The following articles, which deal directly with quantification in at least one significant passage, were identified as figuring on the website (www.panetics.info, no longer in existence) of the International Society for Panetics on the 12th of February 2001. Panetometric comments, by Robert Daoust, and relevant excerpts (that can be seen by clicking on the titles) are given for each article. The present document is a part of an ongoing work that is described on the webpage entitled "Quantification Research about Suffering at the ISP".

Panetometric comments - Quantities in pain and suffering can be measured in function of external stimuli or events, and of internal modulations. Some such factors are mentioned. Pain can often be measured against a direct external referent, but suffering is too primarily a product of the central nervous system to permit such a direct correspondence. Besides, an observer is influenced by empathy or non-empathy when he or she measures a suffering.

Panetometric comments - Boulding proposes an analytic quantitative tool for decision-making that would include non monetary valuation elements, such as suffering, power, security, welfare… I propose to call it the "Boulding's cost-benefit analysis". The tool would work only if no value is considered to be "absolute", and if we formally address the question of "whose" costs and "whose" benefits are to be included in the calculations.

Panetometric comments - It is suggested that decision makers should have panetic estimates of alternative courses of action, i.e. "balance sheets" showing the relationship of financial costs to human suffering (cf. Boulding's cost-benefit analysis). At the time of the siege against the Davidians near Waco, an estimation of dukkhas and financial costs made by Davis showed prophetically, according to the editor's later addition to the Davis' article, that the decision to end the siege should have been taken as soon as negotiations were at a standstill, in order to minimize both cost and suffering.

Panetometric comments - In this example of panetometric analysis by Davis, the concurrent consideration of costs in dollars and in dukkhas brings us very close to a Boulding's analysis. The basis for the dukkhas calculation is intensity level 2, 16 hours per day, for each smoker. The rationale for this intensity and this duration is not clearly stated : we are left to think that level 2 multiplied by a daily duration of 16 hours constitutes a representative "average" of the suffering endured by smokers. I wonder if this kind of averaging should be generally adopted in order to bypass the impossible task of assessing all the variations of intensity and of duration in a given problematique. There would be at least one proviso : the assumptions and operations leading to the average should be clearly presented.

Panetometric comments - In this example of panetometric analysis by Davis, dukkhas (on the basis of intensity level 3, during 15 seconds, for each person exposed to one hi-noise aircraft takeoff) are used to quantify suffering within the framework of a policy-making issue. Costs could be weighed against suffering (cf. Boulding's cost-benefit analysis).

Panetometric comments - Philosophy (or epistemology or critical study) of panetometry should take note of the view that "objective quantification for the purpose of control" may be a source of problems rather than of solutions.

Panetometric comments - In the light of Widner's suggestions about methodology (4 conditions and 4 challenges), and with some references to Saunders' suggestions about connecting people to remote causes of their suffering, Fisher examines the relevance of "decisional panetometry" to the issue of food and drug safety. A good starting point would be to work out panetic tables that describe the complexities and trade-offs of this issue.

Panetometric comments - Galtung asserts that five constitutive principles can be found in the concept of the dukkha unit.
1- Humanism or personalism (Man, or sentience, is the measure of all things).
2- Subjectivism (I am the only judge of what is my situation with respect to suffering).
3- Egalitarism (all dukkhas are equal, there is no worthy or unworthy sufferer despite widespread tendencies to affirm the contrary).
4- Impossibility for dukkhas to be averaged with a supposedly positive counterpart like the measure of pleasure or happiness (people who have reasons for suffering do not suffer less because they may have reasons for being happy).
5- Independence from theories or ideologies (ideas about causes, kinds, or roles of suffering are not taken into consideration).
First applications of the dukkha could lack accuracy, but the measure would still be of immense value because of these principles. For a critique of Galtung's views, see Striner's Quantification and Values : Error or Confusion?

Panetometric comments - Inasmuch as the prevention and relief of suffering is a paramount goal for patients and health care workers, this goal should be a criterion for decision-making, and various tables that present quantitative data about suffering should be developed to allow more humanely cost-effective formulation, selection, and improvement of options for medical treatment and health care plans. Some illustrative panetometric tables for medical purposes are given (not available in the Web versions of the articles), showing the numbers of dukkhas, of cases (incidence), of dollars, and of days that can be related to certain illnesses or treatments. An interesting quotient is shown : the "econo-panetic efficiency" of a treatment or of a policy, expressed as dukkhas divided by costs. Another especially interesting number is the estimate of dukkhas typically attributed to an illness or to a treatment… Complete sets of such panetometric tables should be developed with data taken from existing medical literature, vital statistics, and public health statistics. Four sources are mentioned for assessing suffering intensity : sufferers, professional caretakers, instrumentation, and social indicators (incidentally, I note that pain is beginning to be considered as the fifth vital sign in medical practice, next to temperature, pulse, blood pressure, and respiration : we can already see bed charts that include inscriptions at regular time of pain intensities stated by patients, and eventually we should be able to draw new knowledge by compiling these charts). The authors add that medical dukkha tables could also includethe amount of suffering generated in others by a given illness : for example, the dukkhas flowing from the worries of the family members, the final burdens and associated sacrifices on the part of those who have to pay the bills, and the sadness and hardships of bereaved dependents. Let us note that the actual process of putting up these tables would teach us much on how to make them and on how to improve them.

It is proposed to measure suffering in dukkhas because of the following advantages :
1. The precision and accuracy is adequate for the purpose and context at hand.
2. The basic data is the direct personal estimates by the sufferer (how bad, how long, how frequent are your sufferings?).
3. The manipulation of the basic data to provide the final figure for quantity is logically sound.
4. The procedure is sufficiently simple, so that even laymen with minimal education are capable of using it to estimate their own amounts of suffering flowing from various sources and causes.
5. No special equipment is required other than paper and pencil.
6. The method is universally applicable for all individuals, institutions, governments, kinds of sufferings, conditions, and so on, so that comparative analyses, choices, and judgments can be made.
7. The ease and reliability of eliciting the necessary inputs to the calculations have been demonstrated in actual use for some time (see pain assessment in medical practice).

Panetometry introduces a new paradigm in science, with widespread consequences in medicine, government, business, social sciences, jurisprudence (for ex., increased uniformity and "fairness" in the award of damages for suffering in legal suits), insurance (for ex., higher predictability and confidence in the setting of related premiums), etc. I think that philosophy of panetometry would learn much, for the development of the discipline, from what Thomas S. Kuhn and other such thinkers have written on paradigmatic shifts.

Panetometric comments - One dukkha corresponds to the amount of suffering endured at intensity level one for one day by one person. This is a convenient magnitude for a unit of measure dealing with human suffering. I suggest that the usual or standard verbal description of the 9 degrees of intensity (1- Noticeable 2- Bothersome 3- Moderate 4- Considerable, seeking relief 5- Interfering with daily life 6- Quite A lot 7- Miserable, visiting physician 8- Excruciating 9- Unbearable) should definitely be improved : we can have recourse for that to the terminology of "pain questionnaires" that have been extensively studied in the field of pain research. I bring to attention that the 9-steps scale, which Siu favored because it has an easy-to-find middle point at 5, can actually be seen as a scale with 10 levels if we allow fractional degrees between 0 and 1 and between 9 and 10.

I suggest that panetics and panetometry should have more than one measure to deal with suffering : (1) the Siu's dukkha, (2) the neo-dukkha or NDK (see here above; the appellation NDK would also permit to avoid the impossibly awkward spelling of the word d-u-k-k-h-a), (3) the extra-dukkha or XDK (see here above), (4) the weighed dukkha or WDK (see comments on Striner's article), (5) the "case of excessive (or extra-aversive) suffering" (that would be a kind of epidemiological unit), (6) the "noxiousness" system of units (measuring the dukkhas-producing potential of various stressing conditions that can be inflicted to elicit suffering)…

Panetometric comments - An extensive literature can be found on the subject of pain or suffering measurement. It is panetometrists' responsibility to establish comprehensive bibliographies, and to review periodically what is published in the field.

Panetometric comments - Ten axioms and ten laws are very tentatively proposed as basic panetic principles. Some of them belong to the philosophy of panetometry, and some other could eventually be reformulated to become panetometric hypothesis to be tested within specific research projects.

Panetometric comments - Poverty can cause suffering, wealth can alleviate it : is it possible to work out a dukkha-to-dollar scale that would express this axiom quantitatively? Langmuir tries and fails, but he admits that his starting assumptions are questionable. I think that one data he should have taken into account is the psychological surveys which show that as far as subjective well-being is concerned, money makes a difference only below one level of revenue : the one at which you have enough to live. Above that level, more or less money does not by itself make you more happy or unhappy. Seeking a conversion formula between dollars and dukkhas is natural, because we see that suffering and money are linked in many ways… However, I think that a dukkha-to-dollar scale would have to be worked out for every different problematique in which money and suffering are involved… A universal dukkha-dollar correlation is probably nonexistent.

Ten years after Ralph Siu asked the question : "Can we formulate a semi-quantitative unit of suffering for evaluative purposes?", Langmuir expresses doubts and asks : "What would panetics be without the dukkha?". One answer can be found in Striner's Toward a Values Based Methodology for Panetics. Another answer would be to furnish objective, repeatable evidence that the basic concept of the dukkha is valid and useful.

Panetometric comments - Bentham mentions seven circumstances that affect the value of a (actual or potential) pleasure or pain : 1- its intensity; 2- its duration; 3- its certainty or uncertainty (how sure are we of its existence?) ; 4- its propinquity (proximity) or remoteness (is it present or more or less future?); 5- its fecundity (how much sensations of the same kind does it necessarily brings about?); 6- its purity (how much sensations of the opposite kind does it necessarily brings about?); 7- its extent (how many people are affected by it?). Bentham's opinion is that quality of life can be expressed as a ratio of people's pleasures divided by their pains. I believe that panetics does not have to share this utilitarianism, because values cannot be reduced entirely to affectivity. Moreover, I think that pleasure and pain are two separate, independent phenomena that should not be considered as two opposites, except in a narrow "qualitative" sense. It is granted, however, that pleasure may be a value which has to be included, along with suffering and other affective or non affective values, in processes of panetic decision-making.

Panetometric comments - A quantitative measure of suffering could have many uses for humanitarian organizations, national governments, international agencies, the international community as a whole, and all those who have to deal with problems related to refugees and displaced persons. Limits of tolerance to suffering differ widely between individuals or cultures, but the "subjective discrepancies in direct and trans-personal appraisals of suffering lie well within quite technically manageable proportions". Social indicators that are already in used could be integrated with newly devised quantitative measurements of suffering to allow for a more comprehensive, thorough-going approach.

Panetometric comments - Michael worries about accuracy of dukkha measurement : well, a science become more valuable by becoming more accurate, and this comes with time and practice… Let us be optimistic for widespread acceptance of new measurements concerning suffering : in social sciences, it often happens that approximate judgmental indicators (e.g. the Consumer Price index, the poverty threshold) assume over the years the status of objective indicators.

Panetometric comments - In a lecture that is in part relevant to philosophy of panetometry, Saunders argues that, as far as policy-making is concerned, the challenge is not to quantify suffering but to give a new meaning to the concept of suffering in people's conceptual frameworks or mindsets. He suggests valuable ways to do that, but none seems really new or sufficient. Perhaps he has overlooked one thing : could quantification of suffering provide the needed new conceptual meaning? Introducing a measuring "lens" for suffering would surely "makes a big difference how issues are named and framed for deliberation". It could modify views not only in technical or objective dimensions of decision-making, but in deliberative or subjective dimensions as well. As for Saunders' question on what the connection is between citizens and distant suffering, I think it all depends on allegiances (or on what Bentham calls sympathetic bias) : from the self to the cosmos, and between the most far-off past or future, there are various groups or individuals for whom our compassion may be more or less excited, depending on how much our loyalty or devotion to them is a part of our mindset. Perhaps the "egalitarism" of the dukkha, or the "universalism" of quantitative numbers, would have a broadening effect on the citizens' conceptual frameworks! Another, more panetometric answer to Saunders' question could be that the more we let happen avoidable suffering in humans or animals, the more probable it is that we ourselves come to suffer monstrously! In any cases, when it is possible, we should take care to point to the connection between people and the remote causes of their suffering.

Panetometric comments - Siu here mentions some of his grand visions that are relevant to futurology in panetometry : gross national dukkha, gross global dukkha, overall equation of human well-being (into which is melt the generation and expenditures of dollars with the infliction and alleviation of dukkhas), unified mathematical theory of humane capitalism, international flow of dukkhas and antidukkhas… It may take 50 years before such things happen, he says, though many could also happen in a span of 6 years if political will was there. What can we do for now? Siu mentions a short-term possibility that is perhaps within our reach : "Any sophisticated polling body, like the Gallup organization and the New York Times-CBS News, can come up with a reasonably fair estimate of the running GND within a relatively short time." Such a service is unaffordable for us now, but national and international surveys have been made in the past about a lot of questions with which we are concerned, even about such things as people's happiness or unhappiness : our forthcoming Annual Handbook on Suffering could take advantage of those surveys, and for the future, we could perhaps get associated with pollers to suggest new contents and methods.

Panetometric comments - First, let us recapitulate Striner's position. Egalitarism is one of the constitutive principle of the dukkha unit, according to Galtung, but egalitarism cannot be accepted without restrictions under all conditions : equity, justice, or ethics often call for differentiation between less or more worthy sufferers. Errors in quantification may be allowed, because scientific progress is made through them, but confusion in values may not : since we measure suffering for lessening it, we should take into account not only intensity, duration, and the number of persons involved, but also values. But value-weights cannot be attributed in an objective, credible, impartial manner. Even with regards to value-free quantification, there can be no purely egalitarian measure of suffering : two measurements cannot be compared because there are differences between people, or between external events, or within the same person at different times. Moreover, in so far as suffering is a private emotional experience, the dukkha is perhaps as meaningless, as useless, and as misleading as would be a quantitative unit called the "christo" for measuring a Christian's level of faith! For all these reasons, the best that panetics can do is to develop, on one track, a credible (probably limited) source of quantitative data, capable of satisfying some aspects of a quantitative model, while on another track, since quantification is not the only way to develop a science, panetics should develop a methodology anchored in the use of a values-based model.

For the latter model, Striner suggests to resort to his decisioning analysis, a method that deals with the relationship between values, assumptions and policies in the decision-making process. We can make a connection, I believe, between Striner's decisioning and Boulding's cost-benefit analysis : Striner speaks of what is right for someone and of personal values systems, while Boulding speaks of one's best interest and of identifying what persons are considered when costs and benefits are calculated… Both authors suggest ways to assess suffering as a factor in a decision-making process. Could we make use of a Boulding-Striner analysis in panetics?

Striner's critique of the egalitarist dukkha seems beside the point as far as quantification is concerned : we have to know how much a person suffers, no matter how much worthy or unworthy he or she may be, and problems of individual or circumstantial differences can probably be attenuated by developing more finely tuned measurements or averagings… However, as far as values are concerned, suffering should be "weighed", but then it must be noted that a weighed dukkha constitutes a different unit than the Siu's dukkha, and it should have another name (the WDK?). A suffering is perhaps always more or less inherently negative, but it may be seen as more or less instrumentally positive or negative. The instrumental value of a suffering should be expressed by a weighed dukkha, the weight-value being dependent on the appraiser's preference. About qualitative, subjective, or private aspects of suffering, let us recall, as we do in comments about Whittemore's article, that the role of quantification is not at all to capture the "unsliceable wholeness of feeling and true knowledge" by a means similar to the "christo" unit. Panetometry is only a part of an integrated, evolving study which is dedicated to approach the subject of suffering in all its ramification. In any event, we should handle a gross national dukkha with as much discernment as a gross national product!

In relation with Striner's critique, I see some other problems related to the definition of the intensity component of the dukkha. On this matter, please refer to comments on ISP's document The Dukkha.

Panetometric comments - This article is partly different from Striner's Quantification and Values : Error or Confusion?, but passages relevant to quantification are the same.

Panetometric comments - Bentham's utilitarianism is a relativism because it opposes pain and pleasure, while Siu's negative utilitarianism (least suffering for the least number of people) would be an absolutism, as is the ideology of human rights in the opinion of Hannah Arendt for example, because it favors only one paramount value. I don't think that panetics has to be utilitarian. Values cannot be totally reduced to affectivity like Bentham does, and they do not even have to be arranged in a hierarchy of superiority-inferiority : they can be envisioned as forming an ecological web in which each has its own interdependent function. Moreover, if any (anti)suffering is an absolute value, no "Boulding's cost-benefit analysis" is possible.

Whittemore seems anxious about quantifiers' mischiefs. We can agree with him that we are in many ways victims of greedy, power-hungry, quantitatively oriented perception manipulators. But as scientists, we must share our belief that quantification is indispensable for modernity and progress. Panetics is precisely a quest against the wrongdoers, including ourselves... Whittemore also questions the validity of quantification for suffering, saying that it cannot capture the "unsliceable wholeness of feeling and true knowledge". Let us recall that quantification is only a part of an integrated, evolving study that is dedicated to approach in all its ramification the subject of suffering.

Panetometric comments - Widner's experiment in Georgia is certainly, to this day, the most extensive exercise in panetic quantification. The author, who admittedly used incomplete data based on a few surveys and on casual conversations with Georgians, comes to the hypothetical number of 17,510.9 megadukkhas of suffering inflicted yearly by acts of corruptions in that country. This number of dukkhas is the sum total of estimates made under 21 categories covering the scope of the problem (as a result of a detailed panetic analysis). Of course, our new panetometric methods used to quantify suffering presents several anomalies. For example, Widner acknowledges that because our efforts to alleviate suffering should always focus on those people who suffer most intensely, panetics must develop a means to take this into account in its weighting and calculation of intensities. Another anomaly that I personally find conspicuous is the overestimation of the number of dukkhas when it is assumed that people are suffering from a certain cause 24 hours a day, 365 days a year, at a given average intensity : duration and/or average intensity should be very much lower. Except for such anomalies, Widner's attempt to assess suffering caused by corruption in Georgia seems to be exemplar in its simplicity, even if the author notes that in such a complex situation, panetic quantification would call for "capabilities rivaling those necessary to create a highly sophisticated econometric model". Strangely, the author argues that in a context of emergency such as the one in Georgia, and in the present stage of panetic development, it might prove more efficacious to report the result of a panetic analysis of corruption in economic terms rather than in terms of suffering and dukkhas, because economic data are available more readily, are understood best by the users and audience, and are an adequate index of well-being. I am skeptical! While a novelty like panetics can perhaps profit from being associated with an older approach, I wonder if economic or social units of measure can convey the new specific understanding that panetics is proposing for the betterment of people's fate... If they can, why don't we do social economic analysis rather than panetic analysis? If they cannot, why should we put in the foreground socio-econometric data rather than panetometric data?

