Where can buy Introduction to healthcare delivery a primer for pharmacists 5th edition robert l. mcc

Page 1


https://ebookgate.com/product/introduction-tohealthcare-delivery-a-primer-for-pharmacists-5thedition-robert-l-mccarthy/ Download more ebook from https://ebookgate.com

More products digital (pdf, epub, mobi) instant download maybe you interests ...

Drug Delivery and Targeting For Pharmacists and Pharmaceutical Scientists 1st Edition Anya M. Hillery

https://ebookgate.com/product/drug-delivery-and-targeting-forpharmacists-and-pharmaceutical-scientists-1st-edition-anya-mhillery/

Sociology for Pharmacists An Introduction 2nd Edition

https://ebookgate.com/product/sociology-for-pharmacists-anintroduction-2nd-edition-kevin-m-g-taylor/

Healthcare Delivery in the U S A An Introduction to Hospitals Health Systems and Other Providers of Care 1st Edition

https://ebookgate.com/product/healthcare-delivery-in-the-u-s-aan-introduction-to-hospitals-health-systems-and-other-providersof-care-1st-edition-margaret-schulte/

Management Engineering for Effective Healthcare Delivery Principles and Applications 1st Edition

https://ebookgate.com/product/management-engineering-foreffective-healthcare-delivery-principles-and-applications-1stedition-alexander-kolker/

Economics for Healthcare Managers Third Edition

https://ebookgate.com/product/economics-for-healthcare-managersthird-edition-robert-lee/

Introduction to Ratemaking and Loss Reserving for Property and Casualty Insurance 3rd Edition

Robert L. Brown

https://ebookgate.com/product/introduction-to-ratemaking-andloss-reserving-for-property-and-casualty-insurance-3rd-editionrobert-l-brown/

Economics for Healthcare Managers Second Edition

Robert H. Lee

https://ebookgate.com/product/economics-for-healthcare-managerssecond-edition-robert-h-lee/

The little SAS book a primer 5th ed Edition Delwiche

https://ebookgate.com/product/the-little-sas-book-a-primer-5thed-edition-delwiche/

A Practical Guide to Behavioral Research 5th Edition

Robert Sommer

https://ebookgate.com/product/a-practical-guide-to-behavioralresearch-5th-edition-robert-sommer/

IntroductIon to HealtH Care Delivery

A Primer for Pharmacists

FIFth EdItIon

edited by:

robert l. McCartHy, PhD dean and Professor School of Pharmacy university of connecticut

KennetH W. SCHaferMeyer, PhD Professor and director division of Liberal Arts and Administrative Sciences St. Louis college of Pharmacy

KiMberly S. PlaKe, PhD Associate Professor department of Pharmacy Practice Purdue university, college of Pharmacy

World Headquarters

Jones & Bartlett Learning

Jones & Bartlett Learning Jones & Bartlett Learning 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA info@jblearning.com Canada United Kingdom www.jblearning.com

Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com.

Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to specialsales@jblearning.com.

Copyright © 2012 by Jones & Bartlett Learning, LLC

All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used.

Production Credits

Publisher: David D. Cella

Acquisitions Editor: Katey Birtcher

Associate Editor: Maro Gartside

Editorial Assistant: Teresa Reilly

Senior Production Editor: Renée Sekerak

Production Assistant: Sean Coombs

Marketing Manager: Grace Richards

Manufacturing and Inventory Control Supervisor: Amy Bacus

Composition: DataStream Content Solutions, LLC

Cover Design: Kristin E. Parker

Rights and Permissions Manager: Katherine Crighton

Photo Research Coordinator: Jessica Elias

Cover Images: Assortment of multicolored pills © Radkevich Siarhei/Dreamstime.com; hundred dollar bills © Deshacam/Dreamstime.com; U.S. Supreme Court building © Jonathan Larsen/ShutterStock, Inc.; female pharmacist © Mangostock/Dreamstime.com

Printing and Binding: Malloy, Inc.

Cover Printing: Malloy, Inc.

To order this product, use ISBN: 978-1-4496-4488-8

Library of Congress Cataloging-in-Publication Data

Introduction to health care delivery : a primer for pharmacists / [edited by] Robert L. McCarthy, Kenneth W. Schafermeyer, Kimberly S. Plake.—5th ed. p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-7637-9088-2 (pbk.)

