Reviews

- by Jeremy Agar

“SELLING SICKNESS”

Ray Moynihan and Alan Cassels, Nation Books, New York, 2005

Henry Gadsden, a former Chief Executive Officer (CEO) of Merck, a mammoth drug company, once declared an ambition to “sell to everyone”. Up till then, sales of health products had been limited to sick people. For profits to soar, the company needed to convince healthy consumers that they were sick. No wonder the markets liked Merck (it’s worth noting that Merck Sharp and Dohme NZ is a finalist in the 2005 Roger Award for the Worst Transnational Corporation Operating in Aotearoa/New Zealand. It is the first drug transnational corporation to make the Roger finalists Ed.).

The anecdote is a fitting start to “Selling Sickness”. Ray Moynihan and Alan Cassels, health researchers in North America, think that much of what passes for modern medicine has been too successful in taking Gadsden’s lead. The drug industry, they charge, is more interested in a healthy balance sheet than healthy patients.

Most medical research is now privately funded, so there’s always a potential for a conflict of interest, with influence exercised through conferences where corporates advertise to specialists and through articles they commission. The major corporations set the agenda. Literally. Researchers on the payroll are known as “thought-leaders”. Their role is to tell us what to think about the new products that their boss wants to sell us. Other touters are called “product champions”.

Branding A Condition

Chapters detail ten of our modern complaints. It’s hard to know what to call them. Our grandparents had flu or measles or dodgy tickers. We go to the pharmacy to treat a “disorder” or a “syndrome dysfunction”. There seems to be rule-of-thumb we could apply. If the name is vague it might be because the thing it purports to denote isn’t quite there. And the longer the name, the more unsure we should be.

In the drugs game they talk about “branding a condition”, which is what happens after a brisk marketing campaign induces lots of us to feel uneasy about life. It’s not surprising that most of the disorders and dysfunctions are to do with our moods and our sex lives. These are what we fret about, and for which precise diagnosis is notoriously elusive. The medical hucksters offer a lethal prescription of super-rich corporations who can exploit our distrust of doctors, our vanity and insecurity. High-powered advertising targets our low-powered libidos.

One huge market success was telling young Aussies that they should be feeling more chipper. Australian anti-depressant sales to 15-24 year olds increased ten times between 1990 and 2000. And as almost all anti-depressants are researched privately, we shouldn’t be surprised by a claim that fully 30% of Americans are alleged to suffer a “mental disorder” in an average year. What is a “mental disorder’? Whatever you like, really. Apparently some of us are burdened by “social anxiety disorder” (SAD), a doubly evasive phrase. Others call SAD “social phobia”. Expert opinion couldn’t even agree on whether these two conditions were the same or different. For us laypeople, the corollary of this dispute is that as neither can be named, neither can be said to exist.

An expert sees the defining aspect of this post-modern medicine as being its insistence that “boundaries” are blurred. “Depression”, he asserts, “is just an extreme form of sadness”. Is that right, doc? Mightn’t your patient be thinking that the borderless approach is what’s wrong with your advice? Doesn’t it mean “scholarship” is no more than random assertion? Doesn’t it suggest that the lack of “boundaries” is a way of saying you’re making it up as you go along? And doesn’t it follow that those who can dominate public discourse - the corporations and their flunkies - can serve up whatever self-serving nonsense they like?

Depression isn’t the result of a chemical imbalance? Or - to take a different tack - the result of emotional trauma? By blurring his boundaries the expert has blurred any ability to mark out methodologies we can assess. With no fences around our states of mind there’s a continuum from momentary irritation to psychosis. Of course only the experts can tell as the rest of us literally don’t know what they’re talking about (neither, by their own frequent admission, do they).

