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If there is no struggle, there is no progress.
Those who profess to favor freedom, and deprecate agitation, are men who want crops without plowing up the ground, they want rain without thunder and lightning.
- Frederick Douglass, 19th century abolitionist

There is nothing so powerful in all the world as an idea whose time has come
- Victor Hugo

“An optimist isn’t necessarily a blithe, slightly sappy whistler in the dark of our time. To be hopeful in bad times is not just foolishly romantic. It is based on the fact that human history is a history not only of cruelty but also of compassion, sacrifice, courage, kindness.
What we choose to emphasize in this complex history will determine our lives. If we see only the worst, it destroys our capacity to do something. If we remember those times and places—and there are so many—where people have behaved magnificently, this gives us the energy to act, and at least the possibility of sending this spinning top of a world in a different direction.”
- Howard Zinn

Only those who attempt the absurd will achieve the impossible.
- M. C. Escher

The best time to plant a tree is 20 years ago; the next best time is now.
- African proverb

There was young man walking down a deserted beach just before dawn. In the distance he saw a frail old man; he saw him picking up stranded starfish and throwing them back into the sea.
the young man gazed in wonder as the old man again and again threw the small starfish from the sand into the water.
He asked, “Old man, why do you spend so much energy doing what seems to be a waste of time?”
The old man explained that the stranded starfish would die if left in the morning sun.
“but there must be thousands of beaches and millions of starfish!” exclaimed the young man. “How can you make any difference!”
the old man looked down at the small starfish in his hand and as he threw it into the safety of the sea, he said, “I made a difference to this one.”
- Ivy Furman

Go to the people
Live among them
Learn from them
Love them
Start with what they have
Build on what they have
but of the best leaders
When their task is accomplished
Their work is done
The people all remark
We have done it
- Annon

There is a tide in the affairs of men,
which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
is bound in shallows and in miseries.
On such a full sea are we now afloat;
And we must take the current when it serves
or lose our ventures.
-William Shakespeare Julius Caesar Act IV scene 3

“Our discussions must be full, they must be thorough, and they must be courteous. The votes which we take must be free. It is essential, above all, that decisions, once taken, should be accepted loyally, and we must all of us do our best to implement them to the full.”
-Mr. P. H. Spaak,, President of the First Session of the UN General Assembly, January, 1946

“O would some power the giftie gie us to see ourselves as others see us.”
- Robert Burns, Poem “To a Louse” - verse 8

Try to see it my way,
Do I have to keep on talking till I can’t go on…

We can work it out

Think of what you’re saying
you can get it wrong and still you think that
it’s all right

Think of what I’m saying. We can work it out
and get it straight or say good night

We can work it out…

Try to see it my way,
Only time will tell if I am right or I am wrong
While you see it your way
there’s a chance that we might fall apart
before too long

We can work it out
We can work it out…

-John Lennon and Paul McCartney We can work it out 1965

Vital Lies Simple Truths. The psychology of self-deception

We live at a particularly perilous moment, one in which self-deception is a subject of increasing urgency. The planet itself faces a threat unknown in other times: its utter destruction. ...

... we live our lives oblivious to the consequences for the planet, for our own descendants, of just how we live. We do not know the connections between the decisions we make daily - for instance to buy this item rather than that - and the toll those decisions have on the planet. ...

And for most of us, being oblivious to that relationship allows us to slip into the grand self-deception, that the small and large decisions in our material lives are of no great consequence. ...

Self-deception operates both at the level of the individual mind, and in the collective awareness of the group. To belong to a group of any sort, the tacit price of membership is to agree not to notice one’s felling of uneasiness and misgivings, and certainly not to question anything that challenges the group’s way of doing things.

The price for the group in this arrangement is that dissent, even healthy dissent, is stifled.

[There is a] lesson for those who want to break through the cocoons of silence that keep vital truths for the collective awareness. It is the courage to seek the truth and to speak it that can save us form the narcotic of self-deception. And each of us has access to some bit of truth that needs to be spoken.

It is a paradox of our time that those with power are too comfortable to notice the pain of those who suffer, and those who suffer have no power.

To break out to this trap requires as Elie Wiesel has put it, the courage to speak truth to power.

An ancient malady and its cure

The dynamic of information flow within and among us points to a particularly human malady: to avoid anxiety, we close off crucial portions of awareness, creating blind spots. That diagnosis applies both to self-deception and shared illusions. The malady is by no means new: Buddhaghosa, a monk who wrote a fifth-century Indian text on psychology, describes precisely the same twist of mind as moha, “delusion.” ...

What is fascinating about Buddhaghosa’s assessment of the human predicament is not only its compatibility with the modern view, but its prescription for an antidote. The cure for delusion, says Buddhaghosa is panna, or insight - seeing things just as they are. ...

