Dansong's Angle Ticker: Patronage Politics, Cancer Nannies, Aesthetic Snake Oils
By Dansong on 29 Mar 2008 11:33 PM
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Political change beckons up north after the earthquake of an election that is reconfiguring Malaysia in more ways than one. Many would laud it as democratization; I hope it is. But here, I offer a different interpretation, partly because I am deep into writing something academic on this topic: the seismic shifting is a reconfiguration of patronage politics not democratization. Back home, two recent controversies, by Singapore standards, as the limping suspense of the escaped terrorist turns into a somewhat blasé wait for the report of the commission of inquiry, one concerning cancer research funding and the other concerning the regulation of beauty treatments by medical doctors. Yawn, perhaps they still hold some lessons?

Patronage Politics, Unusually Usual

A nice summary of Malaysian PM Abdullah Badawi's troubles appeared in the Straits Times on Friday (28/3/08, p. 6), anchored by a photo of a pensive and tired-looking Pak Lah, headlined with his resolution, "I'm not going to run away". His first trouble is "assertive sultans", as the Perlis and Terengganu rulers rejected the PM's choice of Menteri Besar and got their way of putting their preferred candidate in office. Next is "empowered opposition", with the motley crew of PAS, DAP and PKR testing the waters with vote of no confidence musings and talk of defections of UMNO-allied parliamentarians, particularly those in the far periphery of Sabah and Sarawak. The third is "UMNO infighting", with bristles from the Mahathir faction and the schismatic Tengku Razaleigh Hamzah to the unsettled grassroots rank-and-file. The last is "cabinet woes", as a third deputy minister resigns, of course, for "a very private reason". The first two said they had held those positions for too long.

Underlying these four problems could be a recalibration process of Malaysia's patronage politics, which some scholars have termed as "neo-patrimonial". Very briefly, patrimonialism refers to the traditional rule of a chief or a prince over a group of people through personal ties in which the chief offers some form of security (physical or economic) in exchange for the loyalty of the people and surplus resources produced by them. Neo-patrimonialism refers to the mixing of this traditional rule with modern political and economic institutions.

Once upon time, Suharto's regime in Indonesia was studied as an exemplary neo-patrimonial state, where lucrative government business contracts and subsidies, mining and forestry licenses, land titles and plum jobs cascaded down from the chief patron down the party-government hierarchies, from patron to client who is patron to another client until it reaches the ground of the hapless laborer or peasant, securing a stable net of captured loyalties. In such a situation, formal democratic elections are political struggles between rival patrons and political parties with formidable political ideologies favoring the hapless masses strangely fail to get much support. Interestingly, perhaps ST is discovering a spirit of irony, but more likely it is pure coincidence, a ghostly image of Suharto hovers over the page as a leader to a story of him being cleared of graft charges.



So what happened in Malaysia? A new multiracial generation of voters who are plugged into the new economy and new media and autonomous from old patronage system in Malaysia seemed to swing the elections to the progressive modernism represented by Anwar's PKR. That is why the epicenter of the earthquake took place in ultra-modern Perak and Selangor, while the swings in Penang and Kelantan still have the more parochial ethnic-political feel to them, i.e., voters choosing a different patron.

What this has done is to cause everyone in the old patronage system to reevaluate their ties and positions. The sultans, long neglected in the UMNO patronage system and pushed aside rather brusquely by Mahathir, are looking to recover their even older patrimonial powers and privileges, in what minimally constitutional way they can. Within UMNO, rival patrons are starting to jostle to replace the existing ones and loyalty suddenly becomes a currency. At the very top, the Mahathir faction represents the business elites in the party who had been targeted by Abdullah's abortive anti-graft campaign, while Tengku Razaleigh represents the old aristocratic bureaucrats pushed aside by Mahathir making their perpetual comeback. In the middle, the horse-trading over loyalties has begun; cabinet resignations are just the tip of the iceberg. Rumors of negotiations of defections make the opposition suspect, and the earlier infighting among the three parties over the state government positions also suggest that patronage horse-trading as usual is taking place. Is the opposition merely creating an alternative patronage system to replace the old one?