ISBN-10: 0-7637-9088-5 (pbk.)

1. Medical care—United States. 2. Pharmaceutical services—United States. I. McCarthy, Robert L. II. Schafermeyer, Kenneth W. III. Plake, Kimberly S.

[DNLM: 1. Delivery of Health Care—United States. 2. Drug Industry—United States. 3. Economics, Pharmaceutical—United States. 4. Pharmaceutical Services—United States. W 84 AA1]

RA395.A3I567 2012

362.1’0973—dc22

6048

Printed in the United States of America 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

2011011420

To my grandson, Patrick Robert McCarthy.

—Robert L. McCarthy

To my wife, Donna, for her love and the many anniversaries to come.

—Kenneth W. Schafermeyer

To my husband, Michael, whose love and support have never wavered.

—Kimberly S. Plake

Preface

When the First Edition was published in 1998, Professor McCarthy hoped to meet a textbook need he felt was not adequately met. As an instructor who taught healthcare delivery, systems, and policy, he had long sought a book that provided an introduction to this rapidly evolving area, but that would do so from the perspective of pharmacy. In subsequent editions, we believe that we have been true to his original intent. Over the years, as we developed new editions, we tried to be responsive to the needs of our colleagues by adding, subtracting, and changing subject matter; by providing active learning exercises; and by developing online resources for instructors and students. Given the rapidly changing nature of healthcare delivery, we have also been committed to an aggressive revision schedule; this Fifth Edition is being published just 13 years after the First Edition.

The Fifth Edition includes several major revisions and chapter restructures to reflect the current reality, which one might argue is the most dynamic period in American health care yet. Given the changes in health information technology and mental health care, the reader will see significant changes in the chapters exploring these important topics. Medication therapy management and the medical home appear prominently for the first time. At the request of our adopters, a comprehensive chapter on public health has once again been included. The Patient Protection and Affordable Care Act of 2010, the most sweeping piece of federal healthcare legislation since the passage Medicare and Medicaid in the 1960s, is addressed in detail, including a description of the pharmacy-specific provisions that have the potential to alter the way in which pharmacy is practiced and pharmacy services are reimbursed in the United States.

We hope you will find the Fifth Edition of Introduction to Health Care Delivery: A Primer for Pharmacists achieves the goals of its forebears, but also enables instructors and students of healthcare delivery to consider, more fully, how healthcare services in general—and pharmacy services in particular—are delivered. Moreover, we hope that the text and its supplementary materials—including those provided online—will facilitate thoughtful discussions among students, faculty, and practitioners about not only how health care is delivered, but how the system might be improved for all those seeking care.

This book is also accompanied by extensive student resources. To learn more, visit: http://go.jblearning.com/mccarthy5.

Contributors

thomas E . Buckley, MPH, rPh

Assistant Clinical Professor

University of Connecticut, School of Pharmacy Storrs, Connecticut

Suvapun Bunniran, PhD

University of Mississippi, School of Pharmacy University, Mississippi

aleda M . H . Chen, PharmD, MS

Assistant Professor of Pharmacy Practice

Cedarville University, School of Pharmacy Cedarville, Ohio

Craig I . Coleman, PharmD

Associate Professor

University of Connecticut, School of Pharmacy Storrs, Connecticut

Shane P . Desselle, BS, PhD

Associate Dean for Tulsa Programs

Professor and Chair

Department of Pharmacy: Clinical and Administrative Sciences University of Oklahoma, College of Pharmacy Oklahoma City, Oklahoma

Louis P . garrison Jr, PhD

Professor for Pharmaceutical Outcomes, Research, and Policy Program

Department of Pharmacy

Adjunct Professor

Departments of Global Health and Health Services

University of Washington, School of Pharmacy

Seattle, Washington

Dana P . Hammer, PhD, MS Director

Bracken Pharmaceutical Care Learning Center and Teaching Certificate Programs in Pharmacy Education

University of Washington, School of Pharmacy Seattle, Washington

ardis Hanson, MLS Head

FMHI Research Library University of South Florida Tampa, Florida

Peter D . Hurd, PhD

Professor and Assistant to the Dean for Research

St. Louis College of Pharmacy St. Louis, Missouri

Bruce Lubotsky Levin, DrPH, MPH

Associate Professor and Head

Graduate Studies in Behavioral Health Program College of Behavioral and Community Sciences

