Class Inequality: Abolish It or Win Nothing
Class inequality prevails everywhere in the world.
This article is about why we need to make abolishing class inequality our number one priority. So let me first spell out what, exactly, I mean by it.
Class inequality means some people owning or having control of a far greater share of social wealth than others, with no justification based on need. It doesn't mean a large family having a larger home than a small family, but it does mean one family owning several mansions while another family of the same size and with the same needs goes homeless. It doesn't mean a sick person having the use of a lot more medical care wealth than a healthy person, but it does mean a very sick person having the use of a team of personal physicians and unlimited expensive medical technology when an equally sick person dies waiting for care in the emergency room. It doesn't mean one person being trim and another person being fat, or one a great athlete and the other not; and it doesn't mean one person having the respect of others because of his or her talents or dedication or wisdom and another person having no such respect; but it does mean equating such respect with deserving to own or control more social wealth than others. It means communist government officials in the city having incomes hundreds of times greater than peasants in the countryside, and capitalists and their top management having far greater incomes than workers. It means allowing some people to enjoy greater wealth and privilege than others because of their race, nationality, religion or ethnicity or because of their supposed superiority as a capitalist entrepreneur or investor or because of their inherited wealth or because of their supposed leadership skills or even their supposed "good luck." Genuine need, as for example sick people needing more than healthy people and large families needing more than small families, is the only justification for some having or using far more social wealth than others; otherwise it is class inequality.
This article is about why, if we don't make the abolition of class inequality our most important goal, we will never really win anything else that we want.
This article is about how the upper class, be it a capitalist or communist or aristocratic upper class or a theocracy, try to maintain class inequality by persuading us that what we really want is not the abolition of class inequality but something else--"equal opportunity," "affirmative action," a "Palestinian State," "racial equality," "the abolition of apartheid"-- that sounds good, and may even be good, but allows class inequality to continue.
This article is about why it will be an empty "victory" for the vast majority of people if we define victory as anything other than the revolutionary goal of abolishing class inequality. Even if we define victory to mean winning the most far-reaching reforms advocated by Barack Obama or Dennis Kucinich or Ralph Nader or your favorite labor union or Ron Paul or Noam Chomsky or Cynthia McKinney or Cindy Sheehan or the Green Party or The Nation Magazine or the Communist Party of anywhere, or Hamas or Hezbollah, it will be an empty "victory." None of these leaders say the goal is abolishing class inequality! Abolishing class inequality is revolutionary, and anything else, even if it calls itself revolutionary, is not--it is reformist. Reforming class inequality just means preserving it, making it harder to mobilize people to fight it. The defenders of class inequality are all too eager to reform it when necessary. We must not let reformist leaders control what we fight for.
Sometimes it is not obvious if a leader is a reformist or a revolutionary. Venezuela's Hugo Chavez, for example, calls for a "Bolivarian revolution." He says the revolution is for equality and democracy and lots of good things. The proof is in the pudding. The point is that the most important criterion for judging leaders like Hugo Chavez is whether they are truly helping people abolish class inequality, or doing something else.
Before discussing why we need to focus on abolishing class inequality, it is important to stress that this goal will unite us with billions of people even if it may separate us from the hundreds of reformist leaders who won't provide revolutionary leadership. Most people on the planet want what reformist leaders don't want--to abolish class inequality.
Take a look, for example, at this video about Argentine workers who defied capitalist laws to take over and operate the factories where they used to work for capitalist owners. At the Ceramica Zanon factory the workers pay everybody exactly the same wage. This is what ordinary people do when they are actually in control, which is almost never the case unfortunately.
In every country on the planet the government aims to prevent workers from having such control. For some reason the Argentine government, as of the filming of this video, hadn't yet used its military power to return the factories to their former owners. Maybe they were afraid that it would provoke an uprising they wouldn't be able successfully to suppress. But as the video's interview with one former owner makes clear, the owner is confident it is just a matter of time before the government will hand over the factory to him. And if the workers don't overthrow the Argentine government first, he will probably turn out to be right.