What the therapist does for the patient, a lone voice can do for the group - if he is willing to break the hold of the group’s blind spots. In his suggestions for countering group think, Irving Janis suggests that a group designate one member as a deviant - that is, as a critical evaluator of what goes on, raising objections and doubts. The devil’s advocate can save the group from itself, making sure if faces uncomfortable facts and considers unpopular views, any of which could be crucial for a sound decision.

This willingness to rock the boat is the essential quality of all those who would remedy delusion. It is the stance of the investigative reporter, the ombudsman, the grand jury, and the therapist alike. To accomplish the task, they each must bring into the open those facts that have been hidden in the service of keeping things comfortable. ...

The impulse to obscure dark facts, we have seen, comes from the need to preserve the integrity of the self, whether individual or shared. A group may implicitly demand of its members that they sacrifice the truth to preserve an illusion. Thus the stranger stands as a potential threat to the members of a group, even though he may threaten them only with the truth. For if that truth is of the sort that undermines shared illusions, that to speak it is to betray the group.

Still the truth-teller may fill the quintessential modern need. We live in an age when information has taken on an import unparalleled in history; sound information have become the most prized of commodities. In the realm of information, truth is the best of goods.

Daniel Goleman. Vital Lies Simple Truths. The psychology of self-deception. 1985 Bloomsbury London 1997

Tale as old as time, true as it can be
Barely even friends, then somebody bends, unexpectedly
Just a little change
Small to say the least
Both a little scared, neither one prepared
Beauty and the Beast

Tale as old as time
Tune as old as song
Bittersweet and strange, finding you can change,
learning you were wrong

-Howard Ashman and Alan Menken. Beauty and the Beast. Walt Disney Co. 1991

“When customers feel dissatisfied with products and services, they have two options: they can say something or they can walk away. If they walk away, they give organizations virtually no opportunity to fix their dissatisfaction. Complaining customers are still talking with us, giving us an opportunity to return them to a state of satisfaction so they will be more likely to buy from us again. So as much as we might not like to receive negative feedback, customers who complain are giving us a gift.

If we shift our perspective in this way to see complaints as gifts, we can more readily use the information the complaints generate to grow our own businesses. Customer complaints are one of the most available and yet underutilized sources of consumer and market information; as such, they can become the foundation for a company’s quality and service recovery programs. This is no small gift!

In order to better understand complaining customers, Part 1 of this book examines the behavior and desires of dissatisfied customers. With understanding comes acceptance. We must welcome these complaining customers and make them want to come to us with their feedback.”

Barlow J, Møller C. A complaint is a gift. Using customer feedback as a strategic tool. Berrett-Koehler Publishers. San Francisco 1996

“People will contribute hard work and money cheerfully if they are convinced that their contributions will truly benefit the public.”

-Aung San Suu Kyi, Letters from Burma. Penguin London 1997; 17

A number of different paradigms were presented at the First International Conference on Improving the Use of Medicines in Chiang Mai April 1997. Dr Alfredo Bengzon, former Minister of Health for the Philippines presented the political paradigm. He defined politics as:

“the process through which individuals and groups – whether these be organisations, sectors nations, even the global community as a whole – clarify and articulate their priorities and values and how, subsequent to such clarification and articulation they organise and mobilise to achieve these.”

If defined in this way, everything is political; everyone is a politician. …

If the political process, at its first level seeks to order a group’s priorities, we might then deduce that a political problem is one that is characterised by numerous stakeholders with multiple, usually conflicting interests that demand such ordering.

He went on to say that:

An analysis of one critical concern – that of irrational drug use – would be illustrative in this regard, as the roots of this problem are embedded in the complex interrelationships that exist between patient, physician, drug manufacturer and government. These are, inturn reflective of the dynamics of power in its various forms.

To wit:

The patients use of drugs, particularly prescription products, is very much dependent on his physician’s prescribing habits. From the physician’s perspective, the prescription of medication based on diagnosis represents a concrete manifestation of the practice of his profession. His ability to do so freely, responsibly and knowledgeably is thus a source of professional pride and fulfilment.

Yet in this significant element of his practice, the physician often finds himself dependent on the drug manufacturers themselves. These firms employ aggressive and institutionalised methods of advertising and promotion in order to generate sales. In an unregulated and highly competitive environment, the temptation is great to project biased and incomplete information, where benefits are emphasised, while costs and risks are downplayed. In the absence of objective product information, the physician is rendered vulnerable to persuasive promotion practices designed to extol the merits of various drugs and induce their purchase. He may prescribe drugs even as he is unaware of their active ingredients or their true therapeutic value. Thus, it is often the pharmaceutical company that exercises decisive influence over the physician’s and ultimately the patient’s choice. In these situations, the economic interests of the manufacturer prevail over both the technical expertise of the physician and the general welfare of the patient.