University of South Florida, College of Public Health Tampa, Florida

Earlene E . Lipowski, PhD

Associate Professor Pharmacy Health Care Administration

University of Florida, College of Pharmacy Gainesville, Florida

Marcus Long, Ma

Vice President, Marketing and Communications St. Louis College of Pharmacy St. Louis, Missouri

Frank Marr, PharmD General Manager Walgreens Infusion Services East Berlin, Connecticut

David J . McCaffrey III, BS, MS, PhD

Associate Professor of Pharmacy Administration and Research Research Institute of Pharmaceutical Sciences

University of Mississippi University, Mississippi

Maureen a . McCarthy, rPh, MBa

Clinical Pharmacist

Walgreens Infusion Services East Berlin, Connecticut

William W . McCloskey, Ba, BS, PharmD

Professor of Pharmacy Practice

Massachusetts College of Pharmacy and Health Sciences Boston, Massachusetts

Helen Meldrum, PhD

Associate Professor of Psychology Bentley University Waltham, Massachusetts

Kristin B . Meyer, PharmD, CgP

Assistant Professor of Pharmacy Practice Drake University Des Moines, Iowa

Brenda r . Motheral, PhD

Associate Professor of Pharmacy Administration University of Kentucky, College of Pharmacy Lexington, Kentucky

Carol a . Ott, PharmD, BCPP

Clinical Assistant Professor of Pharmacy Practice

Purdue University, College of Pharmacy West Lafayette, Indiana

Catherine n . Otto, PhD, MBa

Former Chair

Patient Safety Committee

American Society for Clinical Laboratory Science Washington, District of Columbia

ana C . Quiñones-Boex, PhD, MS

Assistant Professor of Pharmacy Administration

Midwestern University, Chicago College of Pharmacy Downers Grove, Illinois

Kyle D . ross, PhD

Assistant Professor of Economics

Department of Economics and Finance

University of Arkansas at Little Rock Little Rock, Arkansas

xxii n Contributors

David M . Scott, MPH, PhD

Associate Professor of Pharmacy Administration

North Dakota State University, College of Pharmacy, Nursing, and Allied Sciences Fargo, North Dakota

Jennifer L . tebbe-grossman, PhD

Professor of Political Science and American Studies

Massachusetts College of Pharmacy and Health Sciences Boston, Massachusetts

alan P . Wolfgang, MS, PhD

Associate Professor University of Georgia, College of Pharmacy Athens, Georgia

Social aSpectS of HealtHcare Delivery

Healthcare Delivery in america: Historical and policy perspectives

Case Scenario

The Palmers, a large, extended family, immigrated to New England in the early 1700s. In the 18th and early 19th centuries, the family and their descendants lived on farms in New England. They prospered through farming and some occasional work in small factories in nearby towns. Around 1860, family members moved to the growing cities. A number took jobs in factories; others were fortunate enough to go to high school and even college and found positions in the new professions of teaching, business, and health care. In the 20th century, some family members thrived, especially in the period of rapid economic growth after World War II. Others were barely able to make ends meet, relying at times on government programs and private charities.

One constant in the extended Palmer family is that from the time of their arrival in New England in 1740, various family members kept journals and wrote letters (and later emails or Facebook entries) recording information about their extended family members’ daily lives. Suppose that in the 21st century, you have found some of these records spanning several centuries. As a future health professional, you learn about the health and disease history of the Palmer family members: what they thought caused disease and what their philosophies of health and disease were when they made their choices to seek health services; what kinds of diseases family members confronted; the differences public health improvements and technological changes made in their lives; how their health services were paid for; from whom and where they got or didn’t get their health services and why; and what they thought about different healthcare policies presented by politicians and branches of government as these policies changed over time in the United States. The written or electronic record covers much of what appears in this chapter.