The fact that workers seldom have an opportunity to abolish class inequality does not mean it isn't what most people throughout history have wanted. Ordinary people have long fought to abolish class inequality, but our rulers work hard to prevent us from knowing about it. Schools don't teach it and the mass media don't report it. But just because it's unreported doesn't mean it doesn't happen. Millions of people have been doing it for centuries.
Peasants did it in Germany in the 1524-5 Peasants War, asking, "When Adam dug and Eve spun, where was then the nobleman?" The Diggers tried it in England in 1649-50, declaring their intention of "making the Earth a Common Treasury for All." In China, from the late 1840s to 1864 the Taiping Rebellion challenged Imperial rule--successfully instituting its "Heavenly Kingdom" for a time in some areas--with a movement that "was founded on a radical economic reform program in which all wealth was equally distributed to all members of society. Taiping society itself would be a classless society with no distinctions between people; all members of Taiping society were 'brothers' and 'sisters' with all the attendant duties and obligations traditionally associated with those relationships in Chinese society. Women were the social and economic equal of men; many administrative posts in the new Kingdom were assigned to women. This social and economic reform, combined with its passionate anti-Manchu nationalism, made the Kingdom of Heavenly Peace a magnet for all the Chinese suffering under the dislocations and disasters of the mid-century." Nearly thirty million people died in the war between this movement and the Chinese Imperial government.
In the Spanish "Civil War" (actually revolution) that began in 1936 workers and peasants, in a heroic fight against the fascist General Franco, seized power in much of the provinces of Catalonia and Aragon and abolished capitalism and the inequality on which it is based, in some areas even abolishing money. Expressing the views of the great majority of people, the newspaper of the leading organization of Spanish workers, the anarcho-syndicalist CNT, wrote the following attack on class inequality in Catalonia on September 19, 1936:
"Proletarian mothers with sons at the front here suffer stoically of hunger together with their innocent little ones...We say that sacrifices ought to be by all and it is an inconceivable situation that in actuality there are places where, by paying prices outside the reach of any worker, it is possible to obtain all kinds of food. These luxurious restaurants are veritable foci of provocation and should disappear, as ought to disappear all privileges of any sector. Flagrant inequality, privilege, is in such cases a terrible dissolvent of popular cohesion. It must be eliminated at all costs...Protected...there has entered into action a repugnant caste of speculators and profiteers who traffic in the hunger of the people...We repeat that our people do not fear sacrifices but do not tolerate monstrous inequality." [Felix Morrow, Revolution and Counter-revolution in Spain, pg. 262]
Why do we need to make abolishing class inequality our number one priority? It is not simply that class inequality is unfair, which it certainly is. It is because class inequality is the root of all the other evils in society that people struggle against. It is the root of crime and corruption. It is the root of governments being undemocratic even when they are officially democratic. It is the root of human rights being denied to people, including rights that have nothing directly to do with class inequality. Until the root of class inequality is eradicated, the evils that grow from that root will always grow back, no matter what.
As long as we tolerate class inequality those at the top will buy or otherwise obtain more than their fair share of social wealth. Some will possess several mansions while others are homeless. Worse--and this is the key point--they will live in and enjoy those mansions with full social approval. Likewise some will, with full social approval, buy a team of personal doctors and enjoy unrestricted use of expensive medical technology while others have no medical insurance and die waiting to be seen in emergency rooms. In a society that tolerates class inequality, buying things like this is as easy as buying a slave in a society that tolerates slavery, or buying a child to molest in a society that tolerates child abuse.
By the same token, nobody can buy a slave in a society that does not tolerate slavery. Nobody can buy a child to molest in a society that does not tolerate child abuse. And in a society that does not tolerate class inequality, nobody can buy several mansions or a team of personal doctors and unrestricted medical technology when others are homeless or dying while waiting in emergency rooms.
Abolishing class inequality doesn't mean simply passing a law against it. It means the great majority of people who oppose class inequality taking whatever steps are necessary to make it physically impossible for anybody to own or otherwise possess and use far more social wealth than others unless there is a genuine need for it. It means creating a social reality in which, for example, a small family, no matter how much money they may claim to own or what connections they may have with "important" people, could never occupy a mansion while larger families make do with far less, because if they did their neighbors and others would be so outraged that they would literally forcibly evict them, the same way people would treat somebody if they discovered they were holding another person in slavery or abusing a child. There would be no excuse for such behavior, and it would not be tolerated.
