We publish the third chapter of a book on the workers’ and patients’ struggles at the university clinic in Rome in the mid-1970s.
We recommend watching this inspiring documentary about this historic movement in tandem.
In the first part of the third chapter the authors describe the resistance of the Workers Collective against the decision of hospital management to close parts of the hospital during summer. In the second part they lay out the position of the Collective regarding medical research at the university clinic. The medical hierarchy uses working class patients for experimentation, often to the detriment of the patients’ health. They research issues that are primarily serving an academic and individual interest, not the interest of the working masses.
The polyclinic collective formed part of a wider network of political committees in major workplaces and working class areas; you can read more about them in these articles on Magneti Marelli, on the committees at Alfa, Siemens and Pirelli, on Senza Tregua and the political committees in Veneto. The collective’s outstanding character was based on the fact that it included medical students, nurses, porters and doctors, and aimed at the socialisation of the divided knowledge within a project of workers’ control of the clinic. Patients were participating in the regular assemblies of the collective. Workers fought for equal conditions between permanent and precarious staff, they imposed free health services for local workers against the private interests of the bosses of the clinic. The collective supported the occupation of administrative buildings for the establishment of a children’s nursery for hospital workers. They also joined a feminist occupation of an operation theatre for free and safe abortions. The collective was locally linked to similar collectives within the energy sector, railways and various working class neighbourhoods.
In terms of understanding, the comrades use the word ‘barons’ to describe the very elitist, if not semi-feudal character of the medical and university hierarchy at the time. Many of the bosses of the university clinics were embroiled in corruption and had close links with conservative, religious and sometimes fascist circles. They write about the ‘university workers’ struggles’ for equal wages with the workers directly employed by the hospital – at the time university contracts were used as a form of subcontracts within the hospital, in order to pay less for the same work. So the ‘university workers’ are actually medical workers in the polyclinic.
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Proletarians and research
In summers the university hospital functions worse than usual
It’s summer 1973 and “like every summer, the illustrious barons of medicine close down the departments, partly in order to make sure they get their holidays, partly in order to avoid the problem of workers’ struggle who demand more staff in order to be less exploited on the wards and to provide better care to the patients” (4th of July 1973)
This situation has all the aspects of a proper ‘lockout’ from public services, which the private clinics can take advantage of by making high profits from those patients who have been refused by the public hospital. By denouncing this absurd situation, the Collective invites the hospital workers (on whom this situation will have the greatest impact), the university workers and the patients to find a moment of unity and organisation in the name of “a common will to beat exploitation, be it of one’s own skin or that of the patients”, against all the true enemies: the barons in hospitals and universities, the private speculators etc.. “The university barons use the hospital for their academic endeavors […] thereby depriving the wider population of 2,000 hospital beds; the hospital barons enrich themselves by contracting out patients to private health clinics; and meanwhile they hope that poor treatment in hospitals will lead to greater income for their private clinics.” (28th of August 1973)
To the barons who justify the closure of departments by referring to workers’ holidays, the Collective responds:
- “The holidays are a right which workers have conquered through struggle, to withdraw from the slavery of labour”: the lack of staff during the holiday season can be resolved by increasing the number of staff (“through recruitment of permanent staff”, recalling the struggle of the temp workers from the previous year)
- The patients should not be piled up in the corridors of the hospital pavilions, but should be admitted to the wards of the clinics: “let’s take over the empty wards”, “let’s force the barons to re-open the departments”.
