How partisanship, polarization, and medical authority stand in the way of evidence-based medicine

The U.S. medical system is touted as the most advanced in the world, yet many common treatments are not based on sound science. Unhealthy Politics sheds new light on why the government's response to this troubling situation has been so inadequate, and why efforts to improve the evidence base of U.S. medicine continue to cause so much political controversy. This critically important book paints a portrait of a medical industry with vast influence over which procedures and treatments get adopted, and a public burdened by the rising costs of health care yet fearful of going against "doctor's orders." Now with a new preface by the authors, Unhealthy Politics offers vital insights into the limits of science, expertise, and professionalism in American politics.

Reforms at Risk is the first book to closely examine what happens to sweeping and seemingly successful policy reforms after they are passed. Most books focus on the politics of reform adoption, yet as Eric Patashnik shows here, the political struggle does not end when major reforms become enacted. Why do certain highly praised policy reforms endure while others are quietly reversed or eroded away?


Patashnik peers into some of the most critical arenas of domestic-policy reform--including taxes, agricultural subsidies, airline deregulation, emissions trading, welfare state reform, and reform of government procurement--to identify the factors that enable reform measures to survive. He argues that the reforms that stick destroy an existing policy subsystem and reconfigure the political dynamic. Patashnik demonstrates that sustainable reforms create positive policy feedbacks, transform institutions, and often unleash the ''creative destructiveness'' of market forces.



Reforms at Risk debunks the argument that reforms inevitably fail because Congress is prey to special interests, and the book provides a more realistic portrait of the possibilities and limits of positive change in American government. It is essential reading for scholars and practitioners of U.S. politics and public policy, offering practical lessons for anyone who wants to ensure that hard-fought reform victories survive.