Jacques Attali: Medicine Under Prosecution (from Future Li

Jacques Attali: Medicine Under Prosecution
From: Future Life, Michel Salomon, ed (Macmillan, 1983, original title 'L'avenir de la vie' (1981)

"Em Wunderkind," the Germans would say—a child prodigy. At less
than forty years of age, Jacques Attali is an economist of international
reputation, a professor, a political adviser much heeded by the Socialist
Party, and a versatile writer—the author not only of theoretical works
in his own discipline but of noted essays in such various fields as
politics, music, and, recently, medicine. The book that he published in
the fall of 1979, The Cannibalistic Order or the Rise and Fall of Medicitie,
refueled the debate in France not only about the therapeutic act but
about all the existential problems, from birth to death, that underlie
medical care in the West.
What makes Attali run?
For his friends, so much energy expended in so many directions at
once is disconcerting. For his enemies—and he has many of them, because
of his political opinions, despite his amiable personality—this
very gifted man is suspect. Rooted in the soil of reason, of measun
the "juste milieu," the establishment has always been distrustful ^\ intellectuals.

Jacques Attali, with his excesses, his outrageousness, his constant,
feverish questioning, is no doubt disturbing. But in these times of crisis,
don't we do well to be more "bothered" than reassured?
M.S. Why have you, an economist, taken such a passionate interest
in medicine, in health?
J. A. In studying the general economic problems of Western society,
I found out that health costs are among the main factors in the
economic crisis. The production and maintenance of consumers costs a
lot—even more than the production of the commodities they consume.
People are produced by the services they render one another, especially
in the field of health, where economic productivity is not growing
very fast. The "productivity of the production of machines" is
growing more rapidly than the relative productivity of the production
of consumers. That contradiction will be eliminated as health and educational
systems become more commercialized and industrialized. One
look at our economic history and it's easy to see that our society is,
more than ever, transforming craft activities into industrial activities,
and that a growing number of services are becoming mechanized.
The confluence of these two questions leads one to ask: Can medical
care, too, be produced by machines that will one day replace the
doctor?
M.S. That question seems a bit academic, theoretical. . . .
J. A. Of course. But it goes a long way toward explaining the present
crisis. If medical care could, like education, be mass-produced, the
economic crisis would soon be resolved. This is somewhat the viewpoint
of the astronomer who says: "If my reasoning is good, there is a
star there." If this reasoning is accurate, and if our society is coherent,
the logical conclusion is that, just as other functions have been devoured
by the industrial apparatus in the earlier phases of the crisis,
so medicine is becoming a mass-produced activity, which leads to the
metaphor.
Doctors are being replaced by prosthetic devices whose role it is
to repair bodily function, restore it, or take its place. If the prosthesis
tries to do those things, it behaves as the organs of the body do,
hence becoming a copy of one of the body's organs or functions. Such
devices would thus be objects destined to be consumed. In economic
language, the metaphor is clear: it's cannibalism. The body is consumed.
Beginning with this metaphor (and I've always believed it was
the source of knowledge) I asked myself two questions. First, is cannibalism
a possible form of treatment? Second, does there exist a conSlant in the different social structures such that an accepted kind of
cannibalism, dissociated from one's experience of it and reduced to the
lowest common denominator, would be found again in therapeutic
behavior?
First, cannibalism can be seen, on a wide scale, as a basic therapeutic
strategy. Second, it seems that all strategies for healing a disease consist
of a series of operations carried out by the body itself but also by
cannibalism, and that one finds in all these strategies the following:
selecting the signs that one is going to observe; monitoring them; denouncing
what is going to break the order of those signs, what one
calls Evil; negotiating with Evil, separating Evil from the rest. All healing
systems employ these operations: selecting the signs, denouncing
the Evil, watching, negotiating, separating. These different operations
are equally applicable to political strategy: selecting the signs to be observed;
watching them closely; denouncing the Evil, the scapegoat, the
enemy; and driving him away. There are very profound connections
between the strategy followed to combat an individual Evil and the
strategy employed against a social Evil. This is what made me think,
basically, that the distinction between social Evil and the individual
Evil was not a very clear one. These various fundamental operations
apply to different historical periods, to different conceptions of disease,
of Evil, of power, of death, of life, and thus of what identifies the
Evil—and effects the separation. In other words, the operations and
the roles are the same, but the actors who play those roles are different.