Panetometric comments - The principal objective of Panetics is to develop and see applied quantitative measures of human suffering that help guide decision-making toward alleviation of that suffering, says Widner. Most conditions (opinion trends, familiarity with social indicators, institutional capacity and purpose) are in place for the use of applied panetics in collective governance. What is still lacking is a method for values-based decision making. This has been evoked in my comments on Boulding's and Striner's articles : weighed dukkhas are needed to decide about trade-offs between suffering and other values, and the chosen weight-values cannot be universal, they depend on different appraisers' preferences. Each context may require its own set of weight-values, not only for suffering but also for other interests involved. In that respect, Warfield's process and systems for taking into account diverse values and expectations can probably be usefully (a Boulding-Striner-Warfield analysis?). What is also lacking for the implementation of applied panetics is an extended set of panetometric tables, like the medical tables presented in Geelhoed and Siu's article. Such quantitative data lists should be developed for spheres other than the medical sphere, like justice, security, foreign policy, education, social services… In addition, regularly-employed social or economic indicators should be integrated into the panetometric toolbox, and this is what we are beginning to do in our forthcoming Handbook on Suffering. Eventually, development of applied panetometry will have to be carried on by universities and governments.

Panetometric comments - This article is partly the same as Widner's Four Big Methodological Challenge.

Panetometric comments - This article is essentially the same as Widner's Application of Panetics to Government Decision Making.

Panetometric comments - Decisional (or normative) panetometry : this is how I suggest to call the study of panetic decision making when quantification is involved. I suppose that in order to develop decisional panetometry we could resort to plenty of works dealing with the use of mathematics in decisions, especially in ethical decisions. A bibliographical research would be helpful. I have a feeling that the field of calculation with qualitative values is still deficient, but that panetics may pretend to an original contribution in the qualitative as well as quantitative mathematical handling of suffering. Though It is clear that decisions will remain made by human beings who cannot be reformed by any means in our possession now, bringing better quantitative and qualitative data on suffering would represent a concrete progress which can lead to at least some ideological changes.

The present Widner's article is akin to Widner's Application of Panetics to Government Decision Making, but it adds new details that are relevant to decisional panetometry. To address the challenge of complexity and trade-offs, it proposes to develop graphical and analytical conventions in the line of those offered by Siu (flow of dukkhas and antidukkhas between entities) and by Langmuir (system of dukkhas aggregation, and curve of concern). For the challenge of foreseeability, it proposes to develop procedures for anticipating and monitoring panetic consequences, and for adjusting decisions. For the challenge of time limits, it proposes to prepare in advance "panetic contingency tables" in much the way military, foreign policy, or natural disaster contingency plans are prepared by policy-planners. For the challenge of conflicting perceptions and values, it proposes to adapt John Warfield's procedures for facilitated "Interactive Management", so as to help individuals of very divergent views to come together, agree on a definition of the problem, evaluate intensities of suffering, rank consequences of inflictions or alleviations, establish a sufficient level of trust to reach consensus on what strategies are likely to ameliorate the problem, decide on trade-offs, settle on a decision, and agree on who has responsibility for implementation.

Panetometric comments - Social indicators, such as the ones presented by the Miringoffs in their book The Social Health of the Nation, are definitely an important tool for the measurement of suffering and for "decisional" panetometry. The use of indicators in the forthcoming ISP's handbook on suffering will be a first step toward developing a collaboration between us and people interested in social indicators.

It is essential that we keep in mind the distinction between pain and suffering.

Both are certainly influenced by subjective factors--compare the apparent experience of the religious martyr being burned at the stake with that of the individual trapped in a burning vehicle.

Pain, however, as customarily defined, is a result to stimulation of pain receptors located throughout the body (except in the case of central nervous system disease such as tumors, affecting the central pain centers). As such, the experience of pain can be measured against a standard stimulus to a group of those peripheral nociceptors, as, for example, in the application of a known amount of heat energy to a measured area of skin, or in the restriction of circulation--and consequently oxygen--to the arm, both for a determined period of time. Identical stimuli will not be similarly perceived by different people--or even by the same person at different times--because of the multiple synaptic steps between the stimulation of the pain receptor and the conscious perception of the pain, or even a reflexive response to the stimulus, such as withdrawal of a pain-stimulated extremity; a "gating" system, largely controlled by higher centers in the brain, has been identified within the spinal cord itself that controls the progress of the pain impulse, and while not as well defined, similar modulators doubtless exist within the brain.

Suffering, in contrast, is purely a mental phenomenon, a product of activity within the central nervous system. I know of no way to determine an external referent for it. (…) In medical/psychological terms, suffering is a consequence of injury to the ego, a result of an event that is unexpected and felt to be undeserved. It ranges from being treated badly-disrespectfully--in an encounter with another, to something untoward happening, whether it be illness or economic deprivation. Individual expectations, largely based on life experience, obviously play a key role here, from how one thinks one "ought" to be treated, to notions of personal invincibility/immortality, to concepts of opportunity and entitlement in a just society. (…)

As humans, we seem to be "hardwired" to compassionately respond to the image of a suffering human--something that both confidence men and public relations people recognized long before it was scientifically confirmed by the sociologists. This has been attributed to a "sympathetic identification" with the sufferer, a "like me", and "There, but for the grace of God..." reaction. Yet not all respond compassionately. The role of personal experience in influencing this response to suffering is complex and difficult to define. (…)

As an economist, I would have to say that Panetics has to come to grips somewhere along the line with cost-benefit analysis.

(…) Cost-benefit analysis is a kind of balance sheet which comes up with a "bottom line" of net worth. I have argued that we should perhaps expand this to "net worthiness" to include valuation elements that cannot be reduced to monetary measurement.

If suffering is seen as a cost, then if the overall value of the benefits resulting is larger, then suffering is justified in terms of "net worthiness". Then a very important research question arises: what are the circumstances under which decisions are made which, in terms of some overall system of valuation, imposes costs which are less than the benefits?

Here we face some very tricky problems in the study of decision. Economists, of course, are rather obsessed with the principle of maximizing behavior, but the principle that people do what they think is best at the time, which underlies the mathematics of maximizing behavior, seems to me one of these things that might be called a "near identity," something that almost has to be true. Then the question arises, of course, as to whose costs and whose benefits are included in these calculations. The torturer inflicts pains, perhaps in part because he is a sadist, in part if he doesn't he will lose his job. This is a very narrow view of what is "best at the time." The person who orders the torturer, who pays the torturer, does so because he thinks the example of carrying out a threat for the information obtained or something is worth the increase in power or security which he believes, perhaps wrongly, that it gives. When Truman decided to drop the bomb on Hiroshima and Nagasaki, he no doubt thought that the suffering involved would be less than would be involved in an invasion of Japan.

The question is therefore, what kind of social institutions and structures diminish the probability of "bad decisions," those in which the net benefit, that is, benefit minus cost, is negative, or at least less than it might be if other decisions had been made in terms of what might be called "mature" structure of valuations?

This perhaps breaks down into two further questions: what are the learning processes by which people improve their estimates of costs and benefit? And what are the processes which make it more probable that people in positions of power will have both more accurate estimates of future costs and benefits and a mature value system that covers not only their own power and welfare but the whole state of the world? Under all this perhaps lies the question of what are the learning processes in the world and the institutions which promote these learning processes which are most likely to improve net benefits?

We also have to recognize that over against cost-benefit analysis, even in its more refined form, there may be an ethic of absolute values. (…)

(…)

Assume that there were 81 colony people and 300 government personnel involved. Assume that 16 government personnel were wounded, spent 2 weeks in the hospital and 5 weeks with outpatient care. Assume that 8 colony people were wounded, without hospital care for 51 days.

Calculations appear as follows:

Govt.: Wounded--16; in hospital 14 days at intensity 7 suffering = 1568 dukkhas. On outpatient basis, at intensity 5 suffering x 35 days x 16 = 2800 dukkhas.

Within the colony: Wounded--8, with crude medical care; 51 days x 8 persons x intensity 8suffering = 3264 dukkhas.

Colony under siege: limited food, watch hours kept, sound disturbance, siege conditions: 81persons x 51 days x intensity 4 suffering = 16,524 excess dukkhas.

Govt. personnel: 300 mounting 24hour watch, tent living, food, maneuvers, exposure to cold: 300persons x 51 days x intensity 3 suffering = 45,900 excess dukkhas.

Total increase in pain and suffering: 65,880 dukkhas. (Suffering of 1 person with mild toothachefor 8 hours equals one dukkha.)

Govt.: cost $51 million through 51 days of siege.

Looking at future:

Every additional day of siege generates 1288 dukkhas of added suffering and costs $1 million. In other words, $7813 generates or sustains or is accompanied by one dukkha of suffering. Government spending is thus connected to suffering at Waco. A continued standoff creates additional pain and suffering.

Siege has reached a steady-state condition. Both sides appear to have talked themselves out. N results from this effort. Only visible future milestone is an exhausted food supply in one year.

Negotiations essentially exhausted.

To continue siege up to one year: over 400,000 dukkhas of suffering imposed; $314 million would be the estimated government cost.

(Note by Robert Daoust : the following sequel has been added by the editor in 1993, within the original article, but after the end of the siege)

Worst case scenario (actually happened): 80 persons die. Average economic worth of person =$3501000 Loss: 80 x $350,000 = $28,000,000 lost economic value to society.

Cost to taxpayers (society) on 51st day: already about twice this 'value' of deceased commune people lost to society. This "value' will be exceeded each 30 days of additional siege. Yet we cannot expect a smart political leader to follow these numbers directly in his reasoning. He could not have predicted the loss of life without access to kinds of information apparently not available to him. Nor does he place a dollar 'value' on human life, yet he will assess in his mind the fact that the commune people are zealots; have isolated themselves from American social life; probably pay no income tax; produce little if any jobs, productivity, or cultural contributions to society. They have withdrawn and isolated themselves as a matter of choice. He will also assess the burden of $1million per day, the energetic scrutiny of the media people into every aspect of the Waco standoff and the embarrassment, of government at having failed on the initial approach. Covering these grim considerations is the heavy overlay of emotional arguments and rhetoric which are brought to bear on the decision making.

The panetic analysis would indicate that government should take steps to conclude the siege even earlier than 51 days. Once again, most errors throughout this episode have been in the execution of plans: failure to avoid swat team operations on an armed colony previously alerted and failure to understand cultism, when a colony with a fanatical leader is under siege and with murder charges hanging over its leaders.

In all probability, first things were not done first. Ideally a thorough assessment of cult behavior–with projected reactions–would have been first. It is an assessment as to whether BATF cadres were trained and equipped to deal with a heavy armed cult group. As a wild conjecture, it could be that a group of Seventh Day Adventist preachers would have been the best group of initial negotiators! Probably, the BATF field troops with flak jackets and automatic weapons were not trained properly to deal with cultists made desperate by a confrontation. Interesting, no one has said much about why the Waco Davidian group acquired such a big armory, and what they felt the threats were, from which they needed protection.

The decision to end the siege should have been taken as soon as negotiations were at a standstill, in order to minimize both cost and pain and anguish. Instead, lacking a panetic analysis, apparently the top leaders waited until the field forces got tired of the siege inactivity, and a tricky way to inject tear gas, etc. into the compound was devised and presented as a logical next step.

When the Attorney General, or other leaders, ask, "What are the options?" or "What are the alternatives?" they should have available such panetic estimates of alternative courses of action.

(…) The decision-maker should have in hand at least a close estimate relating tobacco tax revenue dollars with lives lost and suffering caused by nation-wide smoking under (1) present conditions, (2) after imposing a 50 cent added tax per pack, and (3) after imposing a $1.25 added-tax per pack. (…)

An estimate of the annual direct pain and suffering caused by smoking over that experienced by the remaining population would be 46 million smokers times an intensity level of 2 times (allowing 8-hours sleep per day) 365 days per year, or 32.6 billion dukkhas or: (46,000,000) x (2) x (365) x (0.67) = 32.6 billion dukkhas/yr. The intensity level of two is on a scale of 1 to 9. A level of two is 'bothersome' discomfort. The dukkha is found by multiplying the intensity level times the number of days it is experienced. The intensity level of 2 is estimated for this large population to recognize, beyond nonsmokers, the increase in coughing, colds, sinusitis, headaches, digestive problems, etc., accentuated by smoking. It also includes high intensity suffering leading to the annual 390,000 deaths due to smoking. (…)

In the case of a 50 cent tax 2.5 million smokers will quit. These millions would experience a reduction in pain and suffering due to less frequent colds, headaches, aches and pains in the joints and to the extreme distress of emphysema, fright and pain of heart attacks,, the extreme pain associated with lung cancer, surgery, chemotherapy treatments and, in many cases, terminal illness. Most of the expected 21,000 annual early deaths due to smoking in this group will be avoided. Estimating across this spectrum one might conclude that two dukkhas times 365 days times 2.5 million new nonsmokers, allowing eight hours of sleep, might encompass the reduced pain and suffering by 1.25 billion dukkhas. Of these 2.5 million new non-smokers, avoidance of early death by 21,000 per year at an average cost to society of $650,000 each would save $12.7 billion. (Avoided losses per person include average wages of $30,000/yr. and taxes for average of 20 years.) Additionally, health service costs would be reduced (based on experience of the Maryland Dept. of Health) by about $1.35 billion per year gradually toward zero dollars over the following 5 years. Absenteeism costs caused by smoking would be saved: calculated as 15 days/year at an average salary of $30,000 for 2.5 million smokers equals $5.0 billion/yr.

In the case of a $1.25 tax , we might expect a reduction of smokers by 5.4 million using the same method of calculation as shown above. With respect to pain and suffering, these 5.4 million would be spared an estimated 2.65 billion dukkhas per year induced by smoking. This reduction in pain and suffering is so large it cannot be ignored as a major factor in the minds of political and government officials. About $30.4 billion will be saved by avoidance of death by 46,800 of this group, and about $3.0 billion in health costs would be saved. The cost of absenteeism due to smoking would be saved: $12.9 billion. (These savings are to society. Partly they will be lost wages saved and partly costs to industry saved by avoidance of lowered efficiency and salaries paid in absentia. Both should be very important to the decision maker.)

(…)Number of people in flight path affected by aircraft takeoff noise (1000). Each takeoff affects 1000 people in the 5-10 mile by I mile takeoff path for 15 seconds. Number of takeoffs per aircraft/year (750). (…) Initial Conditions (before Legislation) 2000 hi-noise aircraft for 10 years. Aircraft takeoffs = 750/yr per aircraft or 7500/decade. Fleet (2000) takeoffs 15,000,000/decade. Average discomfort level during one takeoff is 3. Duration is 15 seconds for 1000 people. Then 1000 x 15seconds x intensity 3 divided by 24 hours x 3600 seconds/hr equals 0.52 dukkhas per takeoff. Under these initial conditions, therefore: 15,000,000 x 0.52 7,800,000 dukkhas during the 10 years.

The original FAA regulations called for a linear phase out of hi-noise aircraft in 10 years. Based on the above assumptions, only half as many takeoffs will occur and 3,900,000 dukkhas would be produced in the 10-year period.

Final Quayle Stretch. This plan as imposed is assumed to have extended the replacement years from 10 to 15 years. This is an increase of 50% on the excessive noise experience over the FAA plan, or 5,850,000 dukkhas of discomfort and suffering.

Conclusion. 5,850,000 minus 3,900,000 equals 1,950,000 dukkhas added by the Quayle plan over the FAA plan.

Observations. Beyond the scope of this calculation, a cost estimate could be made of the Quayle plan if more was known about the phase out rate, the cost of money needed to buy new aircraft, etc. Then policy makers could properly weigh cost versus suffering.

(…) my studies of capitalism and of exchange societies are leading me to the conclusion that, if our present situation is not an aberration, then it was the analysis (objective quantification for the purpose of control) that put us here. Continuing to seek solution to problems created by this analysis that put us in our present situation is likely to lead to our peril. I hope to be wrong. Panetics, to the extent that it does not attempt to supersede the analysis of capitalism, is limited by its terms.

(…)

I suggest that the thinking of Lovelock ("GAIA: A New Look at Life on Earth") and Schumacher ("SmalI Is Beautiful") are among the best, well organized, and defensible thinking that addresses the issue of pain. Both propose concrete analyses that advance balance in the relationships between humans and between humans and other creatures. These analyses proceed from fundamentally different assumptions about how the world works, yet are coherent and workable.... (…)

(…) But what is the harm in marketing a product that is probably safe but has little or no benefit? Is this a panetic question? Who gets hurt if they consume a food with empty calories or a drug that is ineffective? Where is the suffering except in the pocketbook? Is this issue ripe for analysis? Is the topic of food and drug safety decision-making a subject worthy of inclusion in the interdisciplinary, inter-professional research effort concerning the infliction and alleviation of suffering? It certainly fits the model as a very complex issue with layers of trade-offs. Thus I’d like to explore this issue and elicit some spirited discussion.

As Ralph Widner pointed out, even while producing considerable suffering on my part when he asked me to speak on this subject, many political decisions involve the imposition of some degree of suffering on one group in order to benefit another. Ralph’s thesis is derived from the powerful book by Harold Lasswell who characterized politics as the art of deciding "who gets what, when, and how".

Applied to the issue of food and drug safety, if we determine by some means that something is safe and something else is not safe, who is going to benefit and who is going to suffer? If those who benefit are not satisfied with the benefit, what will they do that may heighten further suffering? If those who suffer are sufficiently distressed, what further suffering might they induce?

(…)

My point should be clear. What should be a common sense decision or one based on scientific knowledge by informed and educated citizens has increasingly moved into the judicial system where the decision may be based more on legal precedents rather than common sense or weight of scientific evidence. In such situations, where an either/or decision is made by an institutionalized entity that is not directly affected either way, someone wins and someone loses; someone has less suffering and others end up with more suffering. But Harold Saunders offered a slightly different perspective in his concept of "connection". What was a personal or family, or village decision about what foods are safe evolved into a decision made on the basis of science, one step removed. Now we see a second step of removal, science is not enough and we need the courts to decide. The connection to the citizens becomes more and more tenuous. Perhaps the more logical approach of paneticists should be to alert citizens to the complexities and trade-offs in any food safety disagreements.

(…)

First, the guiding principle of safety decisions related to foods and substances added to foods is the regulatory concept of "ordinarily not injurious to health" and "reasonable certainty of no harm". As senior or aspiring paneticists, I would ask you to consider: 1. What is ordinarily? 2. What is injurious to health? 3. What is reasonable certainty? 4. How do you define "no harm"?

(…)

My point is that panetic analysis of issues in public health and safety are indeed complex and application of such analysis is not so straightforward. Thus Dr. Saunders’ idea of less emphasis on quantification and more effort to make connections that provide a basis for the body politic to buy in may have merit here, and in other similar circumstances too.

So where are we? Is the issue of food and possibly drug safety amenable to panetic analysis? The picture is not as bleak as I have painted it. Perhaps I have been too eager to identify complexities and their inherent result, trade-offs. Certainly, development of panetic tables which include both direct and indirect consequences of decisions in the arena of food safety decision-making would be a good place to start. Perhaps this effort could be a way to raise the awareness of the body politic.

Could we do this on an international basis? Probably, its a bit early to try as the climate, even in this country, has not yet reached the point where the public realizes that the food supplies of the world are very complex and interdependent -- on weather, political, economic, and cultural aspects of most of the world’s food producing regions. Education of the US public is a worthy goal.

In the area of food safety, as in other issues of common welfare, governments are perhaps a major barrier to alleviation of suffering that is due to an unsafe food supply. Right now, the purpose within our own government is lacking, but our system of government does have the necessary capacity to undertake such panetic analyses. In the near future, it should be our responsibility to make both citizens and decision-makers more familiar with the methodology of panetic analysis. What better way than to dissect the complexities of food safety and develop sound panetic tables for analysis along with efforts to make the public recognize the connections with their best interests. If these were done on the same or similar topics for several countries, a comparative basis for further work would be established.

