Biomedical Research Centres (BRCs) are partnerships between healthcare organisations and universities in England. Their mission is to generate novel treatments, technologies, diagnostics and other interventions that increase the country’s international competitiveness, to rapidly translate these innovations into benefits for patients, and to improve efficiency and reduce waste in healthcare. As NIHR Oxford BRC (Oxford BRC) enters its third 5-year funding period, we seek to (1) apply the evidence base on how best to support the various partnerships in this large, multi-stakeholder research system and (2) research how these partnerships play out in a new, ambitious programme of translational research.Organisational case study, informed by the principles of action research. A cross-cutting theme, ‘Partnerships for Health, Wealth and Innovation’ has been established with multiple sub-themes  to support individual BRC research themes and generate cross-theme learning.The ‘Partnerships’ theme will support the BRC’s goals by facilitating six types of partnership  through a range of engagement platforms and activities. We will develop a longitudinal progress narrative centred around exemplar case studies, and apply theoretical models from innovation studies (Triple Helix), sociology of science (Mode 2 knowledge production) and business studies . Data sources will be the empirical research studies within individual BRC research themes , plus documentary analysis and interviews and ethnography with research stakeholders. This study has received ethics clearance through the University of Oxford Central University Research Ethics Committee.We anticipate that this work will add significant value to Oxford BRC. We predict accelerated knowledge translation; closer alignment of the innovation process with patient priorities and the principles of responsible, ethical research; reduction in research waste; new knowledge about the governance and activities of multi-stakeholder research partnerships and the contexts in which they operate; and capacity-building that reflects the future needs of a rapidly-evolving health research system. The term ‘crucial case study’ comes from the notion that, if a proposition (such as ‘synergies will result from working in cross-sector partnerships’) fails when conditions are highly favourable, then it is unlikely to work in less favourable conditions .The ‘Partnerships’ research theme is led by TG and includes a core research team  whose roles include overall co-ordination and PPI/E as well as ‘research on research’. In addition to, and with a view to supporting, the main BRC steering group, a separate advisory group for the ‘Partnerships’ theme has been established, with reciprocal cross-representation. The former meets 6–8 times a year and the latter 2–3 times a year.The ‘Partnerships’ theme has a number of sub-themes that are operationally distinct (e.g. each has a designated lead and budget), but which will work collaboratively and flexibly to develop interdisciplinary case studies centred around specific research questions Table . Sub-theA wide range of external stakeholders and independent members will represent the various partnerships shown in Fig. Most importantly, the external advisory group will seek to establish social accountability of the ‘Partnerships’ cross-cutting theme to patients and the public in the spirit of the ‘democratization’ of science , 30. WheThe ‘Partnerships’ external advisory group will address the desirability and priority of current and proposed research topics and approaches, with particular emphasis on improving patient care, educating and training tomorrow’s clinician and scientist leaders, reducing research waste and advancing translational research. An important aspect of the external advisory group’s work will be to deliberate on research priorities, such as the trade-off between research that leads to short-term patient benefits locally versus research that is more oriented to filling national or global knowledge gaps and/or to the medium or long term.We will draw eclectically and critically on three closely related theoretical frameworks, which were respectively developed in innovation studies (the Triple Helix), the sociology of knowledge (Mode 2 knowledge production), and business and management . All have strengths and limitations and will need to be adapted as we apply them to the emerging case study. We describe these in turn.In their Triple Helix model, Etzkowitz et al. , 54 highThe knowledge space: collaboration to undertake research and generate new knowledge;The consensus space: building relationships and supporting dialogue among university, industry, healthcare staff, policymakers and citizens; andThe innovation space: collaborations and activities to achieve the goal of implementing  research discoveries, by combining academic or technical expertise with business expertise and (public or private) venture capital.Central to the Triple Helix model is the creation and support of three ‘spaces’ :The knowA key component of the Triple Helix model is the notion of ‘new organisational actors’ – organisational formats that straddle traditional university–industry–state boundaries – such as incubators, science parks and new models of venture capital  . Indeed,Etzkowitz and Leydesdorff  emphasisThe Triple Helix metaphor is presented positively by its protagonists as enhancing the potential for innovation and economic growth in a knowledge-based society. It is worth noting that critics of the Triple Helix have warned of the danger of ‘irresponsible innovation’ that may result from a combination of strong commercial drivers, technology push, policy pull, marginalisation of ethical principles, lack of precautionary measures and tokenistic rather than democratic input from patients and citizens –59. Perhsocially distributed, application-oriented, trans-disciplinary and subject to multiple accountabilities” [Such knowledge is generated partly or wholly outside the university in a heterogeneous transaction space embracing university, state, economy, culture, and the wider public sphere. In this space, problems are identified, questions debated, methodologies developed, and outcomes disseminated. There are many players, many experts (of different kinds), and an evolving collective view (though rarely a consensus) on what the questions and challenges are.” [“es are.” Our second theoretical influence is Gibbons et al.’s  Mode 2 Kilities” . As summUnlike the producer-consumer or contractor-commissioner relationship between researchers and research end-users in traditional ‘Mode 1’ scientific research, relationships between researchers and users in Mode 2 are  democratic and collaborative, and seek to generate knowledge that is both socially and scientifically robust. However, such an approach constitutes a significant challenge to the norms of academic science, as set out back in 1938 by Merton , which iknowledge production based on relations of power and patronage” – [As with the Triple Helix model, the Mode 2 model has been criticised for taking a politically naïve perspective and overlooking the power of vested interests to distort the research agenda , 65. Indonage” –  to Gibboonage” –  originalThe third theoretical framework on which we seek to draw is an adaptation of Ramaswamy et al.’s , 68 ValuStakeholders will not wholeheartedly participate in the co-creation process unless it produces value for them;The best way to co-create value is to focus on the experiences of all stakeholders;Stakeholders must be able to interact directly with one another (preferably face to face at least some of the time);Platforms are needed that allow stakeholders to interact and share their experiences.Ramaswamy and Ozcan  offer foEngagement of individuals (in which people who will be key to the enterprise are engaged and offered support and open-source resources); andSupport for enterprise, which brings organisations together to work on particular projects and programmes and provides a range of resources for this purpose.Central to the model are platforms  for bringing stakeholders together. The co-creation process is supported through two key activities :EngagemeAs Fig. Although the Value Co-creation model originated in business studies, the theoretical ideas of co-creation can be applied to the co-creation of knowledge within the Triple Helix of university–industry–government relations resting on an active civil society . To our Mode 3 knowledge production in a quadruple helix innovation system”. This framework adds a fourth strand – civil society – to the triple helix and also extends the work of Gibbons et al. [One approach that could potentially bring all three of these perspectives together is what Carayannis et al.  have cals et al.  to addres et al.  call thes et al. , p. 41),an assemblage of persons, processes, interfaces, and artifacts, whose engagement design affords environments of interactions that intensify agential actions in value creation” .www.oucags.ox.ac.uk), a regular email newsletter, a range of training courses and regular face-to-face events, it brings doctoral students and early career researchers together and links them with resources and opportunities. (6) The Oxford-BRC-Partnerships Jiscmail list is an academically run list server open to anyone working in or with the Oxford BRC, including patients and the public involved in PPI/E activities. It provides an informal platform for asynchronous email communication, interdisciplinary discussion and resource sharing on the key domains supported by the ‘Partnerships’ theme . (7) Social media presence for the NIHR Oxford BRC includes a Twitter feed and Facebook account (@OxfordBRC). The ‘Partnerships’ theme has a dedicated ResearchGate site for publications and updates and an active Twitter feed (see ‘Planned dissemination and outputs’ below for