Behind these slogans stood the will of the workers to provide health care for patients also during the summer months. “There are crammed wards next to empty wards, let’s take over the empty beds”. (6th of July 1973) The decision taken in the Medical Clinic 1 was criticised for the same motives: “where the workers had taken director Turchetti’s decision for granted not to admit any new patients.” (11th of July 1973) Furthermore, given the grave situation that had developed during the summer, which infringed even on bourgeois law, the Collective decided to attack the complicity that surrounded the barons and to break the silence that the barons had always enjoyed when dealing with the judiciary: on the 30th of July 1973 the Collective denounced at the public prosecutor’s office “the disgusting situation at the university clinic”, inviting the judiciary “to identify and punish the responsible individuals”. [1]
Many asked themselves why workers would turn to the courts: “the decision of the Collective to file a case at the court about the absurd situation at the university clinic is a political fact that requires the utmost clarity in order to avoid any possible instrumentalisation by various forces, either by the right-wing or the so-called left-wing, the trade unions and reformist parties” (31st of July 1973) They have taken this decision, certainly not because they think that the bourgeois authorities can resolve the problems of the popular masses and put itself at the service of their needs, nor because they want to send the barons to the local Regina Coeli prison. The aim of filing the case is a different one. On one side they try to “increase the contradictions amongst the bosses and make them more explosive, at a moment where for their immediate interests (holidays) they fail to comply with their own laws”, and on the other hand “for raising awareness amongst the largest number of workers.” (31st of July 1973) “It is an occasion in which no worker can withdraw from the responsibility to develop the right consciousness of their own class interests and of who really fights and organises themselves for these interests.” (1st of August 1973)
The Collective’s legal case was therefore a whole different story from the legal denunciations (if they actually make any) of the ‘official left’, who address the ‘authorities’, so that they take note of the ‘disfunctions’ and the ‘inefficiencies’ and do something about it, for example by proposing ‘reform’ laws or punish the responsible people. The Collective comments: “The barons and bosses still maintain their power, also because large parts of the workers fall into the trap of thinking that it is possible to eliminate exploitation through petitions, with laws or reforms. They forget the immense strength that the working class possesses to directly appropriate everything which is theirs.” (29th of July 1973) Explaining the significance of their own action, the Collective uses this legal case as a moment of struggle against revisionism. After summarising the main sensational evidence that has been presented to the judiciary, the Collective affirms in their leaflet: “We don’t invent any of this: us workers suffer and experience this situation every day, which allows the barons to fatten themselves off our skin. As usual, the trade union pretends that they don’t see anything wrong, because they get orders from above, from the party, which has already decided that defending the interests of the bosses is a higher priority than the defence of workers […] In the university clinic, in fact, the trade union accepts that the administration doesn’t recruit any new workers and that in order to deal with the lack of staff they close departments. They accept the absurd division between university and hospital workers.” (29th of July 1973)
The workers file a legal case against the barons
Let’s see which issues the workers address in their legal case. First of all, they point out the fact that on the 11th of July 1973, out of a total of 1,400 beds for male patients, only 931 were occupied, while of 1,930 beds for women only 1,100 were in use (the university clinic is therefore half empty, and certainly not because of the struggle of workers, who were working their usual shifts at that point in time). On the 15th of July 1973, only four days later, only 781 beds for men and 910 for women were occupied. It is obvious that the barons followed the explicit requests from the rector, who “suggested to prepare for the most adequate time, which are the holidays of the doctors, the main exodus of the wider staff.” Where will they scatter these patients? To other hospitals in town or the pavilions of the university clinic, which are already full up, so that they end up being “stacked in places that are less adequate from an hygienic point of view”.
The Collective therefore denounced not only the “forced exodus of the patients” but all shortcomings of the hospital and the “acts of disservice which should have legal relevance.” In this way, the indecent conditions in which the patients are kept are revealed to the public for the first time.
There is a lack of staff. The few staff that remain are overstretched. There is a lack of medication, gauze, dressings, which therefore the patients bring from their own home. The chimney of the refuse incinerator fills the university clinic with dust particles, in particular the pediatric department, where the kids have to skip meals, because the clinic doesn’t provide them and where the entire blood transfusion department (30 beds) has been closed. Ants and other insects infest even the incubators (it is the doctors themselves who report it). Due to the sickness absence of a civil servant, the deceased neonatal babies are crammed into the mortuary fridges, because without registration they cannot be buried. The lifts don’t work in any of the clinics, they don’t meet the requested standards of the ENPI (Ente Nazionale per la Prevenzione degli Infortuni – Health and Safety Board). A patient had died from falling into the lift shaft due to lack of lights. Therefore the patients are transported “by the porters, at their own risk and danger of harm”; the hospital authorities refuse to take responsibility for these issues (they ban the use of the lifts, rather than having them repaired). The outpatient appointments have been reduced and management has put up signs, saying “please do not insist”, at the ophthalmology department.