And the play does not always last the same length of time.
M.S. From that to a theory founded on historical or mythical cannibalism.
. . . Your essay upset and shocked not just doctors but the
patients that we all are, potentially. In short, public opinion. . . .
J. A. That essay tries to do three things. First, to recount an economic
history of Evil—a history of its bearing on disease. Second, to
show that there are, in a wav, four dominant periods and hence three
great crises between which the see-sawings of the system are structured,
and that each see-saw motion affects not only the healer but the
very conception of life, death, and disease. Third, to show that these
see-saw motions concern the signs and not the strategy, which remains
cannibalistic, and that in fact we begin with cannibalism only to return
to it. In short, industrial history can be interpreted as a machine for
translating basic cannibalism—the first relation to Evil, wherein people
eat people—into industrial cannibalism, where people become commodities
that eat commodities. Industrial society would appear to function
like a dictionary going through three different stages of translation
and thus resulting in intermediate languages—in a sense, four major
languages. First there is the basic order, the cannibalistic order. It is
here that we find the first gods appearing as cannibals; and in the myths
that follow, historically, the cannibal gods eat one another. Then it becomes
frightful for gods to be cannibals.
In all the myths I have studied, within different civilizations, religion
serves to destroy cannibalism. For cannibalism, Evil is the souls of the
dead. If I want to separate the souls of the dead from the dead, I must
eat the bodies—because the best way of separating the dead from their
souls is to eat their bodies. Thus, the idea of separation is fundamental
to cannibalistic consumption. That's the point I wanted to make: Consumption
is separation. Cannibalism is a formidable healing force for
the power structure. Then why isn't cannibalism practiced anymore?
(What I am about to say is evident in the myths. And in my essay I
put forth an interpretation both of Girard's work on violence and of
Freud's Totem and Taboo, in which he sees the totem and the totemic
meal as basic, with the totemic meal disappearing into sexuality.) Well,
from the moment I say that eating the dead permits me to live, I'll find
some to eat. Thus, cannibalism is healing, but it also leads to violence.
And it's in this way that I try to interpret the transition to sexual taboos,
which are always the same as cannibalistic taboos. Because it's
evident that if I kill my father or my mother or my children, I'm going
to stop the reproduction of the group. And yet they are the easiest to
kill, since they live next to me. Sexual taboos are secondary to food
taboos.
Next comes ritualization, the religious dramatization of cannibalism.
In a sense, one delegates, represents, sets the scene. Religious civilization
is a dramatization of cannibalism. The signs one observes are
those of the gods. Illness is possession by the gods. The only sicknesses
one can observe and cure are those of possession. Healing, finally,
is expelling the Evil—and the Evil, in this case, is the Devil; that
is, the gods. And the principal healer is the priest. There are always
two healers on duty. The denouncer of Evil and the separater—people
we will later encounter under the guises of physician and surgeon. The
denouncer of Evil is the priest, and the separater is the practitioner.
On the one hand, I tried to show that Christian ritual is basically
cannibalistic. The texts of St. Luke on "the bread and wine," which are
"the body and blood of Christ"—and which, if one eats them, give
life—are cannibalistic texts and, of course, therapeutic. There is a medical,
and at the same time cannibalistic, reading of those texts that is
fascinating.
next tried to recount the history of the Church's relation to healing,
and to show little by little—around the twelfth and thirteenth centuries—
the emergence of a new system of signs. Illnesses come not only
from the gods but from the bodies of humans. Why? Because the economic
organization is beginning. People are emerging from slavery.
The dominant diseases are epidemics, which begin to circulate like men
jnc\ commodities. The bodies of the poor transmit disease, and correlation
between poverty (which didn't exist before, because almost
everyone was either slave or seigneur) and disease is absolute. From
the thirteenth to the nineteenth century, to be poor or sick meant the
same thing. Hence, the political strategy with regard to the poor and
the sick was the same. When one was poor, one got sick. And when
one was sick, one got poor. Disease and poverty did not yet exist.
What did exist was to be poor and sick. And once the poor or sick man
was designated, good strategy consisted in separating him from others,
containing him, not healing him but destroying him. In French texts,
this was called "confining"
—
enfermement in Foucault's vocabulary.