Government intermediation is generally directed at redressing these systemic imbalances. However, government policies and regulation in this area are oftentimes perceived as unnecessary encumbrances on the professional freedom of the physician, as well as unreasonable impediments to the ability of pharmaceutical firms to generate profits. Thus arise some crucial questions regarding the extent to which government should intervene in the exercise of professional choice and in the operation of free private market forces. The challenge to reconcile public good with private gain comes to the fore. …

Dr Bengzon then discussed the political difficulties of reforming drug production before concluding that:

it becomes clear that the problems associated with drug consumption and production can be reduced to tensions arising from conflicting interests where, for the most part, the more powerful stakeholders win out.

Dr Bengzon then provided 3 signposts to guide future directions:

Signpost 1; Our objective

Considering the wide variety of stakeholders involved and the wide variety of their interests, it seems inevitable that there will be winners and losers. Yet that is exactly what we must avoid, because, like the systems of the human body, the systems of the body politic remain deeply connected, even as there interests appear to be at cross-purposes. What we must instead strive for is therefore a win-win situation, one where all positions are advanced, not necessarily equally so, but certainly equitably so. Through open, honest, thoughtful and productive development dialogue, we must direct our efforts at reconciling private gain with public good, professional pride with patient welfare, science with value. Only this objective will sustain the interest of the whole.

Signpost 2: Our constituency

There will of course be occasions when conflicts will have to be resolved in favour of particular interests. Thus the question regarding the identity of our primary constituency arises. I suggest that the primary constituent must be the least empowered of the sectors involved - the ordinary citizen, particularly the poor. This is not only morally correct - but also entirely pragmatic. The ordinary citizen is, after all, simultaneously the patient who provides the physician with his clientele, the shareholder who owns the pharmaceutical corporation, the consumer who buys its products, the voter who installs or brings down governments. It is thus to the interest of us all to serve him, and do so well.

Signpost 3 Our methods

… if we are to make progress, our collective efforts must be orchestrated, enabled and nurtured. Some would propose that responsibility for this lies with government, as the one institution in society with the mandate and the power to pursue the entire range of interests of a national constituency. Others would suggest that elements of the private sector, if sufficiently enlightened and empowered, would be uniquely positioned to influence and even lead the reform process.

Regardless of the platform however, at the end of the day, the operationalization of reform must be undertaken by and through persons. For it is persons who create the vision, build the institutions, formulate and implement policies, and relate within and across nations. To achieve the end of serving our primary constituency, we must therefore meet the challenge of creating a critical mass of kindred spirits with common beliefs and aspirations who will energise, galvanise and mobilise towards reform. These persons will, of necessity, have to be endowed with the requisite competence, courage and savvy. But more importantly, they would have to share and spread and understanding of reality different from that which has become established and traditional, a radical counterculture that is founded on enlarged vistas and enlightened views, one that opens fresh new possibilities for vision and action. The heart of the challenge, then, is essentially political; it is about talent scouting, recruiting, nurturing, challenging, supporting, and measuring the progress of a cadre of leaders who, enlivened by a new way of thinking, feeling and acting, will direct the definition of the health sector’s priorities, and mobilise the sector’s resources in pursuit of these.

… The ultimate challenge then is for us to wield politics, proactively and decisively, as a force for for unification, rather than succumb to it as an instrument for division. It is with such an end in view that we can begin to imbue our participation in the political process with higher, nobler meaning and substance.

Machiavelli, the great master of politics, has said, “Where there is a great readiness, there can be no great difficulty.” I am heartened by this and other similar for a, in which we come together in a collegial, rather than confrontational, setting to enhance understanding of common problems and to seek common solutions. I believe that it is through venues such as these that numerous conversions, at both the personal and institutional levels, are taking place - pharmaceutical firms displaying an active social conscience; physicians committed to the ascendancy of patient welfare over professional pride; consumer and community-based organisations focused on promoting empowerment rather than encouraging dependence; academics and scientists complementing intellectual integrity with real world savvy.

These I believe are the beginning of a great and growing readiness to drive the political process towards lasting and sustained pharmaceutical, and indeed broader health sector, reform. And with this readiness, along with discipline, endurance and resolve that have always characterised our sector, I can truly see no great difficulty that cannot be overcome.”

Peter Senge is a management theorist who sees the world in terms of systems. He believes that “practitioners [of political leadership who] believe that people are motivated by self-interest and by a search for power and wealth” are making an assumption.

“As with many assumptions, this one can be self-fulling. If people are assumed to be motivated only by self-interest, then the organisation automatically develops a highly political style, with the result that people must continually look out for their self-interest in order to survive.

