Freedom of choice

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By JEFFERSON NASCIMENTO & LEONARDO SACRAMENTO*

Elective affinities between neoliberals and denialism.

Let's start with the central one: the neoliberal needs to deny history and contextualized scientific knowledge because their foundations do not withstand serious analysis of the facts.[I] Starting this way may seem like some kind of provocation, but it is a diagnosis. It is not by chance that components of neoliberal thought, such as meritocracy, the denial of State action in the economy with a social purpose and the discourse of entrepreneurship, reach a high degree of diffusion from two allies that also feed on a base ahistorical: postmodernism and the chaotic environment of social networks.

The postmodern foundation, when problematizing History and historical knowledge, is built from the logic in which the notion of truth, reason, identity and objectivity is discussed. With this, postmodernism questions broad-ranging theories from the label of “great narratives” that “only theoretical violence could force”. History would be discontinuous and the world “contingent, gratuitous, diverse, unstable, unpredictable, a set of disunified cultures or interpretations generating a certain degree of skepticism in relation to the objectivity of truth, history and norms”[ii]. The advance of this mistrust about history and about systemic explanations favors fragmentary discourses and, therefore, if all contexts are imprecise, History cannot be very different from another narrative such as Literature. Sérgio Rouanet would give an interesting definition: postmodernism tries to exorcise the old without building anything new; it is a “postmodern consciousness” without an empirical referent.[iii]

The chaotic environment of the networks, at the same time that it gains momentum thanks to a certain advance of the so-called “postmodern consciousness”, feeds back this permanent quest to deny history and “exorcise the old without building anything new” and even disseminates certain modes of think that it would hardly resist in a logic that values ​​structure and totality. This is where the neoliberal economic doctrine gains important allies to expand as rationality, as a “neoliberal philosophy”.

An example of how it operates is the treatment given to the “Index of Economic Freedom – ILE” (or Index of Economic Freedom). This index was used by think tanks, some writers, for y and the like with an explanatory status that the index does not have: this indicator would show that the greater the degree of economic freedom, the greater the success of capitalism. More than that: in some approaches, the index started to have explanatory power, that is, it would explain the degree of development, hierarchizing all countries under arbitrary and abstract concepts. The problem is that there is no evidence in this direction and they do not even ask the banal question: did countries with a greater degree of economic freedom develop because they guaranteed greater economic freedom or did they confer greater economic freedom because they developed? Without this question, neoliberal enthusiasts, as always, ignored the entire historical process, all scientific analysis, cutting out reality and explaining it in the most convenient way, after all, the context in which we live easily accepts distrust in relation to scientific explanations that demand structural analysis and systemic. The context in which we live accepts that History can be just a narrative like the others and, therefore, accepts that skepticism regarding the objectivity of truth becomes the primacy of opinion in the face of the infinity of current conjunctures. The fact is that even with the book “The End of Poverty”, by Jeffrey Sachs, demonstrating that the index has no explanatory potential because there is no significance between it and development, the circulation of the argument was not reduced. Thus, the magic index continues to be able to explain the success of some countries that, Ironically, benefited from centuries of Mercantilism, decades of the Welfare State (welfare state) or that, like the United States, faced a civil war whose slavery, although some say the opposite, was not a greater concern for Northern industrialists in the Civil War (1861-1865) than the defense of economic protectionism, which was opposed by the landlords of the South.

Denying history and science is not just an unwanted consequence, it is, above all, a necessity. Without the dictatorship of opinion at the expense of knowledge, this neoliberal philosophy cannot survive and circulate.

Let's see an example: “In conversations with government sources, the answers are as follows: Although the prescription is mandatory, it is believed that many pharmacies will sell without the prescription, which would lead to an abusive and indiscriminate use of the medicine; Unprepared physicians can also overprescribe medication, with the same consequences; the rich, afraid of the epidemic, will buy everything from pharmacies, running out of stock. It makes sense? First point: the analysis considers that Brazilians do not know how to take care of themselves and, with freedom of choice, will act contrary to their true interests”.[iv]

Now, the core of freedom of choice to consume a medicine, in the midst of a pandemic, is what sustains the defense of chloroquine, ivermectin, early treatment and the like. In general terms, what is said is that, in the absence of a proven effective medicine, if the doctor prescribes, with his freedom in the exercise of the profession, and the patient accepts, in the exercise of freedom of choice, what is the problem? The quote above, however, does not refer to chloroquine, but to Tamiflu. It was not Bolsonaro who defended him, but the economist and journalist Carlos Alberto Sardenberg, in 2009, in the H1N1 epidemic. There are those who might argue that, unlike Chloroquine, Tamiflu was widely used in the fight against H1N1. However, “the Cochrane Collaboration — a network of independent scientists that analyze the effectiveness of marketed drugs — has disclosed that the anti-influenza Tamiflu, used to treat influenza A H1N1, does not prevent the spread of the disease or reduce the complications it can cause. In fact, according to the study, it would have the same effect as paracetamol (popular analgesic)”.[v]