People were confined in various ways: the quarantine camp, the lazaretto,
the hospital, and, in England, the workhouse. The Poor Law and
charitv were not means of helping people but means of designating
them as such, and containing them. Charity was merely a form of
denunciation.
M.S. The policeman took the place of the priest as therapist.
J .A. That's right. Religion withdrew and assumed power elsewhere
because it could no longer claim the power of healing. Of course
there were already doctors, but their role was limited to providing consolation;
for proof of this, we have only to remember government authorities,
very astutely, still did not recognize the doctors' diplomas.
The political power structure considered its principal therapist the policeman,
not the doctor. For that matter, in the Europe of the time,
there was only one doctor for every 100,000 people.
But now I come to the third period, when it was no longer possible
to confine the poor because they were too numerous. They had, on the
contrary, to be supported and maintained because they had become
workers. And so they stopped being bodies and became machines. The
signs one observed were those of machines. Illness, Evil, took the form
of a breakdown. Clinical language isolated and objectified the Evil to
an even greater extent. Thus, Evil was designated, separated, and
expelled.
During the entire nineteenth century, with public hygiene as a new
means of control, the new binds of repairs, and the new distinction
between doctor ,\iu\ surgeon, the policeman and the priest were replaced
by the doctor.
M.S. And today it's the doctor's turn to fall into the trap. . . .
J. A. Today, the crisis is threefold. On the one hand, as in the
preceding period, the system can no longer assure its own proper
functioning. Today, for the most part, medicine is incapable of treating
all diseases because it costs too much.
On the other hand, there has been a loss of faith in the doctor. People
have much more faith in quantified data than in the doctor.
Finally, we witness the emergence of diseases and forms of behavior
that no longer respond to the methods of classical medicine. These
three characteristics lead to a kind of natural contiuum that moves from
clinical medicine to prosthesis. And I have tried to set forth the three
overlapping phases in that transformation.
In the first phase, the system tries to endure by monitoring its financial
cost. But that leads to the necessity of monitoring behavior and
hence of defining norms of health and activity to which the individual
must adhere. Thus the notion of an economical profile of a healthy life.
From that, we go on to the second phase, which is that of self-diagnosis
of illness (which corresponds to the designation of Evil) thanks
to the tools of behavioral self-control. The individual can thus conform
to the norm and become autonomous with respect to his illness.
The principal criterion of behavior was, in the first order, to give
meaning to death; in the second order, to contain death; in the third
order, to increase the hope of life; and in the fourth, that in which we
live, it's the search for an economical profile of a healthy life.
The third phase is marked by the appearance of prosthetic devices
that make it possible to designate the illness (Evil) in an industrial context.
Thus, for example, electronic medication such as the pill coupled
with a microcomputer makes it possible to release in the body, at regular
intervals, regulating substances.
M.S. In short, health care, with the appearance of these electronic
prosthetic devices, will be the new driving force of industrial
expansion. . . .
J. A. Yes. In conclusion, all the traditional concepts disappear:
production and consumption disappear, life and death disappear, because
the prosthetic device makes death a fluid event. . . .
I believe that the important thing in life will no longer be to work
but to be in a position to consume—to be a consumer among other
machines of consumption. The dominant social science up to the present
has been the science of machines. Marx is a clinician because he
designates the illness—the capitalist class—and eliminates it. In a way,
he says the same thing as Pasteur. The dominant social science of the
future will be the science of codes—data processing plus genetics. My
book is a book about codes, because I try to show that there are successive
codes: the religious code, the police code, the thermodynamic
code, and today the data-processing code and what is called sociobiology.
M.S. Does your thesis lead to a concrete approach to medicine,
even in the long run? Does it constitute the beginnings of concrete
ideas by an economist and politician on the organization of the medical
profession and medical practice?
J. A. I don't know. For the moment, I don't want to ask myself
that question. I believe that the first thing I wanted to show—the only
thing—was that healing is a process in full evolution toward a model
of organization that has nothing to do with the present one, and that
we have a choice between three types of attitude: to preserve the practice
of medicine as we have known it; to accept its evolution and see
that it is the best possible, ensuring equal access to prosthetic devices;
or to rethink our view of illness entirely, in order to arrive at an acceptance
of death and an awareness that the urgent thing is not to forget
or delay or await death but to want life to be as free as possible. I think
that people will eventually have to choose from among these three solutions;
and I want to show that, in my opinion, the last one is the
trulv human choice.
