Fictional re-creation of reality - cerebral and the emotional texture of life

In reviewing ‘My name is Red’ by Orhan Pamuk, probably an ultimate compliment was paid by a reviewer when he wrote that Pamuk, in this book, has achieved almost the unattainable, i.e., a convincing juxtaposition of the cerebral, the emotional and the physical elements of the human life.

  

This is not the place to discuss ‘my name is Red’ and debate how (and if at all or how far) Pamuk had achieved such a feat. But the suggestion is at least thought provoking.

The ‘realistic’ representation of life around us is what one normally expects from stories and novels (perhaps in a more complex manner from the latter) as a basic requirement. However, more often than not, if the reader is not careful, this demand is sought to be satisfied by merely a ‘naturalistic’ (akin to a photographic) representation. This debate as to what is naturalistic and whether or not that is good enough to be called realistic is quite old, going back to French novelists of the nineteenth century and their critical assessment in the early or mid twentieth century by critiques like Lukacs and other Marxist writers. The best writers, novelists, they reckoned, came to be perceptive chroniclers of the society and the important economic, social and political changes of their times (often unconsciously and holding quite conservative and reactionary views about the changes) and these they ably reflected by creating immortal characters carrying forward these changes through their personal conflicts and destiny.

While this analytical view point was probably very useful in interpreting many significant fictional writings (especially novels) belonging to the nineteenth century, one may have been less comfortable dealing with European (in general western) writings in the same genres from the early and middle twentieth century with similar critical perspective. Of special importance were the great novels due to Kafka, Joyce, Camus and Sartre (to name a few among the most significant writers of the last century), bringing to focus an individual’s human predicament, agony, angst, difficult and conflicting choices and the responsibility for such choices providing the framework for the life represented. How far an individual’s characteristics and his choices are predicated to the social and economic changes is less definitively hinted in these fictions than their nineteenth century counterparts. Considering the momentous changes occurring during the early and middle part of the past century, it is inconceivable that the individual destinies are dissociated from those changes. But the writers, imbued with new philosophical outlooks like existentialism and the many artistic and literary styles it spawned, probably tried to create a new kind of representation of life where individual’s cerebral and emotional responses are sought to be more comprehensively catalogued and dichotomised. It was hoped that enmeshing such ‘peculiar’ individual destinies would create a more realistic representation of the texture of the life in the present complex times and fragmented societies.

     

Come to think of it individual characters of the earlier times had displayed impulses and went into actions in response to events or as a result of moments of emotional upheaval or goaded by inspiration, which could be traced to some conscious cerebral deliberations. But rarely, if ever, was the individual’s self-awareness so acute as to create almost a distinctly cerebral persona stepped out of a character’s flesh and blood and emotional contour. And it was as if this separate persona watches from outside the character and comments and tries to influence its action. Thus this literary device of variously juxtaposing the cerebral and the emotional had seen significant employment in the best of the twentieth century literature.

The key factor that probably propelled this paradigm shift in the fundamental style of the literary representation was the gradual demise (initially primarily in the western world, developed nations) of the religious-ethical-political moorings of the individuals to a perceived communal or social center, creating first a dissonance with and then almost an eclipse of the societal and the communal, and eventually a void beyond the individual.    

Danger of Do-gooding by capital

A new buzzword has been in vogue, for several years now, both in popular media and in more serious academic literature on management studies, namely, ‘philanthro-capitalism’. A closely related word ‘venture philanthropy’ has been used almost in the same breath. An book entitled ‘Philanthrocapitalism – how the giving can save the world’ was published in 2008 by Matthew Bishop and Michael Green summarizing the new avatar that capitalism is believed, by some, to have been in the process of morphing into, so as to be in sync with the social progress rather than be in antagonism with or be indifferent to it. Bishop, US business editor and New York bureau chief of The Economist, has ever since been propagating this marriage of capitalism and philanthropy with evangelist zeal as the source of a resurrection and a way forward for capitalism. The authors blog regularly on the subject at http://www.philanthrocapitalism.net/.

Predictably, there are detractors, though much fewer, of this starry-eyed and, some might say, naive and glib espousal of the capitalism in a modified form. Michael Edwards, director of governance and civil society at the Ford Foundation, wrote a book ‘Just another emperor : the myths and realities of philanthrocapitalism’ (2008) to point out the fundamental flaws in this new ‘ism’.

Debating on the ideology and the practical needs driving capitalism in its new mutations would be interesting. But we would postpone that to some other time. It is, however, noteworthy to find journals like Economist or Wall Street Journal publishing articles not just speculating about dark intents behind philanthrocapitalist endeavours but pointing out, what many independent activists on ground in areas of agriculture and health (the two areas to which significant investments have been made over the last several years by Gates Foundation in Africa and India as a part of their global humanitarian aid programmes), have called a very negative long term and insidious impact on the countries concerned and the world organizations like WHO, resulting from this ostensibly philanthropic effort.