If a society tolerates class inequality, then it provides a huge motive for people to do whatever it takes to get on as high a rung of the ladder of inequality as they can. There is great truth in the saying that the love of money is the root of all evil. But nobody would love money if there were no class inequality because in that case the most important thing that money can buy would not be for sale. It is class inequality, therefore, that motivates the love of money and the evil some people do to get it. Take away class inequality in society, and money loses its allure. But when society tolerates class inequality it tells people that evil crimes, if committed without getting caught or without breaking the law, will indeed pay very handsomely. This is why, in societies like ours that tolerate class inequality, people murder their spouse for the life insurance money, or they pay their workers the lowest wages they can get away with, or they sell products to the public that they know are unsafe, or they wage unjust wars, or a million other foul deeds we are all too familiar with, all for the love of money.
Money, itself, is not the root of the problem; the toleration of class inequality is. Replacing money with something else as the means of rising in an unequal class society does not solve the problem. If, instead of money, rank in a Communist Party or a religion, for example, is the means of rising above others and controlling greater social wealth, then the evils that stem from class inequality remain the same.
As long as we tolerate class inequality, genuine democracy--everyone having an equal say in decisions that affect them--is impossible. Those on the top rungs of the ladder will always have more than others. If inequality is based on money, the rich will buy politicians. They will threaten to move their business out of state (or out of country) unless the government does their bidding. They will dominate the very regulatory bodies that the government creates to control them, by methods such as promising the regulators cushy jobs after their term of service if they make the "right" decisions. Money means power, no matter what the constitution or the laws may say.
When having little money means having little claim to the ownership or use of social wealth, like food and shelter and health care, then people with little are forced to obey those with lots just to survive. Even those who are better off than many will still be tempted to do the bidding of the wealthiest in exchange for a bribe that will enable them to rise higher on the ladder of class inequality. Class inequality guarantees that corruption of government officials will be rife. Real democracy is out of the question. If instead of money class inequality is based on rank in a Communist party or religion, the result is the same: those with the lion's share of social wealth at their disposal will use it to bribe and corrupt government officials. Any effort to win real democracy that doesn't aim to abolish class inequality is doomed to fail.
Like democracy, human rights cannot flourish in a society that tolerates class inequality. The United Nations Declaration of Human Rights in the very first sentence of its first Article says: "All human beings are born free and equal in dignity and rights." Unfortunately, people do not have equal rights, and hence to not enjoy equal dignity today. Most people on the planet do not have the human rights identified in the Declaration, such as the right to "life, liberty and security of person" (Article 3) or the "right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control" (Article 25). If people truly enjoyed these things as unconditional rights, then they would not need to do the bidding of those with lots of money in order to have these things. Money would lose its power and society would be more equal. Those at the top rungs of an unequal society, who value inequality and fear equality, understand this. That is why they do all sorts of evil things to prevent people from enjoying the human rights listed in the Universal Declaration of Human Rights.
The fight for human rights is thus a fight against the defenders of class inequality. The power of these defenders of inequality comes precisely from the inequality they defend. This is why any effort to win human rights that doesn't aim to abolish class inequality is doomed to fail.
This is true even with respect to human rights that are not so obviously linked to social wealth. Article 13, for example, says that "Everyone has the right to leave any country, including his own, and to return to his country." The most flagrant denial of this right is to the Palestinian refugees whom Israel refuses to allow to return to their country in what is now called Israel. In Israel there is extreme class inequality. In 2006 the "paper of record" in Israel, Haaretz, reported "the income of the 18 wealthiest families in Israel is equivalent to 77 percent of Israel's national budget, which is NIS 256 billion a year, and constitutes 32 percent of the country's revenues." The Israeli upper class controls its increasingly impoverished Jewish population by making sure that Jews fear ordinary non-Jews (i.e. Palestinians) far more than they fear their own billionaire rulers. They ensure this by carrying out a brutal ethnic cleansing of Palestinians (driving Palestinians from their former homes inside what is now Israel and forcing them to live in refugee camps) in the name of "the Jews" thereby fomenting a "Jew versus Arab" conflict that makes Jews feel they need to rely on the Israeli upper class for protection against the Arabs. This is why Israel does not allow Palestinian refugees to enjoy their human right to return to their country. It is all about maintaining class inequality.