There would be many other disgusting shortcomings to report at the university clinic, but for this time the workers contented themselves with denouncing these “tips of the ice berg” (which we have only summarised here briefly, but are documented in detail in the legal charge). But even this shorter list allowed the workers of the university clinic to accuse not only the single responsible individuals for each breach, but the entire system of the ‘teaching hospital’, within which these “attacks on public safety” manifest themselves. The legal denouncement says: “The denounced facts […] are not singular episodes which we find in exceptional circumstances (although it is reasonable to hypothesise exceptional situations that prevent the provision of an adequate health service), but represent the logical consequences of a health policy which abandons entire hospitals to the will of the well-known barons of medicine, by using the pseudo justification of scientific research in a university hospital. They enable the barons to use the hospitals according to their own interests, thereby giving them a power, often over life and death, unparalleled by any other authority. This power to inappropriate health, which, in the case of the university clinic, impacts on entire neighbourhoods and those classes who cannot afford the luxury of treatment in private clinics, has to be crushed.” [2] As one can see, the intentions behind this denunciation are very clear, notwithstanding the initial outcries which spoke of a ‘journalistic blow’, and it would be very difficult to instrumentalise this action for any other interests.
Who does the ‘research’ and who does the ‘guineapig’
Given that the Collective now had the opportunity, it seemed the right moment to confront the question of how the university hospital performs its ‘high research’ directly (not only the ‘dysfunctions’ during the summer period, but also in its ‘normality’ during the rest of the year), how it treats the sick proletarians and how it ‘prepares’ its doctors.
In a leaflet to workers and patients the Collective affirms: “One dies of this ‘care’. One dies, because this is the political will of those who don’t want health care to be a right of all workers, but only a privilege of those who have money. The proof for this we find daily in the hospital, where this political will is expressed in the selection between rich and poor patients.” (18th of November 1971) They maintain: “The university clinics are a prime example of the use of medicine as an instrument of power and enrichment of a few at the detriment of all workers. In the university clinics the patients become guineapigs for experimentation (what is this medical system if not an instrument invented to privilege the ruling and bosses class?)” (10th of August 1972) In this way the workers have singled out the two pillars on which the research in the ‘university hospitals’ rests: 1) the selection of patients; 2) the use of patients as guineapigs.
Let’s start with the issue of patient selection. As we have already mentioned, the first line of selection happens in the outpatient clinics. Some patients are chosen to be examined, while others are pushed towards the private clinics (not only patients from bourgeois background, but anyone willing to pay for the hope to receive better care). But there is an additional type of selection, which happens at a sorting office of a particular kind, the so-called ‘admission’ of the university clinic, which is rather a type of canteen, and the most shameful way to welcome patients. We talk about two huge halls, one for ‘gents’, the other for ‘ladies’, where on single or double beds, according to preference, those patients are gathered who arrive from the accident and emergency department. No one knows where these halls start and where they end, as you can find these beds, and patients in them, in abundance also in the corridors, the visiting halls, in the doctors’ rooms and, if required, in the toilets. We say ‘double beds’, but actually they are single beds with two patients in them, “to make most of the space”. Where does it say that patients have the right to get out of bed from both sides? The patients of these canteen halls hardly ever get out of bed, partly due to their serious physical condition, but also because the space is so crowded that it is impossible to “take a stroll”. Still, let’s try to take a stroll in these halls, as relatives do during visits. The first thing you notice is the nauseating smell, which is not due to medical substances, but the filth that gathers under this “sea of beds”, in the corners, on the walls and everywhere, also on the bodies of the patients, and not because they are “dirt bags” – like some people want to make believe. Fact is that the so-called “hygiene facilities” consist of a single bath tub, in which a porter or nurse tries to wash, as much as possible, the most healthy patients (the problem is that the same porters are also supposed to keep the hall clean, whose floor is close to invisible), two small and cracked sinks with “constipated|” taps and two toilets, where the cleanest thing around is the toilet brush. The window panes are usually broken, but even if not, the rotten window frames are so drafty that even the most fierce hygienists will stay away.
The patients are put into beds randomly, not taking into account the gravity of their affliction or the degree of contagiousness of their illness. Here are crammed together all text book cases of pathological medicine and surgery, the patient with heart failure next to the one with infective diseases and to the person who got mangled in a car accident. Often the lamentations of the severely sick would mix with the curses of the healthier patients and of those who are forced to work in this pigsty. In this situation the less sick patients look around, astounded and scared, not only of the sickness which has struck them, but of the thought about what kind of care they will receive in this place: those who are not yet too sick can sign and quickly discharge themselves, and every now and then screens are put up, as means of guaranteeing privacy, or rather hypocrisy, and block the agony of those patients “for whom nothing can be done anymore” from the view of others.