Anxiety About Phobias

The authors suggest that when the thought-leaders say something is an “anxiety” they will prescribe drugs, and when they say something is a “phobia” they are talking about therapies. If so, it is testament to the power of language to determine reality. A spectacular example of nonsense language refers to something said to be “late luteal phase dysphoric disorder” (LLPDD), which might or might not be the same thing as “premenstrual dysphoric disorder” (PMDD). In the case of LLPDD, feminists protested the implications of including it in the bible of things psychiatric, the Diagnostic and Statistical Manual of Mental Disorders (DSM) a publication with a long history of sexism and homophobia.

Just what is LLPDD, the feminists asked? Shouldn’t DSM know? Not according to DSM. They think ignorance is bliss because, as Moynihan and Cassels conclude, “this lack of knowledge became one of the powerful reasons to create the new condition, with enthusiasts arguing that a listing in the DSM would facilitate more research on its causes and treatment” (p109). A compromise was reached. The new affliction would be put in an appendix as a disorder requiring further research. When DSM came out, however, the publishers had included LLPDD in the main text. This is significant as a condition’s inclusion in the DSM allows doctors to prescribe. LLPDD was a description in search of a fact.

However much they claim to be objective findings to do with biology, our postmodern “conditions” reflect the aspirations of the articulate classes. Attention deficit disorder (ADD), for instance, seems to affect upper-middle class boys, enabling them to excuse their ill-discipline, while their guidance teachers can self-style themselves as “advocates”. More experts are thereby recruited to “educate” their peers. The merchants of unease succeeed in large part because they have provided us with an adaptable series of scapegoats. Personal responsibility takes a beating. Comprehensive health policy is another casualty of the new order. All the random individualism militates against systemic analysis. Public health - a big issue in the US, which has always emphasised private coverage - is not soon going to get a look in.

Joining the US in its privatising, deregulating zeal is NZ. The authors say that they are the only two countries with deregulated advertising for drugs. If the purpose of advertising is to create needs so that we buy stuff we might not need (as has been suggested by so many people, both for and against the prospect, that it seems unnecessary to argue the point) then the drug industry is one of its most potent expressions. Doubts about getting old or ugly or impotent, or fear of dying from some cunning hidden disease, are motivators. It is through our expensively fostered anxieties that the neo-liberal economy has entrenched itself. The hucksters know that if we can be induced to see ourselves as permanently dissatisfied consumers, and if we can be made to obsess about ourselves, we’ll keep buying. And we’ll stop asking questions.

Scepticism is always a healthy pill to take. But one response to the salesmen has been to confuse the source of their manipulations. Just because the “thought-leaders” have hijacked the language and processes of health policy, it doesn’t mean that we should be thoughtless. A lot of good things have happened since Louis Pasteur*. The bath water might be dirty but there’s a baby sitting in it. * ”The scientific contributions of Louis Pasteur (1822-95), French chemist and microbiologist, were among the most varied and valuable in the history of science and industry. It was he who proved that microorganisms cause fermentation and disease; he who originated and was the first to use vaccines for rabies, anthrax, and chicken cholera; he who saved the beer, wine, and silk industries of France and other countries; he who performed important pioneer work in stereochemistry; and he who originated the process known as pasteurisation”. Encyclopaedia Britannica.

Every so often we in NZ can expect a wave of health hysteria. A child is refused treatment for cancer by panicking parents manipulated by New Age frauds. Or an opportunist political leader tells her constituents not to get a vaccine. Please. The response to quack pseudo-science is not quack anti-science, and the denial of health care is not a rejection of the hucksters; it’s buying into the malaise. The problem is exploition of our inadequacies and our fears. The problem is not medical science. On the contrary, it is medical science that has banished many former deadly illnesses and epidemics and it is medical science that protects us from disease. The other reason that we in the richer countries are immeasurably healthier than our ancestors is the provision of public sanitation, things like drains and clean water, over the last 200 years. Publicly accountable science is surely our best bet against the snake oil salesmen. To react to Big Advertising and Big Drugs by a retreat into privatised fantasy and irrationality is to fight their war using their weapon.

