In the previous page I examined the way that incentives and disincentives inhibit reflection about what we are doing and the consequences for others or for the system. They challenge our humanity. This leads us to ask why some of us embrace the incentives and ignore the consequences while others reflect on the consequences and either remove themselves and go elsewhere or are so motivated by a sense of responsibility that they risk their careers by speaking out and blowing the whistle.
Are we born in these two different ways or are these characteristics socially acquired? Is it genetic and if so is its expression influenced by nurture (our backgrounds) and the context within which we find ourselves.
An interesting study is that of successful psychopaths (or sociopaths). Robert Hare, a psychologist from Canada and others have researched sociopathy and sociopathic traits. They have been writing about this for years. On my web site in 2000, I accepted that successful sociopaths are there and are particularly successful in vulnerable markets.
But even Hare claims that only four times as many top executives are successful sociopaths as are present in the general population. It could be higher in vulnerable sectors but we don't know that. I have argued that there are thousands if not millions of people involved in some of the things that I have been examining and that the sociopaths are only at one end of a continuum of behaviour. Most of those involved don't really have typical sociopathic characteristics.
Recent studies do help us understand: I was interested to see where this research had progressed since the 1990s, which is when I last looked at this closely. The 2015 BB Horizon TV program "Are you good or evil" now available on Youtube, comes from these and other researchers. They have now shown clear brain changes on PET scans in sociopaths. They followed that up by showing gene patterns that are strongly or less strongly associated with sociopathy (particularly a "warrior" gene).
Finally, they have shown that environment, particularly in childhood, often determines the way in which the gene is expressed, whether you are likely to become a sociopathic killer, be dysfunctional in other ways, become a successful businessman by exploiting others, or escape altogether. So these genes are quite widespread in the community.
Nature and Nurture: The particular sort of behaviour that characterises sociopathy and the brain changes seen on scans probably do not accurately reflect the vast majority of us, including those who become part of culturopathic organisations. What the research does show is that there are a multitude of genes that govern our psychological potential and that the environment in which we find ourselves plays a critical role in determining how they are expressed and how we will behave.
This makes us very adaptable and responsive and may be why we have been so successful in evolution. We have all these potential characteristics in our genes and express them when we need to do so to survive and succeed. Those who have the best genetic potential for the situation lead the way ensuring our survival. But when the context places the survival or success of the person with the trait (eg sociopathy) in conflict with that of the community then the community is likely to suffer and not survive. That is how evolution works, by trial and error and there have been many blind alleys. It is the development of language, cognition and then science that enables us to understand and so take control our own destiny and avoid the blind alleys.
Significance of the genetic studies of sociopathy
This is compatible with what I have previously suggested to explain what happens in markets that fail because there is no effective customer. I borrowed terms used by Rokeach, a psychologist writing about dogmatism in the 1960s. I used these to conceptualise what was happening. I suggested we view what is happening as a continuum of behaviour between Open Minded (reflective, constructive, exploration of ideas) at one end and Closed Minded (one eyed, responsive, resistance to new ideas, selective perception, defensive etc) at the other.
I suggest that genetically and developmentally, we all lie somewhere along that line but we are not static. We have some latitude and move more towards one or other end of the spectrum depending on the contexts within which we find ourselves - and the pressures there. So people who will be very effective in one context can be disastrously dysfunctional in another and cause harm.
We may in one context (eg. university - a business course) excitedly explore, embrace and construct new ideas that fit what we know and are being taught. Later, under pressure in another situation, we may close our minds and ignore what we don't want to know in order to justifying what we are doing based on those ideas.
High pressure contexts, generated for example in strongly profit driven competitive businesses characterised by strong incentives and disincentives, cause us to narrow down. We stop reflecting and confronting our beliefs with new knowledge. Instead we become responsive in justifying what we find ourselves required to do. We join the rats, but we never see ourselves that way. The strategies we have used enable us to believe in what we are doing.
The new research makes what I suggested 15 years ago sound more credible.
Applying this: Contexts need to be created to match the requirements needed in a particular sector. These contexts should favour the sort of people needed to make that sector work for the community. They should prosper there and be selected by the system as leaders.
