Community Leadership and ManagementSOCIAL RESPONSIBILITY, PROFITS AND SOCIAL ACCOUNTABILITY.INCIDENTS, DISASTERS AND CATASTROPHES. THE WORLDWIDE STRUGGLE FOR SOCIAL ACCOUNTABILITY.COMMUNITY AIMS AND COMMUNITY LEADERSHIP.by Manfred DavidmannSummaryHere Manfred Davidmann published a comprehensive and relevant study of social responsibility and social accountability. This was the first time that incidents, disasters and catastrophes were put together as individual case studies and reviewed as a whole. It was also the first time it was pointed out that we were facing a sequence of events which were increasing in frequency, in severity and in extent, and that something had to be done about this. The report analyses and clearly describes not just the accelerating pattern of hostile events but also the basic causes and what has to be done to solve the problem, to ensure that the planetary environment remains habitable for human beings. Manfred Davidmann lists what has to be done. His analysis was first published in 1981. Now we see a worldwide struggle for social accountability, for achieving aims such as those stated in this report. Many people worldwide are now struggling to achieve them. The points were made so convincingly in this report that it made people aware that public demonstrations and public protests by concerned groups could be an essential survival mechanism under end-of-twentieth-century conditions. The aims he stated included:
The work covers areas such as chemical and radioactive pollution, industrial and nuclear accidents, side effects of drugs, and much else. The case studies are harrowing and include the pollution around the sea of Japan causing the government to advise restricting the intake of locally caught fish, two incidents affecting together one in twelve Americans, patients admitted to hospital in the UK with drug-induced diseases, the uncontrolled level of fish pollution around the British coast. There are other recommendations, such as putting more diagnostic power in the hands of General Practitioners (Family Doctors), about how to provide doctors with immediate access to up-to-date information about side-effects of individual drugs and about greater than expected incidence of diseases such as cancer or leukaemia in their own locality compared with nationwide. The struggle is still going on and needed even more today as incidents occur more and more frequently, as they increase in size and effect. What is happening and its causes are now clear, and so is what needs to be done about them. Contents
Relevant Current and Associated Works Relevant Subject Index Pages and Site Overview SOCIAL RESPONSIBILITIES OF DIRECTORS AND MANAGERS, AND OF THE LEADERSHIPSocial ResponsibilitiesHere we are dealing with another aspect of the work of directing and managing, namely the relationship which directors and managers have with the community in which they live and work, of which they are a part. Decisions taken by directors and managers affect the community, affect the quality of life and indeed the safety of health and life of the people in a widening area.
Hence when we are talking about the 'social responsibilities of directors and managers' then we are talking about their responsibilities towards society, i.e. towards the community. What we are saying is that the purpose of enterprises is to satisfy the needs of the community and that in the end directors and managers are working for the community and that they are accountable to the community for the way in which this work is done. In other words, directors and managers are responsible to the community for what they do, are accountable to the community for the results of their work and for the way in which such results are achieved. Again, this is one end of a scale. It is the 'participative' end of the scale and describes the relationship between the community and its leadership. To understand the point of balance in the many organisations which are neither at one extreme nor the other, we again need to look at the other extreme end of the scale. In theory the 'profit motive' and 'free competition' are supposed to direct effort into areas and directions most needed by the community. In practice it is only infrequently that we have a free market in which prices for needed goods and services are freely determined by supply and demand. Oil prices are determined by what the producers can persuade the customers to pay and the oil producers consult with each other about what to charge next and in this way bring pressure to bear on their customers. Solicitors not only lay down the scale of fees for conveyancing but in addition exclude competition by preventing others from doing the same work. Prices for goods tend not to be the cost of production plus a reasonable margin but tend to be determined by what one can persuade people to pay for what one can persuade them to buy. And demand can be manipulated by the mass media. In practice directors are required by law to act first and foremost in the interests of the owners so that it is profit which is maximised. At this end of the scale, profit is maximised regardless of the cost to others, i.e. regardless of the cost to the community. Since it is long-term profits which are being maximised, profits are maximised regardless of the cost to the community but only to the extent of the likelihood <2> of repercussions. Thus we now need to consider how to assess the work of directors and managers from the point of view of the extent to which their work either serves or harms the community. Hence we now look at some major problems and disasters which have already taken place as the result of preoccupation with profit regardless of the cost to the community and draw some relevant conclusions. PUTTING PROFIT FIRSTHere we are looking at the high cost of putting profit first. But matters are seldom black or white and there are many shades in between. What we see are the effects of speeding on in the search for profits either negligently unaware of the dangers or else without concern about likely or possible consequences to the community. British Railways:- A Source of Profits or a Service to the Community?Many miles of 'unprofitable' railway lines were forcibly closed down, the only apparent terms of reference being to make the railways pay their way. The countrywide uproar which followed the mass closures of unprofitable rural branch lines led the government of 1967 to reconsider policy. As a result of a working party report, a white paper was presented to Parliament in November 1967 by the Minister of Transport. This 'Railway Policy' accepted that there are many railway services which have little or no prospect of paying their way in a commercial sense yet whose value to the community outweighs their accounting cost. It was recognised that one could not continue to close down branch lines just because they were unprofitable but the government acted to safeguard the interests of the community only as a result of countrywide protests. What matters is the value of the service to the community. The measure of success is not the profit or gain accruing to the owners, no matters whether private or the state, but the gain to the community. The profit any enterprise makes is the gain which accrues to the community and the social cost of any operation has to be taken into account. Child-LabourIn 1973 it was conservatively estimated that in Hong Kong 36,000 children aged from 10 to 14 were working regularly in small factories or at their homes. The hours of work range from 9 to 12 hours. Hong Kong is under British jurisdiction and this kind of child labour is illegal. But while in 1970 there were about 600 prosecutions for child labour offences there were only about 300 prosecutions in 1972 and the number of prosecutions appears to be small compared with the number of children affected. Those who wish to increase their profits see that the cheaper the labour, the greater the profit. Hence legislation which protects the community by preventing excesses. But child labour may be part of the family's struggle to survive as may be the case when the father is unemployed or badly paid, when their own small business is struggling to survive, or when all are engaged in sweated home labour at low rates of pay. The legislation which aims to protect the community has to be enforced but people are exploited through their need and one needs to eliminate the need to struggle for survival and for mere existence. This example illustrates the opposing interests of owners looking for increased profits as compared with the community and its leadership. Since profits can be increased by reducing labour costs, those wishing to increase profits aim to reduce the standard of living of the people as a whole, aim to increase their needs so that they will work for less. Responsible leadership aims to eliminate need so as to eliminate exploitation through need, wants the highest possible standard of living for the people. Increased Sales at the Cost of National SecurityA large British company wanted to show certain drawings of their own equipment and installations to a foreign company and discuss them as part of a sales drive towards selling a larger installation. However, these drawings were covered by the Official Secrets Act and thus could not be taken out of the country. Three people were involved, namely the group engineer 'A', his manager 'B' and the divisional director 'C'. Group engineer 'A' was responsible for the classified work. Manager 'B' asked group engineer 'A' to produce copies of the relevant drawings for taking abroad. The group engineer pointed out that this was illegal but was told that as he had been ordered by his own manager to hand over copies of these drawings he would have to do so, that he had no choice in the matter. This group engineer had a wife and children to support. Being highly specialised and facing the possibility of dismissal with consequent very considerable difficulty of getting another job at the same level, he was faced with a difficult choice. His own interests were not protected. What he did was to send a letter to his manager 'B', with a copy to the divisional director, which quoted the relevant section of the Official Secrets Act and pointed out that he himself would not do anything which might go against its provisions. However, he pointed out to his manager that by virtue of his position as manager he had access to these drawings and would have to make up his own mind about whether or not he, the manager, could take copies and send them out of the country. The outcome was that while very ready to order his subordinate to produce copies for sending out of the country, the manager did not take any illegal action himself and the drawings were not sent. But the group engineer's progress within that company was halted and his career and promotion prospects were thus adversely affected by the stand he had taken. This illustrates another area of conflict between the search for increased profits and the interests of the community. While in this instance no harm was done to the community, harm was only prevented at some considerable cost to the individual concerned, namely the group engineer who stood up for the community. This took place some years ago and subsequent legislation in the United Kingdom regarding discrimination, unfair treatment and dismissal would seem to put the individual in a much stronger position when it comes to making a stand to protect the interests of the community. The Social Cost of PollutionIn 1975 the Common Market's nine partners intended to set conditions under which member governments were to control the discharge of toxic substances into rivers or coastal waters. These substances included mercury and cadmium and other substances which are extremely harmful and can kill even in small doses. At that point the British government decided to block the intended plan as British firms apparently considered that the resulting costs would be massive, preferring each case to be considered on its merits. In other words, it costs money to purify a toxic effluent and the firms were unwilling to spend money on purifying a toxic effluent unless it was absolutely necessary. This compares with the decision of an Indian court in Goa about six months earlier which ordered the #28 million Zuari fertilizer plant to be closed because its effluent was polluting the local Kolva beach. In 1978 a report was published in the UK {5} that in about 33 out of 245 tests of food from 100 shops the food contained enough metals and pesticides to exceed the "tolerable levels" put forward by the World Health Organisation.