If we want to stop the evil that some people do for the love of money and power--for the love of rising higher in an unequal class society-- then we must abolish class inequality. If we abolish class inequality, then nobody could buy more social wealth at the expense of others having less. Neither money nor high rank in a religion or a ruling party nor anything else could any longer get one a higher rung in an unequal society. There would no longer be any reason to covet money, and no reason to do evil to get it. For the first time it would actually be true that "crime does not pay." Only by abolishing class inequality can we truly deal with the root of all evil.
Scientific research today is extremely expensive. Whoever controls a society's wealth controls the agenda for scientific research. In a society based on class inequality, real power is held by the few at the top, and they control the agenda of science just as much as they control the economy and the mass media, even if an officially democratic government is the main source of funds for scientific research. The federal government's National Institutes of Health controls the medical research agenda in the United States, but it would be naive to believe that the agenda is not dominated by the big pharmaceutical companies, whose primary aim is to profit from disease, not to cure it. The pharmaceutical companies want to market drugs they can patent; they don't want scientists discovering that something cheap and plentiful can cure a disease. But the people do! The auto and oil corporations don't want scientists discovering how to make cars get 100 miles per gallon, but the people do. Monsanto scientists are paid to figure out how to genetically modify crops to make the seeds sterile (but the crop immune to Monsanto's super weed-killer) so that farmers will be unable to take advantage of the weed killer without having to keep buying new seed each year from Monsanto. Good for Monsanto share-holders, but terrible for everybody else. This is what science inevitably does in a society that tolerates class inequality. [See below a Boston Globe article about how even physicians don't trust their continuing education courses because they believe they are just sophisticated drug company propaganda.]
The second necessary condition for science to serve the people is that the public must trust that that is, in fact, what science is being used for. When class inequality prevails, the public has no basis for trusting scientists. This is why millions of people don't trust their doctor telling them to take an expensive drug for their disease or to have their child vaccinated. Maybe, they believe, the drug is really not as good as a cheap vitamin or herb. Maybe the vaccination is actually harmful and causes autism and is really just a money-making racket for some corporation. Maybe the orthodox medical journal articles are not to be trusted; maybe they are secretly ghost-written by employees of a pharmaceutical company and not written by the supposedly independent scientists who purport to be the authors.
It's not just a distrust of pharmaceutical companies. Science in general is now held suspect by many people. Do seat belts really save lives, or are mandatory seat-belt laws just a way for the police to have another excuse for harassing drivers, or a way for insurance companies to target seat-belt violations as a way to raise their rates for everybody? Does fluoridation of our water really prevent tooth decay and is it really safe? Is carbon dioxide that is produced by human activities really causing a disastrous global warming? Does big money back the scientists who say yes and marginalize the ones who say no? Is human-caused global warming a lie that the elite are using as a pretext for getting us to do what they want? Do we really need to limit our carbon footprint like they say, to save the world? How can people trust the scientists when they know how likely it is that the science is corrupted just like their "democratic" government?
But if people don't believe the scientists, if they don't wear seat belts and they don't take the drugs and they don't get their children vaccinated and they don't vote for fluoridation of the public water supply and they don't limit their carbon footprint and they don't use genetically modified seeds, and the list goes on and on, then even if the scientists are correct, the science will not truly serve the people as it ought to. For science to serve the people, the people must trust the scientists. And in a society that tolerates class inequality, this is impossible.
In South Africa, for example, the ANC led a heroic fight to abolish apartheid. Apartheid was the particular form of class inequality at that time, but its abolition did not prevent class inequality from continuing in a different form. Victory, defined as abolishing apartheid, turned out, in practice, to be a terrible defeat for the great majority of South Africans, who always wanted the abolition of class inequality even if their leaders spoke only of abolishing apartheid.