An alternative assumption is that, over and above self-interest, people want to be part of something larger than themselves. They want to contribute toward building something important. …

When organisations foster shared visions, they draw forth this broader commitment and concern. …

Once, as part of a three-day visioning session for the management team of a Boston area technology firm, the question of honesty came up. The group had casually identified “honesty and forthrightness in all communications” as one of their operating ground rules. The management team had developed a vision they were beginning to get really excited about, when one of the senior salespeople commented off-handedly, ” Of course, we don’t mean that we will be honest to our customers.”

The entire process ground to a halt. The group reconsidered what they meant by “commitment to honesty and forthrightness in all communications”. The president broke the silence by stating, “Yes. For me, this means being completely honest with our customers.”

The salesman responded, “If we do we’ll lose 30 percent of our booking next month. In this business none of our competitors are honest when they tell a customer when a new computer system will arrive. If we tell the truth, our delivery times will be 50 percent longer than what customers believe they will get from competitors.”

“I don’t care,” was the president’s response. “I simply don’t want to be part of an organisation that sanctions lying, to our customers, our vendors, or anyone else. Moreover, I believe that, over time, we’ll establish a reputation for reliability with our customers that will win us more customers than we lose.”

The exchange continued for more than an hour. At the end, the group was together in support of telling the truth. The salesperson knew that if bookings dropped off in the next month or two, the other members of the team would not come screaming for his head. And he and the rest of the rest had begun to develop a vision of building a new reputation for honesty and reliability among their customers. This session took place six years ago. In the intervening period, the firm has prospered in its niche market.

Senge PM. The Fifth discipline: The art and practice of the learning organization. Random House. New York 1990

During his “Inspirational Address” at the International Conference on National Medicinal Drug Policies in Sydney October 1985, Emeritus Professor of Medicine Prawase Wasi, Mahidol University Bangkok said:

“I deeply appreciate the great efforts of many people coming from various disciplines in an attempt to help at least half of humanity, 2.5 billion people, who are deprived of necessary health care and medicine. The people whose children, mothers, fathers, husbands, wives brothers and sisters die unnecessary deaths in great numbers year after year, endlessly, because they are too poor, too deprived and the social system is not efficient enough to help them avoid suffering and death. … Just think about the 865 million people, in flesh and blood, who died in the 45 years after World War II. Compared to the number of deaths during World War I and World War II, 16 million and 51 million respectively, the 865 million deaths tells us that a much greater war is going on. You may want to call it World War III, the war against humanity, because it kills everything, individual human beings, society, environment, conscience spirit and soul.”

Prawase Wasi’s understanding is that:

“The extremely powerful obstacles are structural. Society is stiffly locked by the structure occurring from the interconnection of group interests. This social structural force is beyond presidential power. In this age of globalisation the power of the state is increasingly bypassed. The state no longer has the power it used to have; information and money travel at the speed of light. In the new situation traditional method alone does not work. …

the pharmaceutical system is a social system which is interconnected, multidimensional, very complex and very rapidly moving. …

Any system that is too complex and too unpredictable, beyond the control of its intelligence, cannot be sustained. The world illness is manifested in social crises. …

The symptoms of social crisis include poverty, widened income gaps, social disintegration, crimes and violence. …

The old thinking and the old manner of learning do not generate adequate wisdom to correct the crisis. …

There is a need for new thinking and new wisdom. Albert Einstein once said, “we shall need a radically new manner thinking if mankind is to survive.” …

We have heard [at the conference] expressions like non-confrontational, non-adversarial, win-win situations, openness, partnership, and collegial collaborations. These reflect new thinking. Old thinking tends to divide things into separate parts. Humans and nature are divided. We and they are divided. Things are divided into opposing parts leading to conflict, violence and destruction. In reality, things are not divided into opposing parts, but are interconnected into the same wholeness. Humans and nature are not separate. They and us are not separated. The whole universe is one. Disturbance at any point affects the whole system.

Prawase Wasi recommends:

There should be interactive learning through the action of all the players in the system and between systems because no system exists in isolation. …

This interactive learning is also called community building. The strong community has proved to have great potential in practically solving all kinds of problems, be they social, environmental or poverty. The almost limitless potential of the community comes from the combination of three powerful components:

Interactive learning
Management …
When there is such extreme pain and crisis, it can not go on forever. Something new is about to happen. Like the birth of a baby after critical labour pain, the world is in so much pain and in so much crisis that something new is about to be born.”

Bill Gates. Harvard Commencement. June 7, 2007


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What these howls of outrage and hurt amount to is that the medical profession is distressed to find its high opinion of itself not shared by writers of [prescription] drug advertising. It would be a great step forward if doctors stopped bemoaning this attack on their professional maturity and began recognizing how thoroughly justified it is.
- Pierre R. Garai (advertising executive) 1963