At about the same time concern was being expressed about the possible effects of lead pollution arising from lead based additives to petrol and in particular about the possible effect of this atmospheric lead pollution from exhaust fumes on the mental as well as physical development of young children. Professor Bryce-Smith <3> has pointed out for some years that the amount of lead in the atmosphere continues to rise and that lead poisoning from car fumes affects the mental development of a young child, can lower his I.Q. and in extreme cases can seriously damage the brain and cause deafness and blindness.
At the beginning of 1979 it became known that the village of Shipham in Somerset had been built on the site of old lead and zinc mines and that the local soil contained high levels of cadmium. The concentrations of cadmium in the soil varied between about 10 and roughly 1,000 times the national average. Over 1,000 people live in the village and they were warned by their District Council {7} to cut down on smoking and to stop eating home-grown vegetables in the meantime until the results of a further detailed survey became available. It seems that those living in the village were aware that certain vegetables such as runner beans and sprouts could not be grown well in the area and that there was a kind of stomach upset which affected some local people at times. It seems that cadmium builds up in the body, especially in the kidneys and that it can cause respiratory troubles, dependent on the way in which the cadmium enters the body, on its concentration and on the length of the exposure. After nine months the official survey confirmed high levels of both cadmium and lead in soil and crops. It had been established that the village was expanding into severely contaminated areas, that more recently built homes had been constructed in areas which were particularly heavily contaminated. Cadmium levels in winter crops were about twenty times, in spring and summer vegetables about thirty-five times, the national average. Some samples of certain vegetable crops were found to contain a level of lead which exceeded the legal maximum. It will take another few months for the survey to be completed. So far medical tests have been carried out on over half the villagers and at present it seems that there are no widespread health problems. It is of interest to note that at least some of the villagers seemed more concerned about the effect of the adverse publicity on the value of their properties than about their own health and that of the others living in the village. Purifying effluent increases costs and so reduces profits. Hence discharging unpurified effluent is more profitable to the producer but the community has to suffer the consequences. Just how is the balance drawn, to what extent are social costs included in the economic analysis of alternative proposals or schemes? It may be lack of knowledge or failure to anticipate side-effects or far-reaching and disastrous consequences. But then managers continually assess the reliability of their information and the likely consequences arising from alternative courses of action. Managers tend to err on the side of safety and promotion generally depends on this. In other words, 'responsible' managers err on the side of safety from the point of view of those to whom they are accountable. That is they act to protect and further the interests of the owners who pay their salaries instead of first and foremost protecting and furthering the interests of the community. If the government only acts to protect the community as a result of pressure from the community, then there have to be ways and means for creating such pressure, there have to be ways and means for all to have access to the mass media and to the people. The facts have to become known. But how can one ensure that those in important positions become aware that they are accountable to the community and how can one make them accountable to the community? One method may be through publicising the names of those who made the relevant decisions, who condoned the decision and resulting actions, who carried them out, who failed to stop them from being carried out. Cleaning up pollution costs money, but failing to do so has costly consequences. Design, Application and OperationPerhaps the most menacing aspect of pollution by radio-active materials is that their radiation intensity decays only very slowly so that they remain dangerous over many years, over many generations. The pollution accumulates and there is the problem of what to do with polluted materials. However, what we are looking at here are merely a few examples of how dangerous situations arise from the application and operation of modern equipment and installations, and how they are caused by the initial design and by the people concerned in design, maintenance and operation. These are of course no more than isolated cases. For example what was probably the first large-scale nuclear accident in the United Kingdom occurred many years ago when the filter in one of the chimneys of one of the Windscale plants failed. While it was not a severe incident the milk produced in part of the fall-out area was reported to have been discarded as unfit for human consumption. It was also reported in 1978 that three or four years earlier the earth from about three acres of ground round India's plutonium plant near Bombay had been dug up and dumped in the sea following contamination by radio-active material leaking from a broken pipe. The point about such incidents is that the polluting material is permanent and that it is accumulating, that accidents can affect many people and that there is no way of reversing severe radiation damage to people, that not only are future generations affected by the increased level of pollution but that one of the effects of radiation on human beings is that it can interfere with the reproductive process, affecting and perhaps harming future generations. Take the comparatively simple and apparently straightforward case about the rear wheels on British Leyland's Allegro car {8}. British Leyland, the British Leyland distributor, and the servicing garage were all sued following injuries received when a rear wheel dropped off a new Allegro car. British Leyland maintained that the rear hub design was sound and that the fault was caused by inefficient service mechanics. The High Court judge is reported to have said that British Leyland should have recalled Allegro models from which the wheels later dropped off, instead of concealing the fault until there had been more than 100 accidents. He is quoted as having said "They were faced with mounting and horrifying evidence of wheels coming adrift. Any of the cases could have had fatal results." He apparently said that the company owed it to the public to recall all cars for safety washers to be fitted and is quoted as saying "They knew the full facts. They saw to it that no-one else did." Another example involving design, application and operation occurred in 1979 and was of the kind of scale which can now arise. The likelihood of major disasters of this kind occurring is increasing daily as the number of innovations and installations capable of such far-reaching dangerous effects increases. At the end of March 1979 the Harrisburg pressurised water reactor had a nuclear accident which could have been catastrophic. It seems that the reactor was being restarted when ruptures occurred in the plant's cooling system and radio-active water turned into radio-active steam. It seems that a vent was opened to release the steam as a way of preventing an explosion. This increased background radiation south of the plant to an extent which was apparently safe and which seemed to decrease rapidly. But Federal and State officials were considering {9} evacuating about 1 million people and "children under school age and pregnant women living within five miles of the crippled Pennsylvania power station at Three Mile Island were advised to evacuate the area." People have always feared the grim prospect of an explosion within a nuclear reactor with consequent dispersal of radio-active fall- out and resulting injury to many people and to their future generations. Here it was narrowly avoided. But East Germany's Russian-designed nuclear power reactors appear to lack {10} the massive steel and concrete pressure domes of the kind which saved the population of Harrisburg, and their cooling system seems much less reliable. There is a good deal of concern about this in West Germany, Sweden and Denmark as radio-active fall-out from the explosion of an East German power reactor could affect their populations. The Harrisburg incident is being investigated and no doubt we shall know more in due course about what happened, why it happened and what caused it. However, one is left with the impression that what occurred was a combination of events, each of which when taken separately can occur but is considered unlikely to occur, while the possibility of all of them occurring together is considered improbable. This argument may well hold for a single large installation having great destructive potential. But daily the number of installations having great destructive potential is increasing and this makes it increasingly likely that the improbable combination of events will occur and trigger off a disaster. It may be unlikely in one installation but is a thousand times more likely to take place when there are a thousand such installations. One is left with the impression that at Harrisburg the combination of circumstances which gave rise to the incident included both design matters as well as inadequately trained plant operating staff, i.e. included mechanical failure as well as human error. The plant was probably closer to disaster than people realised at the time or were prepared to tell. The extent to which the community's interests are at stake can be seen. About 1 million people were at risk and these were only those living fairly close to the nuclear power station. The point made here is that it is not just a pollution problem but that the possibility of an accident occurring as well as the possible size of accidents are both nowadays much increased. This is so because the large numbers involved make even a very small chance (of an accident or side-effect occurring) result in much increased likelihood of major disaster and in a considerable number of incidents, because of the increasing severity and permanence of the effects on people, and because some drastic effects now reach and affect future generations permanently. These are major disasters to the community, the interests of the whole community are at stake to an increasing extent. Instead of being responsible largely only to the owners for the extent to which they contribute to profits, there is consequently the daily increasing need for those who work to be responsible to, i.e. accountable to, the community for the way in which they do their work and for the consequences. Protecting the Good of the CommunityAfter the Second World War there was much testing of nuclear weapons, of atomic and then of hydrogen bombs, by the United States, by Britain and by Russia. The debris and condensed vapourised material was carried to high levels of the atmosphere, accumulating there and slowly 'falling-out' back to earth. This highly radio-active material increased the background radiation and the incidence of blood cancer, namely leukaemia, increased in the same way. Tests continued, the background radiation continued to increase and so did the number of people and particularly of children and young people who each year died of leukaemia. It appeared to us that it was only the increasingly popular protests and demonstrations by the nuclear disarmament campaign which brought home to our governments the need for stopping the testing, i.e. exploding above ground, of nuclear weapons. The background radiation then continued to fall, and so did the incidence of leukaemia, until the level of background radiation had fallen to a more reasonable and more normal background level. Subsequent tests by France and China have been comparatively infrequent and have apparently not increased the background radiation to any alarming extent, the radio-active material having time to disperse and fall out from the atmosphere instead of accumulating. The point is that harmful weapons testing was stopped but was stopped only because of the pressure of informed public opinion. And the second point is that while the number of cases of leukaemia caused by the increasing background radiation may have appeared very small when quoted per thousand of the population exposed to the radiation, the number of people affected is quite large when the population size is 15 million, 100 million or 250 million people. There is a recent parallel in economics. When at the beginning of 1974 the price of oil was roughly quadrupled this constituted a large increase but it took some months before people realised that the real problem was not the 400% increase but the very large sums of money which would have to be earned in some way. One had to realise that when such sums were almost impossible to earn in addition to what was being earned already that it was one's assets and capital which were being handed over in return for oil. Similar considerations apply to the sale and use of drugs as these are available to and can reach the whole population just like background radiation. Here also the seemingly low chance of side- effects, and of harm, results in many cases and much injury because of the large size of the population involved. Three doctors in a group practice in Lancashire in England were concerned about the high incidence of leukaemia among their patients and this led to a detailed investigation by experts from Manchester University. What the investigation is reported to have found so far {11} is a marked rise in leukaemia deaths, the rate having doubled in the past ten years in Lancashire, with Blackpool, Blackburn, Burnley, Lancaster and Preston all showing a marked rise in the incidence of leukaemia deaths compared with hardly any change in the rest of the country.