Ashwin Desai, in his book We Are the Poors, writes of post-apartheid South Africa:
"The white elite was allowed to move its corporate assets to London and a small black elite made up of around 300 families became super rich. Unemployment reached 40 percent and by every measure (life expectancy, morbidity, access to food, water, etc.) the living conditions of the poor rapidly worsened...Black leaders during the Civil Rights Movement in the United States did not say the goal was to abolish class inequality, even though that is what most people, blacks included, want. As a result, black Americans fought heroically to abolish Jim Crow laws of racial discrimination only to find that after winning this demand the conditions of life for black Americans continued to get worse, with the number of blacks in prison increasing eightfold from 133,226 in 1970 to one million in 2000, while from 1970 to 1989 black median family income declined from 61% to 56% of white median family income.
"On May 16, 2000, Michael Makabane was shot dead at point-blank range during a peaceful protest against the exclusion of poor students from the University of Durban-Westville. That campus had been considered a hotbed of militant resistance to apartheid. While police repression had been brutal no students had ever been killed during the apartheid era. The local paper, now under black editorship, called for tougher action against protesting students...
"Over a million people had been disconnected from water because they couldn't pay; 40,000 children were dying from diarrhea caused by dirty water each year. Cholera returned with a vengeance, infecting over 100,000 people in Kwa-Zulu Natal alone. People starved in rural areas, throngs of street-kids descended on every town to beg and prostitute themselves, petty-crimes soared, and the jails reached 170% capacity."
Communist led revolutions were able to enlist the support of millions of people willing to make incredible sacrifices. That is how the Vietnamese Communists were able to wage a Peoples War that defeated every imperialist power including the United States. The revolutions in China and Vietnam succeeded because people hoped they would abolish class inequality. But Marxist leaders use various excuses to avoid doing that. As a result, when one compares communist nations to capitalist nations in terms of a widely used measure of social inequality--the Gini coefficient--the communist nations are more unequal than many capitalist ones.
The way the Gini coefficient works is that it can range from 0 to 100, with 0 representing the case of perfect equality with everybody having exactly the same income and 100 representing the case of maximum inequality with one person having all the income and everybody else having none. Sweeden, known for its great social equality, had a Gini of 20 in 2005. In Finland and France it was 26 and 28, respectively, the same year. At the other extreme, Paraguay had a Gini of 58 in 2003. In the United States it was 45 in 2007. In Israel it was 39 in 2005. In Great Britain it was 34 in 2005. In Communist China it was 47 in 2004. In Communist Vietnam it was 37 the same year--worse than France and Great Britain. Furthermore, the trend is towards increasing inequality in Vietnam, from 35 in 1990 to 43 in 2006. This is why Vietnamese workers wage huge strikes for better pay, as, for example, 14,000 workers did in November of 2007 at the factory in Dong Nai, near Ho Chi Minh city, that makes shoes for Nike. The average monthly salary at this plant is $62. Contrast this to the wealth owned by rich Vietnamese individuals, like Truong Gia Binh, Chairman and CEO of FPT, who owns $144 million, or Nguyen Thi Huong, Chairman of Hoan Cau Company, who owns $125 million.
Marxists attract followers with the long term goal of a classless society, but in the meantime, they say, inequality is important as a means of making people work. (They ignore all the evidence to the contrary, from the workers at the Argentine Ceramica Zanon factory to Spanish workers and peasants in 1936 and countless other examples.) Trust us, say the Marxist rulers, we know best how to get to a classless society. But it never involves abolishing class inequality.
Other reformist leaders similarly mislead people by defining the goal as something that sounds good but which is not the abolition of class inequality, like "racial equality."
"Racial equality" really means a certain kind of inequality. It means that all races should be represented in all the rungs of the ladder of inequality proportionally to their demographic share of the overall population. It means distributing the class inequality "equally." So if 15% of the population is black, then 15% of rich people should be black and 15% of poor people should be black. When this condition is not met, it is called "racial discrimination." When this condition is met with respect to race and gender and all other categories of concern, then supposedly "equality" exists. But really what exists is a state of "perfect" inequality--exactly the same inequality within every racial, gender etc. group.