M.S. That's social utopianism. It's sometimes dangerous to be
Utopian. . . .
J. A. Utopianism can take two different directions, depending on
whether we are talking about Utopia as a dream of an absolute, in which
case the dream is one of eternity, or as something that has never taken
place in which case we then try to see which type of Utopia is most
likely to be achieved. I believe that if we want to understand the problem
of health care, we must realize that there are realizable Utopias.
The future is necessarily a Utopia; and it's very important to understand
that it need not be fraught with danger, because to talk about
Utopia means to accept the idea that the future has nothing to do with
merely continuing present tendencies.
I would even say that all futures are possible but one: the continuation
of the present situation.
M.S. Is the future you postulate one in which a whole panoply
of drugs will help man tolerate his condition?
J. A. I'm frightened by the fascination with drugs that reduce
anxiety. People are trying to find ways to make anxiety bearable instead
of trying to learn how to stop feeling anxious.
The medications of the future that are tied to behavior control could
lead to political difficulties. It might be possible in fact to reconcile parliamentary
democracy with totalitarianism. For totalitarianism to take
hold, we would need only to maintain all the formal rules of parliamentary
democracy but at the same time to generalize the use of those
drugs.
M.S. Does that seem possible—an Orwellian 1984 based on a
pharmacology that would control behavior?
J. A. I don't believe in the Orwellian model of technical totalitarianism
with its visible and centralized Big Brother. I believe, instead, in
an implicit totalitarianism with an invisible and decentralized Big
Brother. Those machines that keep watch on our health, that we could
use to our good, will enslave us for our good. In a way, we will undergo
a gentle but permanent conditioning.
M.S. How do you envision twenty-first century man?
J.A. I believe that we must make a very clear distinction between
two kinds of twenty-first-century man: the twenty-first-century man of
the rich countries, and the twenty-first-century man of the poor countries.
The former will certainly be a man much more anguished than
he is today, but he will find the answer to the pain of living in passive
flight, in antipain machines and antianxiety machines, in drugs; and
he will try to live a commercialized form of the good life, no matter
what the price.
But I am convinced that the great majority of people, who will know
about machines and life-style of the rich but will not have access to
them, will be very aggressive and violent. From that distortion will
arise enormous chaos, which will be expressed either by racial wars or
by the immigration into our countries of millions of people who want
to share our way of life.
M.S. Do you believe that genetic engineering is one of the keys
to the future?
J.A. I believe that in the next twenty years genetic engineering
will be as banal, well known, and commonplace procedure as the internal
combustion engine is today. The analogy is, in fact, particularly
apt.
The internal combusion engine presented us with two options: either
to favor public transportation and facilitate people's lives, or to produce
automobiles—tools of aggressiveness, of consumption, of individualization,
of solitude, of stockpiling, of desire, of rivalry. . . . The
second option was chosen. I believe that genetic engineering occasions
the same kind of choice, and that unfortunately the second option will
again be chosen. In other words, genetic engineering could pretty much
create conditions under which humanity could either take responsibility
for itself freely but collectively, or else devise a new commodity,
genetic this time, made up of copies of people sold to people, of chimeras
or hybrids used as slaves, robots . . .
M.S. Is it possible and desirable to live 120 years?
J. A. Medically, I know nothing about it. I've always been told
that it is possible. Is it desirable? First, I believe that the industrial system
in which we find ourselves no longer sees an increase in life expectancy
as a desirable objective. Why? Because increasing life
expectancy only makes sense if the human machine's threshold of profitability
is similarly increased. But as soon as a person gets to be older
than sixty or sixty-five, and his productivity and profitability begin to
slip, he costs society dearly.
Hence, I believe that the very logic of the industrial society will require
that the objective no longer be to prolong life expectancy but to
see to it that man live in the best way possible—but with health care
expenses as reduced as possible for the sake of the collective. Then we
witness the emergence of a new criterion for life expectancy: the value
attributed to extending life expectancy will not be as great as that placed
on maximizing the number of years a person lives without illness, and
particularly without hospitalization. Actually, from the viewpoint of the
cost to society, it is much preferable that the human machine abruptly
stop functioning than that it deteriorate very gradually.