Here we have a problem which is urgent and affects the lives of many people. So far there are no definite answers but neither have measures been taken to protect the community, neither has the community been warned about what action to take in its own interests. Such advice might have consisted of how to avoid buying contaminated fish together with some way of checking that fish landed was fit for human consumption according to specific limits of radio-active pollution. And how come that the doubling of the incidence of leukaemia was not noticed and investigated as a matter of routine from statistics about causes of death? A straightforward system of quality control quickly and automatically points out any exception falling outside stated limits and it would seem that this could have been done in the past and should be done in future, not just nationally but also locality by locality. The second-last example about the rising incidence of leukaemia caused by nuclear weapons testing shows that there is a point at which the interests of the community must and do take precedence over the politics of power and the interests of the owners. But this only happens when people act and co-operate with each other by using the courts, by forming pressure groups to impress the leadership with the strength of the feeling of the people locally or countrywide, by demonstrating if necessary to get the required legislation where it does not exist already, doing so through the use of pressure groups and publicity. The question arises about how one can protest at local and minority level and how such protest can make itself heard when there are so many countrywide problems? And there is the problem of the very central considerations about just what is in the national interest. How, for example, do old- age pensioners protest effectively when their state pensions are eroded by the government of the day? The same applies to those receiving social security benefits. Such considerations point to the need for access to publicity by all groups and shades of opinion and there have to be recognised channels which make this available to everyone. The point of balance between national security (weapons systems), profit (economic success) and standard of living (nuclear energy production, standard of living of the population), pollution and the cost of all these to the community is very different in democratic countries when compared with dictatorships, when compared with authoritarian minds which are profit and power orientated. Drugs which Also MaimThalidomide was first put on the market in about 1957 or 1958 as a non-toxic sleeping drug. It was certainly used in West Germany, Britain and Japan but its sale was apparently blocked in the United States by an official in the American Food and Drugs Administration who was not satisfied that the drug could be used with safety. Sales of Thalidomide stopped in West Germany on 27th November 1961 and in Britain on the following day {12} because independent evidence had shown in Germany and in Australia that the sleeping pill Thalidomide was causing babies to be born deformed. Convincing scientific proof that Thalidomide caused deformities was published in April 1962 and the Japanese companies stopped making Thalidomide between May and September of that year, some voluntarily because of the evidence and others because of internal Japanese requests for an official ban on sales. There then began a continuous struggle to obtain compensation from the manufacturers for the deformed children. By 1975 Britain's 410 Thalidomide children had been awarded #20 million {13} to which the government added #5 million which in effect returned to the children the tax which had to be paid so that they were left with #20 million free of tax. But it was a long and hard struggle, not just in Britain but also elsewhere. In Japan some parents started to protest in 1963, lawsuits began in 1964, a parents' association had by then been formed and by 1968 some small gains had been achieved. The lawsuits were paid for on legal aid, fought by lawyers from the Japanese Civil Rights Association and made only slow progress after which a campaign was launched to enlist public support for the Thalidomide families. People in the different democracies have similar problems and struggle in much the same way against the same sort of social irresponsibility. What we have seen here is that the problems which arise and the mistakes which are made have an enormously increased potential for maiming and destroying, for disaster and catastrophe, not only in just one country but in many countries. In August 1978 the Tokyo District Court in Japan was reported {14} to have ordered the government and three big drug manufacturers to pay something like #9 million in compensation to about 120 plaintiffs. They were claiming compensation for side effects of Quinoform. This is a trade name and the drug was apparently used for the treatment of stomach upsets and diarrhoea and may perhaps still be in use under some other name.
The number of people and the sums involved are very large. The manufacturers and the government were then expected to lodge an appeal against the verdict but the case so far clearly makes the point that the community, i.e. the people, are here also attempting to hold those accountable who should have acted for them, who should have protected them, namely their own Department of Health and Welfare. But if such a case is won then it is compensation which is awarded and this is ultimately paid by all the other members of the community. This amounts to no more than some kind of medical injuries insurance unless there is some way in which those who were careless or negligent, thoughtless or irresponsible can be held accountable for the failure to prohibit the marketing of a harmful drug. In Britain the Department of Health's Committee on Safety of Medicines would seem to be the official body looking after the safety and effectiveness of drugs and since the 1972 Medicines Act new drugs have to be licensed. The Royal Commission on Civil Liability and Personal Injury proposed in 1978 that drug producers should be liable for damage or personal injuries caused by defective products. So far we have looked at the drug manufacturers and saw that countries such as Japan, the United States and Britain found it necessary to institute government checking and licensing to safeguard the community from unsafe drugs. There could hardly be a more telling criticism of the drug manufacturers' profit-orientated motivation than this simple statement. In addition in Japan the government itself is taken to court, i.e. is held accountable, when it fails to safeguard the community. Doctors Prescribe DrugsThere is one additional link in the chain between drug manufacturers and the people and that is the prescribing doctor. The doctor is the expert who in effect is employed by the patient to advise the patient on the best way of curing his complaint. If he is aware of the possibility of side reactions when prescribing a drug, then he is balancing likely gain against possible harm. The patient's chances of his complaint being cured depend on the skill and experience of the doctor. In 1977 a report in the Journal of the American Pharmaceutical Society pointed out that up to 5% of a typical family doctor's patients consult him {15} because of medically-induced illness. Up to 10% of all patients admitted to hospital are suffering from the side effects of drugs, often as a result of "indiscriminate and over-indulgent" prescribing by doctors. Of those admitted 2 to 3% die. <4>
The two authors concluded that their results confirmed growing international evidence of an increase in adverse drug reactions and drug poisonings. They considered that as pharmacists they were "knowledgeably able to intervene to protect patients in cases of prescription error" but that "a few doctors refused to alter prescriptions when evidence of potentially serious drug inter-action was incontrovertable" and comment on these doctors that "they prefer to put the patient at risk rather than accept, as most do, that our intervention is purely professional and in the interest of the patients". Their paper also says that Government figures showed that 93,000 patients were admitted to hospital in 1973 suffering from "adverse effects of medicinal agents". In 1974 the British National Health Service was reorganised and I have already discussed some of the consequences from the point of view of organisation, effectiveness and morale. In 1975 some hospital consultants brought pressure to bear upon their employers so as to obtain extra duty payments by refusing {17} to man emergency and accident units. In 1976 it was {18} junior hospital doctors who, by restricting their working week to 40 hours, seriously disrupted many hospitals and thus broke with the tradition of putting the patient's welfare first. But they collected the overtime pay for the unworked overtime {18}. These examples illustrate the relative importance to some members of the medical profession of the needs of people requiring medical attention when compared with their own financial gain. This kind of attitude was condemned by many when during the winter of 1978/79 the much lower paid manually working employees in the health service, then being among the lowest paid in the country as a whole, went on strike and in this way inconvenienced patients and delayed treatment and the operating programme. When in 1978 the Department of Health proposed {19} that patients should have up to six months to complain instead of eight weeks and that they should have access to the doctor's case notes when the complaint was heard, this idea was considerably disliked by the medical profession. More and more patients are suing doctors for negligence. However, doctors like to settle such cases out of court and have taken out appropriate insurance. Hence the general public is unable to form a considered opinion about which doctor is good and which is bad, about which doctor has been sued, or been taken to court for negligence, or has quietly settled out of court, a number of times. However, doctors themselves are concerned about what is taking place. The General Medical Council, in the view of the Medical Practitioners' Union which then had 5,000 members, cannot protect the public against undesirable or unqualified doctors. {20} Recommendations which they made include that one "must ensure that doctors provide the medical services they contract to give", that "doctors who through infirmity of mind or body are no longer capable of doing so, must be prevented from practising medicine" and that the "segment of the social spectrum from which medical students are drawn today" should be enlarged by recruiting "those concerned less with status or financial reward and more with the challenge of building a first-class health service". Doctors are among the most highly-paid people in the social pecking order and this would seem to indicate that they are part of and serve the establishment rather than the people. Those doctors who aim at financial gain and corresponding luxury and power serve patients who can pay well rather than those who are in need of medical attention. Patients find it difficult to express their grievances about the treatment they receive. For example, no pressure group has been formed by those injured, or by their relatives, pressing for compensation for those injured by the drug Largactil. This drug is known to cause severe and sometimes fatal liver damage but apparently continues to be prescribed and used. It may well be that the reason for this lack of pressure is that the drug is prescribed by psychiatrists and that those who are said to be mentally ill seem to have few friends willing to speak up for them. Or is there some other more sinister reason behind this obvious neglect and gap in community action? It seems that doctors have opposed most strenuously any system of evaluating their performance and there is much dissatisfaction with this in the community, all of whom are patients at one time or another. Far too many people consider that doctors gang up together to protect themselves. One does not as a rule buy a car or a house without assessing