The Market, Teaching and Research

Businesses and large donors make major contributions to research, particularly in the USA. This is both altruistic and also a means of claiming an identity - telling society who they are.

Increasingly research and education are seen to serve market interests and also to threaten them. The market sees a need to control these. Market ideology makes it legitimate to do so. Modern market theory perceives incentives and disincentives as the tools for achieving its purposes. A paradigm conflict is developing. If the market is to bend research and education to its purpose it can no longer claim to be altruistic without experiencing dissonance.

As Samuel's speech shows the market has responded by rejecting altruism as an important value. It considers it expendable. Research and education cannot be controlled, contained and organised as productive and efficient market services while altruism remains the driving motive.

Research and Education are central to universities and so academic life. They are not constrained by the university and occur in many other contexts including the market. The paradigms and "starting points" of research and education are embodied in universities. They teach researchers and teachers. What the universities think and do flows on into the rest of society.

There are a number of areas to consider: -

• the impact of market thinking on academia and on academic thinking in the universities,
• market thinking and the direct impact of corporate interest on research and teaching, and
• the appropriation of teaching and training by the market and the internet.

The Universities

Conflicting values in academia: - A very important ethic in research and education is critical independence in the search for knowledge and in passing this on in teaching. It teaches critical independent thinking, anathema to the ideologist. Academia serves society best because it is not constrained by ideology. Because of this free thinking it is both a strong critic of prevailing ideology and a hotbed for the development of new belief systems.

Intelligence is not always associated with objectivity. Isolation from the practical world can encourage extreme positions. Individual academics and even groups can be as closed minded and "focussed" as any other group and academia includes both socialists and market ideologists. The intrinsic pressures from academic "starting points" will be to challenge and disprove, so there is an inherent pressure to challenge and correct extreme positions, particularly when they are adopted by society.

Universities go "belly up": - Universities have traditionally resisted attempts to subjugate them to prevailing ideology and have fostered independent thinking. As Saul has indicated universities across the world have for one of the first times in history all laid down the red carpet for market principles and big corporations simultaneously. They have adopted corporate thinking and corporate structures. Dissent has been discouraged, even more than in the community. In doing so universities have failed society.

Controlling academic independence:- Independent thinking is the enemy of ideology. If professional independence is a thorn for market ideologists, then academic independence and critical independent thinking is a sharp knife which can inflict lethal wounds. Independent universities and an independent press (read media) are the institutions which protect independent thinking. Ideologies have always sought control of both.

Corporations already own the media and they control much of government thinking. Government owns the universities. The prime obstruction to university "market reform" has been an expectation by the community that governments would remain at arms length and respect university independence. This has never kept politicians in check. They hold the purse strings and fund the universities. In a market the customer with the dollar has power and can use the dollar to get what he wants. While paying lip service to university independence government have introduced market reform and used it to remove this independence.

Controlling independent thinking: - Tenure is a part of traditional university structure. It developed within the context of academic life - a life where independent criticism can result in community anger, animosity and power struggles. It protects independence and so an important role of universities in society. It prevents universities from imposing a particular belief system on their staff. It threatens ideology.

Tenure is seen by the market as inefficient, unproductive and anticompetitive. Tenure encourages dead wood - academics who sit and think and don't produce - who sometimes obviously just sit and don't think. The criticisms of tenure have validity, particularly in a market context. Tenure can be abused and it has been. It can become a refuge for the lame and the lazy. In medicine it can be a comfy income while energy is diverted from university work to building a private practice.

At one time such people were simply pushed by their peers. There has since been an emphasis on the rights of individuals rather than their duties to the community. A multitude of processes have been introduced to protect the rights of individuals. I well remember the difficulties we had in ridding our department of a member, - the impossibility of proving that he was misusing the system. He was eventually induced to resign.

University reform: - Instead of addressing the misuse of tenure, market thinkers have abolished it and replaced it with contracts and enterprise bargaining. New staff enter into 5 year renewable contracts - replacing security with insecurity. Objective measurable output is attained by removing tenure, then making academic staff compete by measuring academic output.

As part of enterprise bargaining academics undergo regular reviews of their activities by senior members in their departments. Output is measured and discussed. Goals acceptable to the department are set for the next period. Independence is effectively constrained. The whole process is logical and increases university's measured productivity, its ability to market itself competitively, and so its standing in the community. It is difficult to argue against it.

There are other major consequences of this reordering of university life within market paradigms. Clearly only measurable outcomes will count in the new competitive environment. Contestability is a value accepted in the market paradigm. One cannot contest on the basis of something which cannot be effectively measured.

As a consequence universities concentrate on the measurable rather than the important. The research clinician who produces 20 studies using short lived rats in the laboratory will thrive particularly if she produces clear results which attract publicity. One who spends 5 years in a detailed study of humans to resolve a critical issue in a serious disease process will whither, particularly when the results are inconclusive. It will be seen as a waste of resources and she will be criticised. Her 5 year contract will not be renewed.