This is perfectly clear if we remember that two-thirds of all healthcare
expenses are incurred during the last months of life. Likewise, all
cvnicism aside, health-care expenses would not reach a third of the
present level (175 billion francs, or about $35 billion, in 1979) if people
all died in automobile accidents. We have to recognize that logic no
longer resides merely in increasing life expectancy but rather in increasing
life expectancy without illness. I think, however, that expanding
life expectancy remains a fantasy that serves two purposes, the first
of which is mainly a question of self-preservation of the power elite.
The more totalitarian or centralized societies tend to be run by "old"
men, and are in fact "gerontocracies." Secondly, capitalist society hopes
to make old age economically profitable by making old men solvent.
Right now the elderly are a "market," but not a solvent one.
This all fits in very neatly with the view that man today 18 no longer
important as a worker but as a consumer (because he is replaced by
machines in the workplace). We see very well how the big pharmaceutical
companies operate today in relatively egalitarian countries
where retirement is adequately financed. They take aim at their target
and favor geriatrics, at the expense of other fields of pharmacological
research, such as tropical diseases. Thus, the technology of retirement
determines the acceptability of increasing life expectancy.
For my part, as a socialist, I am against the increasing life expectancy,
because it's a decoy—a false problem. I believe that posing this
type of problem enables us to avoid more essential questions such as
how we go about freeing our time in the present. What is the use of
living 100 years if all we gain is twenty years of dictatorship?
M.S. The world to come, "liberal" or "socialist," will need a revamped,
"biological" morality—an ethical code to cover cloning or euthanasia,
for example.
J. A. Euthanasia will be one of the essential instruments of future
societies. Socialist logic is based on freedom, and the exercise of the
most basic freedom is suicide. The right to commit suicide, directly or
indirectly is an absolute value in this type of society. In a capitalist
society, machines for killing, prosthetic devices that make it possible to
eliminate life when it has become too unbearable or too expensive to
sustain, will be used routinely. Euthanasia, whether an expression of
freedom or a commodity, will be one of the givens of the future.
M.S. Will the citizens of tomorrow be conditioned by psychotropic
drugs and subjected to manipulations of the psyche? How can
we guard against this?
J. A. The best way to protect ourselves is to educate ourselves
and increase our scientific store of knowledge. We will have to ban a
great number of drugs. But perhaps the point of no return has already
been passed. . . .
Isn't television, for that matter, an abused drug?
Hasn't alcohol always been an abused drug?
The worst drug is the absence of culture. People want drugs because
they have no culture. Why do they seek alienation by means of drugs?
Because they have become aware of their impotence, their inability to
live, and that impotence is expressed concretely in a total refusal of life.
An optimistic bet on man would be to say that if man had culture,
in the sense of tools for thinking, he would be able to escape solutions
that only aggravate and deepen that impotence. To grasp this Evil by
the root is to give people a formidable instrument of subversion and
creativity-
I don't believe that the banning of drugs will suffice. If we don't
attack the problem at its root, we shall inevitably become enmeshed in
the machinery of the police state, and that's worse.
M.S. How are we going to handle mental illness in the future?
J. A. The evolution of medical practice as regards mental illness
will occur in two phases. In the first phase we will still rely on drugs,
psychotropic ones, which have meant real progress in the treatment of
mental illness during the past thirty years. In the second phase, and
for economic reasons, we will begin to rely more on electronic means
oi treatment—either to control pain (biofeedback), or provoke psychoanalytic
dialogues (a data-processing system). This will then lead to
what I call "the explicitation of the normal." That is, the electronic
apparatus will make it possible to define the normal with precision,
and to quantify social behavior, which will then become economically
consumable because the means and criteria for conformity to norms
will exist. In the long run, once a given mental illness is conquered,
the temptation to conform to a "biological norm" will condition the
functioning of social organization.
Medicine reveals to us the evolution of a society that will orient itself
toward a decentralized totalitarianism. The desire, conscious or unconscious,
to conform as much as possible to social norms is nothing new.
M.S. Will forced normalization govern all the realms of life, including
sexuality, since science now makes possible the almost total
dissociation of sexuality from conception?
