There are good reasons why we need more workers’ and patients’ control over the health system. The pandemic was a prime example. We were able to see how disorganised the system is and how different players just followed their own interests. The national governments are pretty detached from the wider world of hospitals and labs. These same national governments are often in competition with each other, which is fatal if you have to react to global problems such as pandemics or climate change. The big private corporations that produce vaccines or PPE are also scattered, each just following their own goals. There were good people in medical science who had a critical view on the government plans, but they were powerless when it came to practical application and separate from the daily experiences on the wards. Hospitals didn’t coordinate effectively with the community and care homes, which was fatal in hundreds of cases. As part of the working class we, as health workers, were not united and conscious enough to provide society with an alternative pandemic plan. This will be our responsibility in the future.
We need more effective control. But this is easier said than done, because we are boxed into our separate professional groups and departments. Medical knowledge is not just unevenly distributed – it is often monopolised by elitist science and corporate patents. The health sector mirrors the problems of society at large. Some workers are caged into complex and specialist knowledge and run the risk of becoming blind to the wider context of their work, let’s say brain surgeons. The large majority of workers are caged into repetitive jobs where you hardly learn anything new. The potential creativity and productivity of billions of people is completely wasted for society!
We are not brain surgeons; we are modestly skilled hospital workers, but with this series we’ll try to understand the development of two main sectors better. We work in local Bristol hospitals, but at the same time our work is closely intertwined with the global pharmaceutical industry and the device and implant industry. These industries connect the local, supposedly ‘public’ hospitals to the circuits of global development and money streams. For example, nearly one sixth of all annual hospital expenses, from wages to buildings, go straight to the pharmaceutical industry. In the case of one of the local hospitals that’s £150 million a year. Some of the private companies hire operation theatres and NHS staff for elective surgeries on weekends – at the Bristol Eye Hospital porters can make three times as much money on a ‘private’ shift compared to a regular shift. Some of the training for scrub nurses is provided by reps of global instrument manufacturers. Most NHS IT systems are run by global corporations, such as ATOS. The connections are endless.
There is a lot of journalistic material about these multi-billion industries, but journalism itself is a private industry and relies on ‘scandals’. And it is easy to find scandals in these industries, from hip implants that give people psychotic episodes due to cobalt poisoning, to the suffering of thousands of women who were given vaginal mesh implants or fallopian tube coils that had never been properly tested. It is important to hold the big corporations to account, but we also have to understand them from within, by reaching out to lab workers, surgeons, and science workers who have more insights than the journalist who looks for a good story. Yes, global medical corporations follow their own profit interest, but within these companies workers generate actual new knowledge. Most of them will get frustrated by the way that market goals limit the development of better medical technology. In academia as well, competition amongst medical researchers (which individual or which institution publishes more papers, gets more funding, etc.) prevents supportive cooperation and the development of a global human knowledge. We have to work together to break this human potential out of the tight shell of the corporate or academic boundaries. We need a counter-science where critical scientists, doctors, nurses, patients analyse new treatments together. We can see this slowly developing in other sectors, too, for example when tech workers at Google or Amazon start criticising the military or state surveillance use of their products or the impact on the climate. In some cases they link up with lesser skilled workers in the warehouses, which could give their critique a more powerful base.
Our class, the working class, has produced an enormous wealth of medical knowledge and resources within the boundaries of the market and particularly during times of social change the working class movement has also managed to popularise more of that knowledge. In India in the 1970s and 1980s doctors left the elite hospitals in the major cities and travelled amongst the rural villages, helping to build peoples’ hospitals. In Italy in the 1970s a movement and psychiatrists and mental health patients questioned the repressive asylums and developed alternative ways to deal with psychological problems. In the 1970s midwives and mothers started to develop a new knowledge on birthing that was focused on the mother and the baby, not the medical vanity of the doctor. In Germany a movement of critical doctors and health workers organised inquiries amongst chemical and other industrial workers, about hazardous substances and unhealthy working conditions – and they are still going strong. We can stand on the shoulders of previous generations of our class.
In the upcoming issues we will make first baby steps towards an understanding of these two main industries – the pharma industry and the medical devices and implants industry within surgery. Our focus will be on questions such as: How is knowledge and technology developed? What are factors that facilitate and what are factors that hinder this development? What role does the market, competition, tight budgets, corporate goals play in all this? How does the hierarchical division of labour impact on knowledge development? How can alternative forms of equal cooperation emerge? We would like to speak to surgeons, lab technicians, pharmacists about their views and experiences. Feel free to get in touch!
