for example, the works of Spinney, 1985,and Rasor, 1983]. For more comparative insight, van Nostrand could also have stronglyprofited by reviewing Kolodziej’s [1987] work on the processes in France, as well as anumber of business texts on corporate management. These sources would have madethe exchanges in the U.S. defense S&T community seem perhaps less amazing andwould have helped the author have a more nuanced understanding of the community.

Interestingly, the author offers an alternative and more persuasive argument inpassing. In paraphrasing the frustrations of technology transfer officials, van Nostrandnotes that very few resources are budgeted for this transfer process. If we accept thatconsiderable budget monies are expensed in the flurry of precontract documents,which van Nostrand identifies as marketing, then we can presume that considerablefunds will be needed to market the knowledge being produced. It is axiomatic inpolitical science or policy studies to follow the trail and volume of money to understandpolicy priorities. If technology transfer is considered important among seniordecisionmakers, then they fully understand that its progress is tied to the budgetamounts dedicated to making it successful. A mind-set, according to van Nostrand,exists among the researchers themselves. An argument more in keeping with theestablished fields of public administration, public policy, and political science wouldbe not to blame the victims—those expected to market their wares without budgets—but to seek the hindrances at the senior level that redirect the resource allocation. Itis significant that van Nostrand does not include political science or publicadministration in the fields of study on which he based this work. Reference to theseworks could only have moderated and improved his assertions.

In addition, there are some disturbing shortcomings of the book that make it lessuseful. The book is based on a rhetorical style that leads the reader piece by piece toa final argument. It is a style for a more leisurely era; it does not concede the need fora summary of the overall argument at the front. For the reader pressed with otherobligations and unused to the normal format of linguistic analysis, this approach is

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frustrating and confusing. Reading the final two chapters first is necessary to makethe rest of the rather discursive discussion fall into a discernible pattern. The discussionranges widely, including references to Pilgrim mind-sets among a variety of othercontextual and tangential issues. Literary references and quotes dot the chapters anddistract readers seeking precision in the discussion. Furthermore, the book cannotbe used as a reference because the index is wholly inadequate. The defense communitylives on acronyms, and these are not included in the index. For example, at least oneacronym (p. 209), “ORTA,” was never clarified. A limited index is perhaps more typicalin literary works but extraordinarily hindering in works addressing governments andtheir agencies. In addition, some relatively common terms well understood in theinformation age are presented as discoveries of unique usage. For example, vanNostrand presents the use of “task” or “transition” as a verb (p. 70) as an example oflanguage peculiar to the defense community. Yet, a quick check of colleagues havingnothing to do with defense or R&D suggests that the usage of both words is widelyunderstood. These shortcomings give the appearance of a work that is dated insubstance and presentation, thus undermining the persuasiveness of the book.

Overall then, I cannot recommend this work for a wide audience. Outside of theliterary analysis community, for whom this may be a novel departure from normaltypes of analysis, other readers are likely to put the book down in frustration. Forscholars in other fields and for practitioners, the time needed to follow this windingargument is perhaps better spent on more traditional texts on defense acquisitionsuch as those by Gansler [1995], Mayer [1991], and McNaugher [1989].

CHRIS C. DEMCHAK is Associate Professor of Public Policy and Political Scienceat the University of Arizona.

REFERENCES

Casti, John L. (1994), Complexification: Explaining a Paradoxical World through the Science ofSurprise (New York: Harper Collins).

Demchak, Chris C. (1991), Military Organizations, Complex Machines: Modernization in theU.S. Armed Services (Ithaca, NY: Cornell University Press).

Gansler, Jacques S. (1995), Defense Conversion (Cambridge, MA: MIT Press).

Gleick, James (1987), Chaos: Making a New Science (New York: Viking).

Gomory, Ralph (1995), “The Known, the Unknown and the Unknowable,” Scientific American272(6) (June), p. 120.

Horgan, John (1995), “From Complexity to Perplexity,” Scientific American 272(6) (June) pp.104–109.

Kolodziej, Edward A. (1987), Making and Marketing Arms: The French Experience and Its Impli-cations for the International System (Princeton, NJ: Princeton University Press).

Mayer, Kenneth R. (1991), The Political Economy of Defense Contracting (New Haven, CT: YaleUniversity Press).

McNaugher, Thomas L. (1989), New Weapons, Old Politics: America’s Military ProcurementMuddle (Washington, DC: The Brookings Institution).

Rasor, Dina (ed.) (1983), More Bucks, Less Bang: How the Pentagon Buys Ineffective Weapons(Washington, DC: Fund for Constitutional Government).

Roe, Emery (1998), Taking Complexity Seriously (Boston: Kluwer Academic Publishers).

Spinney, Franklin C. (1985), Defense Facts of Life: The Plans/Reality Mismatch (Boulder, CO:Westview Press).

Waldrop, M. Mitchell (1992), Complexity: The Emerging Science at the Edge of Order and Chaos(New York: Simon Schuster).