details of these). Importantly, these social media outlets also serve as a mechanism for inviting feedback and external peer review (both academic and lay) on emerging activity.As Fig. The above list is not exhaustive. As the work of the NIHR Oxford BRC unfolds, we anticipate that the number and nature of engagement platforms will change organically. We will capture the emergence, development and attrition of key engagement platforms using ethnographic and narrative methods. Plans include the development of a single point-of-contact for BRC researchers to log help requests from the ‘Partnerships’ sub-themes Table  and a seThe ‘Partnerships’ theme will include a number of specific sub-themes , clinical field, nature of support requested and success metrics, and that all cases have potential to contribute data to address the research questions listed above. The number of case studies will be limited by the need to provide rich description and detailed theoretical analysis .The study will use a variety of qualitative and quantitative data, including the empirical studies within individual BRC research themes, narrative accounts from stakeholder interviews, ethnographic field notes, documents, and quantitative indicators and metrics of success. Data analysis and synthesis will be informed by the theoretical frameworks outlined above, and also by the objectives of action research, namely (1) informing real-time action and system change through ongoing, formative feedback, and (2) making a generalisable contribution to the knowledge base ; ‘generaTable In keeping with the principles of action research and Mode 2 knowledge production, we will engage from the outset with the intended end users of our research. This will maximise the value of our research by increasing its usability and impact while reducing the need for a separate dissemination phase. Specifically, dissemination within the NIHR Oxford BRC and the broader Oxford regional innovation system will occur to a large extent through the researchers’ continuous engagement with the local and regional stakeholders and their active involvement in the co-creation of knowledge.https://oxfordbrc.nihr.ac.uk/research-themes-overview/partnerships-for-health-wealth-and-innovation/). We will also use social networking and social media to increase transparency and broaden outreach. We will post regular updates on our progress and deposit our research outputs on a social networking site for scientists . The ‘Partnerships’ theme leader (TG) is an active contributor to the social media site Twitter  and will use it to reach out to global audiences in real time.Dissemination beyond the Oxford regional innovation system will occur through the professional networks of the research team and the ‘Partnerships’ external advisory group, as well as through collaborations, conferences, and publications in (open-access) academic and trade journals. Patients and the public will be able to access the latest research news and multimedia from our cross-cutting theme on the dedicated webpage of the NIHR Oxford BRC  relevant to the operation of large, multi-stakeholder health research partnerships. We have described the structure and governance of a new ‘Partnerships for Health, Wealth and Innovation’ cross-cutting theme, and, within that theme, we have outlined our plans to support and evaluate a maximum variety sample of cases in different aspects of partnership working. Finally, we have emphasised the importance of creating an ongoing narrative of progress to aid collective sense-making and maintain an over-arching (and evolving) vision.draped in the formal collaborative language and procedures prescribed by funding agency protocols”, but in reality they continue to “view each other pragmatically as consultants, clients or even competitors, rather than partners” [Previous sociological studies of multi-stakeholder research partnerships have shown that they are inevitably characterised by structural complexity, competing interests, ambiguous loyalties and colliding institutional logics , 72, 73.artners” .Multi-stakeholder health research partnerships have been widely studied using ethnographic case study methods , 72–78. However, this study also has potential limitations. The ‘Partnerships’ theme has finite human and financial resources and it will not be logistically possible to explore all aspects of the questions listed in Table It is also important to note that the study design is intentionally a single (‘n of 1’) large case study containing multiple  focused case studies, selected for their contrasting features. This model, favoured by leading organisational scholars as the most appropriate one for studying complex systems , 71, is The single case study design has been chosen because the NIHR Oxford BRC is a unique, dynamic and continuously evolving research system that will be influenced by future research policy developments and organisational changes. As we write this, the United Kingdom faces a changing context for scientific research, drug regulation and health services delivery as a result of its decision to leave the European Union. The unfolding of research partnerships will need to be carefully analysed with relation to what may turn out to be dramatic changes in their external context. We believe the use of the single case study for such a study is amply justified on theoretical grounds and have provided detailed philosophical explanation elsewhere , 80. HowIn sum, this paper has described the rationale, aims, objectives and methodology for an ambitious programme of work to both support and systematically study the work of one of the largest and – currently – most successful of the NIHR’s BRCs as it enters its third 5-year funding period. The case study appears to contain many of the key ingredients for success, but there are also many unknowns, finite resources and an unstable external context. We anticipate that our methodology will, at the very least, produce a meaningful narrative in 5 years’ time of how the NIHR Oxford BRC’s fortunes unfolded and why.


While not achieving widespread acceptance among evolutionary scientists, this theory has been enormously influential in the burgeoning political movement known as the “alt-right.” Examination of MacDonald’s argument suggests that he relies on systematically misrepresented sources and cherry-picked facts. It is argued here that the evidence favors what is termed the “default hypothesis”: Because of their above-average intelligence and concentration in influential urban areas, Jews in recent history have been overrepresented in all major intellectual and political movements, including conservative movements, that were not overtly anti-Semitic.MacDonald argues that a suite of genetic and cultural adaptations among Jews constitutes a “group evolutionary strategy.” Their supposed genetic adaptations include, most notably, high intelligence, conscientiousness, and ethnocentrism. According to this thesis, several major intellectual and political movements, such as Boasian anthropology, Freudian psychoanalysis, and multiculturalism, were consciously or unconsciously designed by Jews to (a) promote collectivism and group continuity among themselves in Israel and the diaspora and (b) undermine the cohesion of gentile populations, thus increasing the competitive advantage of Jews and weakening organized gentile resistance . By developing and promoting these movements, Jews supposedly played a  A People That Shall Dwell Alone: Judaism as a Group Evolutionary Strategy , they placed great value on verbal brilliance and internal consistency rather than testability or agreement with external reality , and they promoted Jewish group interests at the expense of gentiles. The movements advocated separatism and ethnocentrism for Jews, discouraged ethnic identification among white gentiles (in order to prevent group consciousness among white gentiles that might lead to a sense of competition with Jews and thus anti-Semitism), undermined and destabilized traditional European culture to weaken resistance to Jewish control, “pathologized” anti-Semitism, and denied that Jewish behavior plays a role in anti-Jewish attitudes.According to MacDonald argues that Jewish intellectual and political movements were responsible for major trends in twentieth-century scientific, political, and demographic history. These movements, he says, were responsible for the rejection of Darwinian thinking among most mainstream social scientists, and also for large-scale nonwhite immigration to European and European-colonized countries .A People That Shall Dwell Alone “a potentially very important contribution.” Masters  is worthy of study in any case. The conclusion, however, will be that the argument of The Culture of Critique is built on misrepresented sources and cherry-picked facts. The evidence actually favors a simpler explanation of Jewish overrepresentation in intellectual movements involving Jewish high intelligence and geographic distribution.This paper attempts to give MacDonald’s theories a fair hearing. It focuses on the argument of jinfo.org). Lynn and Kanazawa  intellectual activities: The two factors explain why Jews are more than half of world chess champions  for the triumph of the intellectual left in late twentieth-century Western societies” .While Jewish intellectual movements vary in their details, they have (according to The Culture of Critique) the same broad agenda to (a) subject gentile society to radical critique that undermines its traditional institutions, (b) attack white gentile ethnocentrism and unity , (c) “pathologize” anti-Semitism and obscure the fact that anti-Jewish attitudes may be a response to Jewish behavior, and (d) promote multiculturalism for white gentiles (in order to weaken gentile power) while promoting separatism for Jews and racial purity in Israel. Jewish movements