the strengths and weaknesses of what one is buying. The same considerations apply even more strongly to the important choice of who we consult about matters which affect our own present and future health and that of our family. Before choosing a doctor one would like to know how good he is. If one does not evaluate performance then how can good and outstanding performance be rewarded appropriately? It does seem that it is time for patients, i.e. for the whole community, to find ways of assessing the performance of doctors. One way may be to set up a confidential subscribers' data bank to which people contribute their evaluations of their own doctor's performance and from which individuals can obtain confidential information about individual doctors in the same way in which commercial firms can obtain information about an individual's credit rating or of past misdemeanours or carelessness. The statistics on infant mortality and on killing diseases such as tuberculosis and cancer seem to show very clearly that they have been dropping steadily over the last 70 years or so and that the large number of modern drugs produced since the 1940's has had very little effect on this. One wonders to what extent we are producing drugs to cure diseases caused by other drugs, one wonders about the extent to which our health depends not so much on what doctors can do for us but on what we can do for ourselves from the point of view of living conditions and the standard and quality of nourishment and of the way in which we live. It is the medical profession who should be serving the community and the community alone and who are paid and rewarded by the community for the work they do for the community. In my opinion much more pressure should be coming from the medical profession for the safeguarding of the community as a whole. Since they should be or are accountable to the community, one wonders whether and to what extent the prescribing doctor contributes to, carries responsibility for, and is accountable for, the increasing incidence of drug-induced disease. Doctors and particularly general practitioners (i.e. family doctors) have problems of data assimilation and processing, of becoming familiar with an increasing number of drugs which tend to change, of keeping up to date his knowledge of possible or likely side-effects. In any case he must wait till side effects are noticed and proved, and till the information is reported. Only then does it become available to him. Doctors should be able to benefit from the experience of other doctors by having a computer terminal in their surgery which would be linked to a central computer storing information about symptoms and illnesses which may be of concern or which would help to diagnose, and also information about drugs and apparent side effects. This makes available to the doctor virtually at the touch of a button the practical and up-to-date know-how and experience of the other doctors working in his field, for example in general practice. Confidential to doctors, doctors would feed into the computer information about diagnosis, prescription, results, apparent or suspected side effects. The patient's records would remain with the doctor and no details which could be used to identify the patient would be given apart from age, sex and the doctor's own reference number and his 'case number'. This would enable him, and him only, to refer to his case notes if asked for information by the central data bank or by some researcher. Those who feed information to the system would also obtain information from it:- country-wide, up-to-date, for the doctor's locality if need be. Time sequences when required can give the incidence of disease and its trend for his or for other areas, year by year, or week by week, or even day by day. Regarding specific drugs he would have immediate and up-to-date information on number of suspected, probable, or reported side effects as reported by other practicing doctors. It would make the doctor's diagnosis more certain, give much more powerful and almost immediate warning of abnormal reactions or side effects. Putting Profits FirstThat loyalty to those who put profit above other considerations is harming the community is beyond doubt. We are after all merely looking at a few examples selected from those which have become public knowledge, that is from the visible tip of the iceberg. Take the case {1} of the William S. Merrell Co. <5>. The American Food and Drug Administration approved the marketing of their drug MER/29 in 1960. But two years later permission to market the drug was immediately withdrawn after an on-site investigation. There had been disturbing side effects such as failure of the reproductive systems of men and women, loss of hair or change in its colour or texture, varying effects on the eyes including cataracts and one of the associate directors of the company had been given the task of dismissing these as being of little concern or else coincidence. The Food and Drug Administration's investigation showed that Merrell employees had been instructed by their senior executives to revise test charts which did not indicate the results which Merrell required. This was referred to as "smoothing out data". "Most of the false information submitted to the FDA had been included in brochures the company sent to doctors and had been vigorously disseminated." The company and its parent company were taken to court. The indictment "in effect, challenged virtually every statement that had ever been made on behalf of the drug." And the companies were fined. Here is another case, this time from Japan. A chemical company called Chisso operating near an attractive bay on the island of Kyushu in South-West Japan dumped effluent {2} into the sea at a town called Minamata. The effluent was the cause of methyl-mercury poisoning:
The company is now paying compensation because some citizens got together to help the patients and took the company to court. At one time 200,000 people in the area were at risk because they were consuming the contaminated fish. The long-term genetic effects are not known but many children with Minamata disease have been born to mothers who have shown no signs of poisoning. It is staggering to think that the company continued to dump deadly effluent into the sea for so many years after the first recognisable effects of their actions. Yesterday's Incidents, Today's Disasters, Tomorrow's CatastrophesIn 1973 the Japanese people received a very rude shock {21}. Fish is one of Japan's main sources of food. There is hardly any alternative for the ordinary person. Hence it came as a tremendous shock when the government was forced to warn the people that it could be dangerous to eat more than specified quantities of the various kinds of seafood. The government pointed out {21} that "pregnant women and young children should not eat fish at all". The reason was that most of the seafood being sold contained a dangerously high proportion of cadmium, mercury, polychloro- biphenyls (PCB) and other industrial waste products. In Japan well over half a million families earn a living which depends on the fishing industry. Prices fell drastically. Their livelihood was threatened and thousands of fishermen started to picket large factories demanding compensation from industry and government. The government hastily withdrew its original set of standards and increased the amounts which they said could safely be consumed. It was also reported {21} that "many large industrial concerns agreed to compensate angry groups of fishermen". What a price to pay for economic growth and increased profit. A nation's staple diet, its basic food after rice, polluted. The fishermen themselves at even greater risk than the rest of the population, their livelihood at stake. Fish can be obtained from fishing grounds elsewhere, but for how long? I remember being told by an experienced manager that the only person who never makes a mistake is the person who never does any work. But, he said, in my outfit we do not make the same mistake a second time. Some people learn from experience and in this way improve and do better. However, this assumes that we get another chance. The next case underlines the danger. In September 1973 a quantity of magnesium oxide was delivered in the state of Michigan to a large famers' co-operative. It was mixed into animal feed in the usual way and distributed to farmers in many parts of the state. About eight months later it was discovered that what had been delivered was not magnesium oxide but {22} polybrominated biphenyl (PBB). By that time thousands of cattle had been poisoned. Many months later it was realised that "this was a disaster which potentially affected all of Michigan's nine million people since by then milk, meat and eggs from contaminated farms had been widely sold in local supermarkets". Like the Japanese fishermen, it is families from contaminated farms who ate their own produce who are most at risk. A large-scale health study was begun in 1978 to determine how far town dwellers and farming families have been affected. However, it is already known that "A large segment of Michigan's rural and child population is 'different'. What we do not know is the extent to which Michigan's nine million men, women and children have been affected and can only guess at the likely consequences. The Same Worldwide StruggleWe are now looking at events which took place only recently and which are being investigated and to that extent the events, symptoms and consequences which I am now describing are based on knowledge available at the time of writing. It would appear that in the area of Seveso near Milan in northern Italy the safety valve on a chemical reactor blew off in 1976, releasing something like 2 lbs of vapourised dioxin into the atmosphere. It seems that "200 millionth of a gram of dioxin will kill a rat. In smaller doses dioxin has produced tumours, stillbirths, foetus deformations and liver cancer in laboratory monkeys. The cancer latency period for humans affected by dioxin could be ten to fifteen years." The latest information {23} is that it would seem that 64% of the workers from the factory and local residents have permanent liver damage. There are indications of a high rate of blood disorders and skin irritations. Cows have had to be slaughtered because dioxin was found in their milk and traces of dioxin have been found in gardens and streets in front of buildings some 50 yards from a more highly contaminated area. At the time of the incident some 24 persons had to be hospitalised and 43 families, about 180 persons, were evacuated. At the time the authorities ordered {23} a strict ban on the consumption of meat, fruit, vegetables and milk produced in the affected area and there was concern about the possibility that the fumes could cause genetic damage. By May 1978 nearly 5,000 persons were suing Italian government officials "for mishandling evacuation and decontamination of zones poisoned by the dioxin cloud that escaped ... in July 1976". They allege that