Based on the material in this chapter, what might you find out about the health experiences and beliefs of the Palmer family members, given their differing socioeconomic backgrounds over time? What might you think about how much or how little healthcare services and their models of delivery have improved over time for American populations?

learNiNG oBJectiveS

Upon completion of this chapter, the student shall be able to:

•  Explain paradoxes of the U.S. healthcare system

•  Explain health conditions in 18th- and 19th-century America in relation to disease patterns and causation theories

•  Explain types of health practices and practitioners and factors explaining access to health care in 19th-century America

•  Explain the various roles of government in healthcare delivery in 18th- and 19th-century America

•  Explain the differences between orthodox and sectarian practitioners and their patients in relation to their perspectives on therapeutics and the delivery of health care

•  Explain changes in the character, organization, and purposes of hospitals as health delivery sites from the early 19th century through the early 21st century

•  Describe reforms in medical education at the turn of the 20th century and the consequences of the Flexner report of 1910

•  Identify the golden age of medicine and describe what replaced it in the late 20th and early 21st centuries

•  Explain the ways in which medicine and pharmacy pursued professionalization in the late 19th and 20th centuries and how these professions define themselves in the 21st century

•  Explain how the factors of public health, lifestyle (diet, housing, personal hygiene), and medical practice influenced the decline of infectious diseases and increase in life expectancy at the turn of the 20th century

•  Discuss the occurrences of infectious and chronic diseases in the 21st century

•  Discuss the types of government policy that affected healthcare delivery in the 20th and early 21st centuries, particularly in relation to the implementation of public and private health insurance

•  Discuss the implementation of Medicare and Medicaid in the 1960s, the 1973 Health Maintenance Organization Act, the 1996 Health Insurance Portability and Accountability Act, the 1997 Children’s Health Insurance Program, and the 2010 Patient Protection and Affordable Care Act

•  Explain the benefits and costs of the Medicare Part D Drug Plan

•  Explain problems associated with incremental healthcare reform

c H apter QU e S tio NS

1. What kinds of health beliefs did Americans hold in the 18th and 19th centuries?

2. What factors account for the decline in mortality rates and increases in life expectancy at the turn of the 20th century?

3. What were the benefits and drawbacks of the reforms in education that pharmacists and physicians implemented in the early 20th century as part of the professionalization process?

4. Who provided healthcare services for Americans and in what kinds of settings during the 18th, 19th, 20th, and 21st centuries?

5. What kinds of changes in private and public health insurance plans were considered by Americans in the past?

6. What is the potential for improved healthcare delivery in implementing patientcentered care, interdisciplinary care, and the medical home model of care?

7. How is the 2010 Patient Protection and Affordability Act characteristic of incremental healthcare reform?

iNtroDUctioN

Taking a historical perspective, this chapter examines the evolution of health care and health services in the United States. Emphasis is placed on the changes in social spaces where Americans experience healthcare services—from the home, physician’s office, neighborhood dispensary, or hospital—to the outpatient clinic, multigroup specialty practice, community pharmacy, or federally qualified community health center. Patterns of health and illness in the United States are examined in the context of mortality and life expectancy and the occurrence of infectious and chronic diseases. The changing social meanings of health and disease, the roles of health professionals, such as pharmacists and physicians, and the expectations of citizens as patients and consumers in an increasingly complex healthcare delivery environment are explored. Of particular concern is the context of changes in attitudes and practice toward individual and social responsibility in the delivery of healthcare services.

paraDoXeS

of tHe U.S. HealtHcare SySteM

The U.S. healthcare system is characterized by many paradoxes. The United States has the best, most advanced technology available—yet we have a very high rate of medical errors. There are gaps in who has access to health care, with 21.1% of persons aged 18–64 in 2009 lacking health insurance (Cohen, Martinez, & Ward 2010, p.1). Compared to other industrialized nations, the level of spending in the United States means that the country has one of the most expensive healthcare systems, especially in terms of administrative costs. The U.S. healthcare system is also fragmented in terms of how it is financed and how healthcare services are organized and delivered. The following overview highlights the paradoxes of health in America and some key components influencing the continuing crisis.