“THE COLLAPSE OF GLOBALISM”

John Ralston Saul, Viking, Camberwell, Victoria, 2005

John Ralston Saul, a Canadian, is a member of an endangered species, the public intellectual. It’s good to read an old-fashioned humanist with a sense of history. Saul deplores what he sees as the decline of community and its replacement by market relationships. We are being privatised. The ascendancy of money has had the effect of converting social relationships into a series of contracts. At the core of this economic rationalism is its desire to set government policy. As there is thought to be only one right path, the one that lets business do what it wants, any alternative course that the public might want its representatives to explore is a threat. Politicians will get in the way of market efficiency. Thus a contradiction defines the market society. It claims to uphold choice, but seeks to disenfranchise anything but the policies favoured by Big Business. It wants total deregulation for business, but for governments it wants rules rigid enough to prevent any meaningful independence.

Saul has an insightful analysis of the consequence, an ideology known as managerialism. In the popular mind the bureaucracy that defines modern public life is a hangover from the inefficiency and waste within government departments from which the business ideology is trying to deliver us. In reality, it’s the opposite: bureaucracy is the essence of business ideology. Managerialism claims technical exactness, and, by extension, objectivity. We tend to accept its claim that it’s good to remove the politicians from political life because that’s in line with long established folk wisdom. Saul, however, argues that the resulting “belief in the inevitability of a particular economic theory and an overly complex managerial method” has narrowed possibility so that “the most common expressions of citizenship are likely to be loyalty, belonging and acceptance, compensated by the rewards of self-interest and marked by the promotion of efficiency in the service of the inevitable”.

Charity Replaces The NZ State

Saul bemoans this erosion of an accountable, public, democratic discourse. To make his case, he asks us to look again at some features of everyday life, like the upsurge in charity. For this, he mentions Auckland, where the number of foodbanks went from 16 in 1990 to 130 only four Ruthanasian years later. This statistic he does not reference, perhaps because at the time NZ was being cited internationally for its reliance on charity. Foodbanks were common in neo-liberal regimes. They were supposed to have been a temporary relief measure, but lingered. The aspect of NZ’s foodbanks which caught overseas opinion was that their clients included working families. We were gaining a reputation as a low-wage economy.

Another symptom is gambling. In the flushed years of globalist experiment, government coffers bulged with taxes garnered from lotteries and casinos. Around the Organisation for Economic Cooperation and Development (OECD), annual revenues from gambling soared by up to 51%. People bet away their often meagre funds because life itself had become a bit of a lottery, so there is an obvious corellation between neo-liberal policy and the fostering of social decay. But Saul does not labour the obvious moral theme. His argument is that governments encouraged gambling as a method of revenue gathering. The pokies replaced public funding. NZ is again prominent among Saul’s examples. Surely no other developed economy is so dependent on charity as an expression of policy. Indeed from Saul’s statistics it seems we are one of the worst offenders.

Local readers can provide their own examples. Our daily papers have recently published the results of community grants. The small-print lists of the successful, followed by the unsuccessful, cover whole pages. Social and recreational purposes, which should be at the core of Government policy, exist outside it. The Government talks of national goals - a healthy and fit population and the rest of it - but few organisations can expect a cent from Wellington or their local council.

Social policy itself is set up so that its prize is won by the slickest self-promotion, in competition against other community groups. The process teaches all concerned that their governments’ tables have been cleared for the business of business. So the country’s amateur teams, its youth groups and seniors, learn to beg for crumbs that might drop from the loaded table where the corporations dine. As Saul points out, “the justification in every one of these cases is that some percentage of the earnings is given to good works, to culture, to schools. In other words, the governments silence precisely those who would criticise the ethics of using gambling as a tax tool by addicting them to its revenues”.

