Monoculture: How One Story is Changing Everything (6 page)

Conflicts of interest were also being pointed out in medical research. Before the economic story spread, research was supposed to be performed by disinterested parties according to the traditional norms of science. The
Journal of the American Medical Association
(
JAMA
), a leading publisher of medical research, saw its industry-financed research submissions drop 21 percent after it instituted a policy that required that data in company-sponsored medical trials be independently verified by university researchers. Still, since medical journals rely on corporate dollars (companies buy reprints of articles that support their products),
JAMA
“could face significant financial pressure to abandon the policy.”
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Another study released by
JAMA
’s editors found that in 2008, six of the top medical journals published a significant number of articles that were ghostwritten; other studies have shown that medical ghostwriters, whose work is hidden behind academic authors, are often sponsored by drug or medical device companies.
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That conflict of interest was also spreading to the medical classroom. In 2009, Harvard Medical School students questioned the influence of pharmaceutical companies in what was being taught, pressing for faculty to disclose their industry ties after pharmacology students discovered that a professor promoting cholesterol drugs and disparaging students’ questions about side effects was a paid consultant to 10 drug companies, half of which produced cholesterol treatments. A then 24-year-old Harvard Medical student admitted, “We are really being indoctrinated into a field of medicine that is becoming more and more commercialized.”
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A national survey of physicians published in the
New England Journal of Medicine
in 2007 found that 94 percent have “a relationship” with the pharmaceutical, medical device, or other related industries. That figure has contributed to concerns about how financial ties affect doctors’ prescribing habits and has led to calls for transparency regarding the financial relationship between doctors and medical industries.
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As a consumer of medical services, in the economic story you are free to enter or exit the medical market as you please. You are, the story says, a knowledgeable buyer, and when the price of a health product or service gets too high, you are less likely to want to buy it. Most of us though, don’t choose to be sick, and medical professionals say you are anything but knowledgeable because you don’t have their extensive training. And if your life is at stake, chances are you will still buy whatever medical care you can get, no matter how much it costs; by 2007, over 60 percent of all U.S. bankruptcies were related to medical expenses.
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The economic story says that in the market, no one is dependent; as a buyer, you have a free choice of sellers, and as a seller, you have a free choice of buyers, so no unevenness in power is involved.
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In reality, as a patient, you are heavily dependent on your doctor, and if you’re sick, it’s hard to “shop around” for a better deal like you’re supposed to as a consumer. Finally, when the trust between you and your doctor begins to erode because you begin to suspect that your doctor, as an rational economic individual, is looking out for his or her own interests instead of yours, who is left to advocate for you in the health care system?

What do we gain in return for allowing the economic story in medicine and creating a medical marketplace, a health care industry? Do we enjoy better health or better health care? Relman doesn’t think so. He points out that almost all of the reliable research points toward higher overhead and administrative costs in for-profit health care facilities than in not-for-profit facilities, and that the health service in those for-profit facilities is equal to that of non-profit facilities — or worse.
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Callahan points out that the market model of health care will never encourage us to use less medical care, will never put limits on our desire for ever better health, and will never limit the development and use of health care technology, no matter how expensive it becomes or how incremental the health gains might be. The economic story will never encourage us to accept our own inevitable aging and death. Instead, the economic story in medicine orients us away from all of that, keeps us struggling for ever-longer life through advances in medical technology that simultaneously produce billions of dollars for the medical industry.
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The economic story orients us not just physically, but spiritually, in matters of religious faith. Faith, said Wilfred Cantwell Smith, a scholar of comparative religions, is part of the human quest for transcendence. Faith is an orientation toward oneself, others, and the world, “a total response; a way of seeing whatever one sees and of handling whatever one handles; a capacity to live at more than a mundane level; to see, to feel, to act in terms of, a transcendent dimension.”
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Adhering to a certain religion is considered to be an expression of faith. In the United States, one of the most religious countries in the world, roughly 80 percent of Americans do just that, and identify themselves as Christians.
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Historically, Christianity is the dominant religion of the Western world. As a religion, Christianity encompasses specific beliefs and ideas. It’s also an umbrella term that covers a variety of groups, some of which are convinced the others are misled at best and heretical at worst. Roughly 600 years after Christianity was made the official religion of Rome, the Christian church split into the Roman Catholic Church in the Western world and the Eastern Orthodox Church in the East. Then, during the Protestant Reformation, the Roman Catholic branch split again into Roman Catholicism and Protestantism. Across these centuries, says religious scholar Diana Butler Bass, Christian beliefs and values changed with the times, in distinct historical periods.
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Early Christians, alive during 100 to 500 CE, thought of Christianity as a way of life, says Bass — not a sudden conversion or a doctrinal belief. Early Christians were generally pacifists; war involved killing, killing was murder, and murder was wrong, plus soldiers had to participate in acts of worship to the state, the gods, and the Roman emperor, which was considered idolatrous. These believers were warned against loving money, being stingy, and supporting the rich, and struggled with their relationship to material things like property and wealth. Justin Martyr, an early defender of the faith, said, “We who formerly…valued above all things the acquisition of wealth and possession, now bring what we have into a common stock.”
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When Christianity became the official religion of the Roman Empire in 313, the church itself became rich and the biblical admonition to “go and sell what you have and give to the poor” became allegorical, not literal — a call to give up not money exactly, but whatever it was you happened to love more than God. From 500-1450, church and state joined together in the rise of Christendom. Money was poured into church art and architecture as a vision of God made manifest in the world; the stories of the Bible were represented visually in stained glass so pre-literate followers of the faith could “read” them. Islam emerged, and pacifism gave way to the crusades as Christians and Muslims warred for converts and territory.
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During the Reformation (1450-1650), art in Christianity gave way to words. Christianity changed from a way of life to a carefully worded confession of doctrine. Scripture was read for its transformative power. As a Reformation Christian, you lived the devout life in order to be saved. You believed you could be right with God by making society right, and social justice became a cornerstone of religious practice. Germany’s Martin Luther called faith a gift and said God was about love, not judgment. France’s John Calvin said Protestants ought to work hard and live frugally, that hard work was God’s will and money amassed as a result was a sign of God’s blessing.
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In modern Christianity (1650-1945), faith became tied to morality, not doctrine. Faith and learning became entangled. People valued certainty, believing that the truth could be searched out and solved. God could be accessed directly instead of experienced through church hierarchy, theology, or the written word. Religion was supposed to make people happy, and God’s will could be reasoned out, replacing mystery with knowledge of nature’s design. Progress was equated with hope, and people believed they didn’t need to be transformed spiritually beyond where they naturally were.
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According to Bass, contemporary Christianity (1945-present), has grown more accepting of the traditions and practices of other religions, downplaying the divisions of economic status, class, health, education, and nationality to focus on practicing universal hospitality and justice.
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In contemporary Christianity, people grow into the Christian life by becoming one of Christ’s disciples, a spiritual apprentice formed in the image of God with habits and affections distinct from those of the world. Contemporary Christians aspire to care for the suffering, paying particular attention to the poor. They take on the responsibility of caring for others because they consider themselves to be their brother’s keeper based on the idea that all human beings are children of God, brothers and sisters created in God’s image. Believing that people need God and God’s abundance, and that we belong to one another in communities, they trust our relationships with each other matter, that our fates are intertwined.
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In contemporary Christianity, Christianity is formative, capable of making you a new person in the image of Christ. Beliefs represent revealed truth, and souls need to be redeemed from their original sinful state.