technology

Magnetic resonance imaging systems, new diagnostics, transplant surgeries, biotechnologybased products, genetic engineering, telemedicine, new reproductive technologies, and health information technology are just a few of the rapid technologic advances that have emerged in recent years in the United States. These developments offer hopes for improved quality of life, quicker diagnoses and better treatments, and increased life expectancy. Reliance on technologic innovation also creates problems. Most Americans expect to receive only the best technical care available, which often leads to overuse of technologic advances. New technologies tend to be updated quickly, often without sufficient examination of cost and effectiveness or patient safety threat issues. While the meaningful use of electronic health records offers opportunities for cost savings, reduction in medical errors, and improved patient access and outcomes, health

professionals raise concerns that in implementing electronic medical records they may lose focus on the interaction between the sick and the healer, thereby leading them to “suspend thinking, blindly accept diagnoses, and fail to talk to patients in a way that allows deep, independent probing” (Hartzband & Groopman, 2008, p. 1656; Ralston, Coleman, Reid, Handley, & Larson). While many Americans regard access to medical imaging as a sign of the superiority of the U.S. healthcare system, recent health research has focused on the avoidable public health threat that arises from investing so many resources in performing so many procedures as well as the dangers of radiation overdoses in single procedures (Bogdanich, 2010, p. A1; Lauer, 2009, pp. 842, 843). And finally, technology is not equally distributed among patient populations—significant disparities exist based on insurance status, income, and race (Weiss & Lonnquist, 2006, pp. 332–333).

Health expenditures

The United States easily surpasses all other countries in spending, yet millions of its citizens lack adequate access to health care. In 2008, a total of $2.3 trillion, representing an increase of 4.4% from the previous year, was spent on healthcare goods and services (amounting to $7,681 per person). The federal government and health researchers pointed out that health spending growth was the slowest in 48 years, attributing this downturn as most likely connected to the economic recession (Hartman, Martin, Nuccio, & Catlin, 2010, pp. 147–149). Yet the United States also continues to spend more money for health care with the percentage of U.S. gross domestic product spent increasing from 15.9% in 2007 to 16.2% in 2008. A cost that individual households saw was in the share of personal income spent on health, which increased from 5.3% in 2001 to 5.9% in 2008 (Centers for Medicare and Medicaid Services, 2010; Hartman, Martin, Nuccio, & Catlin, 2010, pp. 147–149). The Kaiser Family Foundation also reported in 2007 that the average premium for family health coverage was $12,106 with American workers paying $3,281 of this cost (Fletcher, 2008).

According to a study comparing the United States with other developed nations, the country spends a higher share of gross domestic product on health care. The 2009 Health Care at a Glance Organization for Economic Co-Operation and Development (OECD) report compared 2007 healthcare spending of the United States (16.0%) to France (11%), Switzerland (10.8%), United Kingdom (8.4%), and Canada (10.1%). U.S. spending is higher than other developed countries in the areas of inpatient and outpatient care, as well as administrative costs, pharmaceuticals, and long-term care (OECD, 2009; Reinhardt, Hussey, & Anderson, 2004).

Health insurance

In a 2009 Centers for Disease Control and Prevention national health interview survey, 46.3 million Americans of all ages were without health insurance. Between 2008 and 2009, there was an increase in the percentage of adults (18–64 years) lacking health insurance coverage from 19.7% to 21.1%. The survey indicated 10.9% of the 46.3 million had been without health insurance for more than 1 year. Lack of insurance varied by state, with one in five adults lacking insurance in Georgia and California, and one in four in Texas and Florida. Due to passage of health reform legislation that sought to achieve near-universal coverage, Massachusetts had a 3.7% rate of uninsured adults. Variability in the numbers of those insured across states relates to such factors as employment rates, cost of private insurance provided by employers or individual health

insurance, and access guidelines for public programs such as Medicaid. Studies have shown that many Americans are uninsured for parts of the year with the numbers highest for those living in families with lower incomes. In addition, the Commonwealth Fund estimated that nearly 25 million Americans had insurance policies in 2007 but were underinsured, meaning their policies often don’t cover important aspects of care including such items as preventive care health practitioner visits, prescription drug costs, medical tests, surgery or other medical procedures, or catastrophic medical conditions, and/or they usually require significant out-of-pocket payments for services (Cohen, Martinez, & Ward, 2010, p. 1; Gabel, McDevitt, Lore, Pickreign, & Whitmore, 2009; Johnson & Johnson, 2010; National Center for Health Statistics, 2009).