But let’s leave this sad situation aside, here are the doctors on their round, arriving in a single file in hierarchical order, to lift up the spirits of the sick, waving their coats in graceful slaloms around the beds, trying to find their way out of that maze; they stand strictly in front of everyone, “examining”, giving instructions, transferring or discharging, everything within half and hour. After that they disappear like ghosts, leaving one of them behind, the one “on duty”. Those patients who have been admitted to a university clinic, receive all their treatment in this half an hour. For the sake of clarity, we will not follow the ‘unselected patients’ in their subsequent journey to other hospitals or private clinics that are ‘affiliated’ with the national health service. Instead we focus on the selected patients, or rather, the guinea pigs. At this point it becomes important to understand why they have been chosen.
There is no doubt that the patients who arrive at the emergency department should have an accurate examination by a specialist, also because their pathologies are the most varied. They should be transferred for recovery to the hospital or the most adequate department immediately. The workers of the Collective have therefore proposed the destruction of the ‘admission halls’, also because of their function as a selection centre for the research departments: in their place the emergency department should be expanded, together with an integrated triage centre, so that the patient who has just been examined can be transferred to the right clinic and receive better care there. All this would require to oblige the ‘gentlemen doctors’ to actually care for the patients and the transformation of the university clinics into hospitals where patients could receive prompt and specialised treatment (there is no reason why the enormous potential of the Polyclinic should not be exploited, given that it houses all medical and surgical specialisations). But this is exactly what would clash with the interests of the barons, which is why they willingly leave the admission halls under the administration of the Pio Institute; this means that they leave the burden of actual care to their hospital colleagues (mainly in the emergency departments, where one has to face one’s responsibility and really get involved in the interest of the patients), but reserve the right for themselves to select those patients who are useful for research or teaching purposes from the large pool in the admission halls.
In fact, the ‘pre-selected’ patients are not admitted because they are the most serious cases or the cases with more needs than others, but on the basis of an entirely different criteria: they are chosen according to the specific research interests of the clinic in which the selecting doctor works. In these clinics they don’t accept any other patients, unless they have been ‘recommended’ from higher up. These patients may be suitable because they actually have the actual disease in question, or because it is thought that, due to their particular characteristics (they are physically fit, but socially defenceless), they can be administered substances that produce the symptoms of the disease. The comrades of the Collective said: “You become sick at work, in the factories and in the neighbourhoods while enriching the bosses. These bosses continue to exploit you even once you are in hospital. Instead of curing you, the barons use you as guinea pigs on which they can experiment with new drugs or techniques to improve their science and increase their personal fame and wealth.” (14th of January 1974)
We have reached the point where to talk about how the “proletarians of experimentation” are treated. The need to test new drugs and therapies on humans in order to approve their clinical use, and therefore their sale and marketability (in addition to the fact laboratory animals are expensive), means that human guinea pigs are chosen from among the proletarians admitted to teaching hospitals, who can be used free of charge and are easily available. In order to maintain this condition of availability and to prevent that patients gain information about the experimentations (which the law and the Geneva Conventions require) and then may refuse to undergo treatment, the hospital protects itself by “keeping secret” what is being done and by trying to convince patients that the treatment they will undergo will certainly be effective.
Drug trials are the most common way to use human guinea pigs. The simplest form is to experiment on ‘healthy patients’, meaning, on patients who don’t present with symptoms that the medication is supposed to treat, in order to “monitor” and compare the reactions to those of the patients who suffer from the respective illness. In this way they evaluate the side effects of the drug (meaning, or all undesired effects, which do not treat the condition and are unpleasant for the patient). Another way to monitor is the administration of placebos, of which only the doctor knows, while the patient is made to believe that it is a medication to treat their condition. One of the most shocking aspects of a truly inhumane medicine is that sometimes the symptoms that one wishes to study and treat are artificially induced by other drugs, without the patients’ knowledge. In fact, in these cases, patients are surprised to notice the appearance of new symptoms during their hospital stay. In other cases they adopt a so-called ‘double-blind’ approach, during which neither doctor nor patient know whether the substance that is administered by the one and consumed by the other is a drug or a placebo. It is not too difficult to imagine the consequences of this approach in cases of emergencies. Sometimes this technique is further “refined” (so to speak, of course): in these cases of “truly double blind” studies, they administer randomly and always unknown to doctor and patient either the adequate drug or an antagonistic substance, which is therefore harmful. The result is that patients show slight improvement, then suddenly worsen, experiencing strange and rather unpleasant symptoms, much to their surprise and that of their families, who naively attribute them to indigestion or food poisoning: which is a thing that happens rather frequent at the university clinic and which the Collective has denounced many times (10th of August 1972). [3] In these cases the patients prefer to wait until the relatives have brought something decent to eat from home [4], only to become even more distressed when they notice that also the better food is not able to alleviate their suffering.