The trick of course, will be to pick topics that would arouse the interest and understanding of citizens in several countries, and, at the same time, be amenable to comparative analysis. Perhaps, we can start the discussion with this aspect of furthering the application and utility of panetics in understanding and alleviating human suffering that is a component of the world’s ability to provide a safe and adequate food supply for the population of the world.

(…) we can measure dukkha on a 9-point dukkha scale from "1", the "barely noticeable", to "9", the "unbearable, wanting to die"; the unit, one dukkha, being defined as one person suffering level "1" for one day ("0" means no suffering). This permits us to make comparisons across time and space for any set of humans from the individual via the couple/family and the country to the globe, for any length of time, measuring the level of suffering as: Average level of dukkha x No. of persons involved x No. of days.

Let us deconstruct, to understand the underlying message.

First, the measure is in the homo mensura tradition of Protagoras, "Man is the measure of all things". In a community, a country, you may have the most glittering buildings or other material achievements, you may be politically/ideologically correct, being based on the purest implementation of the single true teaching of whatever kind. This measure makes us focus on the reality of the human experience. If people, persons, humans, in fact suffer, then what is so great about it?

Second, the measure is subjective. The single person is the only judge of his/her situation. My suffering is mine. Nobody is going to tell me I am not suffering when in fact I am; nor that the suffering is good for me, I have already considered that. Nor is anybody going to tell me I am suffering when in fact I am not; because according to them the objective circumstances should make me suffer. I decide that. I alone.

Third, the measure is profoundly egalitarian. Each person's suffering is given the same weight in the terse, mathematical, "No. of persons involved". Sounds trivial, and yet filled with dramatic implications. We humans suffer from serious fault-lines in our social constructions, between us and other forms of life, between genders, generations and races, between classes, nations and states. Genocide is massive violence across such fault-lines, direct or structural. Yet we protect ourselves against taking in the suffering on the other side, drawing clear lines between worthy and unworthy sufferers, like we do these days in Yugoslavia. The suffering of dehumanized, even demonized persons does not count. This measure makes us all equal before the suffering, like before the law. My enemy counts like myself.

Fourth, the measure does not include sukha, bliss, happiness. We might argue that there could be a separate sukha scale, and I would probably argue that. But the danger would be that some people's sukha is used to compensate, in an average way, for a lot of other people's dukkha the way economists construct their flawed measure of growth as per capita growth. This is both humanly, intellectually and politically impermissible, and panetics, the study of (inflicting) suffering, does not commit that elementary mistake. The dukkha is there, revealed by figures staring us in the eyes. Our task is to reflect it and reflect on it, not to reduce it through some averaging. Averages bring no comfort to the sufferer; reducing the infliction, alleviating the suffering does. Quite another matter is the dispersion, the distribution of suffering. Some groups, some persons, suffer more than others. There is a policy in that: give priority to those who suffer most.

Fifth, the measure is non-theoretical. All that is said is that concrete human beings report suffering, some more than others. The measure does not tell us why. Maybe this is an improvement on Lord Buddha's reductionist insistence on greed and craving as the prime cause. Maybe better trying to identify the causes for each concrete case? But there is also a deeper reason hidden behind this formula: the theory we have may itself cause immense suffering. A formula to obtain the good society is usually also a formula to reduce suffering, and that formula may close out the suffering that is not supposed to be. Fault-lines dehumanize the unworthy sufferers; theories make us see the suffering as transitory, as means hallowed by the ends -- you cannot make omelets without crushing some eggs.

(…)

P, the perpetrator, has made V, the victim, suffer through an act of crime: theft, violence, sexual violence. One way of handling this is through revenge: V inflicts suffering on P, or V's family on P's family, in a vendetta that lasts generations. But the (modern) state intervenes, deprivatizing the counter-violence, telling V "I'll do the infliction of violence on P for you, on the condition that you remain quiet". There is even a new terminology: violence from the state, from above, is not referred to as violence but as "justice", as when the head is severed from the body by the French guillotine and the henchman pronounces: "Au nom du peuple francais justice est faite." The panetics approach will now inform us of the following: we started with V's family suffering, now there are two families suffering. The point here is not that they can be compared, all sufferings can be, using the measure. The point is that in the Judeo-Christian legal tradition a mathematical theorem is invoked in such cases: the sum of two sufferings is zero. One suffering washes away the other: the victim feels fulfilled, reconciled to his/her fate, knowing that justice has been done. In the USA today V may even watch P being executed, presumably to speed up the process whereby one violence cancels the other. The panetics approach harbors no such theorem. The sum of two sufferings is two, not zero, sufferings. No stand is taken on crime and justice except one: try to minimize the infliction of suffering by preventing crime in the first run; do not believe that you reduce human suffering through punishment.

(…)

Multiply the military figures about casualties at least by a factor of 10 for the primary bereaved (near family and friends) and by a factor of 100 for the secondary bereaved (extended family, neighbors, colleagues). Panetics will show the madness of war much more clearly; our usual statistics conceal the suffering.

(…) Combine this with the image of the bereaved and traumatized and we sense the enormous suffering through the millennia. But we only sense this if we open our hearts and minds to the suffering of everybody, not privileging some suffering at the expense of others. As a matter of fact, probably one of the worst forms of dehumanization is to deny some categories their suffering, invoking theories like "they suffer less because they are so used to it". Deprive a human being of suffering and you deprive him/her of subjectivity, deprive him/her of subjectivity and you have constructed a non-human. The genius of Ralph Siu consists exactly in presenting us, in the double meaning of present, with an image so compelling that we can act upon it.

(…) In short, his image, expressed in megadukkhas, is of a society where crime may be an irritant but of very little significance relative to the suffering caused by Capital and State as expressed in unemployment and poverty. Even lawyers and church leaders get off the hook; their role is very minor.

(…) War and unfettered growth become like slavery and colonialism: labels for untold suffering. Due to Ralph's work the untold can now be told, if we sit down and to the job, trying to get some numerical estimates. As he says, they may be 100% off, yet the measure will tell us something of immense value. We may differ as to the good society, the good world and human happiness. But we might agree on something very basic: to reduce suffering, to stop inflicting suffering. So let us all do our best to translate these brilliant insights into tools of policy theory and practice, breaking the pattern of selecting some suffering and neglecting the other, and of aiming for the stars, oblivious of the suffering in our backyard.

and http://www.panetics.info/DisplayOneEvent.cfm?i=45 (Part Two)

Part I

Physicians and health care workers daily face the task of assessing suffering and the steps to be taken to relieve it for individual patients. And one of the most important and difficult of the ongoing tasks facing leaders in any country is to formulate a continually updated, humanely cost-effective health care plan for their people. A critical input is the comparative amounts of the associated suffering, potentially preventable and/or relievable, among the given arrays of available resources and feasible options. What follows may be one of the most direct, practical, simplest, tested, and accurate methods to quantify suffering for these purposes. We believe the occasion for their application may be propitious.

The description of a "dukkha-based" assessment of the suffering entailed in individual illness and medical treatment described below is the subject of Part I. Part II summarizes the products of intensity and duration of suffering, with and without treatment options for the national frequency of selected illnesses and treatments of concern to United States public health. Only after judging the burden of suffering of illness and that additional suffering both imposed and relieved by medical treatment will we factor in Part II quantitative cost, both for individual treatment options and for collective national health planning.

(…)

Health Care Reform and Reduction of Suffering

The discussion might not have to be couched in terms derived only from the "dismal science." Might it not be feasible to start with the professed fundamental goals of both the patient in seeking help from a health care provider and the professional in practice–to reduce suffering? If this suffering were quantifiable and various treatment options could be expected to accomplish a reduction in the suffering, a humane analysis of the optimum medical treatment options might be possible, and economic cost/benefit considerations would become derivative from it. If a certain reduction in suffering were predictable, resource allocations might be decided by what accomplishes this predetermined goal most efficiently--with some expeditious high-cost options quite probably winners.

There are no magic wands in health care–whether the treatment is a procedure, a drug, or reassurance. Not only is each intervention accompanied by cost but also hazard--and one real risk is that of the iatrogenic infliction of still more suffering. It is quite possible that health care contributes to the sum of human misery in some conditions, and how can that infliction be mitigated or such options be selected against?

There are some agreed upon benefits against trivial infliction–the immunization injection that brings tears to the eyes of a child and lowered risk of communicable disease, for example. There are some procedures for which the balance of inflicted suffering against predictable relief may prohibit the technique as therapy except in terms of Phase II development in clinical research–bone marrow transplantation following radical chemotherapy of metastatic cancer, for example. To analyze the relative success of any medical intervention, then, we would have to consider the sum balance of suffering relieved, and select against all treatments that would cause more suffering to be inflicted than they could reasonably be anticipate to be relieved.

It is particularly timely to redirect attention to first principles in view of the intense debate across the United States on a new trail-blazing national health care plan for the American people. Many options and variations are vigorously advanced. Beyond the humane analysis of a preferred medical treatment option for a given patient, what public good may result from optional health care plans?

It would appear that the version ultimately adopted by the federal government would address the following complex economic types of questions (among others) explicitly and head-on in as clear, direct and firmly grounded a manner as possible:

1. What national health care plan will potentially bring about the largest amount of medical suffering prevented and/or relieved for the population as a whole per million dollars expended?

2. What will be the likely family of curves of the amount of medical suffering sustained by the people at large plotted against time for the period concerned at various levels of funding?

3. What will be the likely corresponding families of curves for various categories of the citizenry calling for special consideration?

4. How about analogous curves for the various proposals regarding the distributions of resources among categories of illness for various overall levels of approximations?

To the degree that the best available tools for the quantitative estimation of suffering are used, to that degree will the answers to the above kinds of questions be more sharply focused and useful. We wish to bring the recently developed quantitative unit of the dukkha and medical dukkha tables to the attention of the responsible policy makers. They might be of some facilitating assistance.

How can such a gauge of suffering be derived? By doing what all clinicians have always done--ask the patient. Describe the pain to me–how bad is it? For how long have you had it? Does it come and go? What seems to make it better? What exacerbates it?" Pain is the experience of the sufferer, but the intensity, duration, and characterization are judged by the clinician, who is always at least ranking it.

lf prevention and reduction of suffering is a fundamental principle in health care, can a new paradigm be constructed using the first principle for decision making among treatment options and national plans?

Quantification of Suffering

The direct quantitative measure of suffering, called the dukkha, is a slight adaptation of the routine intuitive practice followed by physicians and laymen alike for millennia. Among the first questions asked the patient by the doctor is: "How badly do you feel on a scale of ten--ten being the worst possible." And the second is: "For how long have you been feeling so badly?" The dukkha is determined by the standardization of the two steps and a multiplication of the two answers to provide the quantity of suffering.

The first factor regarding the intensity of suffering is set as an odd-number nine-step range, in order to make it easier for the respondent to find the midpoint of five. The intensity scale in approximately equally spaced ascending de descriptive terms is as follows: 1, noticeable; 2, bothersome; 3, moderate; 4, considerable, seeking relief; 5, midpoint, interfering with daily life; 6, quite a lot; 7, miserable, visiting physician or other healer; 8, excruciating; and 9, unbearable, wanting to die.

The second factor of duration is given in days. Thus the number of dukkhas experienced is (number of persons) x (average intensity of suffering on a 9-step scale) x (duration in days). One dukkha is the suffering borne by one person experiencing an intensity level of one unit for one day.

A person with a moderate toothache for eight hours, for example, endures one dukkha of pain, i. e., (1 person) x (intensity 3) x (8/24 day). A thousand persons with flaring peptic ulcers without medication for a year is estimated as having collectively endured approximately a million dukkhas, i. e., (1,000 persons) x (average intensity 6.5) x (10 hours of pain/24 hour day) x (365 days).

At lower levels of suffering, sleep is a possible source of relief with or without hypnotic or sedative agents. At higher levels of suffering, sleep is impossible sometimes even despite analgesics. So, for example, at levels of intensities at 1-3 steps, it is assumed that eight hours of suffering-free sleep may be possible and the average intensity of suffering per day is reduced by a third within a 24hour interval. At the higher levels of intensity of 7-9, sleep is precluded, so no such reduction is made in the estimate of sleepless suffering.

The dukkha is fit to meet the following specifications, which have been advanced for a direct and practical quantitative measure of suffering for- everyday social usage by laymen:

1. The precision and accuracy should be adequate for the purpose and context at hand.

2. The basic data should be the direct personal estimates by the sufferer. This requirement stems from the very definition of suffering itself as being subjective.

3. The manipulation of the basic data to provide the final figure for quantity should be logically sound.

4. The procedure should be sufficiently simple, so that even laymen with minimal education would be capable of using it to estimate their own amounts of suffering flowing from various sources and causes.

5. No special equipment should be required other than paper and pencil.

6. The method should be universally applicable for all individuals, institutions, governments, kinds of sufferings, conditions, and so on, so that comparative analyses, choices, and judgments can be made.

7. The ease and reliability of eliciting the necessary inputs to the calculations should have been demonstrated in actual use for some time.

The key new input required for the generation of dukkha tables to serve as a useful addition to public health statistics is reliable estimates of the intensities of suffering. The rest of the data arc readily available from existing vital statistics and the medical literature.

Four avenues are at hand for obtaining estimates of the intensities of suffering. The direct method is a statement by the sufferer himself/herself. By the very definition of suffering, this is thc unarguable estimate. The indirect methods derive their validity from an invariable correlation with this subjective reference.

Where direct methods are impractical at the moment, recourse must be made to indirect approximations. Reasonably reliable figures may be forthcoming from attending medical personnel familiar with a large body of cases. This would hold especially if the non-sufferer's estimates had been demonstrated to be highly correlated with the sufferer's statements in other instances.

Another indirect method involves physical instrumentation. Here again, its utility depends on the correlation with the patient's estimates. We do not foresee the time when sufficient correlations can be worked out for even a small fraction of the purely physical suffering, not to mention mental ones.

The fourth approach involves social indicators, such as lost labor hours, freedom, and income. These are too gross, indirect, both overlapping and incomplete at the same time, and disparate for logical combination. In the absence of a direct quantitative measure of suffering, they have been the most expedient under the circumstances. But this no longer is the situation.

We are thus practically left with the first two avenues. While awaiting the day when the ultimately standardized medical dukkha tables would be largely based on direct estimates from the sufferers themselves, we have relied on indirect estimates by a limited number of physicians for the construction of the present illustrative prototype table.

Illustrative Prototype Medical Dukkha Table

A complete table of the number of dukkhas suffered by the average patient stricken with various illnesses, the probability of prevention and cure with respective costs in dollars and time for the optional treatment regimes now available, and the numbers of patients so afflicted would appear to be necessary as a minimum for a rigorous basis of comparative evaluation of health-care system options. The core information is the number of dukkhas suffered by patients in each case of illness, with and without medical treatments. An illustrative prototype medical dukkha table of this nature is presented below.

The core array can then be amplified with additional relevant columns. Typical would be the number of cases in the United States per year with and without medical treatment, thereby providing the total number of dukkhas of suffering endured by the American people as a whole for thc particular illness (Part II to follow). Econo-panetic information may also be incorporated, such as the cost of treatment, thereby providing estimates of the number of dukkhas relieved per million dollars for the country as a whole for various combinations and permutations of plans, resources, categories of people, and systems of treatment.

Other representative tables for finer-grained analysis might include the following: (1) Dukkha tables for the twenty illnesses engendering the greatest amount of suffering for individuals per case, (2) Dukkha tables for the twenty illnesses engendering the greatest amount of suffering for individuals at intensities 8 to 9, (3) Dukkha tables for the twenty illnesses engendering the greatest amount of suffering for the population of the country as a whole, (4) Dukkha tables for the twenty illnesses engendering the greatest amount of suffering at intensities 8 to 9 for the population as a whole, (5) Dukkha tables for the twenty illnesses costing the most for medical treatment per case, (6) Dukkha tables for the twenty illnesses costing the most for the population as a whole, and (7) Dukkha tables for illnesses without known medical treatment.

 Part II.

Proper health care for all the citizenry has increasingly become a concern for all national governments in recent decades. The ongoing process of health care reforms in the United Sates has reached an intensive phase with the first years of a new administration pledged to make health security a centerpiece of domestic policy.

Part I of this two-part article described a missing critical component of the voluminous demographic and cost data, which are presently available to decision-makers and the public. Without this humane component of health care's objectives and limits, a clear-headed formulation of health plans and a prudent and humane selection of the optimum for the country as a whole and for individuals in special circumstances is severely handicapped.

Because the health care system is a very complex and specialized entity, one component that can be measured by a universally comprehensible metric is cost -and that has been the primary focus of most analyses of health care options. We have chosen to begin with a more fundamental measure of health care's humane effectiveness, and have offered for initial consideration a measure of human suffering and its relief.

As explained in Part I, the dukkha is a direct quantitative unit of suffering, applicable to the determination of the amount of suffering of all kinds across the board, as experienced and quantified by the sufferer. The number of dukkhas endured by a group of individuals is the product of (number of persons) x (average intensity of suffering on a scale of nine) x (duration in days).

Previously, not a single figure for any illness has been published; nor has there been an attempt to rigorously measure and sum suffering for patients and populations. By way of illustration, a set of suffering values for ten illnesses was presented in Part I. An abbreviated extension for six illnesses and eight medical treatments is given in Table 1 below.

These dukkha data can then be coupled with illness incidence, cost, medical, and social information to provide side by side comparisons of the emerging alternative health care proposals.

This Part II exemplifies the use of this dukkha information with the associated incidence and cost. The resulting econo-panetic implications are consolidated in Table 2.

We believe that attempts at this knowledge of health "numerator" data would be of considerable value in the understanding of, and decision-making for key public health issues. In addition to the discussion in Part I, the following are several more topics that can be extrapolated from having both humane numerator and cost denominator quantifications before policy decisions.

• Total amount of medical suffering potentially prevented and/or relieved in the national population by each of the proposed health care plans per million dollars appropriated;

• Total amount of medical suffering remaining unrelieved by each of the proposed health care plans at various levels of overall appropriation;

• Amounts of medical suffering potentially relieved and unrelieved within various subclassifications of people by each of the proposed health care plans at various levels of overall appropriation.

A reasonably reliable comparative analysis of this sort will facilitate the process of arriving at a prudent formulation, selection, and progressive improvement of national health care plans and humanely cost-effec¹ive programs.

Discussion

The common availability of data of the type illustrated in the tables in this article and in preceding Part I would be most helpful in addressing the inescapable questions perennially confronting government officials, community leaders, and others concerned with public health. Typical of the critical issues are the following:

• What fraction of the overall budget should be allocated to health care? One of the significant criteria has to be the comparative amounts of net suffering among the respective budgetary components thereby burdened on the citizenry.

• Given a limit for total health care expenditures, how should the resources be distributed among the various illnesses, regions of the country, and categories of people?

• How should the funds available for medical research be divided among the various illnesses without effec¹ive palliation and remedy? A comprehensive, standardized, and internationally accepted set of continually updated medical dukkha and econo-panetic tables would also contribute to decision making in areas far beyond the immediate setting of individual illness. Several examples are sufficient to make the point.

• In jurisprudence: increased uniformity and "fairness" in the award of damages for suffering in legal suits.

• In insurance: higher predictability and confidence in the setting of related premiums.