Then the story changed. Again.

The economic story says religion too can be understood in terms of economic values and assumptions. Religious market theory, in particular, says the world of religion is a religious economy, and that the religious economy operates like a commercial economy. The religious market, like the actual market, operates according to the laws of supply and demand. Your interest in religion, as compared to your neighbor’s, represents variation in demand, and the different activities of different churches represent variation in supply. People interested in religion and spirituality are a market of current and potential customers. Different kinds of churches represent the set of firms that want to serve those markets, and different religions represent different product lines.
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In the economic story, you go to church as a buyer looking to satisfy your religious preferences, whatever those preferences may be, since the content of those preferences doesn’t matter. No one religion is particularly “moral” or “good.” What is “moral” or “good” is just a consumer preference. There is no divine authority that makes your preference right or wrong; you are the sole authority on what you prefer, and in your spiritual search, you’re searching for a religious product — a certain kind of religion — that meets your needs as a consumer.
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A church is an efficient and eager religious firm that exists to create, maintain, and supply religion to people like you. Because some people are more or less interested in religion than others, churches have to market their products vigorously and compete with other churches for your support. A single religious product line — any one religion — is inherently unable to satisfy the whole range of individual tastes because some people prefer their religion to be more strict or more permissive, more exclusive or more inclusive. Different segments of the market (children, teens, young families, empty-nesters, seniors, and shut-ins) will prefer different aspects of religion and so can be targeted with different product offerings as churches compete with each other for market share.
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In the economic story, America’s most successful churches are deemed to be those that model themselves on businesses, complete with MBA-staffed management teams, strategic plans, identification of target markets, consulting services, and thousands of customers.
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Pastors are CEOs. Laypeople are advised to “invest your life for the highest return” and live a life of “entrepreneurial faith” by applying the principles of business entrepreneurship to their spirituality: “When you are a spiritual entrepreneur, you are obeying God…According to Scripture, being an entrepreneur is for everyone.” Jesus is “the Ultimate Entrepreneur,” having “set the standard for entrepreneurship…Jesus looked at life around Him and saw how He could add value.”
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According to the economic story, Christianity is a brand and the cross, as a recognizable symbol, is Christianity’s logo. Churches are to focus on efficiency, effectiveness, and organizational growth. As the former executive vice president and business manager of the Billy Graham Evangelistic Association put it, “Our job is to dispense the world’s greatest product — with the greatest economy — to the greatest number of people — as fast as possible.”
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Churches grow by being responsive to customer needs, and customer needs are revealed through demographic and target market research that focuses on what the unchurched in the neighborhood want from a local church.

If you’re already in the pew, you too belong to a target market. Your church is a social network and your pastor is a network connector who can spread product information and influence your purchasing behavior. In 2005, church leaders “had a chance to win a free trip to London and $1,000 in cash if they mentioned Disney’s film ‘The Chronicles of Narnia’ in their sermons.”
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In Detroit, Chase Bank sponsored one mega-church’s back-to-school festival by giving out free backpacks, and Pepsi donated a 15-passenger van to the church after the members bought 13,500 cases of product; the church’s communications director described the deal as “win-win.”
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In 1998, Pope John Paul II’s visit to Mexico City was sponsored by over two dozen corporations, and the Pope’s image was used on packaging and billboard ads.
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