This type of “clinical research” involves the interests of the monopolistic corporations of the chemical-pharmaceutical sector (primarily multinationals), which is directly related to those of the barons. The latter, using their careerist doctors as foot soldiers, endorse (in exchange for often ‘clandestine’ payments and other favours) the validity and therefore ultimately the sale of particular drugs. In turn, pharmaceutical companies play a leading role: they provide clinics with funds, equipment and bibliographic services, as well as ensuring the publication of research results in so-called “scientific” journals, thus guaranteeing doctors those precious publications that are in fact the only way to advance their careers and to “make a name for themselves”, as they say. (Needless to say, these drugs invariably prove miraculous, even when it is easy to see the emptiness behind typical phrases such as “although not definitive, we feel confident in saying that product XY has opened a new chapter in the treatment of WZ”.)
Another sector that has equally important economic interests in the “research” is that of the scientific appliances manufacturers for whose equipment the hospitals pay hundreds of millions of Lire every year, even if they end up not being used at all. In many of the laboratories you can admire expensive diagnostic or research equipment which are only wheeled out and shown to the occasional foreign or native guests, as a proof of the elevated technical level that has been reached at Italian universities. The most shameful aspect is that in many cases this equipment could even be used adequately for clinical purposes, meaning at the service of the health of the patients, but this doesn’t happen due to the lack of adequate structures and of qualified staff who could make this equipment work; while, in fact, the university and National Research Council (CNR) are – or at least were – ready to expand the funds necessary to acquire these machines (we are talking several millions of Lire here), they are absolutely unwilling to hire new staff or to renovate the departments, saying that this doesn’t fall within the range of their competency. Thereby they postpone everything to the fateful “university and health reform” (we should point out that those people who decide about reform are the same people who call the shots in the university and in the superior research institutes). Thus, while the barons readily indulge the interests of those who invest their capital in the production of scientific equipment [5], they are much less inclined to indulge the interests of the proletarian patients who could benefit from it (it should also be noted that, since the personnel who could operate such equipment are often found in private clinics, after a while these machines are also… diverted to private clinics). However, even proletarian patients may come into contact with new equipment when it is used in operating theatres – needless to say – for research purposes, or to enable the development of new diagnostic or surgical techniques. In these cases, medical interventions that normally take one or two hours maximum are prolonged hour by hour, until the experiment is finished. During surgery, patient-guineapigs are often subjected to risky procedures, their bodies are artificially pushed to the limits of their vital capacity, their cavities are explored with special measuring instruments or probes, and foreign substances are introduced, such as contrast media, radioactive substances, drugs, probes and everything else that “science” has made available to doctors. All of this doesn’t contribute to a speedy recovery of the patients, who, amongst other things, had to undergo hours and hours of additional anesthesia. The alarmed relatives, who fear for the worst, gather outside of the surgical theatres are immediately sedated by phrases of the doctors, such as: “Don’t you worry, everything went as planned” (meaning, according to the research program). “She is in good hands, we will return her to you as good as new”. Sometimes they return patients dead, or “asleep”, as they say when people end up in coma.
