Identification of genetic variants in pharmacokinetic genes associated with Ewing Sarcoma treatment outcome (Study I)

Modern society is characterized by an antagonism between self-determina-tion and heteronomy, inclusion and exclusion, cooperaself-determina-tion and competi-tion. Heteronomy, exclusion, and competition are the dominant features that coin the overall character of contemporary society. Humans are not able to fully participate in the economic, political, and cultural system; they are confronted with property that they produce, but that is owned by others, with decisions that affect their lives, but are taken not by themselves, and with values and lifestyles that they have to share in order to be accepted, although they are defined by others.

Marx pointed out that with the division of labor a contradiction between the interest of the separate individual and the communal interest of all indi-viduals who have intercourse with one another emerged. The structures of modern society are alien powers; they are not controlled by all but by certain classes. In modern society individuals and groups compete for the control and accumulation of structural resources, which separates society into classes who own, decide, and define and those who don’t or do so to a limited extent. If cooperation and participation are the Essence of society as such, then modern society is not a fully developed society, its existence doesn’t correspond to its Essence, and individuals and society are alienated from the immanent Essence of society. Modern society hence is an alienated society; individuals in this society are class individuals. In contrast to a soci-ety dominated by competition, a cooperative socisoci-ety is a socisoci-ety in which Essence and Existence correspond. Hegel defined such a correspondence philosophically as truth. Such a community is the “reintegration or return of man to himself, the transcendence of human self-estrangement”, “the real appropriation of the human essence by and for man”, “the complete return of man to himself as a social (i.e., human) being” (Marx 1844b, 536).

In modern society social structures are capital, that is, the aim of this society is the ever more accumulation of social structures in the hand of cer-tain competing groups. Modern society is shaped by the competition for the accumulation of property, power, and definition capacities. These structures function as economic, political, and cultural capital, that is, structures that are accumulated, which implies competition, an asymmetrical distribution of capital, and an asymmetrical distribution of ownership, power, and hege-mony. Hence, modern society is a capitalist society.

Modern society is also a class society. The logic of competition and accu-mulation has originated in the capitalist economy, but it has simultaneously colonized the political and cultural system; hence, it is not limited to the

economy but has a more general meaning. It would be a mistake to concep-tualize class only as an economic phenomenon because traditionally this has often meant to reduce political and cultural phenomena to the economy and to leave out of sight their relative autonomy. In order to avoid a reductionist concept, I find it tempting to define class with Bourdieu in a more general sense. He does not as in classical Marxism define class as depending on the position in the economic relations of production but as depending on the volume and composition of capital. The social position and power of an actor depends on the volume and composition of capital (i.e., the relative relationship of the three forms of capital—economic, political, and cultural capital) that he owns and that he can mobilize as well as the temporal chang-ing of these two factors (Bourdieu 1986a, 114). The main classes of society are for Bourdieu a result of the distribution of the whole (i.e., economic and political and cultural) capital. This results in a social hierarchy with those at the top who are best provided with capital and those at the bottom who are most deprived. Within the classes that get a high, medium, or low share of the total volume of capital, there are again different distributions of capital, and this results in a hierarchy of class fractions. For example, within the fraction of those who have much capital, the fractions whose reproduc-tion depends on economic capital (industrial and commercial employers at the higher level, craftsmen and shopkeepers at the intermediate level) are opposed to the fractions that are least endowed with economic capital and whose reproduction mainly depends on cultural capital (higher-education and secondary teachers at the higher level, primary teachers at the interme-diate level; ibid., 115). Bourdieu says that orthodox Marxism can’t explain new forms of social struggles that are, for example, linked to the contradic-tions resulting from the functioning of the educational system (Bourdieu 1993, 32). He points out that one should not only take economic capital into consideration.

If the subsystems of modern society take on competitive, asymmetric forms then it does not suffice to term these systems economy, polity, and culture; one rather needs to find terms that better capture the qualities of capitalism. Economic property in capitalism is private property controlled by economic classes and produced by subsumed classes. It takes on the form of commodities and money capital. In line with French regulation theory, I use the term regime of accumulation for signifying a specific historical model of the accumulation of money capital (Aglietta 1979; Lipietz 1987).

The regime of accumulation describes the concrete forms of capital accu-mulation, production, distribution, and consumption in a specific mode of development. Its result is the accumulation of economic capital within the framework of antagonistic economic structures (money, commodities, mar-kets, class relations). It includes aspects of production such as the productiv-ity of labor, the degree of mechanization, the distribution between branches of production, norms of productivity, technologies of production, means of labor and organization, connections between different modes of production

and organizational modes of decision, class relationships, the existing forms of the appropriation of nature and knowledge, as well as aspects of con-sumption such as conditions that shall secure demand, modes, patterns, and norms of consumption and channels of distribution.