One of the great problems in a society, where a single belief system is generalised is that the sort of systems that have worked in one sector and for some activities are seen to be universally applicable. They are applied to sectors and activities where they are unsuitable and often harmful. This brings the least suitable into the sector. In addition society provides fewer of the diverse contexts where those who don't fit the market model can "actualise" worthwhile lives, develop meaning systems and make contributions.
We can ask ourselves about the waste of human potential that is out there waiting to realise itself but unable to find anywhere to do that. These people become alienated and our human resources are squandered. This is an inefficient way of managing society. If the pressures (eg in the young) to actualise are strong enough they will grasp at any available belief system or cult and develop a context there. Because of their disenchantment with a system which rejected their potential some adopt a system that enables them to vent their anger against the one they perceive as rejecting them - terrorism.
I think there is plenty of evidence of that in the world today. If we are unlucky to be in the wrong place some angry zealot might try to behead us!
But to come back to our focus on aged care. The point I am making is that many contexts are negatively impacted by having to conform to the dominant belief system and so attract the wrong people and become dysfunctional. That is what I am writing about and exploring in aged care on these web pages.
A glaring example
We do not know the genetic makeup of the doctor in the following frightening example from the USA but it does illustrate the sort of interplay of genetic factors and context that we can use as an example and speculate about. A potentially sociopathic doctor with the warrior or similar gene placed in a cultural context driven by incentives and strong competition. One where financial success would give status, credibility and social standing as a charitable donor. Because of this others would struggle to challenge and expose what was happening.
The articles quoted below describe a large company employing doctors working in hospices treating dying patients and at least one doctor deliberately making diagnoses of cancer in patients who did not have cancer -- then starting them on a lifetime of very expensive cancer treatment.
Because of the early guilty pleas in this case there is not a lot of information about what actually happened or about the actual links between this doctor and his employer MHO.
The reports indicate that large numbers of patients have been treated in this way but only a selection of the cases have been prosecuted. The convoluted story suggests the recruitment of young relatively inexperienced doctors and the use of kickbacks
The recent case involves a company Michigan Hematology and Oncology Inc. (MHO) and a physician, Dr Farid Fata. There probably isn't enough detail to classify him as a "successful sociopath" but it seems likely. Once again it required the efforts of multiple nurse and medical whistleblowers trying to expose this over some years before anything was done.
“I’m very disappointed,” she (Patient) said outside court. “He (pleaded) guilty to a handful of patients when there were thousands. We wanted to hear the details about how he was allowed to (do this) and how this was allowed to continue.”
U.S. Attorney Barbara McQuade, who was in the courtroom when Fata entered his guilty plea, said “this was one of the most egregious crimes I’ve ever seen.”
She added Fata “tortured” patients with unnecessary cancer treatments for financial gain.
Fata faces up to 175 years in prison and a $250,000 fine on the health care fraud counts and up to 20 years and a $500,000 fine for money laundering. He also faces fines on his admission he solicited kickbacks from Guardian Angel Hospice and Guardian Angel Home Health Care for referring patients to the facilities.
A new trial date on the remaining six counts of healthcare fraud is March 16.
Source: Surprise guilty plea for Oakland Twp. cancer doctor over false treatments, fraud The Detroit News, 16 Sep 2014
Robert Sobieray speaks with a slight slur because all but two of his teeth fell out after 24 months of chemo treatments for cancer he never had.
Source: Victims recount abuse by convicted cancer doctor The Detroit News, 30 Sep 2014
The government contends Fata victimized 553 patients and ordered at least 9,000 medically unnecessary infusions or injections, including chemotherapy for people who did not have cancer. He was more concerned about billings than the health of his patients, prosecutors say.
Fata's cruelties included treating patients for cancer until they died, robbing them of opportunities to make end-of-life choices, resolve issues with their families or otherwise face their impending deaths with dignity and self-awareness, prosecutors said. Nurses and social workers in the practice reported he told new cancer patients they had a 70 percent chance of remission, regardless of the medical facts. "Fata would say he was giving those patients hope," according to the sentencing memo.
Source: Feds: Doc's 'patients poisoned for money' Detroit News, 20 May 2015
By 2013, Dr. Farid Fata operated Michigan’s largest private cancer practice, with seven clinics and 1,700 patients. He now awaits sentencing for fraud and a kickback scheme with a hospice.