A struggle is developing in America, a struggle by the people on the spot who are directly affected, against {24} "aerial dousing of crops and forests with tons of herbicides (weedkillers) and pesticides which environmentalists say cause cancer, miscarriages, birth defects and (other) ailments". One result of this protest movement has been that, early in 1979, sales of the herbicide 245T were banned after it was linked to miscarriages among Oregon women. This weedkiller (245T) contains dioxin. We saw what happened when dioxin was released accidentally in Seveso although the full extent of that disaster will not be known for some time. Although weedkiller 245T has been banned in America, another weedkiller (24D) is freely available and used extensively although one official and extensive study concluded that it produced as many birth deformities as 245T. It would appear that in Britain the Forestry Commission {25} uses weedkiller 245T and it is this which can contain dioxin as an impurity. A report by an advisory committee concluded at the beginning of 1979 that the use of the pure weedkiller 245T was not hazardous provided it was used as directed. Already there has been a complaint about one instance where it seems that sheep and lambs died and ewes aborted following spraying with weedkiller 245T on adjoining land. It is claimed that the symptoms of the sheep which died were similar to those of dioxin poisoning. So far I have seen no concern expressed about possible effects on the farmer and on those who also eat of the food he produces, or about those who came into contact with contaminated areas. The Outlook for the FutureWe have together looked at many examples of far-reaching devastating and horrifying consequences of the irresponsible application of science and technology. These happened recently and more are taking place daily. They are the unresolved problems of today and tomorrow. How close are we to the one suicidal mistake which cannot be put right? Can we take such chances, can we afford such risks? Can we afford to start or continue with the production and use of the kind of substances we have discussed? What we need to do is to assess what is likely to happen, to assess what the future holds on the basis of what we have seen so far. In the first place we need to be aware that much else is happening, that there are areas not covered by this report. For example, we have not in any way considered the many industrial injuries and diseases caused by conditions at work when those who work are not protected adequately by existing applied and enforced legislation. Neither have we looked at socially irresponsible advertising and propaganda or at the effects of editorial 'censorship' which ignores and thus pushes aside matters of interest to the community but emphasizes and gives publicity to, and in this way spreads, matters which the advertisers wish to propagate or which would be in the interests of advertisers (i.e. owners) to propagate, so as to keep and attract income from advertisements placed by owners in the media. It is because of this that publicity and thus the spread of knowledge has been obtained only by co-operative action, by demonstrations about matters affecting very many people. Examples are discotheque over-amplification and the resulting cumulative and permanent damage to the hearing of those who visit discotheques, excessive noise around airports and the mental distress which this causes to those living near flight path areas or the effects which result from this. Little publicity has been given to the emotionally disabling effect of promiscuous behaviour and the resulting clinically connected break-up of family life, delinquency and drug abuse. Neither have we discussed to any real extent the quality of food produced by irresponsible factory farming which apparently results in the meat produced containing small amounts of those hormones and anti-biotics which were used by the farmer to speed up growth and to reduce illnesses arising from the unnatural and unhealthy environment in which the animals are produced and reared. But what we have done is to look at a considerable number of incidents and we saw what is causing them. To look at forward trends we need to look at what is occurring in particular areas such as the effect of pollution on the food we eat or the effect of drugs on people, not just from the point of view of what is happening to us but from the point of view of future generations. Consider what we know to be happening to the fish we eat beginning with what methylmercury pollution did to the people of Minamata in Japan who were poisoned by eating polluted fish. It also happened a few years later at Niigata which is another Japanese island but it seems that fewer people were affected as the symptoms were recognised more quickly in this case. By 1973 the fish in the seas around Japan had been polluted to such an extent that the government had to set limits to the amount of fish eaten each week which should not be exceeded by each person so as to reduce the risk of mercury poisoning, so as to limit the intake of mercury to what was then thought to be an acceptable level. To the Japanese fish is a staple diet and one could no doubt argue that one way of dealing with the situation is to fish further away from Japan, to buy fish caught in unpolluted waters. Here the question arises that while it may be possible to do so now, for how much longer will alternative supplies be available? This is a question which is of concern not only to the Japanese but to everyone else as well. Pollution caused by mercury is a problem elsewhere. In Sweden one may not sell fish from lakes where they are known to contain more than 1 ppm of mercury <6>. The Swedes have been told that fish which contains between 0.2 and 1 ppm should not be eaten more than once a week. The United States government has prohibited the sale of fish containing more than 0.5 ppm of mercury. In Britain an average mercury content of fish caught within 25 miles of Britain's coast in England and Wales was 0.21 ppm. This figure of 0.21 ppm is an average one for the whole of the English and Welsh coastline. There are considerable stretches of coastline where the fish contains a very considerably higher proportion of poisonous mercury. Some of the concentrations are:- Irish Sea 0.33 ppm, Mersey estuary 0.60 ppm and Thames estuary 0.51 ppm. There are other equally polluted coastal seas. These mercury concentrations were published by the Ministry of Agriculture, Fisheries and Food in 1971 and 1973. They show clearly that along very considerable stretches of England's coastline fish is being caught within 25 miles of the coast, is being eaten locally and is being sold when according to Swedish regulations its sale should be accompanied by the warning that it should not be eaten more than once a week and when according to American legislation fish as polluted as this must not be sold at all. You know, there is much else which could not be discussed here and which are also matters of concern. For example, methylmercury is also used extensively to protect seeds. Sweden found it necessary to prohibit the use of methylmercury for seed dressing because several species of their birds were nearing extinction. At a time of hunger in Iraq the Americans kindly provided much grain as seed for the next harvest. There were far too many tragic cases of poisoning in Iraq when Iraqis simply used some of this grain to keep themselves and their families alive. These farmers were unable to read the written warning on the bags as these were written in English and they had not been told about the danger of poisoning. They simply did what they had always done, namely took part of their store of grain and used it to feed themselves while keeping enough seed back for the next harvest, and in this way they poisoned themselves. However, the trend we saw is towards rendering fish unfit for human consumption to an increasing extent and we are now trying to obtain a general view of the direction in which events are moving so as to form an opinion about what is likely to happen in future if trends continue to move in the way they have been moving. We have seen that thoughtless and careless behaviour kills. But we are not just poisoning and maiming only ourselves. What we do has long-term effects, is affecting not just babies born today or within a few years after an incident but is affecting unborn future generations. Many fires are started by socially irresponsible behaviour, by carelessness or by accident, but are noticed in time and are put out before too much damage results. What frightens us is that the fire brigade can arrive too late to control the fire, that one socially irresponsible act may drastically and irreversibly condemn future as yet unborn generations, that one incident can start a sequence of events which could make this planet uninhabitable for human beings. These considerations are not new since they only differ from those one takes into account when managing and running a business enterprise by the vastly greater scale and devastating effect of the possible and indeed likely consequences of making a mistake. After all, a sufficiently drastic mistake can bankrupt any enterprise and the enterprise stands or falls by the way in which it safeguards itself, by the way in which it trains and controls its employees not to take excessive risks. Two years after the Seveso incident the Italian government was being sued by nearly 5,000 people who said that it was too early to fully measure the results but that the facts which had become apparent by then were "dreadful":- nearly 350 ill or deformed children had been born, there had been an increase in miscarriages and in liver tumors, and livestock had become sterile. We know, for example, that in Minamata some mothers who had no symptoms of mercury poisoning gave birth to defective children. In America you may remember that 9 million people were at risk and that 10% of the farm children who were being studied were "different". You may remember that their symptoms closely paralleled those of the poisoned animals and that the latest symptoms in cattle included reproductive problems and abnormal births. In Britain we saw that in Berkshire samples of food which were tested contained poisons which exceeded internationally recognised acceptable limits. They contained heavy metals and pesticides and you may remember that there are at present no legal limits in Britain for traces of metals like cadmium and mercury, for pesticide chemicals or for limiting and controlling the sale of foodstuffs containing unacceptable amounts of poison. In Britain it is legally permitted to catch and sell fish containing a higher proportion of mercury than would be permitted in either Sweden or America without some kind of restriction. The poisoning and maiming of unborn children which followed the various incidents was the result of severe poisoning, but as far as we know liver trouble, abnormal blood pressure and severe headaches can also be caused by long-term consumption of low levels of mercury. Such symptoms could go unidentified and by the time even the early symptoms of mercury poisoning appear, they may be permanent and irreversible. We simply do not know as much as we should about the long-term effects of exposure to low levels of mercury and there is some suspicion that cadmium and pesticides do cause genetic mutations and cancer. Of particular concern is that children eat more than adults in proportion to their own body weight. Hence pollution affects them more readily and perhaps more severely, and the risks to them are greater. And "always to be dreaded are the poisons that the placenta could accumulate to affect future generations". The same applies to the drugs which we use. Evidence has been produced which indicates that the number of people dying in a population increases as unemployment increases. We know that poverty, unhealthy living quarters and environment and the consequent lack of wholesome food seem to reduce lifespan and can result in killing diseases such as that which attacked during early 1979 a considerable number of babies born in Naples. We know that the incidence of killing diseases such as tuberculosis and cancer was dropping anyway and that infant mortality was also dropping rapidly, in developed countries such as Britain and America, even before chemical (synthetic) drug therapy started in the early 1940's. Remember that in Britain about 93,000 patients were admitted to hospital in 1973 suffering from "adverse effects of medicinal agents". In America "up to 10% of all patients admitted to hospital were suffering from the side-effects of drugs and that of those admitted 2-3% died". "Up to 5% of a typical family doctor's patients consult him because of medically induced illness". The Michigan and Harrisburg incidents together put at risk and possible affected 18 million people. In other words, well over 8% of the American people, i.e. every twelfth American, were affected by these two incidents, by these two disasters. Not so long ago some smallpox virus was allowed to escape in a British laboratory and killed one of the laboratory assistants, and this after the disease had been eradicated all over the planet. Research workers also make mistakes and it is in grappling with the unknown that the kind of mistake can most rapidly occur which could wipe out humanity as a whole.
