OtherIndia.org

What does all this have to do with us in this meeting? We are grateful to George W Bush for putting the matter simply and clearly when he said that if you are not with us then you are against us. Turning that argument around on its head, we say that if you are not against them then you are with them. The first thing we health professionals need to realise is that questions regarding our political posture can no longer be pushed away to the periphery of our field of vision, but have now willynilly come to occupy centre stage. In particular, considerations of equity and justice can no longer be sequestered safely with in boundaries of the Community Health department, but instead, have to be brought into research protocols, departmental work plans and financial investment decisions. It is especially important, when we talk of quality and cost of care, that these discussions do not take place in a moral and ideological vacuum, but that the equity and access and entitlement parameters of the discussion should be made transparent, specific and plain.

The justifying ideologies of past empires appear to us, on looking back, to be ludicrous and obscene. However, the present ideologies, in which we are all complicit, appear to us to be self evidently true. The unchallenged legitimacy of a commodified technology is one of the unifying principles of the present imperium, and the violence of the global market helps keeps this in its place. It is important to stress that every time one operates a protocol or makes a research decision without reference to issues of equity and access, we further contribute to this violence and to the movement towards an amoral ethos for the health care industry.

In this situation, as we proceed to deliberate on the issues of cost and quality of health care, a few questions that, in my opinion, need to be examined are as follows:

• How do IPR regimes impact on the quality and cost of health care? What practical alternative health care regimes are possible today?
• What are the possible juridical and institutional mechanisms that would allow alternative quality and cost of care norms to achieve mandatory as opposed to recommendatory status?
• How could one construct diagnostic and therapeutic algorithms that would impact favorably on equity and access in quality as well as cost of care?
• How could one democratise social and technical relations within the healthcare profession? Is it possible to ensure equity and improve access without such a democratisation? Could such a democratisation be extended to the doctorpatient (or health care system-user) relationship? Is litigation under the Consumer Protection Act the only or even the most desirable way forward?