The fatality and class
But, as we know, things don’t always turn out fine: in this case we deal with fatality, this damned fatality which, due to the ignorance in which people are kept, is believed to be purely accidental. This ignorance has served for centuries to justify the bad faith and contempt for the lives of others that doctors have often displayed. “The errors of the doctors are covered by two metres of earth”, is a common saying amongst nurses. On the other hand, one wonders how people are supposed to be able to know about the way that sick people are often made use of. You would have to be able to know how to read between the lines of the various “scientific” publications of the surgical clinics in order to become aware of what is happening. Certain results and certain information can not be obtained in any other way. But unfortunately most people don’t know how to do that, at the most they will think that the interventions that “went badly” will have been done by inexperienced doctors, who, as we know, “must be able to learn and practice”. Actually, the reason for these failed interventions is hardly ever the inexperience of the young, but the indifference of the established doctors, the knowledge that the skin is not yours and even less of your class. Because if people of your class are operated on at the university clinic, you won’t do certain things to them and you better take care not to make any errors. If we deal with just anyone, with a proletarian, then everything is permitted, even the “tragic errors”, as it happened in the case of the young proletarian Anna Maria Protasi, who had been killed in August 1973 by two high-ranking butchers (Malizia and Buonaccorsi). These are two ‘professors’ who would fail students in their exams because they cannot describe a simple procedure such as a tracheotomy, which is precisely what killed Protasi.
Also in this case the workers of the university clinic take on the responsibility of denouncing at court what had happened, because, as they explain in a leaflet, after the arrest of the two ‘butchers’, “us workers have understood that those incidents that the bosses want to let pass as ‘normal’ are nothing else but intentional homicide, which are the result of the exploitation of workers through which the bosses continue to grow rich […] We want to emphasise that A.M. Protasi has been killed because she is a proletarian, someone who can be treated as a guinea pig without further qualms. A similar thing would not have happened to an ‘important’ person, for example the daughter of Vicari, former chief of police and wife of Becelli, director of the emergency department […] all barons to prison!” (4th of November 1973) The workers then explain in a leaflet of ‘counter-information’ that the surgery has been a very simple procedure (‘a simple intervention’). After having analysed the different phases of the fatal surgery and the errors that had been made by the two doctors [6], they show that the two had not only acted in negligence, but that they had falsified the surgical notes in order to hide what had happened. This time the legal complaint has concrete results: the two doctors were sent to prison. Unfortunately they stayed there for only a short time [7], because the whole profession stood up for these two poor doctors who had been blamed and the court was full of understanding for their “high moral standards”.
The mafia of the Order of Doctors – for the first time accused in such a direct manner – reacted very harshly, affirming in official documents that if the doctors cannot operate “in peace”, they would not enter the surgical theatres anymore. The Collective comments rightly: “In order to continue operating the doctors want immunity, a license to kill […] Facing the possibility of losing the credibility that the medical class has enjoyed up to now, they blackmail us with the threat of not operating anymore on emergency cases and not providing their ‘charitable work’ to the wider population.
In this way they only shoot themselves in the foot: the first blackmail is nothing else but failure to render assistance and regarding the second blackmail, it only revealed to the proletarians that the profession of a doctor is all about making a profit. The example from Napoli demonstrates this, where only 30 doctors had responded to an emergency call for a vaccination drive against cholera, while all the others provided vaccinations only to those who could afford to pay 5,000 Lire on the medical black market (14th of November 1973). We also want to mention that the legal complaint against the two butchers also upset the fringes of the ‘democratic’ doctors, who reacted in an esprit de corps with the other doctors, while whispering amongst each other that: “in some cases you need to take the risk, which is better than not acting at all” (one way amongst others to justify the ‘tragic’ fatalities).
For a research at the service of the masses
When the workers started their struggle for the abolition of the teaching hospital, pointing out that the research that is carried out there is profitable for the barons and harmful for the masses, and when they acted on the contradiction between care and research, such as in their proposal for regionalisation, they unfailingly met with two types of objections. The barons of the conservative type, who were interested in using the public infrastructure for their individual gains, spread their arms and said: “but research is necessary, without research there is no progress!”, and with that they put an end to the discussion. On the other hand, the barons of the revisionist kind, together with scientists and the ‘left leaning’ and more ‘modern’ and ‘progressive’ administrators, criticised the workers for not understanding the importance of overcoming the ‘low level’ of research in Italy, which was dominated by the interests of the multinational pharmaceutical companies; this overcoming would need more state investment, more modern technology and… more sacrifices on the part of those who would then make this technology work or be subjected to it, without being able to question its aims and results. Facing these objections the workers made clear that their struggle is neither motivated by a disinterest in research nor by their interest in perpetuating the dependence of this sector of the Italian economy on the monopolistic international capital. The workers were against the ‘specialisation’ of research, against the fact that it existed separate from care, because the “scientific disinterest [impartiality] of the research sector” means nothing else but the disinterest in the sick person. This has widely recognised consequences: researchers see the sick person as a vehicle of a pathological phenomenon, rather than a human being with their own complex experience; the sick person is treated like a guinea pig; research only deals with specific illnesses, which have to be complex (so that they can become a yet uncovered subject for scientific papers, sufficiently sophisticated and elegant for academic dissertations, which are the jumping board into future university posts) and frequently affect the upper levels of society (so that later on the adjusted treatment can be used in the clinics that are attracting the rich).