"Equal opportunity" is another mask for perfect inequality. Equal opportunity means that everyone, no matter what his or her race, gender etc., should have an equal opportunity to occupy a high rung in the ladder of inequality, and by the same token an equal chance of occupying a low rung. There is no limit to how unequal an "equal opportunity" society may be. None at all.
George W. Bush, Barack Obama, Israeli President Ehud Olmert, Palestine Authority President Mahmoud Abbas, Jimmy Carter and virtually all government leaders on the planet tell the Palestinian people that what they really want is a "state of their own"--a "Palestinian state" to live in peace next to the "Jewish state" of Israel. Since class inequality is not at all threatened by having it prevail separately in a "Palestinian" and "Jewish" state, the upper class elites would like nothing more than for Palestinians to follow leaders who define victory as winning a Palestinian state, especially if this is the only way to prevent Palestinians from fighting to abolish class inequality.
And yet slavery is now abolished. Why? Because a lot more people wanted to abolish it than to keep it, which was a necessary but not sufficient condition, and because the Civil War created conditions that made it impossible for the slave-owners to prevent large numbers of slaves from fleeing the plantations (to join the Union Army.)
There are those today who insist that it is impossible and even undesirable to abolish class inequality. Inequality, they say, is what motivates people to work--to "get ahead"-- and without it people wouldn't work or be creative or become extraordinarily skilled at anything. Without inequality our culture of greatness would become a culture of mediocrity. Abolishing inequality is a wild and crazy idea, impossible they say.
But those who defend class inequality today are as wrong as those who defended slavery in the past. The notion that equality means mediocrity and laziness is just wrong. People work hard and excel in different ways and tackle social problems for reasons that have nothing to do with wanting to have more social wealth than others. We could have a modern and wonderful economy in a society based on equality.
As with slavery, far more people want to abolish class inequality than want to keep it. In health care, for example, the public wants equality. The most recent expression of this longstanding fact occurred in Massachusetts in the November 2008 election, when the following question was on the ballot in ten legislative districts:
"Shall the representative from this district be instructed (1) to support legislation that establishes health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts, and (2) to oppose any laws penalizing the uninsured from failing to obtain health insurance?"CommonHealth newsletter reported, "The measure passed with margins ranging from 65% in the Fifth Middlesex to 83% in the Third Hampshire. Nearly 73 percent of 180,000 voters said yes."
The opposition to equality in health care, which can only realistically be achieved by a single-payer health insurance system, does not come from the majority of people but only from those at the top of our unequal society. This was made clear recently by none other than President-elect Obama's choice to be Secretary of Health and Human Services--Tom Daschle--in his new book, Critical. Don McCanne, the president of Physicians for a National Health Care Plan writes in a review of this book:
"Most troubling is Sen. Daschle's conclusions on single payer. He describes it as the model used by the 'world's highest-ranking health care systems.' He acknowledges, without dispute, that supporters say that it is 'brilliantly simple, ensures equity by providing all people with the same benefits, and saves billions of dollars by creating economies of scale and streamlining administration.' Yet he rejects it merely because it is 'politically problematic.'""Politically problematic" does not mean difficult to sell to the public. Far from it. It means impossible to sell to the big money folks, who don't want society to move in the direction of equality if they can help it. Big money has a veto when it comes to abolishing health care inequality.
People expressed the same desire to abolish inequality when, during the same election, voters in Massachusetts's 25th and 27th Middlesex districts (the only ones where the question was on the ballot) voted 73% and 62% yes on the following question:
"Shall the representative from this district be instructed to vote for a non-binding resolution calling on the federal government to support the right of all people, including non-Jewish Palestinian citizens of Israel, to live free from laws that give more rights to people of one religion than another?"These yes votes were in spite of unanimous opposition to the question by politicians and newspapers.
Trying to make the world better without focusing on winning equality and without identifying and defeating those who enforce class inequality is futile. The reason the world doesn't get better is because the people in power don't want it to get better: they want more class inequality, not less; they deliberately create artificial scarcities to increase job insecurity, health insecurity, housing insecurity and education insecurity for people at the bottom of society in order to pit them against each other and control them so they will be unable to abolish class inequality.*
To control people who want to devote their lives towards making the world better, the rulers of our unequal society employ them in schools and foundations and other institutions that officially aim to make the world better, but at the same time make sure that these institutions never challenge the power of the ruling class that values and defends class inequality. This keeps good people occupied and makes it seem like the ruling class is trying to make the world better, while ensuring that nobody ever tackles the problem at its root.