• In the transition zone of public health and communal well-being: extension of the medical dukkha table can aid health policy decisions that include higher order panetic ramifications. What would be the amount of suffering generated in others by a given illness? For example, the dukkhas flowing from the worries of the family members, the financial burdens and associated sacrifices on the part of those who have to pay the bills, and the sadness and hardships of bereaved dependents? How far should the concerns of physicians and other public health professionals be stretched into the domain of societal wellbeing from the narrow confines of medical suffering of the patient alone to the associated distresses of related others? In particular, how do the econo-panetic efficiencies of the various mixes of preventive and remedial measures compare? How should public policy go about taking this factor into explicit account?

• In the implications of panetic responsibility in personal and social ethics: the enormity of breaches in ethics takes on a new dimension of astareness when the amount of suffering engendered by the causing or passing on of various illnesses is dearly laid out and appreciated.

Conclusion

Sound medical dukkha tables and econo-panetic analyses can play critical roles in the prudent formulation, selection, and continuing improvement of national health care plans and medical treatment options. Their usefulness can also be extended far into the realms of other human concerns, such as business, law, ethics, and panetitude. The institution in the best position to compile authoritative arrays of these kinds appears to be the national government. A comprehensive and provisionally usable set can be developed by American public health agencies within a relatively short time. We urge that serious consideration of their development be given by the responsible public health leaders. This will refocus the crux of the debate on suffering and its reduction instead of dollars, sources of revenues, and managerial procedures and prerogatives.

What is essential at this point in time is not wishful debates over the speed of progress in the research on and compilation of the pertinent figures. What really matters is that the arduous task be begun at the earliest date by sufficient numbers of talented persons in or out of government. The present and continuing requirement for the enhancement of basic human well-being everywhere is obvious.

The dukkha is a quantitative unit proposed by Ralph G.H. Siu to measure suffering. The term is based on "dukkha", meaning "suffering" in Pali, the ancient language of the Buddha.

Siu developed a 9-step intensity scale to quantify the infliction of suffering. In step 1 suffering is "noticeable"; by step 9 suffering is so intense that "one would rather die". A rough description of the respective intensities is given in Table 1.

Table 1. Intensity scale of suffering

1- Noticeable 2- Bothersome 3- Moderate 4- Considerable, seeking relief 5- Interfering with daily life 6- Quite A lot 7- Miserable, visiting physician 8- Excruciating 9- Unbearable, wanting to die The quantity of suffering borne by a person is calculated by multiplying the intensity of suffering by the duration in days. Thus, one dukkha expresses the amount of suffering endured by one person at intensity level one for one day. It is roughly equivalent to that felt by one person with a moderate toothache for eight hours, i.e. (1 person) x (intensity 3) x (8 hours / 24 hours in a day).

A million dukkhas, or a megadukkha, represent the order of magnitude of suffering sustained for about 10 hours a day collectively by 1,000 persons with severe stomach ulcers without medication for a year, i.e., about (1,000 persons) x (intensity 6.5) x (10 hours / 24 hours in a day) x (365 days).

To summarize, the dukkha is calculated by multiplying the number of persons by the intensity level by the number of days: persons x intensity level (1-9) x days.

Those who are skeptical about the practicality of Ralph Siu’s proposed Dukkha Scale to measure the intensity of human suffering might be interested in several press accounts of similar scales applied in medicine.

On September 14, 1999, the New York Times reported guidelines of a pain management regimen for patients with sickle cell anemia. "Drafted by an expert panel sponsored by the American Pain Society...the guidelines are the first in a series of research-based recommendations for treating pain in several diseases, including arthritis and cancer," reporter Warren E. Leary writes. Since Sickle Cell Anemia is a life-long affliction, a scale of pain intensity was developed for use in treating pain in children. This "Oucher Scale" grades upward from zero to 100. Each level in the scale is accompanied by a child’s face showing rising levels of anguish. A child can point to the face that reflects the pain he or she is having. The report continues: "Dr. Lennette J. Benjamin, clinical director of the Comprehensive Sickle Cell Center at Montefiore Medical Center in the Bronx, a member of the drafting panel, said: ‘I see patients every day who have suffered a lifetime of needless pain simply because their doctors and others treating them don’t understand or practice the principles of good pain management...Unrelieved pain leads to longer hospitalizations, greater suffering and complications and more deaths’."

On February 27, 2000, the New York Times reported still another effort to gauge the severity of pain and suffering by Dr. A Vania Apkarian at the State University of New York's Upstate Medical University in Syracuse and Dr. Nikolaus Szeverenyl, a radiological physician in Albany. The Times reported that: "Volunteers in their studies are subjected to varying degrees of discomfort and their brains' responses are recorded in an electroencephalogram or imaged by a C. T. scan or M.R.I. But even with such a complex assortment of electronic gadgetry, results depend ultimately on the subjects' description of the degree of pain they feel, which is signaled by how far they separate their opposed thumb and forefinger" on a scale of 1 to 10. In this way, the two physicians hope that they can create a "quantitative analysis to characterize the brain's representation of pain." The Times account goes on to report that measuring the many manifestations of pain, objective and subjective, has proven so complex that an International Association for the Study of Pain has been organized. Pain, the article points out, is both a sensation and an emotional experience influenced to a significant degree by the emotional predispositions of the sufferer.

A more tongue-in-cheek piece appeared in Men’s Health (www.menshealth.com) in November 1999. The reporter interviewed physicians using "a 2-inch strip of paper called the ‘visual analog scale’ or VAS. During a procedure, patients rate their pain by marking the strip close to the left (a pinch) or right (being burned alive, or listening to the music from Rent.)"Asked by the reporter to rank pain intensities on the scale, physicians provided the following analogs: VAS 1: Having a Mole Removed VAS 6: A spinal tap. VAS2: A digital rectal exam VAS 7: A penis catheter VAS 3: Five stitches VAS 8: A rabies shot. VAS 4: Removing wisdom teeth VAS 9: A barium enema. VAS 5: A colonoscopy VAS 10: Testicular torsion

(…)

Provisional Axioms

The infliction of suffering is intrinsic to the processes of life and social operation. Every decision and action of a person or an institution has the potential, qualitatively or quantitatively, to modify the state of suffering in oneself or others, immediately or n-steps removed. Everybody inflicts suffering on others and everybody is inflicted upon. The threatened or actual infliction of suffering is the most powerful instrument of persuasion. Every human being is caught in a never-ending personal tug-of-war between the largely cultivated need to inflict suffering on others and the largely natural desire to reduce it. The victim's pain is a function of the infliction actually delivered and independent of the inflicter's awareness, intentionality, and justification. It is the situational context which usually opens the door to a given spectrum of panetic choices. Any significant change in a given social relationship among parties will eventually modify the distribution of suffering among them. The success of a government in reducing the suffering of its people and maintaining it at a practicably humane level is a direct function of its panetic knowledge and integrated management. Humaneness starts with stopping the inflicting.

Provisional Laws

The equilibrium constant of an ongoing infliction/acceptance relationship between two individuals or groups will remain unchanged unless some external influence is injected. The magnitude of suffering inflicted varies directly as the intensity of the inflicter's desire for the fruits of infliction and capacity to inject noxious conditions, and inversely as the capacity of the victim to retaliate and of outsiders to intervene. When two or more inflicters concurrently inflict suffering on the same victim for mutually exclusive gains, the inflicter who gets what he/she is after is the one whose increment of infliction first increases the total suffering borne by the victim above his/her tolerance threshold. The capability of an organized group to inflict suffering on another goes up arithmetically with its superiority in technical proficiency and geometrically with its superiority in numbers. The amount of suffering inflicted, within and externally, by an organization varies geometrically with its membership and rate of growth. The amount of suffering by the citizenry in a democracy varies inversely with its depth of awareness of the panetic ramifications of governmental deliberations and immediacy of transmission of this understanding to its elected officials. The probability of revolt against a government goes up geometrically as the level of suffering among a third of the citizenry rises above three dukkhas a day for over three years (3-3-3 threshold). The drive to alleviate suffering varies inversely with the spatial, temporal, fraternal, kinship, national, and cultural distance between the parties. The amount of effort required to preclude a given infliction of suffering varies inversely and geometrically with the number of successive linkages and the duration of time before the overt act itself. A maximum position of panetic well-being of a society under a given set of conditions is achieved when any decrease in suffering of any individual will result in an associated greater increase in suffering in another.

(…)

The pertinent question is: Can we formulate a semi-quantitative unit of suffering for evaluative purposes?

Ten years have passed since R. G. H. Siu, in pursuing the above question, devised the dukkha scale as a provisional means to measure suffering. The field of Panetics is based upon this scale, but comparatively little has been done to explore the dukkha in detail, or to apply it in calculations. The following discussion presents an attempt in these directions by examining possible relationships between dukkhas and wealth. It is obvious that poverty can cause suffering and, wealth can alleviate it. Might the dukkha offer a way of expressing this axiom in some quantitative way?

Figure 1 shows the approach to the problem adopted in the present study. Across the abscissa at the bottom of the chart is the dukkha scale, including the 26 words and nine numbers upon which the field of Panetics is based. On the vertical scale shows the qualitative distinction between rich and poor. The gray area sloping down to the left is a graphical expression of the idea that poverty inflicts suffering and that wealth alleviates it.

The present discussion obviously is confined to a narrow slice of the broad Panetic spectrum; namely to suffering inflicted by shortage of income. We are concerned here only with income-inflicted dukkhas (IID's).

Within the gray area of Figure 1 there must lie a path which shows how the dukkhas inflicted on a family by money shortages increase from a low value at the rich end of the scale to acute and desperate suffering at the extreme poverty level. The discussion which follows proposes a basis for determining this path. Once established, this path becomes a "dukkha-to-dollar" conversion scale which can be used to calculate dukkha values for any social situation for which dollar statistics are available. The results of several such sample calculations are presented.

Establishment of the Dukkha-to-Dollar Relationship

We are seeking to identify a curve lying somewhere within the broad shaded area of Figure 1 which would establish a definite value for each level of income. The most convenient and simple curve possible would be a straight line, and as a first approximation this will be sought. Since a straight line is defined by two points, our problem can be reduced to picking out two points within the gray area, each of which can be accepted as correct in itself. All intermediate points would then be determined by using the line for interpolation.

To approach this problem we pose two questions:

1. At what level of annual income would a family find life "unbearable", causing members "to want to die"? The level D = 9 on the abscissa would be assigned to the income selected in answer to this, and the first point on the line, at the lower right end, would be determined.

We then face the second question:

2. At what level of annual income would a family find problems due to shortage of money "barely noticeable"? Such a value of income would be plotted against the abscissa value D = 1. With two points thus determined the straight line can be drawn, and a dukkha-dollar relationship established for testing and evaluation..

How Defensible Is The Straight Line?

While the straight line might seem suspiciously simplistic, reasons can be advanced in its defense. If the income values on the ordinate axis are plotted on a logarithmic scale, the straight line would make the relationship of dollars to dukkhas conform to Fechner's Law. Arguments in support of application of this Law to the scale of suffering have been presented before.3 The remainder of this paper is therefore based upon the selection of two points in conformity with questions 1 and 2 above, and using a logarithmic scale ordinate (dollar) axis to define points between the two selected ones. Figure 2 shows an actual curve that results from this approach. It will be noted that the answers to Questions 1 and 2 in this case have been selected to be $10,000/year and $100,000/year respectively. An attempt to evaluate this dukkha-to-dollar scale as a tool for studying actual societal problems has been made as described below.

Test of Figure 2 Against The Real World

Figure 3 presents the economic status of 68,500,000 American families in 1993, as published by the US Census Bureau's "Statistical Abstract of the US". The data show the number of families receiving income in seven different brackets.

The related Panetic question would be, how much suffering is inflicted on each family by the income it receives, and what is the gross national burden of such income-inflicted dukkhas? Figure 2 provides a tool for answering this question, since it enables a definite suffering level in dukkhas to be calculated for each of the income brackets used by the Census Bureau. Multiplying the dukkha level for each income by the number of families in that income range yields the total income-inflicted suffering endured in 1993 by those families. Summing these values for all the brackets gives the gross IID's for 1993.

The results of the calculation described are shown in Figure 4. The darker bars show the gross income by classes as in Figure 3, and provide a basis for comparison of this figure with the related ones which follow. The white bars present panetic information in the form of total dukkhas inflicted by income on each economic class, using the curve of Figure 2 for the income-to-dukkha relation.

Discussion

Good things and bad things can be said about Figure 4. If it could be taken seriously, it would add panetic statistics to economic statistics in a simple and straightforward way, illustrate a practical and easy way to conduct panetic analyses in the vast area of economics and open new avenues for incorporating dukkhas into discussions and calculations of public policy issues. New comparisons could be made. The exercise includes calculation of the national total of IID's (1.3 gigadukkhas per day = 465 gigadukkhas per year). Values for these subjects, if ever verifiable and accepted, could be important in the future.

There are also many faults to find in Figure 4 and its implications. Its validity depends entirely upon the soundness of Figure 2, with its semi-logarithmic dukkha-to-dollar transformation curve. Are the two questions used to determine the upper and lower points of the curve legitimate? Was the choice of $100,000 per year to correspond to D = 1 a reasonable one? How about $10,000 for D = 9? There is also an overall judgment to be made; namely, do the lighter (dukkha) bars in Figure 4 present a view that is reasonable and acceptable to paneticists? Could they merit and win acceptance among the broader community whose support will be essential if Panetics is to achieve what is hoped for it?

The confesses to grave doubts about all the above questions and suggests that the value, if any, of the effort represented by Figure 4 is that it may shed some illumination on the dukkha and its definition. The subject contains more difficulties than can be discussed here, but Figures 5 and 6 reveal some of the questions involved. In these figures, the "wealthy point" corresponding to D=1 is set at $1,0000,000/year and $30,000/year respectively. With each would go a modified Form of Figure 2, the line being steeper in the former case and less steep in the latter. Both probably will and should be regarded as absurd by sane Paneticists, but the aim here is to test the dukkha by using it in experiments ("thought experiments") and finding out how well it washes. In the opinion of the present author, the dukkha does not wash very well in this attempt to relate it to economics. It is disappointing that this paper has not provided an answer to the "pertinent question" quoted at its beginning. This is also somewhat disturbing.

After all, what would Panetics be without the dukkha?

(…)

Much of his (Bentham's) work was spent in attempts to reduce suffering in governance, among other things. He recognized that pleasure is used as "reward power" by politicians. The concept of "social power" is useful in that it draws attention to the role of power in social relations that lead to suffering. He explained that "Pleasures then, and the avoidance of pains, are the ends which the legislator has in view: it behoves him therefore to understand their value. Pleasures and pains are the instruments he has to work with: it behoves him therefore to understand their force, which is again, in other words, their value." With reference to suffering, the implication of the term, "value", is that it may sometime become a quantitative and not only a qualitative measure. More recent views on suffering and its measurement have been expressed by members of the International Society for Panetics, particularly in the excellent work of Ralph G. H. Siu.

We should note that Bentham is quite specific when he writes: "To a person considered by himself, the value of a pleasure or pain considered by itself, will be greater or less, according to the four following circumstances: 1. Its intensity; 2. Its duration; 3. Its certainty or uncertainty; 4. Its propinquity or remoteness.. This constitutes the fecundity of the first pain, and the impurity of the first pleasure." He follows up with . . . . "These are the (basic) circumstances which are to be considered in estimating a pleasure or a pain considered each of them by itself. But when the value of any pleasure or pain is considered for the purpose of estimating the tendency of any act by which it is produced, there are two other circumstances to be taken into the account; these are: 5. Its fecundity, or the chance it has of being followed by sensations of the same kind; that is, pleasures, if it be pleasures; pains if it be pain. 6. Its purity, or the chance it has of not being followed by sensations of the opposite kind; that is, pains, if it be a pleasure; pleasures, if it be a pain."

He explains: "These two last, however, are in strictness scarcely to be deemed properties of the pleasure or the pain itself; they are not, therefore, in strictness to be taken into the account of the value of that pleasure or that pain. They are in strictness to be deemed properties only of the act, or other event, by which such pleasure or pain has been produced; and accordingly are only to be taken into the account of the tendency of such act or such event."

Bentham further explains in summarized form: "To a number of persons, with reference to each of whom the value of a pleasure or a pain is considered, it will be greater or less, according to seven circumstances . . . . 1. Its intensity; 2. Its duration; 3. Its certainty or uncertainty; Its propinquity or remoteness; Its fecundity; Its purity. And one other . . . . 7. Its extent.; that is, the number of persons . . . . who are affected by it."

Bentham's further instructions for applying this system of accounting are: "To take an exact account then of the general tendency of any act, by which the interests of a community are affected, proceed as follows. Begin with any one person of those whose interests seem most immediately to be affected by it: and take an account,

1. Of the value of each distinguishable pleasure which appears to be produced by it in the first instance.

2. Of the value of each pain which appears to be produced by it in the first instance.

3. Of the value of each pleasure which appears to be produced by it after the first. This constitutes the fecundity of the first pleasure and the impurity of the first pain.

4. Of the value of each pain which appears to be produced by it after the first. This constitutes the fecundity of the first pain and the impurity of the first pleasure;

5. Sum up all the values of all the pleasures on the one side and those of the pains on the other. The balance, if it be on the side of pleasure, will give the good tendency of the act upon the whole, with respect to the interests of that individual person; if on the side of pain, the bad tendency of it upon the whole.

6. Take account of the number of persons whose interests appear to be concerned; and repeat the process with respect to each. Sum up the numbers expressive of the degrees of good tendency, which the act has, with respect to each individual, in regard to whom the tendency of it is good upon the whole; do this again with respect to each individual, in regard to whom the tendency of it is good upon the whole. Take the balance; which, if on the side of pleasure, will give the general good tendency of the act, with respect to the total number or community of individuals concerned; if on the side of pain, the general evil tendency, with respect to the same community."

It is surprising how modern Bentham's formulations were and how he anticipated critical issues in the study of suffering. The most striking is his insight about the importance of the use of measurement in the formation of public policy, and the recognition that pleasures and pains are instruments of that formative process. History teaches that in the practice of politics, policy formation and governance, particularly in the uses of pain and punishment, physical and psychological motivaters have always been used to control behavior. The preponderant method has been to use pain and suffering to control others, often in the most highly grotesque forms in earlier times. The use of positive incentives as general policies to deter antisocial behavior appear to have developed only recently. Retribution for a criminal act by undue use of pain and suffering still remains in certain cultures around the world where these practices continue.

Intensity and duration are basic dimensions for measurement that deal with the psychophysical response of pain or pleasure. Bear in mind that Bentham worked in a pre-statistical period and lacked many of the modern advances in statistics and quantitative measurement. By those standards, given his times, his insights are noteworthy. Bentham's use of the words, "certainty or uncertainty", for example, suggest that he may have suspected the role of probability, as contrasted with purely deterministic explanation, in explaining some forms of behavior. This is definitely a more modern concept that takes us in yet another direction in understanding causation, away from strict determinism, and even further away from teleological explanations of causation still popular in his time.

Distance of an event in space and time is a dimension awaiting the appearance of modern statistical techniques. Looking back, it must have been difficult without them, yet Bentham tried to define proximal and distal events. Fecundity (an event that leads to others of a similar or different kind) and purity (uniqueness as an isolated event) round out his list with the exception of one other, extent, which means in this case, distribution over space and time. And here we have the possible anticipation of the science of biostatistics and epidemiology, as well as modern measures of variation, which techniques, incidentally, would have allowed Bentham to map the incidence and prevalence of a painful or pleasurable event in different environments, organizations and other contexts. If we allow ourselves to see beyond his language and methodological limitations, he surely was at the forefront of his times.