are alleged to have been responsible for banishing Darwinian thinking from social science, promoting environmentalism as an explanation for individual and group differences in behavior, and proscribing the study of group differences in psychology. As noted, the way in which Jewish intellectual movements are organized—headed by charismatic, authoritarian leaders such as Freud and Boas—is supposedly analogous to the organization of traditional Judaism.To review, the claim of The Culture of Critique. The following is a preview—more detailed examples will be given in later sections.There are several categories of questionable argumentation in The Culture of Critique is that the same behavior is given a different interpretation depending on whether it is performed by Jews or gentiles. For example, when gentiles assume leadership positions in radical movements , it is because “gentiles have . . . been actively recruited to the movements . . . and given highly visible roles . . . in order to lessen the appearance that the movements are indeed Jewish-dominated or aimed only at narrow Jewish sectarian interests” (1988a:4). MacDonald calls this phenomenon “a major theme” of his book. Another explanation he gives for gentile involvement in radical politics is that “once Jews have attained intellectual predominance, it is not surprising that gentiles would be attracted to Jewish intellectuals as members of a socially dominant and prestigious group and as dispensers of valued resources” (1988a:3).A common pattern throughout possible that in all these cases where Jews and gentiles were both involved in radical politics, the Jews were acting as ethnic activists while the gentiles were being manipulated. But this theory requires strong positive evidence to be credible. As shall be argued, MacDonald never provides such evidence.Of course, it is The Culture of Critique was published and still to this day—is Noam Chomsky. Chomsky is mentioned one time in The Culture of Critique—in an endnote where MacDonald comments simply that he “could . . . be regarded as someone whose writings were not highly influenced by his Jewish identity and specifically Jewish interests” . There is no mention of Chomsky’s extreme anti-Israel positions and opposition to Jewish nationalism. George Soros—possibly the most politically influential Jewish financier in the world and a major promotor of liberalism/multiculturalism—dissociates himself from the Jewish community and opposes Jewish interests . He is not mentioned once in the book. MacDonald paints a picture of Jews as hypocrites who impose liberalism on gentiles and adopt nationalism for themselves, but he ignores the fact that many of the most influential Jews seem to promote liberalism and multiculturalism for both gentiles and Jews.MacDonald says that “there is a broad Jewish consensus [in the US] on such issues as Israel” (1988a:305). Nowhere in the book does he acknowledge that a great deal of Jewish involvement in politics across time and place has been decidedly opposed to narrow Jewish interests, including Israel. The most influential Jewish radical in history, Karl Marx, held extremely anti-Jewish views Marx . The mosJust as problematically, in a number of cases MacDonald fails to report that Jews whom he identifies as ethnic activists took stands against Israel and other Jewish interests .Many twentieth-century Jews ostensibly abandoned their Jewish identity and sought to assimilate. MacDonald points out that these Jews often did not support gentile nationalist movements—which he acknowledges were anti-Semitic—and he argues that this is evidence that these Jews were insincere in their desire to assimilate and were actually engaging in “Jewish crypsis” (his term).It is highly questionable whether this inference is justified. Twentieth-century anti-Semitic nationalist movements were generally not welcoming of ethnic Jews regardless of their desire to assimilate. And even if they were, it seems unreasonable to question a Jew’s desire to reject Judaism because he did not want to kill, expel, or oppress his (probably still-Jewish) family and former friends.The Culture of Critique, references are given to support a claim but no support can be found in the original source, or the original source is misrepresented. Because the present paper is focused on the argument of the book, it only reports some of these misrepresentations where they significantly affect the argument. Also, for considerations of length, it only reports cases of mishandling of sources where the problems can be clearly exposed in a reasonable amount of space. Despite the fact that only some instances of mishandling of sources are reported here, these cases alone raise serious questions about MacDonald’s research practices.In numerous places in support his views.In many places, MacDonald himself brings up facts that seem to go against the predictions of his theory. While these individual facts may not in themselves necessarily refute his hypothesis, rather than revising his ideas or acknowledging that he cannot explain everything, he dogmatically insists that the apparent counterexamples actually support affirmative action. His explanation for this is that “because of their competitive advantage” among whites, “Jews may perceive themselves as benefiting from policies designed to dilute the power of the European-derived group as a whole on the assumption that they would not suffer any appreciable effect.” Again, he shows a facile tendency to spin an apparent disconfirmation of his theory as actually a verification of it.For example, he claims several times that Jews are opposed to affirmative action because it is against their ethnic interests . He says that affirmative action policies “would clearly preclude free competition between Jews and gentiles” (1988a:101) and, elsewhere, that they “would necessarily discriminate against Jews” (1988a:315). In a parenthetical, he notes that when an anti-affirmative action measure was put on the ballot in California, Jews voted for it “in markedly lower percentages” than other white groups (1988a:311). That is, Jews voted to The Culture of Critique who has no knowledge of history is led to believe that European society was traditionally marked by “hierarchic harmony” (1988a:315) and naive, happy acceptance of traditional religion, institutions, and family relations. Then, after the Enlightenment, Jews emerged from the ghettos and commenced what was to be a 300-year war on the foundations of European culture. MacDonald ignores a long history of radical and critical gentile thought from the ancient Greek philosophers to Rousseau to the Social Gospel Movement to French existentialism to Bill Ayers to Peggy McIntosh and countless other examples.The reader of The Culture of Critique is titled “The Boasian School of Anthropology and the Decline of Darwinism in the Social Sciences.” MacDonald sees Boas as having been a strongly identified Jew who pursued (and distorted) science with the goal of preventing anti-Semitism. Boas and his followers in the 1920s promoted the idea thatAmerican culture [was] overly homogeneous, hypocritical, and emotionally and esthetically repressive . Central to [their] program was creating ethnographies of idyllic cultures that were free of the negatively perceived traits that were attributed to Western culture. Among these Boasians, cultural criticism crystallized as an ideology of “romantic primitivism” in which certain non-Western cultures epitomized the approved characteristics Western societies should emulate (1988a:28–29).This passage and others throughout the chapter suggest that Boasians were the first to romanticize primitive cultures as “idyllic” and not subject to the ills of Western civilization. In reality, by Boas’s time this had been a major theme among many gentile intellectuals for more than 150 years. Jean-Jacques Rousseau, who popularized the romantic image of “savages” in the eighteenth century, is mentioned once in The Culture of Critique—in passing, in an endnote . According to Rousseau:The more one reflects on it, the more one finds that this state [of primitive life] was the least subject to upheavals and the best for man, and that he must have left it only by virtue of some fatal chance happening that, for the common good, ought never have happened. The example of savages, almost all of whom have been found in this state, seems to confirm that the human race had been made to remain in it always Rousseau :74.Not all eighteenth-century European intellectuals agreed that civilization was a mistake. But virtually all seemed to accept Rousseau’s characterization of primitive life as idyllic. His ideas, including his critique of Western civilization, played an important role in triggering the French Revolution and (later) in the development of socialism, especially by Marx. All in all, he was quite probably the most influential thinker of the eighteenth century in both the short and the long run —not particularly surprising given the high concentration of Jews at Columbia University at the time. But the most effective and indefatigable “Boasians” were not Jewish. MacDonald (1988a:26) notes that the students of Boas who “achieved the greatest public renown” were the gentiles Ruth Benedict and Margaret Mead. He expounds: “As in several other prominent historical cases . . ., gentiles became the publicly visible spokespersons for a movement dominated by Jews.” According to MacDonald (1988a:27), Boas “strenuously promoted and cited” Benedict and Mead as part of a ruse to hide the fact that the whole movement was designed to promote Jewish interests.So, contrary to what is suggested in But MacDonald does not supply any compelling reasons to think that Benedict and Mead were under the control of Boas. Even if we accept that Boas’s commitment to Jewish interests biased his science and made him