J. A. I think that we will go very far in that direction. The production
of people is not yet a market like any other. But following the
logic of my general reasoning, I can't see why procreation should not
become one. The family, or the women, thus becomes a means of production
of a particular object, the child. One can, in a way, imagine
"wombs for rent"—something already possible, technically. This notion
corresponds perfectly to an economic development in which the
woman or the couple will take part in the division of labor and in general
production, making it possible for people to buy children as they
buy peanuts or a television set.
If, on the economic plane, the child is a commodity like any other,
society will in turn consider it such, but for social reasons. The survival
oi the collective depends upon a sufficient pool of people. If, for economic
reasons, a family does not want to have more than two children,
the interests of the collective will be at risk. Thus, we get an absolute
contradiction between the interests of the family and those al society.
The only way to solve the contradiction is to allow society to buy children
from the family. I'm not referring to family subsidies, which are
feeble incentives. I mean that a family would agree to have lots of children
if the state would guarantee it both the payment of progressive
substantia] allowances and specific reimbursement of all material expenditures
for each child. Under such a plan, the child would become
a kind of medium of exchange between the individual and the collective.
What I have just said is not something I take lightly or view complaisantly.
It's a warning. I believe that the world we are building
will be so frightful that it will mean the death of humankind. So we
have to be prepared to resist it; and it seems to me today that the best
way to do so is to understand and engage in the battle in order to
avoid the worst. That's why I take my reasoning as far as I can.
M.S. Resist what, since you foresee a world of prosthetic
devices?
J. A. The prosthetic devices I forsee are not mechanical but will
be used to combat chronic afflictions linked to tissue degeneration. Cellular
engineering, genetic engineering, and cloning are preparing the
way for the development of prosthetic devices that will in effect replace
defective organs.
M.S. The increasing role of data processing in society calls for a
revaluation of ethics. Do you see this increased reliance on data processing
as a threat to man's freedom?
J. A. It is clear that all the talk about preventive medicine, the
economics of health care, and good medical practice will make it necessary
that each person have his or her medical record on tape. For
epidemiological reasons, all such dossiers will be centralized in a computer
to which doctors will have access. The question arises: Will the
police have access to those records too? Sweden has this kind of sophisticated
system but does not have a dictatorship while certain other
countries do not have this record-keeping system but do have dictatorships.
In the face of new threats, we must know how to create new
procedures. Democracy has a duty to adapt to technical evolution. The
combination of old constitutions and new technologies may lead to totalitarian
systems.
M.S. One of the commonest predictions for the future is that man
will be able to exercise biological control over his own body thanks to
microprocessors, among other things.
J.A. That control, which already exists, in the form of pacemakers
for the heart, and likewise for the pancreas, should ideally be
extended to apply to the elimination or reduction of pain. Researchers
predict the perfection of little implants capable of releasing, in the target organs, hormones and active substances. If one's aim is to prolong
life, such progress is inevitable.
M.S. It seems that we are leaving an era of physics to enter <m
era of biology—something close to a panbiology. Do you agree?
J. A. I believe that we are leaving a world controlled by energy to
enter a world of information. If matter is energy, life is information.
That's why the major product of tomorrow's society will be living matter.
Thanks in particular to genetic engineering, new therapeutic, nutritional,
and energy tools will be developed.
M.S. What is the future of medicine and medical power?
J. A. In a rather brutal way, I would say that just as washerwomen
have been displaced by advertising images of washing machines,
so doctors integrated into the industrial system will become the
developers of biological prostheses. The doctor as we know him will
disappear, yielding his place to a new social category living off the
prosthetics industry: inventors, salesmen, installers, and repairmen
—
much as exist now to keep those washing machines in running order.
What I have to say may seem surprising. But I wonder how many
people are aware that the main enterprises interested in prosthetic devices
are the big automobile manufacturers like Renault, General Motors,
and Ford.
M.S. In other words, we'll no longer have any need for internists
because "normalization" will be effected by a kind of preventive medicine,
self-managed or no, but in any case "controlled." But how can
we accomplish this without resorting to force?
J. A. The appearance on the market of implements for medical
self-monitoring will create a preventive-medicine mentality. People will
adapt to conformity to the norm. Preventive measures will not have to
be forcibly imposed; people will embrace them to achieve social acceptance.
But we must not lose sight of the fact that the most important
thing is not technological progress but the highest form of commerce
among men, represented by culture. The shape society takes in the
future will be a function of our capacity to master technological progress.
Will we dominate it, or be dominated by it? That's the question.