Apart from suggesting that measurement was necessary in order to deal with the policy issues present in his time, he strongly suggested that an accounting system should be developed with profit and loss replaced by pleasure and pain. One's calculation of one's quality of life, therefore, would be summarized by the ratio of pleasure (the numerator) to pain (the denominator) in any given case. The debate over measurement in the ISP continues the search for improved ways to accomplish this, but does so in the shadow of Jeremy Bentham who helped to pave the way.

Social indicators, for example, are another technique for measuring social trends and were anticipated under Bentham’s form of social accounting of pain and pleasure related behavior. (…)

(…)

Since involuntary displacement of the population engenders enormous amounts of suffering of different kinds, it deserves the full attention of panetics. The ability to quantify the degree of suffering in a population would enable policy-makers to estimate when the amount of suffering reaches the point at which a displaced population may destabilize a country of asylum. With such estimates, resources could be allocated to avert the problem, especially in poorer countries accommodating large numbers of refugees.

Policy makers of the countries introducing restrictive immigration procedures might estimate the amount of suffering in the countries of the asylum seeker's origin. It may help them to find out whether the amount of suffering has reached the critical point at which people will flee the country and the measures adopted will only encourage illegal migration. Perhaps alternative foreign aid policies might prove more effective.

A quantitative measure of suffering used as a social indicator can help national governments and the international community estimate more accurately the amounts of unintended infliction of suffering resulting from humanitarian assistance, compare it with the benefits of the on-going assistance and make rational choices among policy options.

Devising a quantitative measure of suffering is not an easy task because "the limits of tolerance (for suffering) will differ widely from society to society and culture to culture" (Lundstedt, 1995, p. 23). Nevertheless, as Siu has points out, for the sake of developing a quantitative measure, "the subjective discrepancies in direct and trans-personal appraisals of suffering lie well within quite technically manageable proportions." If scientists devise such a measure, they will need considerable time to test and improve it. The introduction of a more refined measure should eventually benefit everyone involved in understanding the issues of mass displacement, refugees, internally displaced persons, national governments and the international community as a whole.

Currently, government and international agencies involved in assistance to refugees and internally displaced persons use social indicators as indirect measures of suffering. The most commonly used social indicators are: mortality rate, morbidity rate, the number of the unemployed among refugees, the number of refugee children not attending school, and the health condition of the most vulnerable refugee populations--children, women and the elderly.

While these indicators serve the purpose of rendering assistance to refugees and displaced persons in different areas (health care, education, income-generating activities), they do not allow for a comprehensive approach to addressing the needs of refugees and displaced people in order to prevent and alleviate suffering. The integration of such partial methods with more thorough-going panetic methods is a worthy objective to consider.

Commentary by Donald Michael, Emeritus Professor of Planning and public Policy, University of Michigan:

"With the dukkha, we're in a realm of approximations. I want to be assured, not necessarily that the measure is theoretically 'precise,' but that it is sufficiently accurate for the purposes and contexts of use."

Commentary by Herbert Striner, former Dean, Kogod College of Business Administration, American University:

"All social measurements belong to the realm of approximations. Take the Consumer Price index used by economists. The starting point for estimation is the so-called 'market basket' of arbitrarily, albeit judiciously, selected goods. Another is the 'poverty' threshold established by the Bureau of Labor Statistics as being the 'right' summation of a 'proper' combination of considerations. These two judgmental figures have, over the years, assumed the status of 'objective' social indicators."

(…)

• First: Presidents make policy judgements in a highly complex domestic and international political environment. The variables are countless and the mix is continuously changing.

• Second: Presidents reach those policy judgements primarily through deliberation, not calculation. With one exception, I have never seen a quantified presentation of the human condition play a part in presidential decision-making. Military balances were the exception.

• Third: Presidents as human beings bring to each judgement their own conceptual frameworks.

• Fourth: The policy-influencing public that plays a significant role in shaping the political environment in which the president decides also works from its own conceptual framework.

Let me elaborate on what I mean by deliberation when I say that presidents reach policy judgements primarily through deliberation, not calculation. In the Cabinet room scene I described, there were plenty of analytical data to work with; they were presented with precision. I am in no way denigrating careful use of data.

But I am saying that there is an additional way of knowing. In the give and take of dialogue, people learn–not just facts but ways of thinking about facts. President Johnson was weighing policy choices not only in the light of data but in the light of how his colleagues felt about them. Presidents as leaders of people value and find most usable the knowledge that is generated in deliberative dialogue. Every administration has its formal meetings, but every president has his space for informal dialogue. Dialogue provides a way of knowing that is often more authentic for human beings than "scientific" data.

As we also know, it makes a big difference how issues are named and framed for deliberation. There was a period of time when the whole National Security Council system was built as a three-stage process which first laid out all technically reasonable options for dealing with a problem, then reshaped those options in light of political feasibility and finally provided space for deliberation on those options which itself might further reshape the options for final choice. It was a very careful process of deliberation in which knowledge was generated, accumulated and processed through dialogue and in which choices were shaped through interaction and made in the personal decision of the president.

I have also stated that presidents -- as well as the policy-influencing public -- bring their own conceptual framework to this policy dialogue. I have concluded in my own field of interest that the way to change how presidents decide to act in our rapidly changing world is to try to change the conceptual framework they use to give meaning to developments. The concepts that make up that framework are the lenses a president or a public uses to bring the world into focus. Those concepts are the lenses people use to give meaning to the chaotic world around them.

The conceptual lenses a president or a public uses to bring the world into focus determine how he or they act. That is why I as a reflective practitioner have decided that it is essential to deal head-on with concepts that no longer fully explain the rapidly changing world in which we live. Changing the conceptual framework–however slowly and laboriously–can change both the personal basis from which a president acts and the basis from which the public shapes the political environment within which a president acts.

(…)

For more than a century the idea of "scientific objectivity" has dominated our research–the notion that we can only know what can be materially defined and measured and that other kinds of knowledge are "subjective" and therefore to be discounted. Now as we put human beings back onto the stage of our thinking about politics and international relationships, we recognize that there are ways of knowing that grow out of human experience. In fact, many people today recognize that there is a degree of authenticity that comes from personal experience that no scientific experiment or measurement can capture.

(…)

The challenge is not to quantify the amount of pain in a destructive situation. The challenge is to create a political environment–a conceptual framework–in which the reduction of human suffering is seen by a significant majority to be in the national interest.

The challenge is to cause people to understand that suffering in far-off as well as nearby places hurts them–to cause people to understand that it is in their interest to see the level of suffering in the world reduced. At the heart of that challenge for research is to learn what the connection is between citizens and distant suffering.

This is the immediate challenge. People have begun to understand that globalization of the economy affects them. They need to understand that suffering in the world also affects them. That is a much more difficult point to make real.

(…)

To conclude, what kind of research agenda would flow from these remarks? As I hope will be apparent by now, I believe the challenge is not to measure the amount of pain in a given situation, but to enhance the likelihood that policy-makers and the policy-influencing public will respond effectively to it.

First and foremost, I believe it is essential to learn what connections Americans see between their larger interests and suffering far from where they live. People act to deal with problems when they feel the connection between what they value and the problem.

The study I mentioned a moment ago carried out through an extensive series of focus groups not only revealed great ignorance about the foreign assistance program, but it also revealed that people became more supportive when assured that the aid made a difference not only in alleviating present suffering but in building local capacity to reduce it over time. They supported the kind of aid they would value in their own communities.

Given the complexity of potential connections and the fact that we may not imagine some of them, I believe the focus group offers the most fruitful place to explore this subject.

Second, I would give attention to defining the paradigm shift in a way that captures your concerns and then I would give attention to gaining the broadest possible academic and public attention possible to that emerging conceptual framework. I would consider all possible media for calling attention to the damage done by continuing to ignore that the old lenses will not help us see our way into the world that is becoming.

Third, I would give attention to strengthening narrative and dramatic ways of making vivid the many dimensions of pain in the world, ranging from the obvious costs of violence to the subtle costs of corruption in a society.

Fourth, I would commission a few studies on why our government has been slow to respond to complex emergencies, such as the genocide in Rwanda.

This is a formidable agenda. I apologize for being so bold. But the subject is daunting and I could not do other than respond to your flattering invitation to share my thoughts fully with you.

(Written in 1995)

The newly elected President George Herbert Walker Bush promised on his first day of office that he was going to make the United States of America a "kinder and gentler nation."

Did he succeed? No way of telling, for sure.

Why not? Because there was no direct method for calculating the net amount of suffering that were actually being borne by all of the Americans put together, as well as by peoples elsewhere upon whom the country might have been inflicting suffering and bestowing benefits, and whether the trend figures were going up or down as a consequence of the government's decisions and actions.

The dukkha, after the Pali word for suffering, is an adaptation of an intuitive method used for thousands of years very satisfactorily by physicians and laymen alike. One dukkha is roughly equivalent to the amount of suffering borne by a single person with a moderate toothache for eight hours. Mathematically, it is the product of (number of persons) x (average intensity of suffering on a scale of 9) x (duration in days). Phasing out high-noise commercial aircraft in fifteen years, as had been decided by the Bush administration in lieu of the ten years originally promulgated, for example, would mean an additional infliction of nearly two million dukkhas of suffering/discomfort on Americans living near airports.

If that is so, will the new President use the dukkha and the Gross National Dukkhas (GND), for example, as governing guides and convincingly demonstrate his own success toward the minimization of suffering at the end of his term of office? Hard to say.

Is it because the procedure is too complicated for practical purposes? No, it is actually very simple. Any sophisticated polling body, like the Gallup organization and the New York Times-CBS News, can come up with a reasonably fair estimate of the running GND within a relatively short time. But the underlying principles and techniques of the new discipline of panetics (the integrated study of the infliction of suffering and the reduction of infliction) have only just begun to permeate academic circles, not to mention the upper reaches of The New York Times and the White House. It may take years before that happens. Perhaps ten, or even fifty.

But what if a strong chief of state is genuinely dedicated to humane governance? Then he can have the necessary econo-panetic operations, which would meld the generation and expenditures of dollars with the infliction and alleviation of dukkhas into the overall equation of human well-being, in place within a matter of months. The people can begin to see encouraging signs within a year.

For example? He can start with the setting of overall national goals of human well-being. It might consist of an economic progress of, say, three percent growth in GNP per year and a panetic improvement of, say, four percent reduction in GND per year. Furthermore, he might add the constraint that gains in material wealth are not to be attained through augmentations in human suffering. The ratio between the GNP and GND therefore is also important as a complementary criterion of excellence in stewardship. The basic chart for monitorship, containing all three of these parameters, is illustrated in the following figure.

Dukkhas would accordingly share the managerial spotlight with dollars. Detailed planning can be conducted for the respective components contributing to the GND. This would include inflictions and preventions/ameliorations according to classes of people, regions, categories of suffering, agents of infliction, governmental initiatives and their effects, and so on together with options and avenues for the prevention and reduction of dukkhas in each case. For example, how can a c given funding for health care be allocated for the maximum reduction of dukkhas for the population as a whole or optimally for predetermined differential patterns among the various types of patients, geographical locations, incomes, and the like.

The dukkha (infliction) potentials and antidukkha (relies investments of national programs under consideration can be quantified with approximate times and rates of "pay-offs." For long-term projections, the chief can explicitly address the issue of "dukkha-deficit" in tandem with "dollar-deficit." An example of the former is the generating of radioactive wastes with long half-lives. Plutonium-239,which is poisonous in itself, with a half life of 24,360 years poses a health hazard for hundreds of generations into the future. There is a potential dukkha-debt to be paid by someone down the way. Even denuding forests may mean an I. 0. U. in suffering to be exacted from some future descendants. Knowledgeable vigilance can be paid against possibilities of a present population increasing its own economic gains at the cost of unreasonable suffering for the yet unborn offspring.

Antidukkha investments toward reducing the national baseline of suffering with time can link dollars and dukkhas more directly and clearly, as well as dissect the nature of these relationships for specific cases. Judicious employment policies, sound monetary practices, enriching educational programs, and prudent health care agendas, for example, can be optimized in terms of antidukkhas returns at specified milestones in the future. Dukkha intensifying enterprises can be audited carefully as they approach the unjust/unreasonable threshold of infliction. We might even envision that some econo-panetic mathematician might come up before too long with 'an unified mathematical theory of humane capitalism.

For the short haul, explicit and quantitative accountability of inflicted and precluded/ relieved suffering can become standard procedure. A "panetic impact statements can be added to applications for government approval of toy safety, food and drug clearance, environmental impact statement, and the like. Eventually, a "people's well-being report card" can be developed. This would summarize the government's responsiveness to the people's wishes for the minimization of suffering. This can be fleshed out with associated details such as the number of dukkhas added to and subtracted from various groups by the range of national programs, as well as the net gain in well-being and chief beneficiaries in each instance.

The dukkha consciousness can be extended to international relations.7 The concrete part to be played by one's own country and the associated trade-offs can be directly faced in terms of the calculated flow of dukkhas and antidukkhas across national boundaries. This can be shown not only in matters of war and peace, but also in the vast array of other social interactions, such as global environmental pollution, spread of diseases, trade, illicit drug traffic, cultural exchanges, entertainment, financial aid, and so on.

Wholesome international encounters may be viewed as those which result in a net reduction of dukkhas in all countries involved. Worse relations occur when one or both parties end up with a significantly higher level of dukkha baseline for some time to come. When the resulting increase of dukkhas approaches inordinate numbers, then the world would naturally react to bring about a retreat from the inhumane precipice. All this will be facilitated with a universally standardized quantitative unit of suffering.

Given assiduous attention to the dukkha, the Gross National Dukkhas, the Gross Global Dukkhas, and their subdivisions on the part of the President of the United States of America, can there be any doubt but that she can indeed become a "kinder and gentler nation" within a span of six years?

Part One

Truth emerges more readily from error than confusion: Francis Bacon’s dictum is a useful companion as we begin to assess future directions for The International Society for Panetics.

(…) Galtung’s humorous reference to Ralph’s oft-made remark concerning numerical estimates: "They may be 100 % off, yet the measure will tell us something of immense value" -- is of interest, I believe, for what is not said. Not always, I would remind Ralph when he made that statement in my presence. I would not choose that approach for physicians, pharmacists, auto engine designers or a host of others on whom my safety and future may depend. Ralph always agreed with my riposte along these lines. But as an economist who has done his share of research, I knew what Ralph meant to convey. In any first effort, an intelligent, discriminating analyst will take informed shots in the darkness that usually prevails as--with first, faltering steps--one tests assumptions and hypotheses. But this only works as long as one is ready to re-evaluate, judge and--most importantly--be willing to change as new facts and insights begin to emerge. (…)

Helpfully, he (Galtung) sets the framework for an analysis of the underlying structure of the Panetics construct in a series of five points: 1. Man is the measure of all things. 2. The measure is subjective. 3. The measure is profoundly egalitarian. 4. The measure does not include sukha, bliss, and happiness. 5. The measure is non-theoretical.

I do not see how major exception can be taken to the assumptions underlying the first two points. The word major is used only because I desire to accommodate those who see Man as only a part of a larger schema, which assumes a living system that includes all forms of life, indeed, even the earth itself. But most people will not take exception to the point of view that the condition of Man is what ranks uppermost as we all attempt to exist in some mutually interacting, beneficial manner on this planet. And that each individual owns his or her suffering and is the primary judge of that condition cannot be denied. One’s own suffering can only be assessed and comprehended in its type and intensity by its owner. One’s own suffering--like one’s own teeth--can only be experienced by the owner.

Looking at the next three points is a very different matter. And as I assess each of these fundamental points, I hope to surface a conflict that has long perturbed me regarding the most basic assumptions regarding Panetic principles.

When we say the measure of suffering is egalitarian, we must ask what is meant by egalitarian? It cannot mean each person’s suffering can be given the same weight. To do that must mean: There are no conditions under which equality is not subject to some generally agreed-upon limitations. This is nonsense. Even in the most democratic of nations, where each citizen is guaranteed the right to vote, that right is suspended under certain conditions. Convicted felons, medically defined idiots come to mind immediately. The right to a speedy trial is likewise a right that can be limited under certain conditions. Habeas corpus was suspended by no less a person than Abraham Lincoln during the Civil War. Even the most of all cherished rights, one’s own life, is subject to forfeit if certain proscribed conditions of a civilized society are ignored. Contrary to what Prof. Galtung believes: This measure [the dukkha] makes us all equal before the suffering, like before the law. This not quite true of the law, except in some general, theoretical sense. Equality before the law is an equality that is circumscribed by provisions that guarantee a society’s right to a whole host of what are believed to be necessary exceptions. Conditions of war bring many of these exceptions to the fore. Even during peacetime, service in the U.S. military means being subject to a code of justice different from that imposed on all other citizens. Equality before the law is always subject to how the legal system defines that state of equality. How any society defines equality must ultimately square with the larger objectives of that society. And how that is determined is usually subject to a majority of a very small number of people (nine in the United States) who have the last word on what the law means. In a Supreme Court decision that is split 5 to 4, one person has had the last word on what is the law!

One of the unresolved issues regarding the dukkha is exactly how to circumscribe this measurement system in order to achieve our objective of not just measuring suffering but lessening suffering. Galtung’s proposition that "My enemy counts like myself" presents a logic of egalitarianism that equates the suffering NATO has inflicted upon Milosevic to the suffering that dictator has imposed on the Kosovars! Unless this is all merely a game of developing an arcane measurement system, there seems to be a moral disconnect in this sort of reasoning, I believe. But what if one accepts the validity of trying to develop an accurate measure of suffering that assumes the validity of "My enemy counts like myself?" I am certain that Milosevic would indeed suggest that the mental anguish and suffering he and his supporters would have to undergo if Kosovo were to remain in the hands of the Muslim residents is at least equal to any claims of suffering claimed by the residents? If there is to be any realistic use of a system that measures the combined suffering of dictators and their victims, how do we objectively separate or weight the two differently? Indeed, how can we do this legitimately if we start from Galtung’s premise "My enemy counts like myself"? We cannot. But more profoundly, should we? This is a question of both personal values and social ethics. My values and the ethical system with which I was inculcated both dictate that there are conditions when we should. Questions of equity, justice and ethics usually call for this differentiation. For an answer to this sort of problem you need go no further than Ralph Siu’s Shaping One’s Own Life. On page 151, he quotes Andrew Akins asking, "Can you imagine how a jury made up of twelve white landowners would judge the merits of our [Indian] claims [to their lands]?" The question of seeing the enemy as not qualitatively different can be difficult to deal with under some circumstances. Differentiation itself may not be easy. No better case of such an example exists than our own Civil War, when members of the same family might see each other through rifle sights. In other instances, differentiation is far simpler, but not for all persons. This issue arose during World War II. Sweden, Switzerland and a few other nations held themselves aloof from any military involvement in this effort to contain Germany and Japan from their objectives of dominating Europe and Asia. The values systems of those nation’s citizens who supported this position have been subject to much analysis over the years. All that can be said with any authority is that each human being must determine for himself or herself that point at which political principle is chosen over the survival of a large part of humanity and politically free institutions. This brings to mind the ultimate meaning of an earlier quote by Prof. Galtung: "Man is the measure of all things" -- man in a context of moral and ethical values, not in a context of physical or political values!