Next month, before Fata is sentenced in a Detroit federal courtroom, Fata victims will describe the toll of being prescribed toxic medication and testing they didn't need. They will explain how their misplaced trust in a doctor they once revered tore apart their families, cost them the power to make choices about living or dying, and created lingering mental anguish and illness.
Fata's Michigan Hematology and Oncology Inc. (MHO) was the state's largest private cancer practice in 2013, with clinics in seven cities, its own pharmacy and diagnostic center, and 1,700 patients, virtually all of them assigned to Fata, the tireless physician. Those who needed proof of Fata's dedication could look to the doctor's work ethic — he often labored past midnight — or to the Swan for Life Foundation, a charity Fata established to help cancer patients and their families.
Today, MHO is gone and Fata is behind bars, awaiting sentencing for at least $34 million in fraudulent Medicare billings and a kickback scheme with a hospice. The criminal counts only hint at the human suffering behind the financial damages and raise questions about how Fata's schemes could go undetected so long, despite his many contacts, doctors, and huge roster of patients. As Brian McKeen, the malpractice lawyer now representing Flagg, says with outrage: "The one place a person should be safe is a hospital or doctor's office.
"It was like 'The Firm,' " says Dr. Gary Salem, vice president for medical affairs at McLaren-Lapeer Regional Hospital, where Maunglay (the whistleblower) now works — recalling the sinister law firm in the John Grisham novel that sought out young, vulnerable lawyers.
Hindsight may be laser-sharp, but Fata had withstood auditing from insurance companies, at least one malpractice lawsuit, state regulators and the scrutiny of other doctors in and outside his practice for a decade. He had dispensed cruelty as casually as Tylenol, without anyone catching him.
At 7 a.m. on Aug. 6 — not even 12 hours later — agents arrested Fata in his Chevy SUV. By the time Crittenton Cancer Center staff arrived at work, federal agents already were swarming the office. "They did not let another drop of chemo go into anyone. They just pulled the plug," Maunglay says.
Despite Maunglay's belief that Fata likely treated other healthy patients for cancer, only two are known: Flagg and another patient, who sought a second opinion after Fata's arrest in 2013. The Flaggs are suing Fata (but not Maunglay) for malpractice.
On Sept. 16, 2014, Fata pleaded guilty to multiple counts of Medicare and insurance fraud, money laundering, and soliciting kickbacks, while publicly admitting that he'd prescribed treatments that were medically unnecessary. His assets were auctioned, and his wife and three children were allowed to leave the country. Fata is being held at the federal detention center in Milan, awaiting his court appearance July 6. Federal prosecutors are seeking a life sentence. Fata's lawyer has steadfastly declined comment but is expected to file a response under seal next week.
Source: Whistle-blower: How doctor uncovered nightmare The Detroit News, 10 Jun 2015
What about competition?
Competitiveness, a normal characteristic consequent on our evolution is an integral part of our makeup - a genetic inheritance whose expression is controlled by our cultural environment.. Both genetically and environmentally we vary considerably in our development of competitiveness.
We can examine competitiveness as part of our animal heritage, the rat in us. Unrestrained it can lead us to destroy anything that stands in our way as we advance our own interests at the expense of others. If fact that is exactly what an unrestrained competitive market without a sense of responsibility would do and sometimes does. The successful succeed at the expense of those who are unable to compete.
The point I am making is that it needs to be seen as a part of the rat in us, something which will, if uncontrolled by our human ability to reflect and restrain ourselves or by customer and society restraining and directing it, will result in the blindly competitive succeeding at the expense of others. It will harm them and society itself.
Competition in excess ramps up the pressure and the stronger the competition the greater the pressure under which people find themselves. These high pressure contexts drive us to closed minded responsive thinking and inhibit reflectivity. We lose our capacity to indulge in balanced sensible behaviour. All of the processes I have written about and the perverse Social Darwinism that selects for the wrong people and the wrong policies are accelerated.
This is exactly what evolution originally intended and depended on. Its focus was on the survival of the individual and it sacrificed millions in order to select the best. Only the best would survive.
But since then we have evolved into social animals. Reflectivity about the consequences for others and our society is a central attribute of our social selves. Our survival and success is now far more dependent on what we do as a society than what we do as individuals. We no longer squander millions of lives.