Unless Anwar's PKR can emerge as the dominant opposition party, I fear this is inevitable in an alliance of three equally balanced parties and when two of the three are built on alternative ethnic-patronage systems. Expanding the PKR by horse-trading for defections would not be the way to go, but there are very few options for Anwer to grow the PKR into a non-patronage-based modern political party, because of the entrenched neo-patrimonial relations between political office and control of economic resources in Malaysia. That's the limits of democratization in all Southeast Asian countries, Singapore included.

Cancer Nannies

A hint of a controversy as AStar (yes, I refuse to use the asterisk) abruptly shut down its Singapore Cancer Syndicate which had funded $75 million dollars worth of cancer research projects, one month ago (ST, 28/3/08, p. H2). The Syndicate's scientific advisory board was not even told of it until they flew here for its annual meeting on February 27. Then on Monday (March 24), 50 scientists with Syndicate-funded projects turned up to appeal the decision. AStar explained that other funding avenues are now available since the Syndicate was launched in 2002, though the aggrieved scientists protested that the Syndicate also operated as a crucial central body that nurtured promising researchers and coordinated the research. One said that dissolution of the Syndicate "could lead to factionalisation and a turf mentality", another complained of the difficulty of getting fresh grants for his project from another source, and all who spoke to ST declined to be identified "for fear of jeopardizing alternative funding opportunities".

I am not impressed. Our system is supposed to be meritocratic not patronage-based. I read "factionalisation and a turf mentality" as free competition, and I don't understand why it would be difficult to get fresh grants for an existing project if a project has strong merits and the track record of being funded by AStar for its merits. What I don't understand the most is why scientists want to be remain anonymous when making what they purport to be reasonable arguments. If your arguments are reasonable and your projects have merit, why worry about jeopardizing alternative funding? Only if we are operating on a patronage system, where one's loyalty to the patrons and would-be patrons and obedience quotient have to be maintained. Well, it is good then that AStar has shut down the Syndicate, since it seems to be promoting a very unhealthy patronage and dependent mentality among local scientists, who now need to mature from being over-feted by the nanny techno-state into globally competitive researchers. The very day of the ST report, PM Lee announced the establishment of the Cancer Research Centre for Excellence with $256 million funding to be headed by a Harvard Medical School don (29/3/08, p. 1). There you go, it's getting competitive, let's start doing meritocracy.

Aesthetic Snake Oils

Oh, the Singapore Medical Association attacks the ST for repeating the term "snake oil", used by a senior Health Ministry official to refer to aesthetic treatments by doctors (24/3/08, p. H1), as "insensitive" and calls for "more constructive reporting" (27/3/08, p. H11). If doctors are doing the right thing and not selling snake oil, then why are they are so "thin skin" about this? The Association's professional reputation has gone down a number of notches for me with this prickly letter. In the same letter, the Association lauds the clarification made by the Health Minister that his ministry is not banning the scientifically unproven treatments (25/3/08, p. H1), but is emphasizing "self-regulation of aesthetic practices by professional bodies". So, the College of Family Physicians and Academy of Medicine will draw up guidelines for self-regulation, while the Health Ministry seems to have backtracked.

Now, exactly what is this self-regulation? If it involves the mere drawing up of guidelines to send to all doctors as ethical frameworks to follow, then it is doomed to failure because there is no moral or economic incentive for doctors to follow the guidelines. The Association writes in that prickly letter, "Doctors understand that with great powers and trust vested in them by the public, come greater responsibility and accountability". Wait! What if the same public demand aesthetic services and are willing to carry the moral burden and pay a financial premium (yes, people can be irrational when it comes to their sense of body inadequacy)?