A couple of issues need to be emphasized. The correlation between the investments of the philanthrocapitalists like the Gates Foundation with Monsanto and the foundation’s huge support in Africa to biotech research (through the AGRA programme) promoting GM food as an almost exclusive option veering towards effective future domination of agricultural development in third world countries by certain MNCs can not be wished away. In the same vein the ground level activists are concerned about the promotion of the vaccine programme by the same foundation in India being predicated to the profit motive of certain prominent pharmaceutical MNCs in not-so-hidden commercial relationships with the Gates Foundation.

The second issue is of even greater significance. Philanthrocapitalists like the Gates Foundation by their sheer monetary clout has come dangerously close to the interface of philanthropy, business and public policy. Especially in the poor third world countries starved of funds (even in developing countries like India). “Take the money, ‘save’ your people from hunger or diseases, but be a little nice and listen to what we suggest. Or else!”. Reminds one of IMF bailouts, doesn’t it ? The manipulation of policies, acts of omission and commissions (for instance, in the clinical trials) is done in persuasive and indirect manner, not in brutally upfront IMF style. But the deleterious effect on long term national interests in health issues should not be lost sight of. Same caution should be exercised in respect of tendentious promotion of GM food under the cover of philanthropy.    

Greed and governance

Greed is good, said Gordon Gekko, the archetypical suave corruptor of good and the budding, aspiration driven young hero in the movie ‘Wall Street’. That was when the Wall Street was going great guns, in the late 1980s and 1990s, and capitalism in the United States and elsewhere felt as if the sky could not limit it. Two decades down the line, try telling that to those who have ‘occupied’ the Wall Street. They are questioning that premise in a pretty articulate manner. Why should the greedy fat big boys of the Wall Street have all the fun, they question, when the US economy is in poor shape, industry stagnating, unemployment running close to the double-digit figure and the country mired in unwinable war in unfriendly distant countries (which has compounded the economic woes manifold).

Back in 2008-09, the culprit banks were bailed out with the tax-payer’s money and kept afloat even as the top executives did not, quite shamelessly, choose to take any significant cuts in their compensation and the perks. Nothing seems to have changed, no lesson learnt. If anything, despite the apparent congressional wrangling between the desperate and breathless democrats on a survival lease (under threat of government lock down due to budget cut or similar emergency measures) and the republicans on leash by their tea-party masters, who have tasted Obama’s blood, the primordial urges and the anxieties of the capitalism underlying the dominant economic and political structure of the United States finds balancing individual greed of a few ensconced in the high street, with the long overdue delivery of public good to the middle and poor America (like a half-hearted attempt at the health policy reform that would benefit all Americans) difficult if not well neigh impossible. Any talk of reinstating higher taxes for the rich is like showing a red rag to those claiming to monopolise the spirit of free enterprise in that country.

Chetan Bhagat writes well. Argues in a persuasive manner. He says (TOI, 7 NOV 2011) that there is nothing intrinsically wrong with greed, but it should be regulated ! One can make money, be innovative and not break the rules of the game. America practises this principle, India only talks about it but fails to enforce it. And out comes words like governance’, ‘regulation’. Only it is unlikely that those operating the nuts and bolts of capitalism will have any real sympathy for such high-minded but naïve liberal talk, especially if and when that becomes more than that, i.e., attempts to fashion economic policies. American system appears to starry-eyed Bhagat as a fine self-governing complex mechanism, called a 'free' market economy, which works on honour system, encourages boundless individual/private initiatives competing in a free and fair environment, handsomely reward those with merit and relentlessly and efficiently pursues and punishes those who dare break such an ideal arrangement, way of life.

Unfortunately, those intrepid Americans at the barricades and blockades in New York, and others in Madrid and London don’t seem to share such optimism. For them 'governance deficit' is a fact that is impacting on their daily life that cannot be rationalized satisfactorily any more. Interestingly, in respect of vast tracts of India that have come to be painted red (for better or worse), even the intelligent among the Indian government agree that there has been a persistent deficit of governance vis-à-vis the private greed of the mining and other industrial interests on development (read land acquisition and deforestation) spree. Which is why there is widespread disaffectation among the inhabitants of these areas and the Maoist militancy is able to thrive for such a long time. So the gap between the greed and the governance has not been easy to bridge. Neither here in India nor there in the Western countries, especially, the United States. Peaceful coexistence of the two may be difficult to achieve anytime soon.    