It is consequently important that our individuality is tightly linked to our role in serving society - in embracing our responsibility as citizens. So our competitiveness and the way we realise ourselves needs to be reflected on and channeled so that it is directed towards society’s needs. It needs to be balanced by our other attributes,
In discussing the relationship between incentives, disincentives and competition I am looking at them in the context of our intrinsic inherited human attributes, a part of our individual and our societal heritage. These are attributes that need to be reflected on, moderated, balanced and directed by our human selves - our other attributes. They have a place but in excess and by themselves are harmful.
This brings us back to the problem of ideology. The way in which we seek simplicity and certainty in a complex world by seizing on one or other “self-evident truth” and promote it at the expense for all of the other complex factors in our human potential - and sadly at the expense of our reflective social selves. What we get can be very harmful.
Ross Gittins describes this well in his criticism of his economist colleagues. But in a culturopathic ideology criticism has no impact because it is based on belief and belief does not allow any doubt or uncertainty.
The belief that increased competition leads to greater efficiency and higher productivity is one of the articles of faith for admission to the economic priesthood.
Economic practitioners often know little about the peculiarities of particular markets – about their specific areas of market failure – and often don't think they need to know because what they do know about is their profession's two magic answers to inefficiency.
The first is to "get the incentives right" (the claimed rationale for much tax reform) and the second is to increase competitive pressure.
There's a lot of truth to both propositions, but not as much as it suits economists to believe. Because it comes from their model of markets, many economists' belief that the more competition the better – and the more choice the better – is so deeply ingrained it requires no empirical confirmation.
This makes economists chronic sufferers from what psychologists call "confirmation bias"
Source: Let's not repeat our many competition stuff-ups post the Harper review Sydney Morning Herald 30 November 2015
John Ralston Saul, the analyst and critic of our great weakness for ideology, describes the way we seek to escape the uncertainties of a complex world and seek certainty by seizing one or more of our many attributes and qualities and accepting them as absolute truth. But these are only one of a multitude of equally important interacting qualities that constitute our humanness and our society. Each depends on the others and the context within which they are exercised. We depend on the balance between them and the sensible management of each.
If we consider mankind as an evolving species, then we can see that we have reached an evolutionary stage when we have developed the capacity and the intellect to take charge of ourselves and our world - to drive our own evolution. But we have been restrained by our inability to escape from the discomfort of complexity and uncertainty. Instead we create certainty by gasping and embracing ultimate truths wherever we can create them.
We can think of ourselves as at an evolutionary turning point when we need to confront our weakness for ultimate truths and grasp the future by embracing the uncertainty and the excitement of a complex and uncertain world, and move forward to shape our destiny within it. We have been taking small steps forward but then we falter and fall back into ideology.
As Saul indicates to move forward and evolve we must recognise our many attributes and qualities and the way that they interact. We must accept that we need them all and that they are equal. Ideology is based on an imbalance and what we need to do is to create a balance so that our different attributes constrain one another and work together to avoid excess.
And so we slip into ideologies. Strangely enough, there are often several at a time. Overarching truths and tiny truths. Certainties at all levels (Page 15)
The answer (to the problem of conflicting “truths”) over the last two centuries has been a gradual move towards a civilisation of structure and form over one of content and consideration. The way we come at every point is structural, managerial.
Much of the last two decades (now three) has been taken up by precisely this view. The idea, for example, that we are driven by self-interest is the natural outcome of believing in competing certainties (page 7)
qualities are most effective in a society when they are recognised as of equal, universal value and so are integrated into our normal life.
Source: On Equilibrium John Ralston Saul Penguin Books 2001
I argue that we can do this by changing the context of our lives so that instead of experiencing the angst of uncertainty that causes us to behave “responsively” and grasp at something simple to believe in, we experience the excitement and challenge of exploring and reflecting on our complexity and building our future - a constructive environment.
To keep it on track we need a broad context that is closely tied to our experience of the world in that context and to the experience of those who are there. We need to accept a world where there are many different paradigms that illuminate the world. We need to accept and address their differences and use those most suited to each context. In a complex world a one size fits all model is doomed to failure.
The proposed community aged care hub is only one small step in this direction and we need many more. It's a calm and considered process of evolution and not revolution. Revolution is too often the product of a new ideology - its success depending on people believing so strongly that they will die for it