All this constitutes a “progress” that is based on the exploitation of the masses and that keeps the workers in a subordinate position. The progress that the proletarians are fighting for is different. Research has to serve an improvement of care [8], it therefore cannot be harmful; and in order to be a vehicle of progress it has to be based on these two fundamentals: the care needs of the masses and the development of the intellectual knowledge of the workers. Therefore only those forms of research are progressive that put the health needs of the proletarian masses first and which analyse, beyond the clinical causes, the social reasons of those illnesses that are the most common cause for death or invalidity amongst the working population. In order to achieve this goal the entire health care system, first of all the services related to universities, have to follow the workers into the neighbourhoods and factories, where their oppression takes place, ideally before this oppression transforms into ‘illness’. If they move in this direction they will notice quickly that the “advantages of modern technology” could find applications for much more useful goals than those that are pursued currently. For example, instead of immobilising large amounts of capital for the construction of very expensive machinery which the hospitals use to diagnose incurable illnesses that the worker already suffers from, it would socially be much more useful to direct this type of research towards the construction of machines that serve the struggle against the harmful working, housing or transport conditions, so that the workers don’t become sick in the first place. [9]
Secondly, we can call those forms of research progressive which develop the scientific knowledge of the masses, in particular of the workers employed in the health sector and which breaks with the corporatist structure of the medical caste. Within this structure only the barons are considered to be custodians of science, only doctors know the significance of what the barons do (and certainly only those who do research, not all the ‘others’ who only engage in medical care). And the workers are supposed to administer medication of which they know neither aims nor effects; they are supposed to handle equipment whose purpose they don’t understand etc.. Let’s not mention the patients who are not supposed to understand their illness in order to remain ignorant about what is done to them.
All this is happening not because it “would be too complicated to explain these things to people who didn’t have sufficient education in order to understand them” (as a baron would say immediately), but because research is done in a way that is better kept hidden, and the best way to avoid that anything gets leaked to the public is by surrounding oneself with people who “don’t understand where the problematic issue is”. It is clear that the patients together with the nurses and porters can only judge whether the hospital system acts in the interest of the popular masses or of the barons once they know what is happening within research and experimentation.
In fact, often the nurses and porters, given their experiences on the wards (which the doctors lack), become alarmed about the sudden deteriorations of patients and the ‘tragic fatalities’ and doubtful about the efficacy of the ‘newly discovered remedies’ that are being administered to the patients’. As soon as they become daring enough to criticise the medical practice of the doctor – being moved by a strong sense of responsibility – and to oppose treatments that are harmful, they are accused of wanting to exercise a profession (a medical one, in fact) that they don’t possess the ability for. They are reminded in a threatening manner that the law protects professional confidentiality. In this way the doctor can continue “experimenting”… on the skin of the patient and if anything goes wrong he will only have to answer to the superiors of his own professional caste, and not to those who have suffered the consequences.
Current research acts in two repressive ways: repression of the sick person through experimentation and repression of the intellectual faculty of the worker. The latter is supposed to keep within the boundaries of their ‘order receiving position’ (even though every day they are requested to perform tasks which exceed their formal qualification as auxiliary nurse or nurse) and to refrain from pretending that they are contributing to the development of scientific knowledge or from trying to change the direction of this development away from the direction set by the corporation. The struggle of the workers and the patients against the teaching hospital is therefore an important element of the struggle of the proletariat to do away with the capitalist relations of production in the health sector and to overcome this form of division of labour.
Footnotes
[1] The case filed at the public prosecutor’s office: Page 1. For this legal case and all other cases of the Collective, the workers could count on the collaboration with the Red Aid. This political structure of comrades from intellectual and petty-bourgeois background, moving step by step with the political development of the workers, has gained a number of experiences of mass struggle against the bourgeois state, which have subsequently become the base for discussions and verifications in other parts of the movement.
