|Number 220||August 29, 2003|
I thought I was going to have an operation last week, but I did not. I had a small infection, so they delayed the procedure until next week. I imagine the same thing will happen next week as I predicted for last week, as far as publication of this Nygaard Notes thing. That is, the Notes may come out on Tuesday, as I don’t expect to be up and about for a few days, so will not be able to hit my usual Friday deadline. (Unless they delay things again, perish the thought.) Number 221 may be a reprint of a couple of previously published (but, oddly, still timely) essays, depending on my energy level. We’ll see. This hospital stuff is all new to me, so please bear with me. Again, it is possible that I may even miss one of the next couple of weeks entirely. I’ll let you know. Many thanks to those of you who sent good wishes last week.
Welcome to the new subscribers who have recently come on board! I always like to encourage people to send along feedback on the Notes, positive or not. Please do. I learn a lot from your thoughts, and responding to you is a lot more interesting than plowing through statistical charts, as I have been lately.
I realize I haven’t said hardly a word about Iraq or about Afghanistan in recent weeks. It’s not for lack of news, I just think that there are lots of good sources for information about those things to be found these days. Why add to the avalanche? I’m collecting things, though, and will no doubt have something to say before long. Thanks to those of you who have sent along ideas and information. I count on you to make sure I don’t miss things!
Until next Tuesday,
I pointed out in my recent series on U.S. foreign aid that the Bush administration is about to launch a program called the “Millennium Challenge Account (MCA)” Initiative, under which certain “criteria” will be applied to the behaviors of poor countries. Only countries that please the U.S. by meeting these “criteria” will be “rewarded” with U.S. aid. While Mr. Bush insists that these criteria are “objective,” this is ridiculous. Like all criteria that are used to evaluate worth, there is a subjective assessment involved as to what is “good” and what is “bad.” There’s nothing objective about that, nor should there be. People just like the sound of “objective,” and the PR machine of the “President” is well aware of this.
One of the 16 subjective criteria that I did not mention in my series, that of “Immunization Rates,” appears in the Bush program under the heading “Investing In People.” I didn’t mention this criteria last month because I thought it had its own special lesson to teach. I return to it now.
One of the ways that the MCA plans to judge whether a poor nation is adequately “Investing in People” is the rate at which that country immunizes its population against certain diseases. Note the word “certain.” The U.S. criteria, inexplicably, mentions only immunizations against diphtheria and measles. If you don’t know anything about preventable global diseases, this might not seem odd to you.
However, if you do know something about preventable global diseases, you know that vaccines already exist for diphtheria and measles. And you know that those two diseases account for only about 20 percent of deaths from vaccine-preventable disease. Hepatitis B, for instance, kills 104 times as many kids worldwide as diphtheria, and pneumonia-related diseases kill more than twice as many as measles. Yet vaccination rates for these two diseases are not on the U.S. list that purportedly attempts to measure how good a job a country is doing of “Investing in People.” Why not?
Perhaps it has something to do with the fact that, as reporter Tom Paulson put it in the Seattle Post-Intelligencer a couple of years ago, “Vaccines, unlike many drugs, are seldom big moneymakers for industry. There's a lot more profit in treating disease than in preventing it.” His article, headlined “Vaccines Are Often Low on Industry's Agenda,” notes that vaccines to prevent “pneumonococcal disease” (pneumonia, meningitis, and others) the largest group of vaccine-preventable diseases in the world, “have had enough research and clinical testing to justify taking them to the next step—large-scale industrial manufacturing and distribution. But they were ‘orphaned’ by industry” because these vaccines, “designed just for use in poor nations lacked sufficient ‘market demand,’ from industry's perspective.”
“According to Profitability”
This phenomenon of a vaccine being “orphaned” is a predictable—indeed, almost unavoidable—outcome of the privatized, patent-protected, for-profit global health system that is actively promoted by the United States government. “Drugs are not developed according to public health need, but according to profitability,” said Dr Bernard Pécoul, Director of the Campaign for Access to Essential Medicines sponsored by the aid group Doctors Without Borders. “A new paradigm is urgently needed to address this fatal imbalance.”
That quotation was taken from a 2001 report by Mr. Pécoul’s group entitled “Fatal Imbalance: The Crisis in Research and Development for Drugs for Neglected Diseases.” The phrase “neglected diseases” was coined in response to the phenomenon in health care economics that chronically fails to give us effective vaccinations or treatments for “diseases of the poor,” such as malaria, Chagas disease, and sleeping sickness. As the report notes:
A pittance, indeed. Of the 1,393 total new drugs approved between 1975 and 1999, only 13 of them (that’s one percent) were specifically indicated for a tropical disease.