One is concerned that at the least one could accidentally make new micro-organisms which are disease producing and which modern medicine could not control. What we have seen is that later incidents involved more people and were more devastating than earlier incidents. If one mistake can have such far-reaching consequences then one has to be more careful and either eliminates the very possibility of a mistake occurring (which may be impossible) or do without. No matter how small the chance, there are some risks which one simply cannot take. In this category comes our future and we have been taking undue risks with the unborn child, with the next generation, with the future of all humanity. CONFRONTATIONIn this report on social responsibilities we have already covered much ground. We saw that in the end directors and managers are working for the community and that they are accountable to the community for the way in which this work is done. They do not wish to account for what they do and we assessed their work from the point of view of the extent to which it either serves or harms the community. We saw that it is profit which is maximised regardless of the cost to the community, saw the effects of speeding-on in the search for profits either negligently unaware of the dangers or else without concern about likely or possible consequences to the community, and looked at some major problems and disasters which have already taken place as a result. In addition we saw that the extent to which the manufacturer makes a profit is not a measure of success since a so-called 'profitable' operation may result in considerable loss to the community. The social cost of any operation has to be taken into account. The gain any enterprise or organisation makes is that which accrues to the community. We also saw that those who wish to maximise profits regardless of the cost to the community are restrained by the fear of likely repercussions and that government reconsiders its policy following countrywide dissent. Authoritarian MindSince profit can be increased by reducing labour costs, those who wish to increase profits aim to lower the standard of living and to increase the needs of the people so that they will work for less. Child labour, for example, is part of the family's struggle to survive and here we saw legislation protecting the community, in this case prohibiting the exploitation of children by sweated labour and low rates of pay. But such legislation has to be enforced and since people are exploited through their need one has to eliminate the need to struggle for survival, for mere existence. When we are talking about a company, enterprise or another organisation then we are talking about the people who direct it and their employees, about their decisions, their actions and about the resulting consequences. The same applies when we talk about 'government'. What stands out is that organisations cannot be relied on to act responsibly, not even when it comes to protecting the interests of the owners. For example, it is unlikely to be to the advantage of the owners to save money today at the cost of incapacitating those who work in the enterprise. We also saw that there is a considerable risk that future generations are being harmed and possibly maimed to an increasing extent for the sake of present profit. In this conflict and confrontation between the authoritarian mind and the community we saw that at least in the western democracies the government will act to protect its community. We also saw that what a government does to protect its community differs widely from government to government, but that they do so as the result of pressure from the people. However, employees are employed by the owners and are thus dependent on them for their livelihood, for the means of existence. Those who speak up for the community are then liable to suffer victimisation which can range from loss of promotion prospects to dismissal and a number of such cases have been reported. Recent legislation in the UK put the individual in a somewhat stronger position than before regarding unfair treatment or dismissal but it would seem that stronger protection and compensation should be made available to those who are prepared to speak up for the community. We need to establish ways which enable them to speak up for the community without risk of their identity being disclosed to the employer or to other antisocial elements. Responsible leadership aims to eliminate need so as to eliminate exploitation through need and wants the highest possible standard of living for the people. It is the owners, it is the authoritarian mind, which gains from cheap labour and from a reducing standard of living; it is the community which wants to eliminate need and wants the highest possible standard of living for its members, i.e. for the people. Public OpinionThree general practitioners in one group practice noticed that more people seemed to be dying from leukaemia and were sufficiently interested to look into the matter further. They found some researchers who confirmed their findings. The number of deaths from leukaemia had doubled over a period of about ten years, in Lancashire but not elsewhere in the UK. How come that the doubling of deaths from leukaemia in Lancashire was not noticed from statistics about causes of death and investigated as a matter of routine? A straightforward monitoring system could have pointed out that an unusual number of people were dying from leukaemia in a particular part of the country, or that more than the usual number of people were catching some other disease or illness, or that a particular disease was unexpectedly occurring in a few isolated areas of the country instead of being uniformly spread among the population, doing so long before the number of people affected or dying had doubled. One wonders just how many of those who are now dead or dying from leukaemia in Lancashire could have been saved if the seafood they were eating had been monitored and if they had been warned against eating more than a safe amount of the polluted food. But so far no measures have been taken to protect the community, neither has the community been warned about what action to take in its own interests. It is pressure of informed public opinion which brings about change. In this case the community was not made aware of the facts nor was it advised about what to do to safeguard its own interests. Hence in this instance no pressure has so far been exerted by the public (i.e. by the community) towards improving the position. The facts or trend has to be appreciated by some expert who then takes steps to investigate, confirm and report and who hopefully can get sufficient publicity to arouse support by creating an informed public opinion. But it takes much suffering before people are persuaded to go out of their way to do something about correcting what is taking place. This sequence is at present a chain of events which is too risky as it can stop or be sidetracked at each step or as it can be slowed down to the point where it may be too late to correct what is taking place. This points to the need for all groups and shades of opinion to have access to publicity and there should be recognised channels which make this available. Community FirstPollution by radio-active fall-out and the possibility of nuclear explosions underline the importance of these considerations because radio-active materials remain radio-active for thousands of years, and because of the cumulative and irreversible effects on people. Whereas in the past a war between countries placed many thousands of people and perhaps some millions at risk, the single Harrisburg nuclear power reactor accident presented an immediate risk to one million people and threatened many more. What occurred was a combination of mechanical failure and human error, a combination of events each of which when taken separately can occur but is considered unlikely to occur, while the possibility of all of them occurring together is considered improbable. This may be so when one considers only one installation but what has to be allowed for is that an improbable event is much more likely to take place when there are many such installations. The increase in the incidence of leukaemia following nuclear weapons testing emphasised that, even when only a few people per thousand of the population are adversely affected, the number of people who are killed by a disease is quite large when the size of the population is of the order of 50 or 250 million people. Hence seemingly infrequent side-effects of drugs or small increases in the incidence of killing diseases can cause much suffering and loss of life when many people or even the whole population are affected. Drugs can cure but also maim and we saw that a similar struggle is taking place in different countries against irresponsible application of chemicals and drugs. Here also we became aware of the vastly increased potential and likelihood for disaster and catastrophe which now exists. Hence the possibility of accidents occurring and the possible size and extent of such incidents is nowadays vastly increased. This is so because of the severity and permanence of the effects on those living now and on future generations and because the large number of installations and of people involved which make even a small chance of accident or side-effect result in a considerable number of incidents or in much increased likelihood of major disaster and catastrophe. In addition, because of the large and increasing number of likely causes, the likelihood of major communal disasters and catastrophe is increasing daily. Those who work are at present responsible largely to the owners for the extent to which they contribute to profits. But what we see is the increasing need for those who work being responsible to the community for the way in which they do their work and for the consequences. Hence people need to co-operate with each other and in the end demonstrate to obtain redress in courts or for getting the required new and needed legislation. For example, harmful weapons testing was stopped but was stopped only because of the pressure of informed public opinion, by the pressure of increasingly popular protests and demonstrations expressing a deeply felt concern about the effects of testing and using nuclear weapons. There has come a point at which the interests of the community must and do take precedence over the politics of power and the interests of the owners, but it does so only when people act and co-operate with each other by forming pressure groups to impress the leadership with the strength of feeling of the people locally or countrywide, by getting publicity, by using the courts and by demonstrating to get the necessary legislation where it does not exist already, and when necessary by demonstrating to have existing legislation enforced so as to hold those accountable who fail to act for and to protect the interests of the community. Worldwide Struggle For Social AccountabilityNot only do people in the different democracies have similar problems and struggle in much the same way against the same sort of social irresponsibility but the problems which arise and mistakes which are made can increasingly affect not just one country but many countries. The risks are far greater under authoritarian governments, i.e. under dictatorships. In addition it is much more difficult and takes more courage for the people to exert pressure to protect the community or to hold those accountable who are in responsible positions. We saw that Japan, the United States and Britain found it necessary to institute government checking and licensing to safeguard the community from unsafe drugs. There could hardly be a more telling criticism of the drug manufacturers' profit-orientated motivation than this simple statement. What stands out is that it is not just the manufacturer who is being taken to court for marketing the drug in the first place, but also government and government agencies for failing to protect the people from such abuse. It is those concerned with making the relevant decisions and those concerned with testing, marketing and application who are being taken to court. Compensation payments may be large but the payment of compensation, particularly from a government, amounts to little more than medical injuries insurance which spreads the cost over many and in this way reduces the risk to those responsible. On the other hand the community wishes to hold those accountable