critique Western society and promote environmentalist, culture-based explanations of human behavior, both Benedict and Mead were strong-willed, charismatic iconoclasts who seemed to be self-directed. Although MacDonald sees them as puppets of Boas, another possibility is that Benedict, Mead, and Boas were leaders of a somewhat misguided scientific movement, with Boas being technically the “teacher” because he happened to be a few years older, and Mead being the most influential. Criticizing Boas’s scientific standards, MacDonald says that he “completely accepted” Mead’s conclusions derived from a few months of fieldwork in Samoa and “uncritically allowed Ruth Benedict to distort his own data on the Kwakiutl” (1988a:28). But, taking MacDonald’s description of the facts at face value, this suggests that Mead and Benedict were, at least in these cases, taking the initiative to distort science for ideological ends. Perhaps it was the Jewish Boas who made them do this. Or perhaps, in the absence of compelling evidence to suggest otherwise, both Jews and gentiles occupied leadership roles in this movement in anthropology.The Culture of Critique, Boasian anthropology was only the first Jewish salvo against hereditarianism and the study of race. A major theme in the book is that Jews were responsible for tabooing research on race differences, particularly in intelligence. MacDonald ignores the fact that influential gentiles have been well represented among environmentalists studying race differences in intelligence, and Jews have been clearly overrepresented among prominent hereditarians.According to The Bell Curve  This illustrates a blatant double standard applied to Jews and gentiles by MacDonald. The Jewish Richard Herrnstein, then head of the psychology department at Harvard, was the most prominent academic defender of hereditarianism regarding race differences in intelligence since WWII. Instead of accepting that Herrnstein is an example that does not support his thesis, MacDonald spins the facts by implying that Herrnstein supported the theory of race differences in intelligence because it would promote his ethnic interests. In contrast, the gentile Murray is portrayed as having no such sinister motivations—only a wish, in MacDonald’s words, for “a society with harmony among the social classes and with social controls on extreme individualism among the elite” (1988a:314).MacDonald (1988a:314) approvingly cites Ryan’s :11 specuA reasonable list of the most high-profile advocates of hereditarianism might be the following: Hans Eysenck, Arthur Jensen, Richard Lynn, Linda Gottfredson, J. Philippe Rushton, and the aforementioned Herrnstein and Murray. Eysenck had a Jewish mother, making him Jewish by both Jewish law and MacDonald’s standards. Jensen was one-quarter Jewish, so he can be counted as a gentile. That means that two out of seven of the most prominent hereditarians were Jewish, making Jews extremely overrepresented in this group relative to their numbers in the general population.The Culture of Critique, “There is . . . evidence that Freud conceptualized himself as a leader in a war on gentile culture” (1988a:117). Psychoanalysis was a pseudoscientific movement designed to pathologize anti-Semitism and undermine gentile culture and social cohesion by attacking institutions regulating love and sex. “Psychoanalytic assertions [that sexual repression prevented relationships from being based on love and affection] were never any more than speculations in the service of waging a war on gentile culture” (1988a:126). Jews, led in the US by the “New York Intellectuals,” turned Freudianism into a secular religion, using it to attack the philosophical and institutional foundations of Western culture.According to Let’s consider first Freud’s influence via the New York Intellectuals. MacDonald notes that of the top 21 American intellectuals according to peer ratings in the 1970s Kadushin , 15 wereEichmann in Jerusalem  Daniel Bell, (2) Chomsky, (3) Irving Howe, (4) Norman Mailer, (5) Robert Silvers, (6) Susan Sontag, (7) Lionel Trilling, (8) Hannah Arendt, (9) Saul Bellow, (10) Paul Goodman, (11) Richard Hofstadter (Jewish father), (12) Irving Kristol, (13) Herbert Marcuse, (14) Norman Podhoretz, and (15) David Riesman. A closer look shows that only two or three of these cases support MacDonald’s thesis, and several are clear counterexamples. First off, five of these intellectuals are, by MacDonald’s criteria, unambiguously anti-Israel and therefore opposed to Jewish interests. Chomsky was (and still is) arguably the world’s leading critic of Israel. Mailer tended to sympathize with the Palestinians .The link between psychoanalysis and the political left, as well as the critical role of Jewish-controlled media in the propagation of psychoanalysis, can be seen in the recent uproar [over] Frederick Crews’s critiques of the culture of psychoanalysis. The original articles were published in the Silvers is the longtime editor of the New York Review of Books, and one of the 11 whom MacDonald identifies as being influenced by Freud.1It is ironic that MacDonald casts Robert Silvers as a part of a nefarious Jewish Freudian movement. In the paragraph immediately following the one in which he introduces this list of 15 Jewish intellectuals, MacDonald writes:Bell, Hofstadter, and Riesman were liberals, though not particularly extreme, not known for promoting Freud, and not seriously involved in Jewish causes. .But the evidence reviewed above suggests that this is a serious distortion of the facts. Even if it is true that 11/15 of these intellectuals were influenced by Freud “at some point in their careers,” virtually none of them comes close to conforming to MacDonald’s paradigm of a Jewish radical. Only one—Podhoretz—could be accused of hypocritically advocating different immigration policies for the US and Israel, though he was/is not a liberal and Freudianism played no meaningful role in his thinking. On the other hand, we clearly find that several people on the list—a list cited by MacDonald himself to support his thesis—are serious counterexamples to the theory of Judaism as a group evolutionary strategy. We find on this list possibly the world’s leading critic of Israel (Chomsky), a liberal who advocates the same immigration policies for the US and Israel (Marcuse), a leading advocate of traditional Western values (Bellow), and several others who, to varying degrees, were opposed or indifferent to Israel and Jewish interests.The naive reader of Moses and Monotheism “contains several assertions that anti-Semitism is fundamentally a pathological gentile reaction to Jewish ethical superiority,” citing Freud MacDonald brings voluminous evidence that Freud strongly identified as a Jew. Based on numerous sources, he argues that Freud was unconditionally committed to promoting Jewish interests, that he “pathologized” anti-Semitism, and that he attacked gentile culture because he saw it as a threat to Jews (1988a:146). MacDonald emphasizes numerous times throughout the book that “scientist-activists” like Freud developed theories to show that “Jewish behavior [is] irrelevant to anti-Semitism” . He claims that ng Freud :114–17 (ng Freud :120. HowThe Culture of Critique). In 1929, Jews attempted to erect a partition screen to separate men and women at the Western Wall. In response, Arabs killed 29 Jews in Hebron, which led to riots in which 120 Jews and 87 Arabs were killed. A representative of the Zionist organization Keren Hayesod asked Freud to sign a petition condemning the Arabs for initiating the violence. Freud refused to sign, explaining that the Jews were partly responsible for inviting violence on themselves: “I concede with sorrow that the unrealistic fanaticism of our people is in part to be blamed for the awakening of Arab distrust” . “[T]he central agenda of The Authoritarian Personality is to pathologize gentile group strategies while nevertheless leaving open the possibility of Judaism as a minority group strategy” (1988a:172). The Frankfurt School influenced the humanities through the development of “critical theory.”Chapter 5 of Jewish nationalism as long as the latter is not explicitly condemned. He never cites positive evidence that representatives of the Frankfurt School approved of Jewish nationalism, and he ignores evidence that they in fact disapproved of it. Leaving aside the question of the scholarly merits of the Frankfurt School or The Authoritarian Personality, there is no positive evidence that members of the Frankfurt School were hypocrites who condemned collectivism in gentiles and promoted it for Jews.The main problem with MacDonald’s argument is that he interprets criticism of nationalism in gentile groups to indicate approval of The Authoritarian Personality, MacDonald emphasizes “the double standard in which gentile behavior inferred from high scores on the F-scale or the Ethnocentrism Scales is viewed as an indication of psychopathology, whereas precisely the same behavior is central to Judaism as a group evolutionary strategy” (1988a:168). But nowhere does he present evidence that Adorno et al. approved of this behavior in Jews, which is what would be necessary for them to have a “double standard.” MacDonald just assumes that they approve of this behavior because they were Jewish. Regarding the claim in The Authoritarian Personality that anti-Semitism is associated with a strong in-group ideology, MacDonald comments that “the implication is that strong ingroup ideologies should be reserved for Jews and are dangerous in others” (1988a:170). But nowhere is this actually stated in The Authoritarian Personality. It seems the “implication” is strong in MacDonald’s mind because of the nefarious motives he attributes to the Jewish authors. This does not count as evidence.In his critique of The Authoritarian Personality is anti-gentile, MacDonald