If our national bird is to be saved from extinction, it will be thanks to the largesse of a foreign-owned bank. If we have an accident in some remote place, we will be rushed to hospital in a helicopter named for another foreign bank. Etcetera. Well, yes, we have to be grateful, but isn’t it all degrading? In this milieu possibly irresponsible corporations can buy silence from potential critics by the simple expedient of donating a (for them) trivial amount to some scheme that the do-gooders want. The more profitable or appalling the exploitation, the more generous the hush money. Into this vaccum of accountable democracy stepped non-governmental organisations (NGOs), non-profit public associations which lobby for public causes from the local to the international. Saul notes that although there are hundreds of thousands of NGOs, and that we take them for granted, they are a new phenomenon, a response to globalism.

TINA, Roger And Ruth. What A Team!

At the core of Saul’s analysis is his contempt for the ideal of inevitability, for “There Is No Alternative”, the old whore TINA. Not so long ago Marxism was ridiculed for its introduction of the concept of inevitability into economic theory. For years the conventional pastiche of Karl Marx was that he maintained that we are not free to do as we please, that we are cowed by forces beyond our personal control, that we cannot make of the world whatever our wills fancy. But once Marx - and his paler pink comrades - was seduced, TINA entered the world drama, stage Right, echoing her own version of determinism.

TINA had many happy hunting grounds but she was happiest in Godzone because it was here, 20 years ago, that she found the world’s only rich country prepared to obey her every whim (see my obituary of David Lange elsewhere in this issue. Ed). The NGO, Saul writes, is a worthy response to an unworthy need, as the doctrine of the infallibility of markets that informed “the constant chorus of international economic inevitability drove people who wanted to make changes away from politics and government”. The culture of voluntarism “had the strength to free people from the forces of inevitability, but the weakness that it cut citizens off from responsible democracy”.

Through the work of people like Jane Kelsey and the late Bruce Jesson we know the story, and Saul makes no claim to originality when it comes to discussing NZ. His contribution is to place neo-liberal policy into a context. He reminds us, for instance, that all the pet theories of economists have a limited shelf life. What Saul calls globalism is a return of the unfettered capitalism that had its day between about 1850 and 1939. Its record wasn’t too great. Saul shows that the latest “free traders” are repeating earlier mistakes.

Encouraged by economic crises after the oil market went wild in the 1970s, market ideologues cranked up the old, tired nostrums. NZ, as we know all too well, had a Government willing to take a punt. Thus, Rogernomics and Ruthanasia gave life to what had seemed the wishful thinking of a few extremists. Saul thinks they’ve finished their run. 30 years is about all the currency a fad can expect. Saul’s optimism is probably justified, if only because the damage to the world economy caused by neo-liberalism has become too manifest to be ignored. Sharply increased inequality, an inescapable consequence of deregulated markets, can be justified only (and some would say not even then) if it makes us all better off. But we’re not. The rich have got a lot richer. The rest of us have gained nothing or have got poorer. That holds true both for relationships within countries and between countries.

In Bushite USA, workers are being forced to take pay cuts like 10% (groceries) and 26% (airline mechanics) as “free trade” laws have their intended effect of boosting profits at the expense of the community’s wealth. As in NZ, real wages are lower than they’ve been for generations (Press, 28/10/05, ‘Workers on downward slope”). TINA sang her siren song, appealing to our sense of fair play and our credulity. We were being selfish, TINA sang. Those jobs were going to even poorer people in the developing world and it was bad form for ordinary people in the “rich” world to expect to be able to feed a family on one full-time income. If only it were true, it would be all very warm and fuzzy. In fact, “Third World” living standards have been driven down at an even steeper rate than they have in the “ First World”. Once wages are depressed in one place, they can be depressed in another place.