Another consequence of this is that roles become defined within disciplines. Certain sorts of activity do not result in outputs congruent with the directions and expectations of particular disciplines. Others are not looked on favourably.

Controlling Dissent: - The most important consequence of the removal of tenure is that the current university establishment gains control over the income and career prospects of academics - in much the same way that health care corporations like Tenet/NME gained control over doctors in the USA. It enables an administration dominated by market ideology to use a system of incentives and disincentives to secure the outcomes it requires from its staff. Market thinkers rise to senior positions. Few dare speak out. It effectively stifles independent debate. It constrains it within newly defined boundaries of acceptability.

Personal Experience: - During my last 8 years at university I devoted much of my time and energy to learning about corporate health care, exposing their practices, examining their culture, and in keeping them out of Australia. I saw this as an important academic activity. I feel that I served academia and Australia well. My research and educational activities were "downsized" and my measurable productivity declined.

I could not have done this had I been young and had I not had tenure. My efforts were certainly not encouraged by the university. I was fortunate that some of my colleagues were sympathetic to my efforts. My departmental reviewers, while not endorsing it conceded that this was a legitimate activity. It did not benefit my career.

The future: - The flame of independence burns on in the silent university community. There are major paradigm conflicts and as a consequence an undercurrent of discontent. Critical independence is a "starting point" which is congruent with the context of academic life, both research and teaching. It is likely to reassert itself. The immediate future for independent thinking and critical dissent is bleak and there are many battles to be fought. The "starting point" of critical thinking is congruent with the context of a university. Market ideology is not. Truly critical and independent thinking is likely to re-emerge from a dark age, but like Hsu-Ming Teo I am not optimistic for the immediate future.
(Hsu-Ming Teo "Those who can,do" The Australian Jan 1, 2000)

From philanthropy to market:- Corporations and rich businessmen have been great philanthropists, particularly in the USA. Many of its hospitals, teaching and research institutions have been built on this philanthropy. With advancing technology research and education have emerged as important commercial issues. Research provides commercial opportunities and can also destroy established markets.

Handling information: - Education teaches people how to think instead of what to think and this threatens ideology. The market requires a conforming workforce which will think constructively within prescribed parameters. Intelligence is focussed by the market paradigm.

Corporations have a keen interest in what is taught, and with the advent of the internet with what information is provided to the public. Marketing is a prime corporate concern and the media have been the vehicle for corporate marketing. Marketing and education are poor bedfellows. There are major paradigm conflicts and they threaten one another.

In a sense a rough parallel can be drawn between doctors, educators and researchers. Corporations have a keen commercial interest in what they are doing and in gaining control of it. As the contributor of much of the money, a user of the results, and as an employer of the output the market feels that it is entitled to control and guide - to get what it wants.

Market control:- A sinister thread is now visible in the social fabric of the research and education communities. Research and teaching are increasingly seen to serve the market and the corporation, rather than the ethic of research and the community. A culture is developing in which market paradigms pervade both and in which money is increasingly tied to corporate interests. This is what concerns thinking researchers and teachers.

It is the distortion of teaching and research by market thinking and market practices which is of concern. There are major paradigm conflicts with norms and values which have been developed in research and education over long periods of time - at least since Socrates. It is the appropriateness of the market paradigm for research and educational contexts which is the important issue.

Research - specifically medical research:- Research is of value to health care corporate interests in two ways. Firstly to control the medical profession and turn them into team players. Funding a doctors research was a sure way of getting her on side. Many corporations including Tenet/NME have done this.

Medical Research is also of value as a marketing tool provided it is visible and will draw in patients. It can be used to promote the doctor and the hospital's public image. The corporation will hold meetings at which this doctor will talk. Any research which puts in question treatment which makes large profits would be suppressed and a doctor seeking to publish will be victimised. Corporate behaviour in this regard is well illustrated by the way drug companies have responded to similar situations. Dr. Olivieri's case is an excellent example.

Another glaring example was Humana in the 1980's. It funded the first removal of a patients heart and its replacement with a mechanical heart. The project had no chance of success and was unprincipled. It was a multimillion dollar advertisement for Humana. (see Lindorff D "Marketplace medicine")

There are many other examples and they are not isolated to medical research. Researchers receiving grants are tied to nondisclosure agreements by their corporate funders. This is a direct breach of fundamental research "starting points". The most glaring example is the suppression of information about the carcinogenic effects of smoking by the tobacco industry. Corporations have gone to extreme lengths to destroy the credibility of researchers who discredit the products which they market to the public.