OOP health expenses of Indians growing alarmingly

Even before the regional advisor of WHO, Dr. Kathleen A Holloway, sounded alarm on the ballooning out-of-pocket (OOP) health expenses of the average Indians and the direct relation of that fact with the progressive/catastrophic pauperization of the Indian population, the planning commission has apparently acknowledged the scenario (TOI, 2 NOV 2011). The commission has admitted that about 39 million Indians are pushed to poverty (below or close to the poverty line is a matter of debate as there is no consensus in this country yet about this ‘imaginary’ line). A LANCET article estimated that as many as 30% of rural population and 20% of their urban counterparts could not access medical care, during the year 2004, due to financial constraints.

Analysing NSS data on morbidity and health-related expenditure from 1980s till about 2005 it has been shown (Selvaraj and Karan, EPW, 3 October, 2009) how the public expenditure has progressively dwindled significantly over the years. It was estimated by the authors that more than 80% of Indians end up with private cancer treatment facilities and of them more than 90% meet the expenditure for such treatment OUT OF THEIR OWN POCKET. The TOI article mentioned above cites a statistics that about 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets. These figures are roughly consistent with the WHO estimate of about 70% Indians having to meet their health expenditure from their own funds (by beg-borrow-sale route, stealing and other similar means may not entirely remain in the realm of movies in future). The trend in progressive reduction in government spending on purchasing drugs and other support to the public health care system is borne by cold statistics (TOI article as above).

By a detailed survey (conducted during 2006-2007) of the economic cost burden on ‘poor’ people (average monthly per capita household income of Rs 1835/-) suffering from a critical illness like cancer and having accessed significantly ‘cheaper’ treatment in a government funded medical facility adjunct to AIIMS, New Delhi, Mohanti and others (EPW, 22 October, 2011) have found that the overall OOP expenditure for a typical 5-7 week radiation therapy was between 330-450 % of their monthly family income. This was apart from the expenses on diagnosis and other complementary treatments like surgery or chemotherapy. It is important to note that about 60% of these expenses were on transport and food (possibly including those required by the supporting family members and relatives). But still 40% of the expenses which are purely medical are not borne by the government but by patients and the families. With the ideological lurching   towards reducing the government support to all kinds of public services these expenses can only grow with potential penury and destitution looming large.

Drug prices escalation potential in India, senior citizens beware

Drug prices are of significant interest to the senior citizens everywhere including India. Being on the margin of the society especially in urban India, the old denizens cling desperately to the medicines prescribed by their doctors for continuing their tenuous toehold on life and thereby fighting off their shrinking sense of autonomy. That the expanding medical bill would be a fait accompli in their twlight years was clear to many since India became signatory to the TRIPS agreement and accepted product patent regime in the mid 1990s. Under this regime, Indian companies are no longer legally permitted to manufacture a drug whose main active component molecule or a combination thereof are being sold as a patented drug under a brand name. Not only the same molecule but even minor structural or compositional variants that may have remotely similar medicinal properties – the so called generic drugs – can not be made by indigenously developed manufacturing technology with a significant price advantage. The ‘reverse engineering’ credo employed by the protected Indian pharmaceutical companies pre-1990s which had allowed these Indian companies to produce a large number of generic drugs at affordable prices and make them available in the country as well as export profitably in the foreign markets (particularly in the third world countries), had to be discarded. Simultaneously, the price control exercised by the government was also relaxed to promote competition. From the 347 drugs in the list of essential medicines as in 1995, it had come down to about 37 as of now. As a result of these policy changes the prices of most medicines (for diseases spanning routine infections, ones related to lifestyle changes, as well as those for critical illnesses like cancer and HIV) in the retail market, where you and I buy medicines, have shot up appreciably.

As they say all ‘good’ (for the foreign multinational companies) things come to an end, the patents have a seventeen-year life of monopoly protection. Many innocent thinkers (think tanks in the government, academia and industry) during the early years of this century dreamt of resurgence of manufacture of the generic versions of many drugs coming out of the shadow of patents by the indigenous companies vis-à-vis many common and critical diseases that would help reining in the escalation of costs of health services borne both by the government and the individuals/insurance companies. Indians wishfully propose, MNCs dispose with firmness and remarkable deliberateness. There was this famous case of Novartis a few years back, wherein the company tried (though unsuccessfully) to extend the patent protection for one of its branded drugs beyond the initial period by trying to secure a fresh patent on a replacement drug molecule obtained by a mere tinkering of the originally patented molecule. What is more recently being discerned as a notable trend is the spate of successful bids for take over of major pharmaceutical manufacturing companies by MNCs (The Hindu, 3 September 2011, knowledge@wharton Today, 24 August, 2011). This happened under the government’s liberalization policy over the years of allowing 100% FDI in the pharma sector. As it has been argued in the articles cited above, the indigenous manufacturing infrastructure having come under the MNC leash the priorities may be reconfigured to producing blockbuster patented drugs for the rich developed countries rather than manufacturing cheaper generic drugs for the multitudes in India and the poor third world countries.