who should have acted for the community, who should have protected the people. Those who were careless or negligent, thoughtless or irresponsible should be held accountable for having failed to protect the community and for the harm done, for example for marketing or for their failure to prohibit the marketing of a harmful drug. The other link in the chain between the manufacturer and the patient is the doctor. There are doctors who put their own remuneration first and the welfare of those in need of medical advice second. There are also doctors who consider that the public is inadequately protected against undesirable or unqualified doctors, that those should be recruited to the profession who would be less concerned "with status of financial reward and more with the challenge of building a first-class health service". Up to 10% of all patients admitted to hospital are suffering from the side-effects of drugs, often as a result of "indiscriminate and over-indulgent" prescribing by doctors. Of those admitted 2 to 3% die and this is a very serious matter. While it seems that patients are increasingly suing doctors for negligence, doctors like to settle such cases out of court. This means that there is no publicity as a result of the doctor's negligence, and thus no sanctions, no restraint and no accountability. There is already much dissatisfaction about this in the community, all of whom are patients at some time or another. The medical profession is one of the two or three best-paid in the community and resentment is also building up about the preoccupation of many doctors with 'private' practice at the expense of a health service which serves the community. This will in due course reduce their income in measure with the way the community feels about them. So there are four links in the chain between the manufacturer of drugs and the patient, namely the manufacturer, the government's checking and licensing authority, the medical practitioner, and the pharmacist. Each one of them could be incompetent or negligent and here also there should be clear and open accountability at every stage. We saw the kind of disastrous consequences which result from the callous irresponsibility of those who disregard the interests of the community, the value or health and life to other people, for the sake of profit. The suicidal nature of social irresponsibility and of letting people get away with antisocial behaviour and acts becomes clear when one considers that Merrell's drug MER/29 was probably also prescribed for Merrell's employees and that Chisso's employees were probably eating the polluted fish just like other people in Minamata. Japan, America and Sweden have to monitor, prohibit and control the sale and consumption of polluted fish. This takes in about 340 million people. The United Kingdom has a population of about 56 million people and it seems that similar restrictions should have been introduced some time ago. Add that we are here looking at only a few countries and it becomes apparent that the problems we are discussing are likely to be even more widespread than appears at first glance. That it is a worldwide struggle can also be seen from protests, demonstrations and court actions about the use and effect of weedkillers containing dioxin in the United States, in Italy and in the United Kingdom. Here also it is future generations which appear to be affected and maimed. Governments differ in the way and in the extent to which they act for and protect their people. This raises the question of whom the government really serves and it also raises the question of how one can make people in responsible positions accountable to the community. A senior manager, for example, may leave one employer after two years and move elsewhere. But the first employer has to live with the consequences of the decisions he, the senior manager, made. It would seem that it is not just the company but those who took part in the decision-making process who are responsible and thus accountable and the same would apply to government. The examples also clearly brought out that 'responsible' managers err on the side of safety from the point of view of profitability, i.e. from the point of view of those to whom they are accountable. Hence they act to protect and further the interests of the owners who pay their salaries and wages, but need to first and foremost protect and further the interests of the community. Government may be pressurised by grass-roots pressure groups such as self-help groups, and far too often only as the result of public demand and protest after injury and suffering, into introducing protecting legislation. It is those who should have enacted such protecting legislation before people were injured, before people were made to suffer, who should be responsible collectively and individually for the consequences of doing what they did and for omitting to do that which they should have done. If the government only acts to protect the community as a result of pressure from the community, then there have to be ways and means for creating such pressure, there have to be ways and means for people to have access to the mass-media and to the population as a whole. The facts have to become known. It may be that those in important positions could be made accountable to the community by publicising the names of those who made the relevant decisions, who condoned the decisions and resulting actions, who carried them out, who failed to stop them from being carried out. At our level of scientific and technological development the actions of those who work only for personal gain, regardless of its cost to the community, cause increasingly severe disasters. The problems facing us now and those which are likely to face us in the future can only be resolved and overcome by a much more highly developed sense of social responsibility accompanied by far greater accountability on the part of those who direct, lead or manage. STRUGGLEThis is what I said in 1973:
I was right and since then the incidents have become more numerous, more frequent, involved more people, are far more devastating, are moving from disaster towards catastrophe. There is increasing but still limited awareness of the nature of the threat. Even when there is awareness then more understanding is required so that we can resolve the cause instead of merely smoothing a few symptoms which simply occur more frequently and are steadily getting worse. Nationalised enterprises are not controlled by the community but by those who head the state. Hence nationalisation is not the answer because state ownership means subservience of the population to the state, means dependence on those who control the nationalised enterprise and thus on those who control the state. Similarly nationalisation of insurance, banking and other financial 'institutions' such as pension funds and unit trusts, while perhaps changing control from 'establishment appointed' towards 'political party appointed', does not change the system, does not cure the cause. What we see is a continuous struggle to wrest power and control over resources and people from the authoritarian mind. The people protest and demonstrate and exert pressure but only when confronted with some obvious evidence of severe and far-reaching damage and even then only when sufficient people pull together so as to make their opinions felt. But by the time this happens the damage is not only severe but widespread. The pressure of public opinion results in protective legislation and subsequently is reflected by the extent to which the legislation is enforced.
The objective here is to take dependence on, and consequent involuntary obedience to, rulers and owners and replace it by voluntary co-operation and participation in policy-setting of enterprises owned by those who work in them. There are different forms of ownership and of community-based capital but essential is that those who work in an enterprise or co-operate in an organisation both own and control it and remain in control of their share of the enterprise or organisation. In the end that part of which they are independent "owners" is part of and belongs to the community as a whole, is being controlled and administered by those who work for their own benefit and for that of the community. The authoritarian mind aims to oppress and is oppressing the mass of the people for the benefit of only the authoritarian mind. We saw that this results in confrontation and that struggle is taking place both at the workplace and in community institutions. This is a struggle to wrest control over the minds and bodies, over the life and happiness of the mass of the people away from the authoritarian mind. We saw that the community's efforts are concentrated into people co-operating with each other and in this way putting pressure on the owners and rulers towards establishing protective legislation, towards the enforcement of protective laws, towards acting for instead of acting against the community. We saw this struggle taking place in different countries, and we saw it succeed to varying degrees in the different countries. In the United Kingdom, the United States, Japan and the Scandinavian countries there has been much protest and struggle, there has been much pressure towards more socially responsible behaviour. There were demonstrations for nuclear disarmament, there are consumers' associations and protests against nuclear power stations, against the irresponsible use of weedkillers and insecticides, against irresponsible marketing of drugs, protests about the national health service by patients and by the medical profession itself, about the siting of airports and property development as well as about environmental pollution and preservation of local countryside and amenities, by bodies such as parents' associations, trade and professional unions and by self- help groups. In the democracies the extent to which the government serves the people, i.e. the community, or the rulers and owners depends on the government of the day. It depends on who controls the institutions, on the extent to which the government serves either one side or the other. In other words it depends on the extent to which the people are able to put pressure on the government so that the government serves the people. ACCOUNTABILITYWe saw that responsibility implies accountability, that if one carries responsibility one is also accountable for what one does, for the way in which one does it, for the results achieved and for the consequences. The question then arises how people in responsible positions can be made accountable to the community. It needs to be appreciated that in the end they work for the community and that they will be rewarded accordingly, that they will be treated in accordance with the work they do, that they will be rewarded or penalised to the extent to which they serve the community. It needs to be appreciated and seen that their remuneration comes from the community and depends on the extent to which the community is served well. Indeed, the general trend since 1973 has been that owners, directors and managers as well as governments are becoming more accountable to society, i.e. to the community, for the quality of life created by their actions. There are criteria other than personal income, such as security from internal and external threats and the standards of housing, health service, education and living of the population. The reward to the leadership should depend on achievements in these areas and on the extent to which the benefits are freely available to all without restriction. It is probable that stronger sanctions would need to be available to prevent selfish or careless behaviour from harming the community. It may be that the possibility of adverse publicity or of making service records available to the public could serve as a form of deterrent for preventing irresponsible and antisocial behaviour, could possibly prevent incidents of the kind I have described and discussed. However, there may well have to be safeguards limiting the term of office of any leaders to prevent the formation of a self- perpetuating elite which would then once again attempt to take over and exploit the rest of the population. One way of making reward depend on successful service to the community is by limiting the differential between the highest paid to the lowest paid (old-age pensioners or those receiving social security benefits, whichever is the lower) say to a factor of two (gross remuneration), so that the