singles out a chapter by R. Nevitt Sanford . In MacDonald’s words:R. Nevitt Sanford . . . finds that affiliation with various Christian religious sects is associated with ethnocentrism, and that individuals who have rebelled against their parents and adapted another religion or no religion are lower on ethnocentrism. These relationships are explained as due to the fact that acceptance of a Christian religion is associated with “conformity, conventionalism, authoritarian submission, determination by external pressures, thinking in ingroup-outgroup terms and the like vs. nonconformity, independence, internalization of values, and so forth”  is that Fromm and the other members of the Frankfurt School, as individuals who strongly identified with a highly collectivist group (Judaism), advocated radical individualism for the society as a whole” (1988a:142). Here is what Fromm said about Israel: “The claim of the Jews to the land of Israel cannot be a realistic political claim. If all nations would suddenly claim territories in which their forefathers lived two thousand years ago, this world would be a madhouse”  with extremely anti-Semitic slurs and described Lassalle’s physical appearance, mannerisms, and habits as exemplifying unflattering Jewish characteristics  should have typically been overrepresented in leftist movements and underrepresented in nationalist, populist, and other types of rightist political movements: Even if nationalist movements are anti-Semitic, as has often been the case, anti-Semitism should be irrelevant if these individuals are indeed completely deethnicized as Pipes proposes. Jewish prominence in occupations requiring high intelligence is no argument for understanding their very prominent role in communist and other leftist movements and their relative underrepresentation in nationalist movements.This response to Pipes seems unconvincing. First, anti-Semitic nationalist movements generally targeted Jews regardless of their self-identity. Jews who identified as “Russian” or “Polish” would still have been discouraged, if not outright prohibited, from joining these movements as equal participants. Second, even “de-ethnicized” Jews might find it difficult to accept anti-Semitic caricatures of Jews due simply to their close contact with Jewish family and former friends.MacDonald :80 citesEven the most highly assimilated Jewish communists working in urban areas with non-Jews were upset by the Soviet-German nonaggression pact but were relieved when the German-Soviet war finally broke out . . .—a clear indication that Jewish personal identity remained quite close to the surface (1988a:62).On the Nazi-Soviet nonaggression pact:The nonaggression pact provoked a great deal of rationalization on the part of Jewish [Communist Party USA] members, often involving an attempt to interpret the Soviet Union’s actions as actually benefiting Jewish interests—clearly an indication that these individuals had not given up their Jewish identities. Others continued to be members but silently opposed the party’s line because of their Jewish loyalties (1988a:73).Again, he interprets any objection to anti-Semitism—even silent opposition—as evidence that Jews are uniquely ethnocentric.For MacDonald, having a strong Jewish identity appears to be the only reason not to support anti-Semitic movements. As he says:The core members of the security service came from the Jewish communists who had been communists before the establishment of the Polish communist government, but these were joined by other Jews sympathetic to the government and alienated from the wider society. . . . Jewish members of the internal security force often appear to have been motivated by personal rage and a desire for revenge related to their Jewish identity . A key claim in this section, based on work by Schatz , is thaty Schatz :225, whiThe Culture of Critique, “[the Jewish Horace] Kallen’s idea of cultural pluralism as a model for the United States was popularized among gentile intellectuals by John Dewey . . ., who in turn was promoted by Jewish intellectuals” (1988a:250). MacDonald points out that the editors of Partisan Review “published work by Dewey and called him ‘America’s leading philosopher’” and Dewey’s student, Sidney Hook, “was also unsparing in his praise of Dewey, terming him ‘the intellectual leader of the liberal community in the United States’” (1988a:250). Notice that, earlier, MacDonald argued that Margaret Mead was a puppet of her less-famous Jewish teacher, Boas. Here he argues that Dewey was being manipulated by his less famous, albeit Jewish, student, Sidney Hook. What is the reason why Dewey’s actions should be attributed to Jews?Dewey was highly influential with the public at large. Henry Commager described Dewey as “the guide, the mentor, and the conscience of the American people; it is scarcely an exaggeration to say that for a generation no issue was clarified until Dewey had spoken”  quotes Sandel’s :35 opiniThe President’s Commission on Immigration and Naturalization :92–93 ciother whites that justified limiting immigration from the latter group. The report cites Madison Grant:The new immigration . . . contained a large and increasing number of the weak, the broken, and the mentally crippled of all [European] races drawn from the lowest stratum of the Mediterranean basin and the Balkans, together with hordes of the wretched, submerged populations of the Polish Ghettos. Our jails, insane asylums, and almshouses are filled with this human flotsam, and the whole tone of American life, social, moral, and political, has been lowered and vulgarized by them  ideas. But in opposing the theory of Nordic superiority, Jews were effectively promoting, not undermining, white unity. Of course, many “Boasian” Jews argued that there were no differences between any races, but in the early twentieth century they were advocating immigration from all white countries whereas their opponents wanted to restrict immigration from non-Nordic white countries such as Italy and Poland.An irony here is that the issue under consideration in this section of the commission’s report was not whether there were innate differences between whites and nonwhites, but whether there were innate differences between “Nordic” whites and The Culture of Critique, “American Jews have had no interest in proposing that immigration to Israel should be . . . multiethnic, or that Israel should have an immigration policy that would threaten the hegemony of Jews” (1988a:320). Regarding Jewish hypocrisy, MacDonald says:Whereas American Jews have been in the forefront of efforts to ensure ethnic diversity in the United States and other Western societies, 40 percent of the [Israeli] Jewish respondents [in a 1988 survey reported in Smooha :403] agrHypocrisy is when a person or group espouses values but applies them inconsistently. In order to attribute hypocrisy to people, it is necessary to identify the inconsistency in those people. MacDonald says that American Jews support multiculturalism, then cites a survey suggesting that many Israeli Jews advocate policies that are inconsistent with multicultural values. To justify the charge of hypocrisy it is necessary to find individual Jews advocating multiculturalism for the US and opposing it in Israel. Such Jews may exist, but there is no evidence that this is the norm. MacDonald treats the positions espoused by one Jew or group of Jews as a statement on behalf of the Jewish community and concludes that Jews are hypocrites because different Jews advocate policies that are mutually inconsistent. An alternative interpretation of the data is that Jews vary to some extent in their views among individuals and groups, in a way typical of other ethnicities.According to and their non-Jewish spouse and children . “American Jews have had no interest in proposing that immigration to Israel should be . . . multiethnic” (1988a:320). The Culture of Critique, MacDonald asks what the ultimate consequences of Jewish-instituted liberal policies are likely to be in America. He suggests: “An important consequence—and one likely to have been an underlying motivating factor in the countercultural revolution—may well be to facilitate the continued genetic distinctiveness of the Jewish gene pool in the United States” (1988a:318). It is difficult to square this claim with the fact that Reform and unaffiliated Jews—the ones who participated in these liberal/multicultural movements—have an intermarriage rate of 50% and 69%, respectively , which have a large Jewish membership (1988a:313).After arguing so strenuously that liberal movements were designed to advance a Jewish group evolutionary strategy, he acknowledges that Jews are also in the vanguard in the fight against those same movements.MacDonald claims that several major twentieth-century liberal intellectual and political movements were consciously or unconsciously designed by Jews as part of a group evolutionary strategy to undermine gentile societies while preserving cohesion and continuity among themselves. High intelligence and ethnocentrism are supposedly genetic adaptations that help Jews pursue this strategy. According to the “default hypothesis” proposed in this paper, Jews, having relatively high mean levels of general intelligence and being concentrated in major cities, tend to be overrepresented in cognitively demanding fields, activities, and movements that are not overtly anti-Semitic, regardless of whether they are liberal or conservative. Anticipating this alternative explanation for Jewish overrepresentation in liberal movements, MacDonald seeks to protect his theory from being falsified by evidence that supports the default hypothesis:without question, Jonathan Haidt  have also claimed that MacDonald is correctly applying evolutionary psychological thinking to Judaism. But misrepresenting sources and distorting history are not part of the methods of evolutionary psychology, or any other legitimate academic discipline. Those who have competently applied insights from evolutionary theory to the study of Judaism (e.g., Goldberg The Culture of Critique. It is they, not MacDonald, who should be treated as representatives of evolutionary psychology and biosocial science.Finally, let us turn to the question of MacDonald’s relationship with evolutionary psychology. Some opponents of evolutionary psychology have taken his conclusions as the more or less inevitable outcome of applying evolutionary theory to Judaism. Some