In his fourth point, Johan Galtung notes that the Panetic measure does not include any quality of sukkha, or happiness. It is a "pure" measure. Well and good. This is a question of methodological preferences. I have no quibble with this, though I might suggest that there are valid reasons for developing a net measure of suffering. But this is the subject of another paper. What I do find troublesome is Galtung’s fundamental ignorance of what economists see in the measure of per capita growth. He believes this measurement is a balancing or averaging of suffering and happiness. Nothing could be further from the truth!

(…)

The fifth and last of the points, describing the underlying structure of the Panetics construct concerns the non-theoretical nature of the measurement system. In the Galtung paper this is the most obscure piece of writing. All that is said is that concrete human beings report suffering, some more than others. The measure does not tell us why. Then follows the most confusing series of sentences about the causes of suffering related to concrete cases. All of which ends by saying the theory we (We? IPS?) have may itself cause immense suffering. What theory? No theory has really been outlined, insofar as I have been able to discern.

Part Two

What is Panetics Primarily All About? When one asks this question, would the answer be the dukkha or suffering? If the answer is the dukkha, then the emphasis of Panetics must be about a valid unit of measurement. If the answer is about suffering, then the emphasis must be on gaining an insight about a personal, emotional experience. These are two very different--not necessarily mutually exclusive--phenomena.

It often helps to clarify the nature of a problem by placing it in a ridiculous context. For example, can we quantify a Christian’s belief in Christianity by assigning a quantitative measure called a Christo to his or her level of devotion or commitment? If the answer is in the affirmative, could we then take the next step of comparing one person’s total number of Christos to that of another person? Aside from personal values systems, this measure would have to take into account doctrinal differences that impact on such an answer. Are we dealing with a comparison between Lutherans, Episcopalians, Greek Orthodox and Southern Baptists? Answers will abound. Will they be meaningful or useful? Probably not. Misleading? Quite probably.

The Thorny Problem of Measurement

The imagined necessary nexus between numbers and knowledge is a long and-- unfortunately--well-credentialed one. Witness these two respectable evidences of lineage: "Let no one ignorant of geometry enter here." (Inscription above Plato's academy.) "He is unworthy of the name of man who is ignorant that the diagonal of a square is incommensurate with its side." (Plato quoted in Memorabilia Mathematica, by R. Moritz.)

The question of "How much pain?" poses a very difficult problem for Paneticists. And for those Paneticists who have been trained in physical sciences, it is all the more painful. To use a definition of pain based on a toothache pain-unit is problematical. Depending on an individual’s threshold of pain--which is controlled by bio-chemical characteristics that vary with each individual--each toothache is experientially defined differently by each sufferer. To a large degree, we are trapped by genetics. But this problem of objective measurement need not be crippling in the development of Panetics, I believe. Paneticists will continue to search for increasingly effective techniques and units of measurement that describe the infliction and evidences of pain. Progress will come. But we must also begin to look to other methodological means of developing Panetics into an effective tool for analyzing the infliction and control of pain.

A very substantial body of knowledge and insight has been achieved in the absence of quantitative techniques. The future of Panetics will depend on developing a simultaneous, two track methodological approach. On one track will be continuing efforts to develop a credible--probably limited--source of quantitative data, capable of satisfying some aspects of a quantitative model. On a second track will be a methodology anchored in the use of a values-oriented model. In this respect, Panetics is not unlike some other disciplines. Let us examine three groups of disciplines.

Group I. Most--not all--of the problems of concern to physicists, engineers, chemists and geologists can be addressed by the use of quantitative techniques plus insights and visions that have no quantitative anchor.

Group II. Most of the problems of concern to theologians, counselors, ethicists and lawyers, cannot be addressed largely by quantitative techniques. Values figure heavily in the methodologies employed in these disciplines, and is frankly acknowledged to be the case.

Group III. Most of the problems of concern to economists, sociologists, political scientists, psychologists, historians and anthropologists find quantitative techniques to be of great value, but also often find such techniques to be more cosmetic than substantive or of more limited use than generally supposed. Values are acknowledged to play critical roles in all of these disciplines--though clumsily and often inarticulately in the case of economics.

My point is that perfectly reputable areas of knowledge--whose contributions have radically reduced vast areas of ignorance-- do not always have a satisfactory armamentarium of quantitative techniques or models. Credible anecdotal information, historically derived insights, logic, well-informed opinion are all sources of information and knowledge that have long been looked to successfully as a basis for intelligent decision-making. Taxonomic devices have been of inestimable help to intelligent, perceptive researchers capable of ordering, evaluating, synthesizing and using non-quantitative information in arriving at significant, important results-- and new knowledge.

Suffering is a personal, experiential phenomenon. There is no "pure" measure of suffering that permits comparing one person’s suffering with another person’s. Indeed, depending on many variables, even the same person cannot measure the same type of experience through time on the same objective basis. In war, the death of the first platoon mate will take on a different amount of pain than the second or fifth or tenth--and not necessarily on a decreasing basis. And the difference between those who were friends and those who were not is great. Can an "objective" comparison be made between those who were almost at the same level of friendship? To state the question is to sense the nonsense of the answer.

Suffering is not measurable in a "pure" sense. When Galtung advises "Give priority to those who suffer most" that statement suggests that we can measure such differences with objective certitude and that value-weights that prioritize each person’s self-evaluation of his or her level of suffering can be accepted in some credible, impartial sense. These are hardly realistic assumptions. On page one of his presentation he has unambiguously said, "The single person is the only judge of his/her situation." Quite correct.

From the outset, Panetics has suffered from the self-imposed need to develop an objective measurement system that is both pure and egalitarian though obviously subjective and unknowable, indeed, unfathomable to other than the immediate person involved. This is reflected in Galtung’s schizoid efforts to untie this same Gordian knot.

Lacking this scientific capability, in what way can the Panetic approach contribute to an understanding and alleviation of suffering? By viewing Panetics as a personal tool for evaluating ex ante the myriad effects of our contemplated decisions as they reflect our personal values. As they create happiness or suffering.

In the work in which I have been engaged since 1980, I have been concerned with the relationship between personal values systems and the decision-making process, which I term decisioning. As an economist, my major focus has been on the impact of personal values and decisions having to do with economic matters--of a public as well as a private sector nature. I, however, have done much work analyzing how personal values have played out in decisioning in other fields as well--the military, law, education, science, and industry. Regardless of the field, the same nexus exists in the decisioning process. I believe the work I have been doing has substantial implications for a methodological approach in the field of Panetics.

Every decision starts from a perception of what is right in a particular set of circumstances. Based on what is believed to be right, there is usually a series of solutions that comes to mind when a person is confronted by a problem. Relatively quickly--if a problem is one that has been encountered frequently, and dealt with successfully--assumptions are made as to what will probably ensue if the same action policy is adopted. Based on those assumptions, a policy is set and carried out. If new problems arise, more time may be required to assess the proper solution, that is, to determine what is right, what assumptions are fitting, and finally, the most valid solution. This relationship, between values, assumptions and policy, I refer to as VAP. In all of those instances where the word right is used, what is being reflected--in reality--is a values system. An individual’s perception of right or wrong reflects that person’s values system. Contrary to popular misconception, however, a personal values system is not fixed. Above, I stated that "Every decision starts from a perception of what is right in a particular set of circumstances." Personal values systems are hierarchical in nature. Decisions that are difficult to make--and take more than the usual amount of time-- are often so because they may necessitate a re-arrangement of the values in a personal Hierarchy of Values--a painful experience. In many such cases, the longer decision time often results from the greater degree of pain being caused by the re-arrangement of values in the hierarchy.

Panetics should foster a methodology of self-analysis that uses the concept of a Panetic evaluation system that positions important decisions within a context of the consequences of the decision. Fundamentally, a decision ceases to be understood as a self-standing, one-time event. It comes to be seen as part of a system with an epicenter that generates outward circles of suffering and/or happiness. To what degree does a decision I make create suffering? And is it worthy of the values system I wish to reflect by my actions? Can we begin to build these sorts of questions into the mind set of individuals? How can we begin to get individuals to evaluate their values hierarchies in terms of the suffering those systems may be causing and about which they have never been aware? Can we begin to develop a means for training children in this approach so they can grow into adulthood as more sensitive individuals? --more aware and more caring-- of the consequences of their actions and decisions? These are goals I believe Ralph Siu would favor as we continue to build on his past efforts.

(…)

MR. B: Bentham, as you know, is commonly listed in encyclopedias as the founder of Utilitarianism, a theory based upon the proposition that "the greatest happiness of the greatest number is the fundamental and self-evident principle of morality." From that proposition emerged, though perhaps with somewhat less clarity, his proposition that pain is the opposite of pleasure, and therefore logically (but not always convincingly) immoral. Bentham was a discriminating admirer of opposites. From the age of perhaps four he was a master logician who took on traditional authorities in the law--particularly Blackstone--and found their common-law principles littered with what he thought to be unjust fallacies. For many years he assaulted the English Parliament with proposals to make sense--logical, rational, scientific sense--of its legislative muddles. His pleasure-pain principle underlay all his proposals--for he was nothing if not orderly--and he was always in search of ways to regularize the principle. The pain element in his philosophy is clearly the equivalent of suffering in panetics; and he also had statistical approaches to pleasure and pain that are roughly parallel to the dukkhas described by Dr. Siu.

CHAIRMAN: I follow you, Mr. B, with respect to the connection between pain and suffering--surely pain encompasses suffering, suffering encompasses pain--but before we get to the dukkhas, I wish you would elaborate on Bentham's procedure for rendering the opposition between pleasure and pain in a logical manner. Was he statistically logical on this point?

MR. B: Yes and no. He insisted that both pleasure and pain were subjective phenomena, and admitted that nothing subjective is readily quantifiable. Yet he had many many distinct categories for the subjective--kinds of pleasure, kinds of pain--surely a preliminary step to quantification.

(…) Bentham acknowledged the subjectivity of pleasure and pain. His way of measuring them reached for precision only in relation to acts producing them. These he offered up details, even quantitative details.

(…) Ms. L: Does it matter? For either it (happiness) is a given, and as a given , it is not something that has a maximum and minimum. It is just there, an organic absolute, until somebody comes along and starts depriving it of some of its essence.

(…)Bentham kept struggling to be amoral but he couldn't get away from good and bad. All he could do to look amoral was to describe good and bad as utilitarian rather than moral opposites. The effort sometimes made him a relativist of ridiculous precisions. Here is a sample:

"Take an account of the number of persons whose interests appear to be concerned; and repeat the above process with respect to each. Sum up the numbers expressive of the degrees of good tendency, which the act has, with respect to each individual, in regard to whom the tendency of it is good upon the whole: do this again with respect to each individual in regard to whom the tendency is good on the whole: do this again with respect to each individual, in regard to whom the tendency of it is bad upon the whole. Take the balance; which, if on the side of pleasure, will give the general good tendency of the act, with respect to the total number of individuals concerned; if on the side of pain, the general evil tendency, with respect to the same community."

(…)

What I would like to know at this point is where Bentham and Dr. Siu differ.

Mr. B: The difference is not easy to describe, since at first glance it seems to be largely an historical difference, a difference resulting from cultural changes over nearly two centuries. Looked at in this way, their likenesses are perhaps more striking than their differences, especially in their ways of measuring pain. Bentham's units of measurement foreshadow Dr. Siu's dukkhas. Bentham tried to establish a code of pain "values" so that in criminal law, if someone seeking pleasure were accused of causing someone else's pain, the pain could be quantified. He went at it pretty much as Dr. Siu does, by first considering the value of one unit of pain in one person. He noted that it would be "greater or less according to the four following circumstances: ( 1 ) its intensity; (2) its duration; (3) its certainty or uncertainty; and (4) its propinquity or remoteness." He then added a couple of other "circumstances" that I will not trouble you with, so that ...

Cynic: Thank you for being so considerate.

Mr. B: ... so that he could arrive at his next step, which was literally to sum up what his four (or six) considerations amounted to for one pain recipient. Then he was ready to proceed to other pain recipients and sum up their units. Dr. Siu has done roughly the same thing with his dukkhas, but more precisely. He defines a dukkha as a "quantitative unit of suffering, equivalent to that endured by one person experiencing one intensity unit on a scale of nine for one day," Now Dr. Siu's unit distinctions, though phrased informally, are backed up by steady references to modern experiments in psychology, as of course Bentham's could not have been, but it seems to me that essentially Bentham and he are at one in their method of quantification. Bentham would have liked dukkhas.

Chairman: But their difference, Mr.B, their difference.

Mr. B: I would say that Bentham's struggles in balancing happiness and pain are not of interest to Dr. Siu. Those struggles sometimes seem comic to us, for as a psychologist Bentham was a true primitive, but they made him a true relativist, whereas Dr. Siu is an absolutist.

Chairman: What? Please explain yourself, sir. I think it is quite clear Dr. Siu's learned discourses on panetics that he approaches the subject before us in a thoroughly scientific manner.

Mr. B: Yes, and scientists have their absolutes, Mr. Chairman. And our culture's philosophers, politicians and justices have their absolutes, too. Thus our concepts of civil rights and human rights are absolutes--or at least a reaching for them, a denying that they are rights to be recognized only when it is "worthwhile" to do so. These concepts are not, as concepts, utilitarian, though of course in practice they are treated with plenty of relativity. But Bentham, theorist that he was, included worthwhileness as part of his theory. I am not approving or disapproving.

Cynic: At this point I would like to do some approving. And disapproving. I would like to approve Bentham after all, and to worry about Dr. Siu's fixities. I would have nothing against his dukkhas if they were to be placed in the hands of quantifiers like Dr. Siu himself, but I look around me at the quantifiers now at work among us, and all I can think of is how, in their hands, dukkhas might be, could be, would be misused--and therefore how important Bentham's cautionary approach is. Would the use of dukkhas by these s.o.b.'s be worthwhile? Mostly it would be deadly. Our culture is being destroyed before our eyes by quantifiers. Humanity has never before been so beset with detailed measurements of itself--head to toe, outside and inside, waking and sleeping. The quantifiers have become a plague among us from which there seems no escape--because they are so strong, healthy, and inexorably PRESENT. On what does "pc" depend? Where do our tastes in art, literature, clothes, cars, political candidates and headache pills come from? Who among us can say that he or she has not been quantified somehow since yesterday noon? If we are to quantify suffering we should certainly quantify how much suffering is inflicted upon us by quantifiers. And the most insufferable form of the infliction is not the quantifying itself but the arrogance of the quantifiers. Their game is to tell us what we think and then quantify our thought. They provide us with our major concerns, our opinions, our votes, our jargon, our mouthwash, and then they tell us what they have discovered about us. Our quantification climate is extraordinary. Our whole cultural weather is in the hands of quantitatively oriented perception manipulators.

Now I ask you, should weather be in any group's hands? Surely not. And surely, surely not in the hands of greedy manipulators. What do these manipulators manipulate for?--Power, my friends, power, power: their quantified bottom line.

Dr. Siu is himself a critic and an angry one, of the power people who have inflicted suffering on humanity. In his panetics trilogy he races right through most of the earth's great cultures from 8000 B. C. up to our own time, describing the powerful persons and forces of each culture that have inflicted suffering upon humanity; but in what I have read by him he has not dealt with the quantifiers--villains I am talking about. I do think they have to be reckoned with in any quantification theory, since they now dominate most of our sciences, professions, disciplines. My depressing impression of them--subject of course to scientific quantification:--is that Dr. Siu's pleasant dukkhas would rapidly become, in their hands, a major mechanism for INFLICTING suffering. If amoral Jeremy Bentham had not been on our agenda today, I might even now venture to call their machinations evil.

(…) If our chairman had proposed that we inaugurate a new round of meetings at which we would, like Bentham and Dr. Siu, try to devise a precise scale for creativity, with number degrees of complexity, maturity, innovativity, and so on, our poets would have rushed off indignantly.

(…) Ms. L: You boys, if I may use that word, are being awfully clever and nasty, but I will not deny that what you are talking about is important. It is what all scholars face when searching out certainty where facts, if there are any, are slippery. So we have, let us say, the humanities and the sciences--and the two disciplines argue. Or we have the classicists and the romantics, the poets and the critics, the academics and the "beasts", and even the males and females--and they argue. At the moment we definitely have the males and the females arguing, so it might seem appropriate for me to take the line that the males have for centuries been the ones putting the kibosh on sensible approaches to the creating-and-suffering world inside each of us. Especially they have done so in modern times by asserting their precise quantitative scientism, while the females--as well as the poets at that creativity meeting--have sat on the sidelines murmuring of the unsliceable wholeness of feeling and true knowledge. I mention "wholeness" because that is the word that our cynic used in describing the suffering of the hypochondriacs in Kenneth Fearing’s poem. I ...