China & India Defied Neoliberal Orthodoxy

The current hype is for China and India, said to provide proof of the genius of “free trade” (in the mass media every supposed economic success story is attributed to the world’s Rogernomes). In fact, both countries are spurting now - and not necessarily in ways that benefit their citizens - because they have defied neoliberal orthodoxy. Globalism has failed to deliver. That’s one problem with it. Another problem is that its theory and its practice don’t match. Saul argues that mega-corporations have been freed up for vertical integration, or what he calls “internal dumping”. The transnationals talk of a brave new world order “but if the whole process is internal, it resembles not so much market trade as the earlier mercantilist model or that of the 19 th Century empires”. The big corporates have banished protectionism (when it suits) in order to protect themselves.

One all too familiar result of globalism is prices which bear no relationship to real costs. Typically they are too high or too low. Saul talks of the bargain underpants you can find. But there’s also an absurdly pricy Nike product, where you are paying for Tiger Woods’ image. The undies and the shoes were made in the same sweatshop conditions and “[b]oth cases are the product of a market approach delinked from competition, value and need. These are the two extremes of Western consumerism: goods too unnecessarily cheap to support a growth economy; goods too artificially expensive to feed a growth economy”.

Some might think that Saul is being too kind when he suggests that NZ has seen the error of its ways. It’s one of three countries he thinks might be showing the way to a more balanced economy, the others being Brazil and Malaysia. Repeatedly he credits the Clark government for rejecting Rogernomics. But he does so more by quoting Clark’s rhetoric than by checking her record. Let’s hope Saul reads Watchdog. Were he to do so he might conclude that while Labour is unwilling to carry neo-liberalism to the illogical conclusions pushed by Brash and Hide, it has not yet summoned the will to reverse course.

“RECLAIMING PUBLIC WATER”

Corporate Europe Observatory (ed.), Amsterdam, 2005

Not long ago the notion that water could be thought of as a private possession, akin to chewing gum, might have seemed unlikely. Unlike chewing gum, or the new season’s offerings from Christian Dior, water is not something we expect to buy from a private corporation. But why did we used to think of water as being a different type of thing from a new chocolate bar or a designer suit? As this anthology from around the world attests, neo-liberals insist that it is not politically correct to suppose some things should not be traded.

Our habit was to suppose that chocolate bars were discretionary items. We don’t need them but if we have a sweet tooth, why not get some? Others might prefer to pick up a couple of shirts, while the more disciplined among us might put away every spare cent to try to pay off the mortgage. The ideals of thrift, prudence and freedom, the virtues which are said to underpin the market system, might well guide us as consumers of chocolate or shirts, but we’re all consumers of water. Clean water is not a matter of choice. No-one invented water or discovered it, and no entrepreneur’s investment created rivers or rain. You’d think that leaving the supply of water within the public realm would be a no brainer.

The title of this anthology, “Reclaiming Public Water”, indicates that this is not the case. Activists from every continent tell their local stories about how their communities lost control of their own water, and how they’re working to restore social control. Their evidence is clear. Privatising water isn’t fair and it doesn’t work, whether in a village in Africa or in a city in Europe. The profit motive acts to reduce quality and efficiency. It discourages the kind of long-term planning for storage and distribution that every society needs.

It is perverse that we’re making mistakes that we’ve made many times before. In the US during the 19 th Century, at the high tide of irrationally exuberant free markets, public opinion had already been roused to wrest the control of water from private interests. Now, in the 21 st Century, American consumers are trying to fend off privatisers from Europe. That’s a choice sign of the times.

See Jeremy’s above review of John Ralston Saul ’s “The Collapse Of Globalism”, in which Saul concludes that this era marks the high tide of neo-liberal economics. See also Jeremy’s review of “An Uncooperative Commodity: Privatising Water In England And Wales” in Watchdog 108, April 2005. This can be read online at
http://www.converge.org.nz/watchdog/08/08.htm. It contains a more detailed anlaysis of water policy. Plus Jeremy’s review of “Power Play” in
Watchdog 104, December 2003, which can be read online at
http://www.converge.org.nz/watchdog/04/12.htm. This looked at the campaign to restore popular control of electricity at the same time and in the same places as the water privatisations covered in “Reclaiming Public Water” were taking place. Ed.


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