It is not that corporations don't support research. It is that they distort and use it for their own purposes. I suspect that they develop patterns of thinking which make their actions seem legitimate and then build a laager to shield themselves from the outside world.

Corporations increasingly take over and run teaching hospitals in the USA. Much of the research money comes from outside funding, but the researcher and the research is subject to the pressures of the corporation and so the market.

Teaching:- Corporations are eager to teach both students and trainees in their hospitals. There is no better way to secure future patient referrals than to establish strong bonds with future doctors. The earlier they are introduced to market medicine the less likely that they will challenge it.

The problem is cultural. All medical schools and hospitals have ethics courses and structures for measuring and maintaining standards. The greater the threat and the worse the corporate conduct the more likely that there will be external objective expressions of these activities, and the less likely that they will have substance.

Tenet/NME had a plethora of ethics and quality assurance committees but they simply did not work. Knowing about ethics is easy but internalising - absorbing it as part of a culture is what is actually important. It is working with colleagues, talking to them, seeing them talk to patients and then talking to these patients yourself which passes on values and ethics. It is the expression of ethical values in day to day activities which educates. Students from medical families absorb this culture rapidly because of their early exposure. Courses are useful but very much more so when they are a reflection of the culture of the institution.

The problem with teaching in corporate hospitals is that students and young doctors will be heavily influenced by the culture which surrounds them - the sort of culture revealed by Tenet/NME's documents. This is not congruent with what is taught in ethics classes.

The myths of the past:- Education and research were once recipients of funds rather than direct creators of wealth. Truth, objectivity and a commitment to openness were the ethical pillars. The results were made public for others to use and build on. Both were community services which were paid for by government or by individuals. Both were non commercial commitments to our human future. While there have been failures these myths have remained guiding principles and have been expressed in the activities of individuals. Myths are important in all cultures - in all civilisations.

Liberalisation: - Entrepreneurism has now turned to education and research. They have been identified as areas with the potential to develop profits for investors. The US Coalition of Service Industries (CSI), a powerful group representing US corporations is acting through the US government to pressure the World Trade Organisation (WTO) to "liberalise" research and education and open them to multinational corporations.

Corporate interests now undertake research and sell it. It has commercial value and commercial confidentiality agreements are applied. Education has become a product to be competitively bought and sold on the marketplace. Universities are competing to market educational products globally charging what the market will bear. Asian education has become a growth industry in Australia. The internet has become a context for community education and commercial enterprises. The distinction between marketing and education has been blurred in the corporate interest. Education has become a corporate marketing tool.

Outcomes: - It is much too early to evaluate the consequences of all this for research and education. Measurable outcomes will undoubtedly be positive. Clearly there are large benefits in the increasing amount of effort and money spent on research and education. The world is crying out for education. Our survival in an overpopulated world depends on technology and how we use it.

The market, research and education have very different "starting points". It remains to be seen how the paradigm conflicts will be handled and what sort of actions and outcomes will ensue. The concern is that academic paradigms will simply be replaced by market paradigms and that society and the environment will be sacrificed at the alter of the marketplace.

Applying theory: - The paradigm of understanding which I have suggested points to a period of dysfunction and a series of scandals, a period of darkness - a new dark age. The starting points of academia are congruent with the context of research and education and one can only hope that in time academic principles of integrity and openness will reassert themselves - a new enlightenment.

There is always the hope that common sense will force an evaluation of paradigms and that academia and the market will seek to understand each other and their situation. There will then be some prospect that they will develop understandings which allow them to rise above or go beyond the limitations imposed by their own thinking. They might even learn the lessons of the 20 th century. The history of the 20th century and recent developments in health care are not encouraging. The tradition of critical and independent thinking is - if it survives.

Teaching hospitals in the USA have traditionally funded education and research by the money they generated from providing services to private patients. They have been caught up in the torrent of corporate health care and the competition for market share. Not surprisingly, with all these overheads they have been unable to compete in terms of price in the marketplace. While there was a 25% greater chance of dying in a for profit hospital than a teaching hospital this was of little interest to the HMO's whose prime concern was profit. This was secured by keeping costs down.

As a consequence teaching hospitals were under extreme pressure. The practice of diverting funds towards research and education was identified as fraud and they were prosecuted. Many of them have succumbed to the pressures and have entered into working relationships with health care corporations which acquire the hospitals and run them. Corporations turn then into "flagships" using the reputations of the institutions to drive their reputations. Teaching hospitals have entered these relationships reluctantly and this has been an uneasy partnership.

Example:- One of the earliest examples was the cash strapped teaching hospital in Louisville, Kentucky. It entered into an arrangement with Humana. Humana did not perform well and there was unhappiness. I visited it at this time. When it was sold to Columbia/HCA by Humana things improved but not sufficiently. The state eventually took back the hospital and tried to run it again. (information form a doctor in the hospital)