(…) Quantification is not, as a process, in itself a scientific vice--even our cynic admits this--and if there is vice lurking in its neighborhood, we should therefore get after the neighborhood, not the process. (…)

1. SUMMARY
A 1996-1997 letter from the Chairman of the International Society of Panetics to 1100 higher education leaders throughout the world elicited some of the most enthusiastic expressions of interest from universities in Russia and former republics of the Soviet Union. Little wonder.
Many citizens in these countries suffer greatly as they pass through the uncertainties of economic, social and political transformation. Their suffering is aggravated profoundly by high and low level corruption.Illicit activity undertaken for personal benefit at the expense and injury of the rest of the community, corruption is a pervasive phenomenon found in all societies. However, it is particularly virulent in those countries where customs and institutions that should monitor and control such abuse are themselves corrupted.Most efforts to assess the consequences of corruption attempt to gauge the damage in terms of the economic cost or "tax" it imposes on the society. 3 Comparatively little attention has focused upon the behavioral consequences–in particular, the "petty" corruption to which high level corruption induces a major part of the population to resort in order to survive financially. When engaged in by millions of people every day, such acts are far from "petty" in their consequences. Many of the "inflicted" become "inflictors" and the vast majority suffer from round after round of additional suffering as a direct result.
Can we use Panetic Analysis to help find ways to untangle this web of corruption? To assess the relative severity and distribution of national distress engendered by this chain of inflictions? To identify "break-points" where we can intervene to sever the chain and alleviate suffering? To measure our progress along the way? Further, can we use Panetic Analyses to help educate both decision-makers and the public about both the consequences of corruption and ways to alleviate it?
In April 1997, a limited experiment was undertaken in the Republic of Georgia, a former constituent republic of the Soviet Union, to help explore possible answers to these questions.
Although they were unfamiliar with the formal methods of Panetic Analysis, 32 young professionals–-all of them students in the Georgian-American Institute of Public Administration in Tbilisi–-were asked to describe and "diagram" how corruption inflicts suffering on the citizens of their country, and how this jeopardizes their nation’s future. This was an opportunity to take a first step toward defining the complex interactions between individual acts of corruption at a national level, their consequences for individual and collective suffering, and the points at which it is possible to intervene and bring the cycle of corruption under control.
Despite its short duration and tentative nature, the experiment demonstrated just how challenging it will be to develop Panetic Analyses of highly complex national and international systems. It illuminates the research challenges that lie ahead in the further development of Panetics. It also suggests that the tools of Panetics can be useful to decision-makers and the public even when the results are reported in non-Panetic terms.
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QUANTIFYING SUFFERING
In the brief three and a half weeks of this experiment, time did not permit the students themselves to assign relative weights of intensity to the various kinds of suffering Georgians currently experience as a consequence of corruption.
For illustrative purposes, hypothetical Panetic weights ("dukkhas") have been assigned by the author based on casual conversations with Georgians and a few surveys. Table 5 illustrates the possible values in dukkhas which might be assigned by victims of various corrupt acts. The magnitudes, when measured at a national level, compelled the use of "megadukkhas" (1,000,000 dukkhas=1 md). It must be stressed that these weights are hypothetical and are provided solely to raise methodological questions and to stimulate discussion.
Several anomalies in these hypothetical weightings are apparent. For example, a victim might experience corruption during a particular day, but the consequences may affect his or her life–and that of the family–for the rest of the year. So a calculation based on the one-day experience may not represent the actual duration of suffering, only its average for the year. For example, "one-day" can represent actual suffering experienced at different levels of intensity over the course of a year: (a) 4 hours at intensity " 0.5"; plus (b) 4 hours at intensity "1" four times; plus (c) 4 hours at intensity "2."
A small number of people experiencing very high levels of suffering may represent a much smaller gross intensity than millions of people suffering at low levels of intensity. Because our efforts to alleviate suffering should always focus on those suffering most intensely, Panetics must develop a means to take this into account in its weighting and calculation of intensities.
So the experiment in Georgia should not be construed as a definitive piece of research, but solely as an exploration which points in directions for still more useful development.
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QUANTIFYING
• (A) If 63 percent of Georgia’s 3 million adults (Table 3) say they have had some direct experience an average of one day each year with "grease payments" to police---1.89 million people x 1 day/year x intensity 1= 1.89 mds/year.
• (B) If 22 percent of adults say they have had direct experience an average of one day each year with harassment from police more serious than traffic grease payments–--660,000 persons x 1 day/year x intensity 3= 1.98 mds/year.
• (C) If 22% of Georgia’s adults have suffered corrupt harassment from District Inspectors an average of one day each year–--660,000 persons x 1 day/year x intensity 3= 1.98 mds/year.
• (D) If 19% of Georgian adults have experienced corrupt acts by regional officials an average of one day each year–--570,000 persons x 1 day/year x intensity 3 = 1.71 mds/year.
• (E) If 8% of Georgian adults have experienced an act committed by a criminal an average of one day each year–--240,000 persons x 1 day/year x intensity 5= 1.2 mds/year.
• (F) If 5000 street children per year are exploited for illicit purposes average 30 days per year–--5000 persons x 30 days/year x intensity 8= 1.2 mds/year.
• (G) If 1500 jail inmates are tortured an average 5 days each year---1500 persons x 5 days/year x intensity 9= .067 mds/year.
(...)
• (H) If 50% of Georgia’s 3 million adults have had to make grease payments an average of one day per year to the Tax Office–--1,500,000 x 1 day/year x intensity 1= 1.5 mds/year.
• (I) If 25% of Georgia’s adults have had to endure more complex harassment from the Tax Office an average of one day per year---375,000 x 1 day/year x intensity 3= 1.125 mds/year.
• (J) If all of Georgia’s citizens suffer from the lack of public services throughout the year as a result of unpaid or diverted taxes---5,500,000 x 365 days/year x intensity 2= 4,015 mds/year.
(...)
• (K) 6000 households (3.2 persons/family) lost savings x 365 days x intensity 5=35.04 mds/year.
• (L) 990,000 jobless persons x 365 days x intensity 7= 2,529.45 mds/year.
• (M) As result of lost capital, economic development is deterred, 1.5 million adults in the workforce are underpaid/underemployed forcing them to find additional means of support (often through corruption)---1.5 million low paid/underemployed x 365 days/year x intensity 5= 2,737.5 mds/year.
(...)
• (N) If 90% of the population suffer from high prices and low incomes---4.95 million x 365 days/year x intensity 4= 7227 mds/year.
(...)
• (O) If 4 million people suffer an average three hours per day (aggregated as 45.5 days) from cut offs in electricity and water–--4.0 million x 45.5 days/year x intensity 5= 910 mds/year.
(...)
• (P) If 1,500,000 workers experience an average of at least one day of exploitation in the workplace---1.5 million x 1 day x 4= 6 mds/year.
(...)
• (Q) If 100,000 entrepreneurs per year are extorted an average of 10 days per year –--100,000 x 10 days x intensity 4=4 mds/year.
• (R) If 10,000 businesses per year shut down or do not start up because of corruption, then the consequences in joblessness and lost income at 3 persons per business contribute to the losses included in Calculation M.
(...)
• (S) If one-fourth of the population is deterred an average of one day each year from using the health care system because it can not afford or does not trust it–--1,375,000 x 1 day x intensity 4= 5.5 mds/year.
• (T) If 150,000 cases occur an average of one day per year in which counterfeit, expired, or no medicine is provided for patients in dire need–--150,000 x 1 day x intensity 8= 1.2 mds/year.
• (U) If 75,000 cases of food poisoning occur an average of one day per year because of corrupt enforcement–--75,000  x 1 day x intensity 8= .6 mds/year.
(...)
• (V) 375,000 poor or jobless on social security extorted by officials an average of 12 days per year–--375,000 x 12 collection days/year x intensity 6= 27 mds/year.

5. THE BLACK HOLE OF CORRUPTION
If simply summed, these separate acts of corruption inflict a hypothetical 17,510.9 mds of suffering (Table 6). Obviously, reality is not this simple.
Much is missing from Table 6. It must be stressed that limits of both time and circumstance prevented this from being a comprehensive experiment based upon rigorous research and validation. Using incomplete raw perceptual data, the experiment is intended solely to help us sketch the challenges ahead as we apply Panetic Analyses to large, complex national systems.
Because of the way each student described corruption and its effects in his or her assigned sector, causes and effects are jumbled together in Table 6. We must separate one from the other in order to understand the sources of inflicted suffering, motivations to inflict it, and the consequences. For example, the separate high and low-level corruptions in customs, electric power, medical care, education, and the tax system all drain the capacity of the country to provide adequate public services. In rebellion against these deficiencies, people then engage in another round of corruption which aggravates their public service deprivations still further. (See Calculation J-Figure 4)
(...)
Every infliction triggers another, then another, which, in turn, feeds back on itself and others to create system-wide consequences which, unfortunately, incite a whole new round of similar inflictions.
Such circularity in causes and effects can be likened to a "black hole"–a self-perpetuating whirlpool of corruption and suffering from which it becomes increasingly difficult to escape (Figure 5).
(...)
TOWARD A PANETIC MODEL
To quantify all of these interactions and "feedback loops" calls for capabilities rivaling those necessary to create a highly sophisticated econometric model.
(..)
REPORTING IN NON-PANETIC TERMS
We can see why efforts to calculate the "costs" of corruption nationally and world-wide have proven so daunting. It is also easy to see why most such efforts have focused on the "economic cost" of corruption, since economic data are available more readily. But few such inquiries have addressed the behavioral consequences triggered by uncontrolled corruption. This is where Panetic Analyses can be highly useful.
One of the major challenges for Panetic scholars will be to devise models that can facilitate such computations. However, the need to reign in corruption in order to reduce suffering in societies that are transforming is immediate. We must turn to tools readily at hand. The units of measure used for public discussion and decision-making can–and should be–those most appropriate for the purpose, and those understood best by the users and audience.
Obviously, the cumulative consequences of corruption in any country can be quantified, in many ways. They can be reported in income lost, jobs uncreated or lost, skill declines, public services unavailable, declining housing conditions, shortages of food, infant mortality, declining health indicators, etc.
For example, at this stage in the life of the Republic of Georgia, a Panetic Analysis which shows demonstrably how corruption undercuts the most urgent priority agreed upon by nearly everyone in the country– economic revival–may well be understood and acted upon more quickly than if it is couched solely in quantitative measures of suffering (such as "dukkhas"). Georgians know they are suffering, and they seek a specific plan that will help them understand how corruption forestalls economic revival and how to bring it under control. They want to know where they can intervene to break the chain of corruption, and how to identify the main perpetrators.
After several years of trying many different measures, Partha Dasgupta, one of the World Bank’s researchers, concluded that recent suggestions that national income is a vastly misleading index of well-being are not borne out by tests among several indicators conducted by his colleagues and himself. "We can do better than rely on national income, but we wouldn't have been wildly off the mark as regards an ordinal comparison of countries had we relied exclusively on national income per head," he concluded.12
Nearly all Georgians would subscribe to the view that, in order to alleviate suffering from corruption, it is essential to renew the economy so that (1) peoples’ incomes can be raised to levels at which they can support themselves and their families; (2) new jobs can be created for the nearly one third of the working age population currently unemployed; and (3) public services, including infrastructure, can be renovated so that living conditions are improved. So, for the near term, it might prove most efficacious to report the results of a Panetic Analysis of corruption in Georgia in economic terms. The data are readily available.
Panetic diagrams can be used to educate citizens about how corruption, whether inflicted by others, or self-inflicted, inhibits improvement in their income and the availability of jobs. Panetic diagrams can also be used to assist decision-making and planning about how to bring corruption under control, including identification of the "break-points" where anti-corruption measures can be introduced most effectively.
(...)

(...) a three-week experiment by a group of highly-motivated, but non-expert, professionals to address this very complex problem made a good deal of progress in performing–and using–Panetic Analysis to measure the relative degrees of suffering from corruption, and the interconnections between its causes and effects, even if they did not know that they were so engaged.

7. CONCLUSION
Their effort demonstrates a clear need for Paneticists to concentrate their future research energies upon the development of equations and models that take account of the inter-connections between multiple causes and effects of suffering in a complex social system, the behavioral consequences that flow from them, and the way they feed back upon each other and the system as a whole. We must now move beyond simple linear computations and undertake these much more challenging multi-dimensional measurements and calculations.
This same challenge confronts non-Paneticists who are more specifically concerned with measuring the true costs and consequences of corruption.
In the meantime, we should not be reluctant to report the results of Panetic Analyses in economic, social, or physical units of measure if they should suit the purposes and applications of the analysis better.

Several conditions must be satisfied in order to apply Panetic Analysis to government decision-making on a continuous, practical basis:

i. The climate of public opinion must be supportive, or at least not antagonistic.

ii. The basic requirements of the process must be familiar enough that they are understandable and acceptable.

iii. Institutional capacity and purpose must exist somewhere within a government where Panetic Analysis can be applied.

iv. The methodologies of Panetic Analysis must be far enough along in their development to make their use convenient and practical.

(…)

2. The Process of Measurement Is Familiar

The second pre-condition--that the requirements of the process be sufficiently familiar and understandable--is also satisfied in many societies. Many governments and populations are accustomed now to the use of regularly-employed indicators that measure various aspects of human well-being to help make governmental decisions.

Economic indicators have long provided the guideposts for public and private economic decision-making in developed countries and international institutions. Valiant efforts are made by such organizations as the World Bank to transform narrowly-defined economic measures into broader, more elastic, quality-of-life indicators that apply equally well as measures of human well-being in a highly industrialized country or a Third World village.

Each year, the US State Department issues its global report on human rights. Many non-governmental organizations, such as Amnesty International, provide additional reports and measurements on various aspects of human suffering, whether among children, or refugees, or women, or families. These indicators receive attention in the public press and in public forums and find their way into public debate, eventually influencing political behavior and government decision-making.

National and international agencies continually monitor and report on the rising or falling incidence of various threats to public health. When danger is identified, action usually follows.

Growing numbers of social indicators are used to monitor other aspects of human suffering or well-being. Although the US government has issued only one comprehensive social report as a companion to the President's Economic Report (Office of Management and Budget, 1976), every year US government and state government agencies regularly monitor and report on infant mortality, health, education, crime, poverty, housing, racial integration or separation, gender, etc. International organizations such as the United Nations, the Organization for Economic Cooperation and Development, the World Bank, and EUROSTAT, the statistical agency of the European Union, provide similar monitoring.

It can be argued, therefore, that the principal objective of Panetics, to develop, and see applied quantitative measures of human suffering that help guide decision-making toward alleviation of that suffering, is already satisfied to some degree. At least the measurement process itself is quite familiar to both government and the general public.

(…)

4. The Methodological Challenge

In matters of public health and safety, the connection between measurement and governmental action is straight-forward. The well-being of the whole population is at stake. The equation that connects the measurement of a threat to the need for government action to forestall it is quite direct and commands broad popular support.

However, these comprise only a fraction of the decisions politicians and governments must make. Most political decisions involve "trade-offs" between suffering for one group or another. The Panetic equation grows far more complex.

The Case of Environmental Impact Assessment

The Environmental Impact Assessment (EIA) process, adopted in the 1970s to help determine, in advance, the probable consequences of a decision for human health and the natural environment, provides an on-point example directly relevant to potential application of Panetic Analysis.

First, EIA involves measures and a process through which one can gauge environmental threats to human well-being and the planet's ecology. Secondly, a government institution (EPA) is accountable for developing decisions and regulations based upon those measurements. Thirdly, power has been granted to enforce the protections to human life and health that are decided upon.

Twenty years after its adoption, this process is very much a subject of controversy. It is complex and technically challenging. Unquestionably, it has slowed up decisions that, rashly made, might have adversely affected human health, or the integrity of vulnerable national environments. However, the evidence is not yet clear about just how much the EIA process has helped improve public and private decision-making to minimize human suffering and damage to vulnerable natural systems.

In a decision about whether to permit logging in a National Forest, the EIA must weigh, on the one hand, the suffering of loggers who may lose their jobs, together with that of people in the towns that may lose much business, and the saw mill and company owners who may lose income. On the other hand the process must weigh the suffering that harvesting timber may impose on the general public through lost recreation, increased soil erosion, deteriorated water supplies, etc. perhaps supplemented by the loss of rare and endangered flora and fauna.

The methodologies for weighing the trade-offs between these various degrees of suffering are as imperfect as the cost-benefit calculations used by the US Army Corps of Engineers to left construction of a flood protection levee, dam, or waterway. Every calculation is viewed with suspicion by antagonists on either side of any decision.

We can all agree with Herbert Striner (1992) that the dukkha, Siu’s proposed measure of suffering, like all social measurements, can only be an approximation.

But it is totally insufficient for many political decision-making purposes to posit the Panetic equation as a one-sided correlation between a decision, or government action, and the human suffering it incurs.

The majority of government decisions involve trade-offs between the imposition of some degree of suffering–however small or large–for one or more groups on the one side while conferring benefits for one or more groups on the other. The late, great social scientist Harold Lasswell characterized politics as the art of deciding "who gets what, when, and how." The politician's role is to weigh trade-offs involving suffering among groups and then to decide.

Here we face the first of several conundrums as we attempt to apply Panetics to political decision-making. If the weight to be given to suffering is to be determined subjectively by the victim, as has been suggested, the method is at odds with how political decisions are actually made.

First, in our adversarial system of politics, politicians are elected by constituents. By definition, then, they give greater weight to the suffering of their supporters than they give to those who oppose them. On a global scale, decision-making is still guided by the "self-interest" of nation-states. Imagine the Panetic equation involved in a decision by a US President about whether to intervene in Bosnia to stop increasingly intolerable levels of human suffering. The weight he must assign to the loss of lives of his own citizenry on behalf of lives in an area where his own citizenry feels little real "geopolitical" stake is greater than the weight he assigns to one Bosnian human life. The Bosnian can not determine that weight for the purposes of an American governmental decision. Even if the day arises when all such decisions will be made at a "world community" level, it is doubtful that the weight to be assigned to the degree of suffering can, or will be, left to determination by the victim alone.

As currently formulated, the Panetic equation can lead to a second conundrum–inequitable results that run counter to the value systems of a fair and open society.

For example, let us say Congress is considering a major bill to provide financial assistance to poor and destitute families. The "suffering" imposed on the 114 million taxpayers by an increase in taxes is a "Barely Noticeable" 1 on the dukkha scale, giving us a value of 114,000,000 dukkhas. The "suffering" of the affected families is a "Quite a Lot" 6 on the Panetic scale for 13,600,000 families, giving us a total of 81,000,000 dukkhas. On our scale of human suffering, the poor and destitute lose out. Yet, in a society where the majority rules, an important constitutional principle has been to protect the minority from the tyranny of the majority.

Thirdly, as currently formulated, the Dukkha Table measures suffering in terms of physical, and possibly mental, anguish. Yet, if Panetics is to find broad application, the table must contain equivalencies that reflect other forms of perceived suffering. James Davis (1992) has pressed us to recognize that the dukkha must be a measure sufficiently elastic to reflect differing levels of suffering between one society and another.

5. Next Steps in Panetic Development

Clearly, rigorous further research and development is essential in order to bring Panetics to a level sufficiently practical for it to be applied in government decision-making.

One major research thrust must develop a process through which more acceptable weights can be assigned to degrees of suffering. In a society--and world--in which diverse values and expectations operate, a carefully facilitated process that takes this diversity into account is essential. The process and systems developed by John N. Warfield, of George Mason University, offer the most promising avenues for this phase for Panetic development.

The same process can be used to identify equivalencies of suffering for use in the Dukkha table.

To provide a framework within which further research and development might be pursued to make applications of Panetics to government decision-making more practicable, we can use the best expression of political values available--the Preamble to the US Constitution.

i. Establish Justice and Insure Domestic Tranquility

Because the impacts on human suffering that arise from crime, threats to public safety, and riots lend themselves readily to measurement at the current state of development of Panetics, a conceptual first step has been taken that should lead to the development of some Dukkha Tables applicable to law enforcement, the administration of justice, and the preservation of order.

Siu (1993, 1994) has advanced several ways in which Panetic Analysis could have been used in a number of critical court decisions, as well as by New York City's Mayor. Davis (1993) has hazarded an estimate of the dukkhas involved in dealing with the Waco incident. At its October, 1993 meeting, The International Society for Panetics reviewed nine riots, and the Los Angles riot of 1992, in particular. While there was no definitive estimate of the dukkhas incurred, it is clear that the next step is to develop a Dukkha Table for Justice and Law Enforcement.

ii. Provide for the Common Defense

This function of government also lends itself readily to Panetic Analysis in its current state of development. This is a major topic to be covered during the same meeting of the Society at which this paper is presented. For that reason, the subject will not be pursued here except to suggest that a second development challenge is to develop a Dukkha Table that can be applied to Defense and Foreign Policy interventions.

iii. Promote the General Welfare

As we come to the functions of government intended to promote the general welfare, we begin with functions that lend themselves readily to Panetic Analysis and then shade off into the less and less tractable for Panetic Analysis at its current stage of development.

A good start has been made in health and medicine by Glenn Geelhoed and Ralph Siu .

In the fields of education and welfare, however, much work remains to be done to deal with the conundrum outlined in the section above concerning the consequences that would flow from a too-literal application of the Panetics equation to minority vs. majority suffering.

iv. Secure the Blessings of Liberty

Similarly, much rigorous work must be done to reconcile the emphasis in Panetics on alleviating human suffering with some of the values that drive society which accept some degree of suffering as the necessary price of progress and involve hard, but essential choices, i. e. "constructive destruction" as an element of creative capitalism. The current political discussion about widespread anxiety in the face of corporate down-sizing in order to meet the challenges of global competition is a case in point.

6. Laboratories for Further Panetic Development

Obviously, much of this work can be carried forward most ideally in a university environment with faculty and students dedicated to the advancement of Panetics as a new discipline. However, for such research and development to produce the most relevant results, it should occur in an environment closely associated with the realities of government decision-making itself.