MP Lam Pin Min, member of the Government Parliamentary Committee for Health, a doctor himself, weighs in and says the use of term "snake oil" is not fair, "Our final clinical decision and recommendation is a combination of research evidence, clinical expertise and patient preference" (ST 25/3/08, p. H1). Dear Dr Lam, take note of the order of your combination, which is the right order of priority: patient preference is last and least and research evidence is paramount. And the crux of this issue here is precisely that the treatments in question here lack scientific evidence that they work, so they are snake oils until they can be proven to be medicine. I think Health Minister Khaw Boon Wan is too politic, and I support the Health Ministry senior director for health regulations who said doctors would be "asked to stop procedures unless they can provide scientific evidence that these treatments work". The public trust in doctors in not rooted in their "great powers" but in the science that their medical practice is founded upon. If I want "great powers", I will go to a spirit medium with much cheaper snake oils.

Comments (4)

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Jette:

Dansong,
Once again, appreciate your wonderfully provocative piece!
Notwithstanding your very interesting and (to an outsider like me) insighful analysis of malaysia's election, I am wondering about an assumption that you appear to have - the patronage vs meritocracy opposition. In esp. the part on ASTAR and singapore's cancel research controversy, you appear to suggest that the two systems are mutually exclusive. For example, if one's research is good and argument is reasonable, then one needs not remain anonymous and fear about offending potential patron and jeopardizing alternative source of funding. Is a meritocratic system totally devoid of social relations, and as such, one could be fearless about straining these social ties and offending people? It sounds to me, perhaps wrongly, like the idealization of free market economy. Could the social be extricated from the economic or the meritocratic? Is there really a political system or, for that matter, funding structure that could free itself from any form of patron-client relations?

Hey Jette, thanks! And as always, you've found the soft underbelly of my argument =)

As categories describing social relations and systems, patronage and meritocracy is of course idealized at an abstract level. No system can be fully free of patronage or merit-based relations; some sociologists have argued that modern social systems would not survive without a combination of the two. There are many aspects to why this is so, for one, patronage tends to promote trust, while meritocracy efficiency, and both are needed for a modern economy to work. Analogously, a complete free market economy would end up chaotic and undermine itself without government regulation. In any case, merit-based relations are still social relations, it is just that they are not dependent on the exchange of obedience/loyalty for scare resources, but based on appreciation of skills of the people involved (not the project per se in this case)

The questions are: what kind of combination would be efficacious and fulfill the general good? what kind of mechanism does a social system have to make sure the right combination is achieved and maintained? In Malaysia, substantive democratic elections between competitive parties seem to have emerge as a mechanism since the autocratic Mahathir stepped down; previously it use to be UMNO factional infighting that maintained the combination of patronage and meritocracy -- witness the cycle of corruption and clean-ups in Malaysia political history. In Singapore, the mechanism seems to be located in non-transparent decision-making processes that are concentrated in the hands of technocrats, which if one day they cease to be philosopher-kings but have become venal autocrats, then we are in real trouble. More positively, internet public opinion has emerged as an appendix to this mechanism, as the technocrats and other public bodies are now rather sensitive to reasonable commentary, though some seem to be somewhat thin-skin and react defensively.

The same questions should be applied differently to different sectors of society because the sectors have different functions and dynamics. I'd argue that in the arena of public scientific funding, the combination of patronage and meritocracy should be heavily biased towards the latter, since efficiency is more important than trust (the quality of the research does not depend on trust in the scientists, since the research can be evaluated and will be reviewed by peers). The thing about those anonymous scientists and their reactions: these seem to indicate a patronage mentality, if not patronage system, have taken hold of the funding process. And the mechanism -- AStar technocrats making decision to shut down the Syndicate -- seems to have kicked in to reconfigure the combination.

Dan,

intriguing post here, and my first since I just stumbled onto this group blog today, amid sourcing for material regarding Malaysia's internal dynamics.