Despite its rhetoric about support for “Free Trade,” the United States is firmly committed to protecting “intellectual property rights.” These include the patent rights of pharmaceutical manufacturers, “rights” which raise the costs of many medicines, including vaccines, beyond the reach of poor people both here and abroad.
In coming months Congress will be appropriating funds, and I expect we will begin to hear more about the Millennium Challenge Accounts and the supposed “rewards” that will be offered by the United States to poor countries that meet our “criteria” for compassion. What we will not hear is any serious questioning of the fundamental structures of the global capitalist health-care system, a system that “rewards” the huge pharmaceutical companies for giving us Botox and Viagra while it allows almost five million poor people to die every year from diseases that could be prevented by vaccines.
I live right next door to a large hospital. For many decades it was known as “St. Mary’s Hospital,” and was run by an order of Catholic nuns. After it was purchased by a large medical corporation, we had a series of neighborhood meetings, ostensibly to get “neighborhood input” on some projects that the corporation wanted to undertake, such as the burning of medical waste in the neighborhood, and the use of toxic chemicals on the hospital campus lawns. (Both of these decisions seemed to some of us kind of ironic for a health care facility.) After one of these meetings, in which it became clear that the decision had been made long before our “input” was solicited, the “community relations” officer from the hospital corporation singled me out for a little chit-chat.
The officer—for reasons known only to her—decided that it would be a good idea to complain to me about the refusal of the Catholic nuns to let this large for-profit corporation continue to use the name “St. Mary’s” for the corporate hospital. As she attempted to explain to me, “The sisters have such a good reputation, I just can’t understand why they wouldn’t want to have their name continue to be used by us.” The ensuing conversation led me to believe that she was telling the truth: She really couldn’t understand the idea that a reputation might not be for sale.
I thought of this conversation this past Monday, August 25th, when I saw a headline in the Business section of the New York Times (“All The News That’s Fit To Print”) that read “Poverty, Chastity, Marketability: Advertisers Turn Monks Into Pitchmen.” It seems that various megacorporations have discovered the commercial appeal of these men, so we are and will be seeing them (or, I assume, actors dressed up to look like the popular conception of them) on T.V. pitching the products of companies like General Mills, Pepsi, I.B.M., Nintendo, and Sony.
The Times quoted Len Short, executive vice president for brand marketing at America Online in Dulles, Va., part of AOL Time Warner, speaking of the use of monks in ads: “They're lovable.” In the pantheon of widely appealing stock figures, he said, ‘you have dogs, babies and monks. Who hates monks?” (Probably not too many people hate monks, Mr. Short, although if you keep using them in your annoying sales pitches more people may learn to hate them.)
Here’s the fourth paragraph of the Times article (note the last sentence in particular):
Exploiting With Respect
Advertisers are aware that the use of people who cannot and will not speak out in their own defense might be seen as offensive to some. That’s no doubt why the Times, after noting that “most of these commercials could not work if they squared with the way monks actually live,” found an “observer” to tell us that the commercialization of religious imagery is not only unoffensive, but actually may be a “win/win” for corporate America and the big churches:
While this may seem like a pretty small and inconsequential couple of anecdotes, I think they help to illustrate a tremendously important aspect of our increasingly commercialized culture. The fundamental job of “public relations” (of which advertising is a key part) is to manipulate human emotion. So, if we have a positive emotional response to a monk, for example, or a tree, or a mountain, or mom, or apple pie, then it is the job of the public relations professional to get people to think of Cheerios when they see a monk, or of Pepsi when they see an image of the Great Outdoors. As long as it is “done with respect.”
The story of manipulation of the monks’ image illustrates, in a small way, a remarkable fact: Our culture has developed an immense industry (called “Public Relations”) that is capable of taking images of a “lovable” group of ascetics—knowing full well that they are “lovable” largely due to “the way monks actually live”—and getting people to associate their emotional response to that image with products the purchase of which would be quite clearly antithetical to the people whose image is being used.
It’s not particularly remarkable that PR professionals would think of doing something so cynical; that’s their job. The remarkable thing is that so many people appear to be susceptible to such absurd manipulation. That’s why I included the neighborhood story. That story hints at the fact that there are intelligent people in our culture who have somehow learned to separate a reputation from the behaviors that earned it, and that expect everyone else to have learned the same thing. The danger here is not only that words and images cease to have clear and recognized meanings. The danger is that the commercial culture is teaching us, at a deep level, that who we are can be separated from what we do. It’s dangerous because, once that belief is widely accepted, then there’s little point in doing anything at all.