[2] Text of the legal charge, p.10 – the italics have been added by the authors
[3] On the 9th of November 1973 the Collective denounced “the large-scale speculation that happened within the goods management of the Pio Istituto Di San Spirito. This means that all the produce from the Pio Istituto estates, even if it is of the poorest quality and completely unsuitable for feeding the sick, is accepted en bloc by the dispensaries of the various hospitals, based on the usual corrupt recommendations. If we consider that more than 3,000 lire are allocated for each meal, it is easy to understand how many profiteers are shamelessly enriching themselves by feeding the sick rubbish that is not worth more than 500 lire. It should be noted that the occasion for this complaint arose from a further reduction in the quantity of food: “there are some wards where food for 10 has to be enough for 20”.
[4] And also here there is another case of speculation in the making. The relatives will find it comfortable to make up for the “lack” of food at the university clinic by buying something at the only bar close to the hospital, but this bar, due to its privileged ‘monopolistic’ position, charges astronomic prices. This is why the workers have requested “that a bar should be opened inside the hospital, controlled by the workers and patients, where food is sold at cost price to prevent that it becomes another business opportunity, and therefore an opportunity for exploitation. Obviously, this goal is relatively small in comparison to the more complex project that we are putting forward. But it would already demonstrate to all those who have always used the hospital for their own profit that the autonomous organisation of workers is becoming stronger and that our control regarding all the disgusting business that they are engaged in is unrelenting” (Leaflet from the 14th of January 1974)
[5] Often the barons themselves are share-holders of the factories that produce this equipment, which they then manage to sell thanks to the “scientific” opinions they “disinterestedly” provide in the exercise of their profession. For example, “Montecelli operated on a scoliosis on TV and on the following day the prices of the orthopaedic equipment increased. This equipment was manufactured by a company that he is a shareholder of.” (from a leaflet of the Collective from the 15th of June 1976)
[6] During the operation the spine was impacted and the spinal cord injured. (14th of November 1973)
[7] In May 1976 the judge Trivellini referred only Buonaccorsi to trial and requested Malizia’s acquittal! After the workers’ mobilisation, the deputy attorney appealed this decision. (leaflet from the 28th of May 1976 by the Collective)
[8] This has an impact on the actual structure of the training of doctors. Given the social goals of the capitalist medical system, the medical students only frequent the teaching clinics and therefore practice in single-disease wards. They don’t become used to dealing with all kinds of illnesses that appear normally in the wider population (which are therefore those that we should treat) and thereby they learn to separate the illness from the social existence from which it emerged. Amongst other things, the abolition of the teaching hospitals would entail the integration of research and care in all hospitals.
[9] It is necessary to be very clear about this proposal of prevention and the treatment for proletarian diseases. The workers’ demand to pose the health of the proletariat as a main criterion for medical research is an aspect of the ‘class autonomy’ and part of the struggle against the interventionist politics of the state in favour of capital. This has therefore nothing to do with the mystifying revisionist affirmation according to which the public health sector, once ‘reformed’ and in the hands of a democratic administration, would privilege a strategy of prevention because it would have the general interest of the people at heart, while the private sector would only occupy itself with the particular interests of the capitalists and therefore with medical treatments. These are only words: in our society, with its close integration of public and private capital, both prevention and cure figure in the politics of capital for the reproduction of ‘its’ work force, catering to the particular needs of the economic cycle. When capital requires a simple and easily available work force and when there is a large industrial reserve army, it won’t be interested in prevention (and often not even in the cure) of proletarian illnesses, and the public health care would be abandoned. But monopolistic capitalists, which cultivate their working class in order to bind it to themselves, can have an interest in preventing illnesses or in providing better health services in order to avoid other reproduction costs of that precious work force. In this case they exercise pressure on the state to implement a ‘health reform’, which adjusts to the new interests of capital, which do not only concern the ‘health’ of the workers, but better conditions for their ‘exploitation’. Thus, the revisionist perspective completely ignores the question of the harmful living conditions in the popular neighbourhoods. Because the speculators and construction companies have already realised their profits, no one is interested in the prevention of illnesses of those who will inhabit these neighbourhoods.