In January 2017, a large wind turbine blade was installed temporarily in a city square as a public artwork. At first sight, media photographs of the installation appeared to be fakes – the blade looks like it could not really be part of the scene. Close inspection of the object shows that its paradoxical visual appearance can be attributed to unconscious assumptions about object shape and light source direction. In January 2017, wind turbine manufacturer Siemens installed one of its B75 turbine blades in Victoria Square, Hull, to mark the start of the city’s year as UK City of Culture. The ‘Blade’ installation  was conceived by artist Nayan Kulkarni. These turbine blades are huge 75-m long fibreglass, balsa wood and resin composite objects, cast as a single element, and are claimed to be the world’s largest handmade components. Nayan Kulkarni declared that the act of installation in the square changed the blade from an industrial component into a readymade artwork, in the tradition started in 1913 by Marcel Duchamp with his ‘readymades’ which included bicycle wheels, shovels, urinals and bottle racks.visual impression, a metaphorical poke in the eye. Some of this impact must come from its massive scale and its lightness and smoothness, with some specularities, so incongruous against the textures and colours of the ornate Victorian architecture of the square. The local newspaper  reported some visitor reactions. One commented that “It looks like a big tooth. It looks a bit odd to be honest.”Duchamp considered readymades to be an antidote to ‘retinal art’, to emphasise the conceptual qualities of art rather than their purely visual appearance. But the Blade certainly creates a striking The Guardian, February 5, 2017) declared: “An elegant, lovely piece of engineering, it is somehow diminished by being shorn of its function. It is only big.”Art critic Adrian Searle  profile and the more complex (S-shaped) profiles, lit either from above or from the front.


In 2002, the World Congress on Drowning developed a uniform definition for drowning. The aim of this study is to determine the prevalence of “non-uniform drowning terminology” (NUDT) and “non-uniform drowning definitions” (NUDD) in peer-reviewed scientific literature from 2010 to 2016, and compare these findings with those from our unpublished study performing a similar analysis on literature from 2003 to 2010.A systematic review was performed using drowning-specific search terms in Pubmed and Web of Science. Titles and abstracts published between July 2010 and January 2016 were screened for relevance to the study focus. Articles meeting screening criteria were reviewed for exclusion criteria to produce the final group of studies. These articles were reviewed by four reviewers for NUDT and NUDD. The Fisher exact test was used to determine any statistically significant changes.p < 0.05). In addition, 32% of the articles included a definition for drowning (uniform or non-uniform), with 15% of these utilizing NUDD.The final group of studies included 167 articles. A total of 53 articles (32%) utilized NUDT, with 100% of these including the term “near drowning”. The proportion of articles utilizing NUDT was significantly less than reported by our previous study , there is still significant room for improvement. Uniform terminology is vital to the effective study of any process in medicine or public health. The study of drowning faces the challenges of addressing prevention, rescue, and treatment across low income and high income settings. Without high quality data, prevention campaigns cannot be targeted towards high risk populations and treatments cannot evolve in concert with new knowledge and technology. When researchers and providers do not speak a common language in regard to a disease or injury, one cannot expect global data to be comparable and, therefore, of high quality. The study and treatment of drowning has long been hampered by a lack of uniform terminology. A 2005 systematic review  analyzinAt the 2011 World Conference on Drowning Prevention in DaNang, Vietnam, two authors of this paper reported the findings of our unpublished systematic review , which dP < 0.05.We utilized Pubmed and Web of Science to search all peer-reviewed articles from July 16, 2010 to January 1, 2016. The following search terms were used: “drowning”, “drowned”, “submersion”, and “immersion”. These search methods were similar to our original study, except that modifiers  were not used, as these do not enhance the search. Using RefWorks , the resulting titles and abstracts were screened for inclusion based on relevance to the public health, pathophysiology, prevention, surveillance, and treatment of drowning. To remain consistent with the methods of our original study, case reports were included and purely forensic or microbiologic studies, or non-human experimental studies were excluded. After screening, the titles and abstracts of the initial group of studies were then evaluated for the following exclusion criteria: letters and editorials, inability to obtain full text, inability to obtain an English version, and irrelevance to study focus. From the final group of studies, four of the authors independently evaluated the full text of each article for the presence of NUDT and for any definition to describe drowning. Articles were classified as “NUDT” if they contained non-uniform modifiers such as “near”, “wet”, “dry”, “secondary”, “active”, “passive”, and “silent” to describe drowning. Additionally, articles were classified as “drowning definition present” (DDP) if a specific definition to describe drowning was used, with further sub-classification of NUDD if the definition provided did not closely match the uniform definition developed by the WCD. If NUDT or NUDD were present, but were used in a historical sense or to discuss the issue of incorrect nomenclature, this was not counted against the article. Each reviewer’s findings were tabulated into a spreadsheet and compared for discrepancies. Any discrepancies were discussed by all 4 reviewers and a consensus decision was made as to how to count the finding. Once all pertinent articles were reviewed and properly tabulated, annual incidence and overall prevalence of NUDT and NUDD were determined. When then used the Fisher exact test (2 × 2 table) to compare the two time periods (2003–2010 and 2010–2016) based on NUDT; statistical significance was defined as P < 0.05). There was initially a disagreement between evaluators on the presence of NUDT with 15 articles. The most common reason for this was an evaluator missing the existence of NUDT. Another reason for this was confusion over the use of NUDT either in a direct quote from another article or when referencing its historical use. When evaluating for the presence of a drowning definition, initial disagreement occurred with 14 articles. The common reason for this was the presence of unique definitions which did not exactly match that of the WCD, but contained all of the correct elements. All of these instances were easily resolved after careful review of the articles and discussion by the evaluators.The initial literature search yielded 821 articles. By screening the titles and abstracts, 276 articles were included in the initial group of studies. Of these, 109 met exclusion criteria  leaving 167 in the final group of studies. The process of the literature search and review is outlined in Fig In our 2010 analysis of 227 articles published from January 1, 2003 to July 15, 2010, 43% of the articles contained NUDT [As for the reasons behind the continual prevalence of NUDT in the peer-reviewed literature, the authors theorize that this is mainly due to a lack of awareness, on the part of researchers and editors, of the develop of the uniform definition for drowning. To date, no studies have been published evaluating the exact reason or means for improvement, but these should be considered as focuses of future research. Some limitations are apparent with our study. Based on the experience of the authors, there is still confusion on the part of researchers, editors and providers as to which term to use to describe drowning victims who survive the event; it is the opinion of the authors that the term “non-fatal drowning” is most appropriate.Our study is limited by our initial screening criteria, which excludes articles describing purely forensic or microbiologic studies or non-human experimental studies. While articles within these categories often provide useful data specific to drowning, they were excluded in our initial 2010 study, and these criteria were repeated to best provide comparable data. Additionally, over half of the articles excluded were done so due to our inability to locate full text versions. Often this was due to the abstract only being available within a list of conference presentations.Since the development of the uniform definition for drowning in 2002, peer-reviewed scientific articles have continued to include non-uniform drowning terminology. Our study reveals a statistically significant improvement in the use of uniform drowning terminology in the literature, when comparing the 2003–2010 and 2010–2016 time periods, although year-to-year variability over the current study period does not yield an obvious trend.