Class inequality is the root of the problem. Abolishing it is the key to the solution. Winning other possibly good things while failing to abolish class inequality is not enough. Abolishing class inequality is not the same as achieving "racial equality" or "gender equality" or "equal opportunity" or "ending apartheid" or "winning socialism" or having a "Palestinian state" or "defeating Zionism." Clarity about our goal is crucial. Without it, we are easily misled and neutralized by those who make defending class inequality their number one priority.
* As George Orwell expressed it in his novel, 1984:
"From the moment when the machine first made its appearance it was clear to all thinking people that the need for human drudgery, and therefore to a great extent for human inequality, had disappeared. If the machine were used deliberately for that end, hunger, overwork, dirt, illiteracy, and disease could be eliminated within a few generations But it was also clear that an all-around increase in wealth threatened the destruction... of a hierarchical society. In a world in which everyone worked short hours, had enough to eat, lived in a house with a bathroom and a refrigerator, and possessed a motorcar or even an airplane, the most obvious and perhaps the most important form of inequality would already have disappeared. If it once became general, wealth would confer no distinction. Such a society could not long remain stable. For if leisure and security were enjoyed by all alike, the great mass of human beings who are normally stupefied by poverty would become literate and would learn to think for themselves; and when once they had done this, they would sooner or later realize that the privileged minority had no function, and they would sweep it away. In the long run, a hierarchical society was only possible on a basis of poverty and ignorance... It is deliberate policy to keep even the favoured groups somewhere near the brink of hardship because a general state of scarcity increases the importance of small privileges and thus magnifies the distinction between one group and another... The social atmosphere is that of a besieged city, where the possession of a lump of horseflesh makes the difference between wealth and poverty."
For physicians, another option on education
Classes won’t take drug firms’ money
Dr. Martin Samuels wants to provide continuing medical education to doctors across the country. (Adam Hunger for The Boston Globe)By Liz Kowalczyk Globe Staff / September 14, 2010
Last week, Dr. Martin Samuels received a dinner invitation in the mail: He was invited to The Palm steakhouse to hear a Columbia University specialist discuss novel treatments for multiple sclerosis — and to earn continuing medical education credits.
But Samuels will not be attending. The class, he said, is not education, but subtle marketing by Teva Neuroscience, a pharmaceutical maker that sells a leading multiple sclerosis drug and, according to the fine print, is paying for the evening.
It is just this type of program that led Samuels, a Harvard Medical School neurologist, to start a new company that he says will provide continuing medical education to doctors across the country — without funding from the pharmaceutical industry.
“Doctors have lost confidence in [continuing medical education] and the public has lost confidence,’’ said Samuels, who sees patients at Brigham and Women’s Hospital, where he heads the neurology division. “The feeling is that everything is tainted. We simply must have a new way of doing this.’’ The company’s formation will be announced today.
The venture is the latest development in an escalating national debate over the system for educating physicians. States require physicians to take continuing education courses to retain their medical licenses, but doctors often pay little or nothing for the instruction because many of the companies that offer it are partly funded by makers of drugs and medical devices. Samuels himself worked part time for such a company until last year, when he said he decided that commercial support created an unacceptable conflict.
Critics say the reliance on industry funding allows drug and device companies to influence what is taught, potentially misleading physicians about the best treatments for patients and pushing up spending on prescription drugs. They note that many other professionals pay for their own continuing education.
Dr. Murray Kopelow, executive director of the organization that accredits medical education providers, said that the criticism is overblown, and that the vast majority of providers comply with his group’s rules, which forbid industry funders from influencing the content of courses or who presents them.
Teva, the funder of the Palm dinner, said that the education companies it supports follow the group’s requirements, and that its grants benefit patients and providers.
The new company, Lighthouse Learning, was founded by Samuels and two businesspeople with experience in medical education, Jon Leibowitz and Susan Pioli, who put up an undisclosed amount of money to start the company.