That is, according to the researchers, the drug proved to be effective only in cases of serious hospitalized patients with chronic diseases, without preventive capacity.[vi], with a series of reports of serious adverse events, in particular neuropsychiatric events associated with the drug[vii]. In addition, most of the studies that attested to the safety and efficacy of Tamiflu for the prophylaxis and treatment of the flu had been carried out with funding from the pharmaceutical company Roche (which marketed and promoted the drug).[viii]. However, what was at stake for Sardenberg was not the scientific evidence or the effectiveness or otherwise of the medicine, but rather the assumption that freedom of choice is a universal principle and that it should not be relativized even in these more serious cases, that involves health. The State, in that case, should accept as an unquestionable fact that people would not act against their own interests. And there's more: “Moreover, why would doctors in the private sector (including those in health plans and insurance) be more unprepared than their public sector counterparts? In summary, these objections from government personnel contain not only the idea that people do not know how to take care of themselves, but also the suspicion that private physicians, who serve more than 45 million people with health plans or insurance health, are unprepared or moved by other interests. But let's imagine that everything that government people fear happens: that millions of vials are sold without a prescription, that doctors distribute or sell millions of prescriptions and that there is a run on pharmacies, with depletion of stocks and high prices on the black exchange rate. (as prices at the pharmacy are tabulated). And?".[ix]

Ignoring the specificity of an epidemic context that demands constant updating in the face of research that was pursuing the evolution of the disease, Sardenberg addressed the issue of “competence” as a moral and not a technical attribute. How to warn about the risk of lack of knowledge about a new disease, would disqualify the professional. Not every doctor remains a researcher. The protocol aims precisely at guiding that professional – obviously important for health – who goes to the office and is unable to monitor research on the development and application of drugs in real time. Only that!

Finally, the fear that these professionals are “moved by other interests” cannot make sense from the point of view in which he speaks: people have freedom of choice, make rational choices that are not contrary to their own interests and the market it is the perfect instance, which regulates and corrects everything that is imperfect in society. Here is the mystery of faith. The dogma in the infallibility of the market and competition, never proven, but always mobilized.

Fast forward 12 years, change H1N1 to SARS-CoV-2 and Tamiflu to Chloroquine, Hydroxychloroquine, Ivermectin and/or early treatment. The arguments are the same. But, then, why is Bolsonarist logic considered obscurantist and denialist and Sardenberg's not? What changes are the facts. Sardenberg was not confronted with the facts. At the time, the country managed to vaccinate its population quickly and, along with other factors, the epidemic was controlled. Therefore, Sardenberg's text was nothing more than a banal piece of rhetorical juggling that feeds reflection based on “neoliberal philosophy”. Bolsonaro and Bolsonarism were not so lucky to leave their positions in the trenches of ideological confrontation. The facts prevailed, the government's mess and the difficulty in accessing the vaccine resulted in more than 450 deaths, making it unlikely to forget the defense of medicines without scientific proof as part of the tragedy. Not even Sardenberg (as he himself said on CBN, happily vaccinated) can ignore the tragic result, even though he makes formal and insubstantial criticisms and disguises his adherence to the logic that brought us to this chaos.

*Jefferson Nascimento é professor at the Federal Institute of São Paulo (IFSP). Book author Ellen Wood – rescuing class and the struggle for democracy (Appris).

*Leonardo Sacramento President of the Association of Teaching Professionals of Ribeirão Preto/SP (APROFERP). Book author The mercantile university: a study on the public university and private capital (Appris).

Notes


[I] For Max Weber, “elective affinity is the process by which two cultural forms – religious, intellectual, political or economic – enter, based on certain significant analogies, certain intimate kinships or affinities of meaning, in a relation of reciprocal attraction and influence, selection and mutual reinforcement and active convergence” (LÖWY, Michel. “About Weber's concept of 'elective affinity'” [translated by Lucas Amaral de Oliveira & Mariana Toledo Ferreira]. Plural Magazine, v.17.2, São Paulo, 2011, p. 139-140).

[ii] EAGLETON, Terry. The illusions of postmodernism. Rio de Janeiro: Jorge Zahar, 1998. p. 50-52.

[iii] ROUANET, Sérgio P. “The truth and the illusion of the postmodern”. Brazil Magazine, Rio de Janeiro: Government of the State of Rio de Janeiro/Secretary of Science and Culture; City Hall of the Municipality of Rio de Janeiro, year 2, n. 5, 1986.

[iv] SARDENBERG, Carlos A. “For a box of Tamiflu”. People, Economics Section, São Paulo, 10 Aug. 2009. Available at: .

[v] To see: .

[vi] "Tamiflu is only indicated to treat H1N1 in severe cases, such as those involving the chronically ill, pregnant women, the elderly and children under two years of age." To see: .

[vii] GUPTA, Yogendra K; MEENU, Meennakshi & MOHAN, Prafull. “The Tamiflu fiasco and lessons learned”. Indian Journal of Pharmacology, v.47 (1), Jan-Feb. 2015, p. 11-16. To see: .

[viii] Ibid.

[ix] SARDENBERG, on. cit. (see note No. 4)

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