Health Standards

While health care in the United States is the most expensive across the globe, inadequate, improper, and even dangerous care is all too prevalent. In reports on the performance of healthcare systems internationally, the Commonwealth Fund has found that the United States “consistently underperforms on most dimensions of performance” including in areas of “access, patient safety, coordination, efficiency, and equity” (Bodenheimer, Chen, & Bennett, 2009, pp. 69, 72). Major problems for U.S. patients occur in health worker shortages and the ratio of healthcare clinicians to patients, especially in regard to physicians, nurses (including nurse practitioners), physician assistants, pharmacists, and community health and public health workers providing primary care services in rural and underrepresented areas. With increasing numbers of Americans needing primary care for chronic care services, researchers have called for such new national workforce policies as those fostering interdisciplinary and multidisciplinary care delivered in primary care settings, new financial payment systems for primary care practices and clinics, and increased education of health professionals from underrepresented population groups (Davis, Schoen, & Stremikis, 2010).

In 1999, the Institute of Medicine issued a major report, To Err Is Human: Building a Safer Health System, presenting data that showed 44,000 to 98,000 people die each year from medical errors, a higher number than those dying from breast cancer or auto accidents. The report outlined ways to reduce medical errors and urged Congress to create a national patient safety center. In 2005, the federal government enacted the Patient Safety and Quality Improvement Act to continue the effort to foster safety cultures in healthcare institutions. A study commissioned by the Society of Actuaries based on insurance claims data reported that medical errors and the problems that ensued from them resulted in costs of $19.5 billion to the U.S. economy in 2008 (Hobson, 2010). For the same year, the Henry K. Kaiser Foundation stated that “serious medication errors occur in the cases of five to 10 percent of patients admitted to hospitals” (Woo, Ranji, & Salganicoff, 2008, p. 1).

Those studying patient safety disagree on what progress has been made. Some argue that progress has been made in developing new adverse event reporting systems with the introduction of health information technology systems, advancing national data collection and accreditation standards, and promoting new patient safety initiatives supported by such groups as the Joint Commission and the Institute for Healthcare Improvement. Others, including Donald Berwick, an author of To Err Is Human and the new director of the Center for Medicare and Medicaid Services, have seen a change in awareness of medical safety but not fundamental change in the nature of the American healthcare industry (Beresford, 2010; Furukawa, Raghu, Spaulding, & Vinze, 2008;

Another random document with no related content on Scribd:

The Einstein effect, which is appealed to for confirmation of the high density, is a lengthening of the wave-length and corresponding decrease of the frequency of the light due to the intense gravitational field through which the rays have to pass. Consequently the dark lines in the spectrum appear at longer wave-lengths, i.e. displaced towards the red as compared with the corresponding terrestrial lines. The effect can be deduced either from the relativity theory of gravitation or from the quantum theory; for those who have some acquaintance with the quantum theory the following reasoning is probably the simplest. The stellar atom emits the same quantum of energy hν as a terrestrial atom, but this quantum has to use up some of its energy in order to escape from the attraction of the star; the energy of escape is equal to the mass hν/c2 multiplied by the gravitational potential Φ at the surface of the star. Accordingly the reduced energy after escape is hν(1 - Φ/c2); and since this must still form a quantum hν', the frequency has to change to a value ν' = ν(1 - Φ/c2). Thus the displacement ν' - ν is proportional to Φ, i.e. to the mass divided by the radius of the star.

The effect on the spectrum resembles the Doppler effect of a velocity of recession, and can therefore only be discriminated if we know already the line-of-sight velocity. In the case of a double star the velocity is known from observation of the other component of the system, so that the part of the displacement attributable to Doppler effect is known. Owing to orbital motion there is a difference of velocity between Sirius and its Companion amounting at present to 43 km. per sec. and this has been duly taken into account; the observed difference in position of the spectral lines of Sirius and its Companion corresponds to a velocity of 23 km. per sec. of which 4 km. per sec. is attributable to orbital motion, and the remaining 19 km. per sec. must be interpreted as Einstein effect. The result rests mainly on measurements of one spectral line Hβ. The other favourable lines are in the bluer part of the spectrum, and since atmospheric scattering increases with blueness, the scattered light of Sirius interferes. However, they afford some useful confirmatory evidence.

Of the other white dwarfs ο2 Eridani is a double star, its companion being a red dwarf fainter than itself. The red shift of the spectrum will be smaller than in the Companion of Sirius and it will not be so easy to separate it from various possible sources of error. Nevertheless the prospect is not hopeless. The other recognized white dwarf is an unnamed star discovered by Van Maanen; it is a solitary star, and consequently there is no means of distinguishing between Einstein shift and Doppler shift. Various other stars have been suspected of being in this condition, including the Companions of Procyon, 85 Pegasi, and Mira Ceti.