They have recruited 11 specialists, many also from Harvard, to write the curriculum and recruit speakers for courses in cardiology, obstetrics, oncology, psychiatry, and other specialties. The work will be paid for by the sale of the curriculum to hospitals, medical societies, insurance companies, and other organizations that provide professional education to doctors, said Samuels, who is Lighthouse’s director of medical education.Continued...
While prices have not been set, the founders say organizations will eventually pay more because they will want to say the education they provide is free of industry influence, and rules will increasingly require that.
The curriculum directors will not teach other courses funded by drug companies, to further insulate them from industry influence, he said. And, the company’s advisory board, which includes former Harvard Medical School dean Dr. Joseph Martin, will review the curriculum directors’ other relationships with industry. Consulting fees and other industry ties will not be prohibited for those writing curricula, but such payments would have to be limited and disclosed, Samuels said.
Both Samuels and Leibowitz once had ties to M/C Communications — Samuels was medical director and Leibowitz was general manager — a company that accepts industry funding for continuing medical education, particularly for its Pri-Med courses in Boston and other cities. Samuels tried to start a neurology course for the company but he said it was not successful, partly because he was uncomfortable soliciting funding from drug companies.
Samuels said companies don’t need to have their drugs even mentioned to make medical education classes effective product marketing. Just paying for general courses on migraines, or Lyme disease, helps persuade doctors to intervene with treatment for more patients.
“If you plant in people’s minds that Lyme disease is ubiquitous and has all these side effects, you don’t have to say the word ‘ceftriaxone,’ ’’ he said, referring to an antibiotic approved for serious cases. “People become obsessed with Lyme disease.’’
M/C Communications said its model allows it to reach thousands of doctors with affordable programs.
But discomfort with the system has led some institutions, including Stanford University medical school and UMass Memorial Medical Center, to prohibit companies from funding specific courses in their continuing education programs, while a few, such as the University of Michigan, have banned commercial support altogether. Harvard Medical School has taken a more lenient approach, adopting a policy this year that prohibits funding of individual courses by just one company.
Amid the growing scrutiny and a sour economy, industry funding of physician education has dipped. In 2007, commercial support of programs accredited by Kopelow’s group — the Accreditation Council for Continuing Medical Education — was $1.2 billion, 48 percent of total funding. Last year, industry funding fell to $856 million, or 39 percent of the total.
Commercial support of Harvard’s large continuing medical education program also dropped, from 12 percent, or $3 million, in 2008, to 10 percent, or $2.4 million, last year.
Kopelow said that he doesn’t believe Lighthouse’s approach is unique, because 42 percent of accredited providers don’t take commercial support for their educational programs now.
But, Lighthouse executives say, most of those providers are small and don’t operate on a national scale. And, they said, the percentage is actually much lower if one counts money spent by industry on advertising and exhibits at educational conferences — money Lighthouse will not accept at its conferences. Last year, the industry spent $283 million on this category.
Eric Campbell, a researcher at Massachusetts General Hospital who specializes in conflict of interest in medicine, said, “It is unique to recognize that it’s inappropriate to pass on the cost of CME to patients in the form of higher drug prices’’ because of overprescribing. “Doctors should pay for their own education.’’
But, Campbell said, Lighthouse may find it more difficult than expected to be completely pristine. Drug companies, for example, can offer to pay doctors’ tuition to attend certain courses, thereby exerting influence in that way. “You can close down one avenue and drug companies will find another avenue pretty quickly,’’ he said.
Dr. Steven Nissen, chairman of the cardiology department at the Cleveland Clinic and an outspoken critic of industry influence in medicine, agrees that untangling these relationships is hard, if not impossible.
Nissen, who is directing the cardiology curriculum for Lighthouse, said it would be impossible to hire faculty who have no relationships to industry whatsoever. “The biggest name people, the people who have the most expertise and are going to draw an audience — they are people who work with industry,’’ Nissen said.
But, he said, he will try to minimize potential conflicts by not hiring doctors who are paid speakers for companies that sell drugs and devices.
“We are trying to do something here that serves as a model,’’ he said.
Liz Kowalczyk can be reached at email@example.com.© Copyright 2010 Globe Newspaper Company.