Agreed that only in an ideal world can a social system be entirely devoid of meritocracy or patronage: there is always a state of flux in which ideas about which combination is maximally beneficial for the "greater good", however loaded that phrase is. Unfortunately, this intellectual battle of ideas is limited to those who do not feel overwhelming loyalty to either system and are able to evaluate objectively the costs and benefits of each type of social system. For those already deeply entrenched and have grown increasingly comfortable with the status quo, they will only seek to re-perpetuate and reinforce the existing systemic infrastructure.

There should exist some combination of both in Singapore, though most of the dialectical battling happens behind closed doors. While the AStar technocrats have, as you said, self-corrected, there exists a certain unease about entrusting these technocrats with the responsibility of ensuring that neither meritocracy nor patronage dominates. The dangers of functionalism and the "greater good" are all too obvious.

The government has grown more sensitive to such issues, but have responded rather defensively instead of being more transparent. Yes, I understand their concerns that transparency of internal disputes within the different technocratic bodies would convey insecurity and disunity, possibly resulting in loss of public confidence. Yet too sanitised a portrayal of government, where the public is insulated from internal politicking, simply reinforces the paternalistic paradigm that Singaporeans are apparently attempting to discard.

Another query: while you mentioned that what is happening in Malaysia is not democratisation but a reconfiguration of patronage politics, are these processes necessarily mutually exclusive? If the old patronage systems are being eroded by alternative ones, and if loyalty as currency (borrowing your analogy, if you may) is subject to an expanding state of flux, is it possible that a considerable proportion of people would prefer a more stable, meritocracy-oriented system in the future?

If so, that would certainly nudge Malaysia on a new path to democratisation. As we know, Southeast Asian states have remained much of an enigma to contemporary scholars in terms of their ability to maintain political authoritarianism and economic dynamism. Perhaps this is a new "path" to democratisation that has not been explored or validated yet. I would certainly not discount this possibility (maybe because I am trying to be optimistic about it).

Hey harrison,

Sorry for the late reply, been too busy for April. Public unity is usually a must to maintain a good corporate image, like you said, to maintain public confidence. I really do wonder about the sanitized portrayal of government, whether it is a portrayal at all, where there are any internal disputes of significance. My take on this is that the sanitized portrayal reflects actual reality of groupthink in the government organizations. Most of the disputes, usually over issues of minor significance, happen across rather than within government organizations. This is worrying, since technocratic groupthink is detrimental to both patronage and meritocracy, it promotes clever robots not clients or talents. Perhaps that is why the PM is so concerned with the shrinking 'talent' pool, because it is filled with clever robots, unlike the 1950s and 1960s where a much less educated population could yield more than a few good men to assist (and others to oppose) LKY in leading the country forward the way he did -- with the unintended but foreseeable consequence of creating a nation of clever robots (but relatively cheerful, no doubt). I note the current (farcical) fuss about promoting debate and alternative ideas in the PAP Forum.

Your last question is a terrific one! I recently finished writing the paper that kinda inspired this post and dealt with the same question. And I argued that it is not mutually exclusive, in fact, the reconfiguration of patronage politics is part of the process of democratization in the sense that it stabilizes the process, prevents mass politics from becoming a revolution that overturns the system and makes democratization more gradual and occurring in spurts and stops. The reconfiguration usually takes place after an institutional entrepreneur (Anwar in the Malaysian case) appears to challenge the current system and makes populist appeals to segments of the population, rousing them to the extent that the symbolic/ideological framework supporting the current system begins to break down, threatening the very working of the system itself. This would be the racial ideology that supports the race-based patronage system in the Malaysian case.

Two possibilities: (1) no democratization because the race-based patronage system is reconfigured by replacing the actors not the patronage process (everyone chickens out because of the uncertainty of change), (2) democratization because the racial ideology is displaced by a meritocratic ideology (or less racial ideology) that supports a reconfigured patronage system. The experiment that is already launched by the DAP in Penang would be very interesting. Also, the question is what the oppositional coalition would do in Perak and Selangor, the historical symbolic core of Malaya as 'the Malay states'. The response of PM Abdullah would also be significant, and his recent judiciary reform moves are very positive -- engaging the opposition by being as or more democratic than them.

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