amount received by the highest paid increases only after the lowest incomes have risen. COMMUNITY LEADERSHIPIt would seem that the interests of the community and its well- being, that is the well-being of every person, could at this point best be safeguarded by effective community representation on private and public, local and national policy-making bodies in commerce, industry, finance, administration and so on. Such community representatives would need to sit in boardrooms, would need to be concerned about the workplace and would take their place in local as well as in national government and institutions. They would bring to the notice of those present the point of view of the community about the matter being discussed but the presence of a community representative does not absolve the board or the organisation from blame since they are responsible for the decision they take, that is are accountable for the resulting consequences. Community representatives, speaking and acting for the community, would keep the community informed about what was being discussed and decided. They would also report on the way in which the policy-making body either serves or disregards the welfare of the community, the way in which it allows for or discounts the social cost of what they plan to do. Community representatives need to be completely independent, which means that they are dependent only and directly on the community, that they are responsible and accountable only to the community. Hence they need also to be protected from being subjected to pressures or victimisation of any kind, need to be backed and supported by the community. As far as management is concerned it seems that one should find practical ways within the company to let employees (at all levels) express themselves without endangering their position or prospects. All those who work in a place or are connected with it should be able to meet and talk confidentially with the community representative without fear of discrimination or victimisation, i.e. without fear of the subject matter, the content of the discussion, or details of the person who contacted the community representative being made available to the employing organisation. Those who are at the moment unable to stand up against irresponsible managers would then be able to see the community representatives. Part-time directors are able to take a firm stand against the company's executives when it comes to safeguarding the interests of the owners, because they are independent of the executive. In the same way the provisions described here would enable the community representative to take the same kind of independent forceful stand against a company's antisocial policies. But they also need effective ways of reporting to the community, of reaching the people. This means that at the same time the representatives should have ready access to the media, to pressure groups, to the local or national community according to the need. There would need to be much more consulting the people by referendum before passing legislation and this means that people need to be informed far better and far more effectively than they are at present. They need to know the facts, need to see the situation as it is, need to be told how reliable the information is they have been given and what limits there are to existing knowledge. This means that community representatives need access to services and funds to enable them to have investigations carried out in connection with matters being discussed or problems encountered by them and by the communities they represent. For example in Britain the people might have been told the implications of:
It is very necessary that community representatives are not absorbed by the establishment, and there is the problem of how to prevent a self-perpetuating elite being formed which in due course again attempts to take over the people so as to exploit them. One essential requirement is that democratic forms of decision- making are used, such as secret voting at committee meetings, and that they cannot be bypassed or changed by the authoritarian mind. To avoid being influenced through 'self-interest', it would seem that no-one must be able to gain from using, manipulating or exploiting other people. How can community representatives be elected, or selected and elected, for example to the board of governors of a school, so that anyone from the community may stand and be able to offer themselves for election? It seems to me that community representatives must not be appointed, selected or proposed by government, political parties, owners, management or unions. One way of enabling independent citizens to come forward for election might be through standardised and free dissemination of election literature for those willing to take on the arduous and time consuming work of representing the community. Frequent referendums by post and by electronic voting, guaranteed secret and proof against interference, sets policy for the representatives. But then how can community representatives themselves be made accountable to those whom they represent for the way in which they represent them? And how can one make sure that they cannot overturn such provision? One might consider looking at or publishing their attendance and voting record as well as a record of what they said or achieved. In the end, they also are accountable to the community and one needs to find ways of ensuring this. Those who represent the community are drawn from the community and are unlikely to be already aware of the relevant community and technical, commercial, economic, social and human factors, and of their implications, which need to be taken into account. But they speak for and act for the community so that technological and scientific backup is required both for the community and for community representatives. One needs to have a community policy and this requires both knowledge and understanding of the policy both by those representing the community as well as by the community at large. It also requires those who take part in this drive for the survival of the community and for a better life to be aware of the trends, of what is being thought-up in the laboratories. They need to be able to think clearly and straight, to get right down to basic causes. They need to be knowledgeable, strong and skilled enough to stand up for the community point of view when confronted by the owners and their management representatives, or for that matter when confronted by any other combination. People assume that an expert who talks convincingly and seems sure of himself knows what he is talking about, an additional factor being that he is likely to use long important-sounding words with an air of conviction and certainty. This applies particularly in the areas of economics and so-called economic 'science', psychology, the social 'sciences', philosophy and political 'science'. Experts in these fields are too often themselves conditioned into believing concepts which are no more than pro- authoritarian propaganda and policies dressed up to look like sense or science. What people need to do is to see things as they are, i.e. without bias, from the point of view of the community's short- term and long-term interests. It is in areas such as these that back-up and training would be both valuable and welcome. Hence it is necessary for community representatives to be trained in the best way of looking at different matters from the point of view of the community. Community representatives need to be aware that it is up to them to consult such expertise as is available but also need to be able to evaluate the reliability of the advice they are given. Only in this way can they do their work well and stand fast on matters important to the community. Not only do we need channels available for the representatives to make their opinions heard, to bring their case to the community, but they need to be aware of the best ways of getting the direct and indirect support of the community for what they are doing. What is required for preparing community representatives for the work that lies ahead, and for helping them with the work they are doing for the community, is for them to be trained in a completely independent and objective community college <7> which will enable them to gain, develop and practice the required knowledge, attitudes, approach and skills. WORLDWIDE AIMSWe took a good look at the range of needs and wants <8> people strive and struggle to achieve. The basic needs which have to be satisfied if people are merely to survive and exist are shelter and food, clothing and warmth. Once survival is ensured other needs and wants make themselves felt. People need independence <9> from domination by others and struggle to achieve this, i.e. struggle to free themselves from being oppressed because of need. They do so by helping those in need, by co-operating with each other, by behaving in ways which encourage trustful co-operation and companionship, by developing participative organisations for the common good. People's needs and wants are achieved only as the result of struggle against authoritarian minds at the place of work and in all communal institutions. The whole struggle has been described in 'The Will to Work, ...' {27} which illustrates it <8> by a revealing and comprehensive list of people's needs and wants. People have to struggle all the way and this illustration shows what has already been achieved in democratic countries and what remains and has to be achieved. But then at present at least 50 million children under the age of 14 are doing sweated labour. There being no social security in the countries where they exist, the pittance which they earn enables their families to survive. They work between 60 and 80 hours a week. Probably nearer one hundred million children are in this way deprived, robbed of both education and childhood. Extreme poverty and starvation are increasing. About 800 million people are living in extreme poverty, starving and undernourished, and the number is increasing. Hence the higher living standards of rich and developed countries are accompanied by unacceptable extreme differentials. The share rich countries earn is up to 70 times that earned by poor countries and to this must be added internal differentials of about 90 between the rich and the poor. We wish to achieve the highest possible standard of living and quality of life, locally, country-wide and worldwide. Hence we should eliminate starvation, malnutrition, poverty and need, and provide social services and social security, freedom and independence to those who are so much less fortunate than those who are rich and powerful. Mass unemployment and income inequality need to be eliminated. Equality needs to be aimed at and achieved. It would seem that it would be good to aim at a difference in standard of living between richest and poorest countries of not more than 2, that the differential between rich and poor within a country also should not exceed 2 or that within a country all should receive the same. A community's interests would seem to be best served by sharing its high and increasing standard of living with others less fortunate, and by doing this in ways which eliminate poverty and need and the resulting exploitation. But such assistance and progress should go hand-in-hand with the spread and acceptance of an ideology such as that put forward here so that the benefits of any redistribution of wealth and income from rich to poor countries benefits the poor and needy people and not the rich and powerful rulers. In other words, assistance and aid should benefit the people and not the authoritarian minds which oppress and exploit them. In return for assistance and aid there needs to be some sort of lasting commitment to democracy and to the application of democratic principles. People need to make the effort, have to work their way up and struggle for democracy and freedom, both internally and by international co-operation and commitment to democratic principles. NOTES AND REFERENCESNOTES
REFERENCES
Relevant Current and Associated Works
Relevant Subject Index Pages and Site Overview
The Site Overview page has links to all individual Subject Index Pages which between them list the works by Manfred Davidmann which are available on the Internet, with short descriptions and links for downloading. To see the Site Overview page, click Overview Copyright © 1979, 1981, 1982, 1989, 1995 Manfred Davidmann
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