(…)

For practical application, Panetic Analysis must address four methodological challenges. It is proposed that an interdisciplinary team of academicians and practitioners be organized to address them and that a funding proposal be developed to carry out the suggested research and development.

(1) The Challenge of Complexity and Trade-Offs

Most political decisions are concerned not just with the suffering of a victim, but with the many levels through which that suffering ramifies in society and the trade-offs involved. In addition to the suffering of the victim, there is suffering by the family and individuals close to the victim, plus the costs imposed on the community if the suffering is to be alleviated, plus the possibility that resources are diverted from others who may also be suffering.

The late social scientist Harold Lasswell characterized politics as the art of deciding "who gets what, when, and how?" Many political decisions involve the imposition of some degree of suffering on one group in order to benefit another. The politician must gauge "who is going to be glad and how glad. Who is going to be mad, and how mad?"

Siu provides a good example of the trade-off choices political decision-makers face.

An Example of the "Trade-Off" Conundrum

"In 1979, when unemployment stood around ten percent in New York City, robbery rose by 43 percent city-wide and 70 percent in the subways...With the City on the verge of bankruptcy and burdened with increased welfare costs, court-ordered busing for schools, and many other services, the Mayor was impaled on the horns of a dilemma. To assign more transit police to the subway system was to have dirtier streets and fewer teachers. ‘We laid off 2,200 teachers,’ said Ed Koch. "I am not prepared to lay off more teachers to have more cops. That is our problem." The upshot was that even more criminals eluded the clutches of the law than ever before."

Attempts to calculate trade-offs "objectively" and "quantitatively" are not unfamiliar. For example, the Environmental Impact Assessment (EIA) process, adopted in the 1970s to help determine, in advance, the probable consequences of a decision for human health and the natural environment provides an on-point example.

In an assessment of whether to permit logging in a National Forest, an EIA must weigh, on the one hand, the suffering of loggers who may lose their jobs, together with that of people in the towns who may lose business and jobs, and the saw mill and company owners who may lose income. On the other side of the equation, the process must weigh the suffering that harvesting timber may impose on the general public through lost recreation, increased soil erosion, deteriorated water supplies, etc. perhaps aggravated by the loss of rare and endangered flora and fauna.

The methodologies for weighing the trade-offs between these various degrees of suffering are as imperfect as the cost-benefit calculations used by the US Army Corps of Engineers to left construction of a flood protection levee, dam, or waterway. Every calculation is viewed with suspicion by antagonists on either side of any decision. Every calculation is seized upon by advocates on either side as forensic fodder in support of their argument.

Weighing Trade-offs

In most Panetics Analysis so far, the challenge of weighing trade-offs has received little attention. For this reason, the Interdisciplinary Team put forward in this proposal will focus particular attention upon it.

For example, James N. Davis has performed many Panetic analyses of major political issues, e.g. reductions in human suffering that could result from a $1.25 tax per pack on cigarettes, reductions in airplane noise, and a hypothetical calculation of the human suffering that ensued from the federal Waco intervention.

Missing from his computations are the trade-offs that weighed most heavily in the minds of government decision-makers. For example, their anticipations of the potential future human suffering that might arise from a heavily-armed anti-social group which political decision-makers must have had in mind when they decided to "go in." Such considerations might have seemed less credible at the time Davis performed his hypothetical analysis than they appeared after the Oklahoma City bombing and arrest of the Viper militia in Arizona.

In an analysis of the consequences of high level and petty corruption in the Republic of Georgia, Widner attempted to portray the multi-dimensionality of the problem and the consequences that might flow from various decisions not to control it, but time and resources limited the ability to weigh trade-offs implicit in various interventions to bring corruption under control. What is more, the analysis and portrayal could fall back upon no graphical or analytical conventions that can be applied consistently to Panetic analyses of complex decision-making issues.

As in the case of Environmental Impact Assessments, we must, first of all, measure the dukkhas suffered by those hurt as well as helped by any political choice.

Benefits in reduced suffering Costs in increased suffering # of persons x days x Dukkha intensity # of persons x days x Dukkha intensity

The NET of the difference in dukkhas is what counts.

But most political decisions are more than two-sided–-they are multi-dimensional.

For example, let us say Congress is considering a major bill to provide financial assistance to poor and destitute families. The "suffering" imposed on the 114 million taxpayers by an increase in taxes is a "Barely Noticeable" 1 on the Panetic scale, giving us a value of 114,000,000 dukkhas. The "suffering" of the affected families is a "Quite a Lot" 6 on the Panetics scale for 13,600,000 families giving us a total of 81,600,000 dukkhas. On our scale of human suffering, the poor and destitute lose out. In a society where the majority rules, an important constitutional principle has been to protect the minority from the tyranny of the majority, yet on its face, this Panetic Analysis contravenes this principle.

The reason is that many of the "inputs" are missing. There are no calculations of second and third order consequences, and other types of impacts that may not entail suffering. A poverty-stricken population, unable to participate in the mainstream economy and contribute its full measure, imposes many social and economic costs on the general community. It detracts from the over-all quality of the workforce and affects the economic well-being of the general community. It can generate street crime, youth violence, severe public health problems, etc. These multiple dimensions must be included in the Panetic calculations if they are to prove practical for political decision-making.

Portraying Trade-offs and Complexities

Over the past nine years, members of the Intenational Society of Panetics have tried to develop "Panetic Tables" and "Panetic diagrams" that attempt to make the multiple dimensions of suffering and trade-offs involved in a decision explicit , quantifiable, understandable and useful..

Siu proposed a system of graphic conventions that emphasizes the infliction or alleviation of suffering by individuals, groups, or institutions on other individuals, groups, or institutions. Langmuir, a former research Director of the Space Technology Laboratories at TRW, has proposed a system that aggregates the increase or reduction of dukkhas over time, an approach that enables us to calculate "Gross Dukkhas" for a population, community, or nation and focus on those in greatest need of relief. Using this procedure, Langmuir proposed that a "curve of concern" be calculated that focused attention at the levels suffering deemed to be most unacceptable, rather on all suffering no matter how minor.

As already noted, Widner, in analyzing the consequences of corruption in Georgia resorted to a variety of graphic techniques that may help a reader understand the interconnections, but are unique to that analysis and not generalizable as a convention for use in all complex Panetic analyses.

A primary objective under this proposal is to develop the graphical and analytical conventions (models, diagrams, and tables) that can be applied in ANY Panetic Analysis, no matter what the issue or problem.

(2) The Challenge of Forseeability

Panetic analyses must try to take into account the anticipated future consequences of a decision. After all, most major political decisions are about making a change in the present to achieve some anticipated benefit in the future. Often it may prove to be a matter of "no pain, no gain."

As illustrated by the Waco example, much human suffering alleviated or inflicted by a decision lies in the future. For reasons not difficult to understand, methods to anticipate the future are regarded with considerable skepticism by the public and decision-makers alike. The cynicism that greets cost/benefit calculations by the US Army Corps of Engineers in connection with the 50 or 100-year life of a proposed project provides just one concrete example.

Technology Assessment, like the Environmental Impact Assessment process, was formulated as a new discipline over a quarter century ago. Its challenge was to estimate the probable consequences that might arise as a result of the introduction of new technologies. While such analyses had been conducted for many years within the US Defense Establishment in connection with military technologies, the notion of a formal Technology Assessment capability linked to the policy-making powers of the US Congress seemed attractive two decades ago. The introduction of new technologies seemed to be altering the society so rapidly and radically with unforeseen, inadvertent and harmful consequences for some, that Congress believed it needed some "foresight" in order to regulate the process.

After 20 years, Congress eliminated OTA, ostensibly to reduce its "bloated" staff. The elimination might also be ascribed to those who believe "fuzzing things up" can avoid conflict–at least for the present. More charitably, we might see OTA as a victim of the plausible argument that projecting the future is not only an imperfect–but well nigh impossible–art given all of the many complex serendipities that arise around the introduction of any new technology.

Even if we could reliably anticipate events a century and a half hence, which we can not, how much suffering are people today willing to endure for the benefit of their grandchildren’s children? And how much stock are they willing to take in whatever benefits we forecast? We need only turn to current debates over the future of Medicare and Social Security to see how skeptical-–or uncaring–-many are about prognostication.

What frame of time can we place around Panetic calculations that will be credible for decision-makers and citizenry alike? And what methodologies can apply most practically to projecting credibly future suffering or benefits from a decision?

The issue is far from trivial. We have reached a stage in the evolution of human society in which many decisions have awesome implications for the long-run future of the race, life on the planet, and the planet itself. Decision-making must concern itself with potential future consequences. But how? With what reliability?

While the Team will attempt to develop a rigorous procedure by means of which potential future consequences of a decision will be anticipated and portrayed, it will also define a process by means of which the consequences of a Panetics-based decision can be monitored and adjusted to accommodate unforeseen serendipities that arise in the future.

(3) The Challenge of Time Limits

However, time is a problem in the present as well as the future.

Many decisions, if they are to affect the problem at hand effectively, must be made "in time." Should the time-line for decision not be met, no decision results, and "no decision" may produce as much, or more, human suffering than a mistaken "decision".

Twenty years after its adoption, the Environmental Impact Assessment process is often the butt of political jokes for this very reason. EIA is complex and technically challenging. Unquestionably, it has slowed up decisions that, rashly made, might have adversely affected human health, or the integrity of vulnerable national environments. However, the volumes and volumes of analyses required have added new costs to decision-making and incur enormous delays. In the case of environmental matters, this may prove to be more of an advantage than disadvantage, but for a medical decision, or a decision about whether the international community should intervene in a situation like that in a Bosnia, or Somalia, or Rwanda, Haiti, or Iraq, failure to make a decision in time may produce disaster.

Panetic Tables and Contingency Planning

One possible way to meet this challenge is to prepare Panetic Tables covering whole realms of major decision-making in advance of need, in much the way military, foreign policy, or natural disaster contingency plans are prepared by policy-planners.

Following a Panetic Analysis of the Los Angeles riots and eight other urban disturbances by discussants at a meeting of the International Society of Panetics, Siu proposed that a set of continuing Dukkha Tables be prepared based on actual experience in connection with such disturbances:

DUKKHA TABLES AND DIAGRAMS ON CIVIL DISTURBANCE

"Conscientious mayors and chiefs of police would find considerable utility in an up-to-date file of Panetic system diagrams and supporting case studies of various riot and control situations in relatively recent decades...(including) quantitative flows of suffering inflicted and precluded in the course of various interactions, tactics of police, policies of political leaders, size and character of participants and inciters, and the like. By the simple expedient of fax machines, every law enforcement agency would be able to take a quick glance at how other police departments and governmental bodies had successfully handled an actual disturbance or defused a threatening situation with minimal suffering on all parties.

"The very exercise...would assure a progressive self-analysis of what actually happened in the last experience, of lessons learned, of required modifications in tactics for the future, etc. In effect, the police would have access to a running refresher course.

"As far as the mayors are concerned, the continuing practice would provide the following value:

"1. Assurance that their police force has a systematic mechanism in place warning against the unnecessary and counter-productive use of force and raising the efficiency of necessary force.

"2. Public evidence that the mayors and their police take human suffering seriously into consideration in carrying out their law enforcement responsibilities and are constantly reviewing their plans and operations toward that end.

"3. Easily understandable reviews at a glance as to "what really happened?," what was actually behind that which was behind that which was behind, and so on in the intricate causal chain, to lead to answers to what can be done to preclude or reduce public disturbances and what can be done to minimize unnecessary suffering caused by police and non-police actions alike."

The Interdisciplinary Team will develop sets of Panetic Contingency Tables on issues that lend themselves already to straight-forward Panetic Analysis. These will be placed in the hands of selected practitioners for trial application when appropriate occasions arise. The results will be evaluated and Panetic methodologies adjusted accordingly based upon the results.

(4) Conflicting Perceptions and Values

Certainly, when the public perceives a direct connection between objective measurement of a general threat to its physical and mental well-being and the need for government action, it not only accepts, but insists upon apolitical action. In issues of public health and public safety, for example, the Panetic equation can be applied in a reasonably straight-forward manner.

But when a cause of human suffering is distributional in character–that is, in order to alleviate the suffering of one group, another must give up something, possibly even suffer a little pain, decisions become more difficult. Yet such decisions are the "meat and potatoes" of political decision-making. In a way, many political decisions have to do with the "re-distribution" of suffering–spreading suffering around so that everybody suffers a little in order to ameliorate high levels of suffering in a particular segment of the population.

If the weight to be given to the degree of suffering is to be determined subjectively by the victim–an approach that is workable in medicine and in a few other areas of general public concern–the method is at odds with how "distributional" political decisions are actually made.

In our adversarial system of politics, politicians are elected by constituencies. By definition, then, they give greater weight to the suffering of their supporters than they give to those who oppose them, or whom they do not represent. On a global scale, decision-making is still guided by the "self-interest" of constituencies in nation-states. The weight a US President must assign to the loss of lives of his own citizenry on behalf of lives in Bosnia is greater than the weight he assigns to one Bosnian human life. The Bosnian can not determine that weight for the purposes of an American–or even an international– decision.

Most political issues involve conflicts in perceptions, values and interests among groups. Each group is understandably preoccupied with its own suffering–or lack of it. To expect each group to assign values to its degree of suffering that will be acceptable to others is unrealistic. But that weight can not be assigned arbitrarily by the uninvolved. The perceptions of all the parties involved must be taken into account.

To address this challenge, the Interdisciplinary Team can fall back upon procedures already tried, tested, and accepted in the arenas of business and governmental decision-making–to bring people with these conflicting perceptions, values and suffering together to develop an agreed upon outcome.

Facilitators and mediators of many different stripes have employed facilitated group processes that use nominal group techniques to help individuals of very divergent views come together, agree on a definition of the problem, establish a sufficient level of trust to reach consensus on what strategies are likely to ameliorate the problem, settle on a decision, and agree on who has responsibility for implementation.

The most systematic and comprehensive effort to assemble this array of techniques into a coherent body of decision-making tools has been led by John N. Warfield, at George Mason University. Through the use of a set of computer-assisted graphic devices, Warfield’s procedures for facilitated "Interactive Management" help accelerate the ability of individuals with divergent views and perceptions to arrive at agreement and, themselves, produce projections and decisions they believe credible.

Using Nominal Group Techniques, this approach would ask a group representing all of the parties involved in a Panetic decision to rank, on their own, the direct, indirect and anticipated consequences in the infliction or alleviation of human suffering and add their own evaluation of intensity. These are collected and the composite assembled in a table that enables the group to structure a "Problematique" of the sort suggested hypothetically in Figure 3.

In a facilitated discussion by the group, the categories can be both clarified and consolidated so that the group reaches agreement on the "map’ of interconnections–present and future–that the problem or decision entails.

Then, through facilitated discussion and scoring by participants, they can proceed through a series of steps to agree on decisions and actions.

The results can then by represented by a DELTA CHART which is a graphic portrayal of a prescription for action. Panetic Analysis can utilize these techniques to help groups develop the Panetic Tables needed to shorten the time involved in humane decision-making.

The Interdisciplinary Team will experiment with various facilitated procedures in order to develop a practical process through which decision-makers can attempt to reconcile conflicting values and aspirations in order to implement a decision effectively.

With these four methodological challenges as the focus, the Interdisciplinary Team will choose a set of major decision-making issues that can provide the real-life laboratories in which the techniques of Panetic Analysis can bested, developed and applied in trial applications.

A Book Review of "The Social Health of the Nation; How America is Really Doing" by Marc Miringoff and Marque-Luisa Miringoff, Oxford University Press, New York/Oxford; 1999.

Review by Ralph R. Widner, ISP President and member of US Office of Management and Budget Advisory Committee on Social Indicators, 1976

One of the principal interests–and debates–in panetics is how to measure human suffering. Is it increasing or decreasing? While the world is doing a better and better job of using economic indicators to help guide decisions and policies, we are a still a long way from applying non-economic indicators of the human condition in the same way.

One of the professed goals of American society, expressed in the preamble to its Declaration of Independence, is the "pursuit of happiness." How do we measure progress toward such a goal?

Ever since the Hoover Administration, there have been efforts periodically to complement annual reports on the economic performance and condition of the country with social reports of comparable scope and utility. During the Hoover Administration, the classic, Recent Social Trends in the United States, was prepared covering many non-economic aspects of the nation’s condition. This was never followed up during the New Deal. It was only well after World War II, that the idea of a Social Report re-surfaced within the national government, ironically at the urging of NASA. In 1966, a study Toward a Social Report, was released. Then in 1973, 1976 and 1980, prototypical Social Indicators reports were issued by the US government. All this was discontinued by the Reagan Administration.

Now, with support from the Ford Foundation, Marc Miringoff and Marque-Luisa Miringoff, along with Sandra Opdycke, at Fordham University’s Institute for Innovation in Social Policy are trying to rekindle the effort. With a distinguished 23-member Working Group on Social Indicators, they have produced The Social Health of the Nation; How America Is Really Doing. Part a compendium of social indicators, part a well-framed argument for the need for an annual national Social Report on a level comparable to that of the President’s Annual Economic Report, their book makes a cogent case.

Despite professions in the President’s Economic Report since 1995 of "exceptional" performance in the nation’s economy, using nine social indicators aggregated as an "Index of Social Health", the Miringoff’s have developed an Index of Social Health that shows a steady decline when contrasted with Gross Domestic Product over the period 1959 to 1996.

Indicators that show improvement of the period 1970-96 include infant mortality, high school drop outs, the number of elderly in poverty, and life expectancy. Those that have worsened include child abuse, child poverty, youth suicide, health care coverage, wages, inequality, and violent crime. Those that show changing trends over the period are teenage drug use, teenage births, alcohol-related traffic fatalities, affordable housing, and unemployment.

Very usefully, the Miringoff’s provide a tabular summary of the status of social reporting in countries around the world.

The Miringoff’s also have done an outstanding job contrasting the status of development among social indicators with that of economic indicators. While many economic indicators are collected on a daily, weekly or monthly basis. Almost all social indicators are collected only an annual basis at best. And their use is fragmentary and single-purpose.

Clearly, panetics shares a common interest with this valiant band of scholars.

We might ask: what is the difference between indicators of human suffering that some in the field of panetics are attempting to devise and many of the social indicators that the Miringoff’s describe? Are these not measures of the same thing going by another name?

Unquestionably, social indicators of the sort espoused by the Fordham Working Group, as well as by other teams working at the World Bank and on the United Nation’s Human Development Report, are fundamental building blocks for the decision-making applications that panetics is attempting to devise.

Yet a fundamental point for those engaged in panetics is that a single-purpose indicator–such as infant mortality, for example–can not by itself be a useful guide to decision-making. As Dr. Glenn Geelhoed, president of the International Society for Panetics, points out in a new book, interventions undertaken on the basis of a single indicator may wind up increasing rather than decreasing human suffering. His own efforts to reduce deaths from iodine deficiencies in an isolated central African population, for example, resulted in a population boom that could not be supported by the food resources available. Death by starvation increased.

Certainly panetics should join forces with such efforts as the Fordham Working Group on Social Indicators. The Miringoff’s book is highly recommended as an update on the state of work in this urgently important field.

But those of us tilling the fields of panetics must help take such efforts to the next level of application by investigating and developing ways to make effective use of them in the multi-dimensional realm of decision-making.