It is in this context that the public discussion (TOI, 30 October 2011) of a new ‘possible’ policy of the concerned government to introduce price control on a large number of essential medicine, bringing out a new national list of essential medicines (NLEM) and revising the Drug Prices Control Order (DPCO), 1995 make interesting reading. DPCO, 1995 having pruned the original list from 347 items to 74 (further watered down to the current number 37). It is being proposed to revise list in the light of developments and availability of new drugs and increase this number to 348. There is apparently a proposal to redirect the FDI investments to ‘greenfield’ (new product manufacture in new facilities) from the tendency make the so-called ‘brownfield’ investments (i.e. acquiring existing companies).

This is only a draft proposal and first the cabinet and then the empowered group of ministers (EgoM) have to debate and approve it (in the teeth of resistance from the pharmaceutical industry bodies). It is well to remember that such government initiatives to lay down new policy had not been successful twice (challenged in court in 2002 and again stuck in the EgoM in 2006) without success.

Postcript to the left front debacle in West Bengal

 

Two residual questions :

(a)    LF still polled 41% of the popular votes in an election that everybody agreed has been conducted in a fair and acceptable manner. The overall vote percentage all over the state has significantly increased. As usually reticent and even cynical voters might have exercised their votes this time, young newly eligible voters, without either the ideological baggage or a political opportunism, hatred and vendetta, carried their weightage too in a critical balance flipping game, did the LF at all derive any benefit out of this surge ? If not, this 41%, not a small number by itself, represents a solid unwavering support base for the left parties. What do they expect from the parties they had supported even under these hostile conditions probably at great personal risks (validated by the daily events of bloody vendetta by the ruling party supporters) ? The left parties should humbly reach out to this natural resource if they have to survive politically or otherwise.

(b)   To say that the vote against LF played a bigger role than the vote for TMC/Congress combine is no-brainer. However, there must have been some key expectations of both the traditional anti-left constituencies in the state and the sizable ‘adjustable’ segment of voters (who played the arbiter of the election results) from a new government formed by an alliance of parties and colourful individuals who were so far known for their demagoguery, hate speech and pandering to perceived persecution and injustice rather than articulating a coherent policy for the economic renewal of all sectors of the state. What are the changes these sections expect the government to initiate ? Accelerating liberalisation and industrial development (and not touching the interests of the peasantry ) ? Rejig the land relations in favour of the dominant farmers with political clout at the cost of share croppers and labourers, especially those painted with a colour remotely resembling red ? Replacing your favourite cultural and educational elites with a set of mine ?

Such questions must await detailed unbiased analysis of the facts and trends to be unfolded in future.

Withering left front in West Bengal : maladies closing in

Endgame

In the mean time the Berlin wall had fallen. The sense of loss could not have been felt more keenly anywhere in the world. A decrepit regime had fallen after a lot of bravado and pretenses and belying expectations of generations. Was there an object lesson here, asked the more perceptive intelligentsia some still empathising with the left front (LF) government ? But the voice of reason emphasising the need for introspection and course correction did not find favour with the left establishment which more and more was being overrun by opportunists and gradually by people with corrupt and even criminal backgrounds, at various levels of the parties, having a stake in perpetuating themselves at the helm for any but altruistic reasons. The moral ascendancy of the left was seriously undermined in the eyes of a whole lot of left sympathisers. The natural immunity against political incumbency was all but lost.  

Finally, the centrally sponsored liberalization and the eventual globalisation agenda having won the day since 1991 West Bengal found itself in a perilous competition with the center and most states in the country for which the state was ill prepared. Being presented with an alternative path for economic growth and well being embraced by the country, with spectacular results at least in some states, regions and cities detailed daily in the print and the television media, the sense of being left out in this new growth scenario was unavoidable for most Bengalis, more so for the articulate middle class intelligentsia. Desertion of the ship began in right earnest. Looking for better opportunities (education, job, material gain) anywhere in the country or even abroad became the norm. With growing interaction with other places, people who ventured out brought new perspectives and these in turn provided further centrifugal pull against the inertia of the ungroomed. Most sections of Bengalis felt an urgency about acquiring material prosperity and a quality of life they felt they were entitled to, being enjoyed  by people elsewhere in the country and which they were long deprived of. How best they could compensate themselves and their children for the lost years was what occupied them more than the morality of the liberalisation and the naked exploitation that this would eventually entail and the lurking imperialist design behind the globalisation programme. No wonder Karat and co’s strident anti-American rant did not cut any ice with the voters during 2009 loksabha elections. This was a classic demonstration of the disconnect of the party from the people, though as a trend this was discernible earlier.        

It was only a matter of time that the left front had to fall like the Berlin wall twenty years ago.