If the Companion of Sirius were a perfect gas its central temperature would be about 1,000,000,000°, and the central part of the star would be a million times as dense as water. It is, however, unlikely that the condition of a perfect gas continues to hold. It should be understood that in any case the density will fall off towards the outside of the star, and the regions which we observe are entirely normal. The dense material is tucked away under high pressure in the interior.

Perhaps the most puzzling feature that remains is the extraordinary difference of development between Sirius and its Companion, which must both have originated at the same time. Owing to the radiation of mass the age of Sirius must be less than a billion years; an initial mass, however large, would radiate itself down to less than the present mass of Sirius within a billion years. But such a period is insignificant in the evolution of a small star which radiates more slowly, and it is difficult to see why the Companion should have already left the main series and gone on to this (presumably) later stage. This is akin to other difficulties in the problem of stellar evolution, and I feel convinced that there is something of fundamental importance that remains undiscovered.

Until recently I have felt that there was a serious (or, if you like, a comic) difficulty about the ultimate fate of the white dwarfs. Their high density is only possible because of the smashing of the atoms, which in turn depends on the high temperature. It does not seem

permissible to suppose that the matter can remain in this compressed state if the temperature falls. We may look forward to a time when the supply of subatomic energy fails and there is nothing to maintain the high temperature; then on cooling down, the material will return to the normal density of terrestrial solids. The star must, therefore, expand, and in order to regain a density a thousandfold less the radius must expand tenfold. Energy will be required in order to force out the material against gravity. Where is this energy to come from? An ordinary star has not enough heat energy inside it to be able to expand against gravitation to this extent; and the white dwarf can scarcely be supposed to have had sufficient foresight to make special provision for this remote demand. Thus the star may be in an awkward predicament—it will be losing heat continually but will not have enough energy to cool down.

One suggestion for avoiding this dilemma is like the device of a novelist who brings his characters into such a mess that the only solution is to kill them off. We might assume that subatomic energy will never cease to be liberated until it has removed the whole mass —or at least conducted the star out of the white dwarf condition. But this scarcely meets the difficulty; the theory ought in some way to guard automatically against an impossible predicament, and not to rely on disconnected properties of matter to protect the actual stars from trouble.

The whole difficulty seems, however, to have been removed in a recent investigation by R. H. Fowler. He concludes unexpectedly that the dense matter of the Companion of Sirius has an ample store of energy to provide for the expansion. The interesting point is that his solution invokes some of the most recent developments of the quantum theory—the ‘new statistics’ of Einstein and Bose and the wave-theory of Schrödinger. It is a curious coincidence that about the time that this matter of transcendently high density was engaging the attention of astronomers, the physicists were developing a new theory of matter which specially concerns high density. According to this theory matter has certain wave properties

which barely come into play at terrestrial densities; but they are of serious importance at densities such as that of the Companion of Sirius. It was in considering these properties that Fowler came upon the store of energy that solves our difficulty; the classical theory of matter gives no indication of it. The white dwarf appears to be a happy hunting ground for the most revolutionary developments of theoretical physics.

To gain some idea of the new theory of dense matter we can begin by referring to the photograph of the Balmer Series in Fig. 9. This shows the light radiated by a large number of hydrogen atoms in all possible states up to No. 30 in the proportions in which they occur naturally in the sun’s chromosphere. The old-style electromagnetic theory predicted that electrons moving in curved paths would radiate continuous light; and the old-style statistical theory predicted the relative abundance of orbits of different sizes, so that the distribution of light along this continuous spectrum could be calculated. These predictions are wrong and do not give the distribution of light shown in the photograph; butthey becomeless glaringlywrongaswedrawneartotheheadoftheseries. The later lines of the series crowd together and presently become so close as to be practically indistinguishable from continuous light. Thus the classical prediction of continuous spectrum is becoming approximately true; simultaneously the classical prediction of its intensity approaches the truth. There is a famous Correspondence Principle enunciated by Bohr which asserts that for states of very high number the new quantum laws merge into the old classical laws. If we never have to consider states of low number it is indifferent whether we calculate the radiation or statistics according to the old laws or the new.