Healthcare industry continues to evolve under conditions of intense competition in approaching health prevention, protection, and promotion. Therefore, healthcare providers are challenged to always ensure better patient experience, winning patients’ satisfaction, and loyalty and remain competitive on today’s healthcare market. Healthcare markets bring together professionals and their patients into real collaborative relationships, which empower patients to contribute to the healthcare improvement. Within this competitive landscape, which is also characterized by digital health tools boosting patients’ awareness and controlling their own health, medical providers need to be perceived as skilled and trustworthy in relying on patients’ needs, expectations, and sacrifices are required in order to obtain the promised benefits. Moreover, while constantly providing a holistic assessment of the healthcare services’ and experience attributes, acting on feedback and reaching healthcare service excellence, providing a better understanding of all the touch points with their patients and improving the quality and consistency of all these touch points, all these are achieved by employees, who are truly connected to the healthcare business. Today, patients are systematically becoming aware of the diversity of their choices, being increasingly involved in making better healthcare choices, and, so, more and more innovative products are introduced, targeting new patient segments. Findings from the last three years have shown that patients may achieve better outcomes due to the stakeholders’ commitment to innovation within the context of the big-data revolution, by building new values. According to the Beryl Institute’s definition (2010), patient experience (PX) is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions, across the continuum of care”. Four years later, the above mentioned president and other three distinguished colleagues highlighted the real need for a clear, comprehensive and shared definition of PX, as an important indicator , which is more important than satisfaction itself, as it engages patients in the care process [2].On November 10, 2015, Jason A. Wolf, PhD, President of the Beryl Institute  pledged for reframing the core values of the patient experience [3], underlined the difference between PX, patient satisfaction, patient-reported outcome, and patient-defined outcome and reminded the seven key factors for achieving patient-centered care at the organizational level , which were also identified by Dale Shaller’s report , and showed that PX  is closely related to and influences clinical effectiveness and safety , keeping in mind two key issues, the importance of capturing moments at the right time in the patient journey (gathering the necessary feedback) and the determination of the main gaps of the patient survey programs. Moreover, the NHS  Outcomes framework  reflects the importance of PX, domain 4 of the O/F covering PX.In 2011, during the Patient Experience Network Conference, Joan Saddler, the National Director of Patient and Public Affairs, from the UK Department of Health [4]. A special attention is given to the different approaches of measuring patient and career experiences in health services , and to what needs they should be measured [5]. Dr. Debra de Silva from “The Evidence Centre” of “The Health Foundation” also pointed out  that PX  is the only indicator of the healthcare quality, and it is essential to have a broader understanding of the service quality from the patients’ viewpoint by using information on both patient experience (the collection of patient-reported experience measures/PREMs) and outcomes , by concentrating mainly on using feedback effectively (not only on gathering it). Gathering feedback is the central challenge of teams wishing to measure PX. Patient experience is seen as a central outcome for the NHS [6] talked about the “social proximity” which is driven by connectivity and experience excellence, at the same time being defined by how much we are willing to share in the new healthcare environment.Today we are in a new phase of convergence (patients being enabled by technology) which is increased by connectivity. Digitization of our lifestyles is becoming a norm; virtualization disrupting power relationships between healthcare companies, their employees, and patients. On February 2, 2016, Jason A. Wolf, PhD, President of the The Beryl Institute [7]. Seven years ago, the Nation’s first substantial commitment of Federal resources to support the widespread adoption of EHRsin USA, was represented by the Health Information Technology for Economic and Clinical Health (HITECH) Act, as a component of the American Recovery and Reinvestment Act of 2009. In real-time, patient-centered records make information available instantly and securely to authorized users . EHRs provide a workflow to providers, containing the whole patient’s medical history and other relevant information, which allows access to evidence-based tools[8]. In the same vein, a spontaneous online debate from April 2016 [9] on the impact of EHRs and the physician-patient relationship, took into account some concerns regarding the role of EHRs in caring for the patient (beyond improving the business of medicine), the existence of different EHR systems that are not interconnected , and the importance of what patient-centered means in a technological world. There is no doubt that digital technology can transform the way healthcare is delivered and compensated today . For instance, the electronic health records (EHRs) create a considerable flow of information within a digital health care infrastructure, encompassing and leveraging digital progress [10] concerning patient safety in primary care , that patient safety  can be compromised by the electronic systems when they override the opportunities of face-to-face communication between patients and the health care staff. It is also worth recalling within this context a conclusion of a significant synthesis of a published qualitative research [11],when it comes to innovation, no formula has been reached for success, but it is important to consider the eight components of innovation: aspire, choice, discover, evolve (the first four elements help in settingand prioritizing the terms and conditions under which innovation is more likely to thrive), accelerate, scale, extend, and mobilize . Paraphrasing Forrester [12], the author’s opinion is that in the “Age of the Patient” there are four priority areas in which patient-centered healthcare providers have to invest, namely, real-time actionable data sharing, contextualized patient experiences across touch points, sales efforts tied to buyers’ processes, content-led marketing and patient interactions, and the followingof four market imperatives: transforming the patient experience, embracing the mobile mind shift, becoming a digital disruptor and turning big data into healthcare business insight [13].According to McKinsey’s representatives [14], CEO of CustomerThink Corp. (an independent research and publishing firm focused on customer-centric business management) and Founder/Editor-in-Chief of CustomerThink.com (the world’s largest community dedicated to customer-centric business), it should be added that, in order to have a real “Patient Experience Management” (PXM) initiative it is advisable to follow some steps: helping healthcare providers better plan their actions, preparing and managing their healthcare business, knowing the healthcare brand purpose and promise, taking an outside-in perspective (considering patient research and feedback management – the “Voice of Patient”/VoP), developing “Patient Journey Maps” (comparing the existing and desired experiences as a good foundation for a PX plan), empowering healthcare provider employees (so as to be prepared and motivated to deliver the right PX), creating a healthcare business case by connecting PX improvements (what patients want) to healthcare business outcomes . Further, the “Patient Journey Maps” could be useful for healthcare providers to adopt the “Modern Customer Service: Mapping the Journey Ahead” approach designed by Oracle, [15]. In other words, healthcare providers must embrace the modernization as an “evolution” (not like a “revolution”), seeing and serving patients across all engagement channels , better understanding that an effective communication is the key to success (being at the root of most failures when it is missing) and service drives PX . Last, but not least, it is important to take into account the “PX Continuum Journey”, as in awareness, trust, commitment, honeymoon, relationship, partnership, and advocate [16].On the other hand, taking into account the opinion of Bob Thompson[17], a trained medical doctor and histopathologist, at the World Federation of Public Health Associations (WFPHA), the importance of improving communicationwas highlighted with the help of the health community which must accept that there are two-ways discussions: between the patient  and the doctor. Professor Borisch also pointed out the need of a better  prevention support and general wellbeing (compared to care and treatment).In the beginning of February 2016, while interviewing Professor Bettina Borisch [18] such as: engage all voices in driving comprehensively, systemic and lasting solutions, look beyond clinical experience of care to all interactions and touch points, focus on alignment across all segments of the continuum and the spaces in between, encompass both a focus on healing and a commitment to well-being.In a nutshell, there is an accordance between the ideas expressed above and the ones found in the “Guiding principles” underlined by the Beryl Institute [19], and were materialized underhealthcare experiences, which reflect situations of people who remember with great intensity, having an ideal