Hypertension in the community

This is a collection of articles with an introduction and conclusion by the editor.It is divided into sections on theoretical background, general issues, and specific issues.The editor describes the way in which an editorial committee, and the authors, developed the collection through a series of meetings.Its format and genesis thus suggest a relatively integrated approach.However the strengths ofthe book lie in its parts rather than in some architectural whole.This is largely inevitable not only because "This subject ... is a very difficult and complex one", as the introduction warns us, but also because it is a relatively new one.There is little or no shared stock oftheory or vocabulary for the authors to build upon.They are faced with the challenge of identifying the scope and methods of analysis while simultaneously trying to clarify or settle substantive issues.Knox is one of the contributors who does this remarkably well.He uses fluoridation, vaccination, rationing, and confidentiality as illustrations to argue for an irresolvable conflict between the principles of private and public health care, a conflict which, he argues, can therefore be managed only by practical and legislative solutions and not settled by moral theory alone.This discussion is complemented by Karhausen's reflections on the use of relative and attributable indices.Elsewhere there are some useful accounts of the ingredients of ethical reasoning, eg.Pochin on the the problems ofestimating occupational risk.The philosophical issue which receives the most attention is that of paternalism which is treated on the whole as a "necessary evil".