In high-numbered states the electron is for most of the time far distant from the nucleus. Continuous proximity to the nucleus indicates a low-numbered state. Must we not expect, then, that in extremely dense matter the continuous proximity of the particles will give rise to phenomena characteristic of low-numbered states? There is no real discontinuity between the organization of the atom

and the organization of the star; the ties which bind the particles in the atom, bind also more extended groups of particles and eventually the whole star. So long as these ties are of high quantum number, the alternative conception is sufficiently nearly valid which represents the interactions by forces after the classical fashion and takes no cognizance of ‘states’. For very high density there is no alternative conception, and we must think not in terms of force, velocity, and distribution of independent particles, but in terms of states.

The effect of this breakdown of the classical conception can best be seen by passing at once to the final limit when the star becomes a single system or molecule in state No. 1. Like an excited atom collapsing with discontinuous jumps such as those which give the Balmer Series, the star with a few last gasps of radiation will reach the limiting state which has no state beyond. This does not mean that further contraction is barred by the ultimate particles jamming in contact, any more than collapse of the hydrogen atom is barred by the electron jamming against the proton; progress is stopped because the star has got back to the first of an integral series of possible conditions of a material system. A hydrogen atom in state No. 1 cannot radiate; nevertheless its electron is moving with high kinetic energy. Similarly a star when it has reached state No. 1 no longer radiates; nevertheless its particles are moving with extremely great energy. What is its temperature? If you measure temperature by radiating power its temperature is absolute zero, since the radiation is nil; if you measure temperature by the average speed of molecules its temperature is the highest attainable by matter. The final fate of the white dwarf is to become at the same time the hottest and the coldest matter in the universe. Our difficulty is doubly solved. Because the star is intensely hot it has enough energy to cool down if it wants to; because it is so intensely cold it has stopped radiating and no longer wants to grow any colder.

We have described what is believed to be the final state of the white dwarf and perhaps therefore of every star. The Companion of Sirius has not yet reached this state, but it is so far on the way that

the classical treatment is already inadmissible. If any stars have reached state No. 1 they are invisible; like atoms in the normal (lowest) state they give no light. The binding of the atom which defies the classical conception of forces has extended to cover the star. I little imagined when this survey of Stars and Atoms was begun that it would end with a glimpse of a Star-Atom.

***

END OF

THE PROJECT GUTENBERG EBOOK STARS AND ATOMS

Updated editions will replace the previous one—the old editions will be renamed.

Creating the works from print editions not protected by U.S. copyright law means that no one owns a United States copyright in these works, so the Foundation (and you!) can copy and distribute it in the United States without permission and without paying copyright royalties. Special rules, set forth in the General Terms of Use part of this license, apply to copying and distributing Project Gutenberg™ electronic works to protect the PROJECT GUTENBERG™ concept and trademark. Project Gutenberg is a registered trademark, and may not be used if you charge for an eBook, except by following the terms of the trademark license, including paying royalties for use of the Project Gutenberg trademark. If you do not charge anything for copies of this eBook, complying with the trademark license is very easy. You may use this eBook for nearly any purpose such as creation of derivative works, reports, performances and research. Project Gutenberg eBooks may be modified and printed and given away you may do practically ANYTHING in the United States with eBooks not protected by U.S. copyright law. Redistribution is subject to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free distribution of electronic works, by using or distributing this work (or any other work associated in any way with the phrase “Project Gutenberg”), you agree to comply with all the terms of the Full Project Gutenberg™ License available with this file or online at www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg™ electronic works

1.A. By reading or using any part of this Project Gutenberg™ electronic work, you indicate that you have read, understand, agree to and accept all the terms of this license and intellectual property (trademark/copyright) agreement. If you do not agree to abide by all the terms of this agreement, you must cease using and return or destroy all copies of Project Gutenberg™ electronic works in your possession. If you paid a fee for obtaining a copy of or access to a Project Gutenberg™ electronic work and you do not agree to be bound by the terms of this agreement, you may obtain a refund from the person or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be used on or associated in any way with an electronic work by people who agree to be bound by the terms of this agreement. There are a few things that you can do with most Project Gutenberg™ electronic works even without complying with the full terms of this agreement. See paragraph 1.C below. There are a lot of things you can do with Project Gutenberg™ electronic works if you follow the terms of this agreement and help preserve free future access to Project Gutenberg™ electronic works. See paragraph 1.E below.

Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.