A real life example of this logic at play can be found within the domain of health.  When we become unwell we assume (following the above myth) that the treatment that we receive is the best available. In England and Wales best available treatments are presented by the National Institute for Health and Care Excellence (NICE) in the form of published guideline AllTrials. Reasonably enough, treatment options are assessed in accordance with a cost-benefit analysis. In short, NICE quality standards enable “Health, public health and social care practitioners to make decisions about care based on the latest evidence and best practice.” 

As suggested however, there is a serious problem with this seemingly rational and progressive picture of health promotion in this part of the world today. This is because much of this “latest evidence” on which NICE guidelines are based comes from clinical trials. This is all well and good until we learn that not all results from clinical trials are published. As Ben Goldacre has pointed out “the chances of a completed trial being published are roughly 50/50. And trials with positive, flattering results are about twice as likely to be published as trials with negative results.” Yes, that is correct! Those undertaking clinical trials – which typically means large corporations with a legal obligation to maximise profits for shareholders – can choose whether or not to publish the results.  

This picking and choosing which results get published has two important and interrelated outcomes. The first is that it allows corporations to control information in order to manipulate the market in their favour. The second is that it means that professionals and the public do not have access to information that could be used to inform decisions about treatment options. After all, NICE can only formulate their guidelines using published data. This, of course, represents highly irrational (not to mention anti-democratic) practice. Public health is being compromised for private profit.  But what to do?

One radical option – i.e. an approach that gets to the root cause of the problem – is to conceptualise an alternative economic system with a very different logic and then organise towards this new system. An example of this approach has been presented, most notably, by Michael Albert, who, along with Robin Hahnel, developed an alternative economic model called participatory economics (or parecon for short).  In his Realizing Hope: Life Beyond Capitalism – Michael Albert writes:

“The US, for example, with the most prized implementation of corporate capitalist logic worldwide, is also first in voter abstention, homicides, incarceration, teen births, child abuse leading to death, and child poverty, as well as in mental health, and, of course, in the number of billionaires.  What all this has to do with science and technology is that it demonstrates, again, how science and technology can be misdirected, biased, and perverted by profit and market pressures.”

 He then goes on to ask: “What will be different in a parecon?”  His answer:

“Research and technology will be directed where it can do the most good, not where it will be most profitable to a few […] There will not only be no impediment to address real areas of benefit, there will be every incentive to solve social ills in proportion to benefits that can thereby accrue, not to individuals hoarding property, but to all society.”  

It should be understood that all of these positive outcomes are not reliant on people becoming angels, but rather are dependent on the logic of the system. Just as capitalist institutions rationalise selfish behaviour in individuals, parecon institutions rationalise solidarity. We all have good and bad, wholesome and unwholesome, skillful and unskillful tendencies within us. It is just a matter of which of these inner potentials – the positive or the negative – come to the surface and are expressed. What determines this, to a large extent, is the design of the social institutions in which we live. For this reason the logic generated by capitalist economics, that results in public health being compromised for private profit, would not exist in a participatory economy. Instead, redesigning the economy along parecon lines would ensure that this problem had been addressed at the systemic level.    

A less radical – and yet potentially powerful – approach would be to initiate a campaign design to address the specific issue of research publication. This is exactly what the AllTrials campaign has been set-up to do. Initiated in January 2013 the campaign draws attention to the principles for medical research expressed by the World Medical Association which states that “every investigator running a clinical trial should register it and report its results” adding “yet that important ethical principle about reporting has been widely ignored”. As already noted above, to operate in this way leads to an inevitable loss of knowledge, potentially damaging treatment for patients, and inefficiency due to the likelihood of repeated trials.

As their website states “AllTrials calls for all past and present clinical trials to be registered and their full methods and summary results reported”. People can support this campaign in a number of ways, including signing their online petition. However, this campaign may also generate a context in which more radical analysis and strategy, such as that touched on above, can be discussed. It could be argued, in fact, that such a discussion is necessary if we want to avoid the constant battle to protect and further promote our most basic of human and democratic rights from present and future tyranny

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