quality.Healthcare must be safe, effective, patient-centered, timely, efficient, and equitable; patient and family centered care (PFCC) is a philosophy, a process and a practice in order to transform the care experience and improve quality and safety. The PFCC key principles are dignity and respect, information sharing, participation, and collaboration . Within this framework, it is also worth remembering some other valuable ideas coming from the Center for Innovation, at the Mayo Clinic: Patients are experts in their diagnosis, and their expertise is worth something, serving as acknowledgement! Let’s turn patients’ ideas, thoughts, and insights from their social identitiesinto actionable change in the physical world of healthcare! Healthcare will be truly transformed by forming teams of patient experts and healthcare industry “insiders” to take on projects! [20]It is no coincidence that several valuable ideasabout the creation of the ideal patient care experience were reiterated recently [21] pointed out that change efforts are hard work and thus, implementation is critical to the overall transformation success, shifting mind-sets and behaviors. The change in behaviors is a science of organizational transformation . At the same time, there is a real need to combine the technologies  to create a competitive advantage [22]. It seems that McKinsey 7-S model  still works [23].McKinsey’s representatives [24], about the changes in mindsets and behaviors (none of them can be mandated or dictated), there is an urge need to occur at all levels of the organization, starting with the front-line physicians, clinical team, and physician leadership. On the other hand, ChenMed, a primary care-led physician group, considers that there are four key drivers of success in integrated care, namely, focus on the patient relationship , physician decision-making , convenience matters , and communication . Moreover, according to another authorized opinion [25] expressed in 2015 (looking at accelerating patient experience improvement in ambulatory care) it was stated that creating the ideal patient and family experience suggests setting the service expectation, the ideal visit, continuous improvement, and making an impact. Emory Clinic Healthcare approach presented at Beryl Patient Experience Conference on April 9, 2015included: Service improvement , PX , patient feedback , Patient Satisfaction Acceleration Team .According to an authorized opinion – about healthcare models – expressed in 2014 [27] which was launched in February 2008 by the University of Utah Health Care system and was called the Exceptional Patient Experience (EPE), having the following slogan “Medical care can only be truly great if the patient thinks it is”. This project began as a patient satisfaction initiative, but has evolved into a model for cultural transformation , becoming the cornerstone for other project initiatives .Another interesting example of a good PX approach is “Creating the Exceptional Patient Experience in One Academic Health System [28]. Within this challenging context, Michael Hinshaw ; “Doc-in-a-robot-shaped-box” ; “Concierge Medicine” for the masses ; “Trust but verify” ; “Your health data, and your health” .Today, healthcare is considered an exceedingly complex ecosystem of competing priorities and legacy systems, and an ecosystem under the pressure of radically increased patients’ expectations of experience, transparency and access to healthcare market [29], a major insurer which replaced its previous customer wellness program with “Rally” (a more comprehensive one). Therefore, it is time to rally, calling together for the common purpose of creating the ideal PX.The author adds that we are living interesting times, of revolution in healthcare (brought about by the use of technology), providing the opportunity to help patients create “positive habits” that will improve their health, as recommended recently, for example, by United Healthcare [30] (while illustrating the marketing era/concept in 1954), the author states that what the patient considers “value” is decisive, because it determines what a healthcare business is, what it produces, and whether it will prosper. Considering this decisive “value” for the patient, the author adds, by paraphrasing C. Lovelock and J. Wirtz [31], that it is important to implement healthcare services marketing accordingly, by managing relationships and building loyalty, considering patient feedback and service recovery, improving healthcare service quality and productivity, organizing for healthcare service leadership), understanding the challenge of building relationships with patients, including preference, liking, future intentions, etc., and being also able to identify the reasons why patients defect and then take a corrective action.Paraphrasing Peter Drucker [32]. Among others, it is considered that market differentiation via traditional marketing mix variables such as price, is hardly achievable in healthcare, and that superior communication grounded on sound positioning is a more promising lever for competitive advantage. As a main care coordination pivot, hospitals need a better understanding of integrated marketing communications, by using positioning as the proper strategy while implementing these communications, tailoring the message to patient segments accordingly.There is also a growing recognition of the significant importance of patient involvement and knowledge. For example, hospitals – in the light of patient empowerment and channel fragmentation – struggle to target patients in their new role as knowledgeable consumers [33] by making the difference between the nature of technical quality (which encompasses credence attributes) and the functional quality , patients being well qualified to judge the last one. It is well known that there is a widespread implementation of the “Consumer Assessment of Healthcare Providers & Systems Hospital Survey” (HCAHPS) instrument .Also, it is important to better understand the patient-perceived hospital service quality [34]talked about opportunities and lessons for a healthy relationship, within the framework of the so-called phenomenon of “cyberchondria”. There are already many tools answering new expectations by providing insightful and usually real-time data, such as: smart watches , in-home lab tests, exercise trackers, portable ECGs, etc. He suggested seven lessons to address healthcare marketers, as it follows: “don’t tussle for data, share it…; explain what the data means…; if you don’t share data, someone else will…; customers who want data are active in online communities…; not everyone is on the same path…; ensure that everyone in your organization respects customer data…; data is a tool to facilitate the age-old desire to establish a relationship…”There is no doubt within this general context that healthcare marketers are convinced that patients are more and more eager to access information that empowers them, and person-to-person relationship in healthcare is becoming increasingly essential. In June 2015, a healthcare marketing vice-president in Southern California and a marketing instructor at four universities [35] showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals, and when patients (beyond simply providing their views as receivers of care) find such ways to support their involvement in the healthcare improvement, they can influence healthcare in unexpected ways. However, this engagement in healthcare improvement (beyond simply providing their views as receivers of care) defines a dynamic interplay between psychological and sociocultural processes, essential for effective patient participation in the process of improving the healthcare provider organizational cultures.Findings from a UK study [36]. It is well-known that the partnership  between the majority of healthcare providers and the above mentioned Press Ganey (Press Ganey Score functioning comparably to a B2B Net Promoter Score for more than 30 years) ratings are based on the healthcare provider’s ability to create and sustain a high-performance environment that ultimately improves PX. In the ACA (Affordable Care Act) environment, patient experience scoring is also important. The Vice President and Chief Marketing Officer at Qmatic Group , recommended some priorities, as for instance, a simplified appointment scheduling; creating a friendly environment; reducing perceived waiting times; lessening confusion; surveillanceof customers in real time; following up with the patient . The Qmatic Group’s representative concluded that in order to create the care environments that patients appreciate most, it is more important than ever to remain connected, aware, and agile in today’s complex healthcare compliance atmosphere. Healthcare providers in USA are paying a particular attention to how each patient perceives the care they received, in the specific Affordable Care Act (ACA) environment, PX scoringbeing more important than ever [On February 2, 2016, Jason A. Wolf, PhD, President at The Beryl Institute suggested that the most important thing is to bring silence to our work in patient experience, while striving to achieve in caring for one another. Starting from this profound humanist message, the author added a “to do list”  for healthcare providers, such as: put people (patients and employees) at the center of everything the healthcare provider does; create healthcare business objectives to be achieved within a specific time frame and with specific resources; examine healthcare provider’s employee experience in parallel with the patient experience; optimize patient experience programs to strive for enhanced levels of patient brand passion, bonding, and advocacy as well as employee ambassadorship; sustain patient experience initiatives by leadership discipline and consistency; build a PX framework, including a patient decision journey map.