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The Final Frontier: Medicating the Corporation

December 31, 2013

23796316-happy-new-year-2014-greetingsSocial dilemmas are situations where collective interests are at odds with private ones. Neurobiology, culture, trust and social value orientation are among the factors that can influence how cooperatively people behave in social dilemma circumstances.

Social value orientation (SVO) is rooted in social psychology and is defined as a person’s preference about how to allocate resources between himself and others.  It corresponds to how much weight a person attaches to the welfare of others in relation to one’s own. The general concept underlying SVO is inherently interdisciplinary, and has been studied under different names in a variety of scientific fields.

According to Professor Paul van Lange, when people seek to maximize their gains, they are said to be proself. but when they are also concerned with other’s gains and losses, they are said to be prosocial. People with a prosocial orientation aim for joint outcomes and equality in outcomes, and tend to cooperate in social dilemmas. People classified as individualistic, however, primarily pursue their self-interest and try to maximize their own (absolute) outcome. People with a competitive tendency, like individualists, try to maximize their own outcomes, but they also seek to minimize the outcomes for others. They want to achieve relative advantage over others.

Social value orientation is associated with fundamental characteristics such as people’s political orientation, their attitude toward procedural justice, and how “socially mindful” they are in their behavior toward others. About 50%­–60% of people have a prosocial orientation, 20%–30% are individualists, and only 10%–15% are competitors. Competitors, however, receive vastly disproportionate prominence and attention, especially in countries such as the United States, where competitive metrics are the norm in business and entertainment.

Antisocial personality disorder, also called dissocial personality disorder, is a condition in which a person’s ways of thinking, perceiving situations and relating to others are dysfunctional. It results in a pervasive pattern of disregard for others and may include an impoverished moral sense or conscience.

The WHO International Statistical Classification of Diseases and Related Health Problems defines dissocial personality disorder to include the following characteristics:

  1. Callous unconcern for the feelings of others;
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
  3. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
  4. Incapacity to experience guilt or to profit from experience, particularly punishment;
  5. Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

A legal fiction is a fact assumed or created by courts, which is then used to apply a rule that was not necessarily designed to be used in that way. A common example is a corporation, which is regarded in many jurisdictions as a “person.” Corporate personhood is the legal concept that a corporation may be recognized as an individual in the eyes of the law.

The term “fiduciary” refers to a relationship in which one person has a responsibility of care for the assets or rights of another person. In a corporation, the board of directors, as a body, has a fiduciary responsibility for the decisions they make with regard to corporate assets and the rights of stockholders. The directors must always act in good faith, use their best judgment, and do their utmost to promote the corporation’s interests.

When we apply the legal fiction of corporate personhood, the exclusive focus on the interests of the corporation is obviously a proself orientation, and specifically a competitive orientation. With a capital C, that rhymes with T, and that spells Trouble.

In economics, an externality is a cost or benefit, which affects a party who did not choose to incur that cost or benefit. Air pollution is a readily understood example. When car owners use roads, they impose congestion costs on others, with negative externalities that include pollution, noise, carbon emissions, and traffic accidents. High healthcare costs and decreased productivity are just some of the negative externalities of the obesity epidemic. Excessive antibiotic use contributes to antibiotic resistance, thus reducing the future effectiveness of the drugs for everyone. And pharmaceutical company drug pricing policies and their focus on variations to existing drugs rather than new drugs for today’s health challenges result in externalities of disease burden and high mortality rates.

The commons dilemma is a specific class of social dilemma in which people’s short-term selfish interests are at odds with long-term group interests and the common good. How can it be mitigated?

Nobel prize winning economist Amartya Sen declares that market decisions will not account for externalities unless the decisions are forced on them by regulation, or unless they are influenced by taxes and subsidies and other added incentives of public finance. (Sen holds little hope for “huge changes in human mentality that make people think about the lives of others even when their own lives are not endangered.”) This implies that market decisions on public health will be continue to be based on completely wrong indications of the real costs and benefits.

A recent paper on school food in Mexico is illustrative.  In Mexico, schools have long been promoting the sale of unhealthy foods, and researchers studied stakeholders’ perspectives on proposed regulations that would address the situation. They got input from academics, parents, citizens, health professionals, and the food industry. For academics, citizens and health professionals, the primary issue is obesity, while for parents it is the health of children. The food industry did not contest the claim that the foods were unhealthy, but opposed regulation because it would cost income and jobs. They demanded policies aimed at families that included nutrition education and physical activity. The food industry also rejected the narratives and perspective of other stakeholders—improve the food environment and share responsibility—espousing instead the standard narrative of personal responsibility.

In this example, the collective “person” of the food industry exhibits textbook dissocial personality disorder. When corporate interests conflict with social or collective interests, the corporate entity often displays a “gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.” It professes to have no choice under fiduciary responsibility, claiming to be structured to ignore other constituencies such as customers, the economy of the state, the region, and the nation, or to accommodate community and societal considerations.

Coordinated change among consumers and business is vital to make progress toward a healthy and sustainable life. Government must drive progress by taking a leadership role in setting out long-term policies that unite health, environment and economic goals. We deserve nothing less.

This is my final blog for AJPM. I have enjoyed sharing my thoughts with you over the past year, and I hope they stimulated your thinking and talking about health. Thank you for reading.  Stay well.

—Michael Lytton, AJPM Blog Editor

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