In regulation theory, the political system is termed the mode of regulation (Boyer 1990; Lipietz 1986). The mode of regulation refers to the institutional framework that enables and constrains capital accumulation. Its result is the accumulation of political capital within the framework of antagonis-tic poliantagonis-tical forms (laws, the state) and poliantagonis-tical relationships. Regulation means agency that works as a sort of cohesive force on the economy.

For regulation theory, economy and polity are the two systems of capital-ist society. However, it leaves out the cultural aspect of society that has been stressed in other Marxist theories (such as critical theory, Gramsci’s theory of hegemony, and Althusserianism): ideology. Regulation theory overlooks the relative autonomy of culture and hence subsumes ideological and cul-tural aspects within the mode of regulation. To avoid these shortcomings, I suggest to add a third aspect: the disciplinary regime which is made up by mechanisms that shall secure the hegemonic consent of the oppressed to the dominating mode of societal development. It produces hegemony, ideologies, and dominating norms and values and results in the accumula-tion of cultural capital within the framework of cultural forms (dominating norms, knowledge, values, ideologies) and cultural relationships. Hegemony can be seen in accordance with Antonio Gramsci as “the ‘spontaneous’ con-sent of the masses who must ‘live’ those directives, modifying their own habits, their own will, their own convictions to conform with those direc-tives and with the objecdirec-tives which they propose to achieve” (Gramsci 1971, 266). Hegemony always has political and cultural aspects; it is formed in the framework of the complex relationships between politics and culture. In this process of enforcing consent between dominators and the dominated, politi-cal institutions such as law and the repressive state apparatus are important, but also cultural institutions, that is, institutions, which organize ways of life and socialization, are necessary. Cultural institutions involve, for example, the family, churches, religion, media, the educational system, schools, art, and science. Hegemony can only work in and with ideology. An ideology is a system of ideas and beliefs that dominates the consciousness of a human being or a social group (Althusser 1971). Ideology is a ‘representation’ of the imaginary relationship of individuals to their real conditions of exis-tence, that is, they do not map reality but are social constructions that show how certain groups want to define reality in order to make others see reality the same way. Someone who favours a certain ideology takes part in cer-tain practices (going to church, meetings, consumption of information and culture, etc.). These practices show that ideologies have a material existence and are not confined to the ideational realm. Ideology calls human beings as subjects; this is a process termed interpellation by Althusser. Ideology inter-pellates individuals as subjects and makes them become subjects (members

of families, churches, associations, parties, etc.). An interpellation takes place in the name of an absolute subject (god, leader, state, boss, guru, etc.).

The individual is interpellated as a free subject so that he or she voluntarily submits to the will of the absolute subject.

Capitalism develops in certain phases, that is, there are periods that are characterized by certain overall qualities that change due to the antagonistic structures of modern society. A concrete historical phase of capitalism is termed a mode of (capitalist) development; it is a coherent unity of a regime of accumulation, a mode of regulation, and a disciplinary regime.

Capital Accumulation and Competition in the Modern Economic System

As in all societal formations, in capitalism goods are produced that satisfy human needs. The specific ways this is done distinguish different societal formations. In capitalism the production process is based on the fact that economic actors produce goods which are sold on the market after their production in order to achieve a profit that allows reinvestment, more pro-duction, the selling of more commodities, hence again more profit, and so on. Marx called this process the accumulation of (money and commodity) capital. Capitalist production doesn’t satisfy immediate needs (as was, e.g., the case in the production of the medieval craftsman), but each capital-ist is in need of the so-called anonymous market for the socialization of products. That the single capitalist enterprise produces in an isolated way is not something biologically given but a social relationship. Marx says that private labor produces commodities. Another foundation of capitalism has been the detachment of the means of production from the workers. Marx is speaking of “double free wage-labor”; the workers don’t own the means of production and the produced goods, and they are forced to sell their labor power (Marx 1867, 181–183). Wage labor and the industrial divi-sion of labor (which has been enabled by machine technologies; Marx men-tions machine-systems, large industry, or the cooperation of many similar machines that are powered by a motor mechanism such as the steam engine;

see Marx 1867, chap. 13) are necessary conditions for the full development of capital accumulation.

Capital accumulation is an autopoietic cycle that has been described by Marx as the expanded reproduction cycle of capital in his labor theory of value. The starting point is money capital that forms a social relationship.

The capitalist buys with money (M) the commodities (C) labor power (L) and means of production (Mp). This means that here a relation between relations of production and the productive forces is established. The means of production are considered in their value form as constant capital (c) and can be subdivided into circulating constant capital (the value of the utilized raw materials, auxiliary materials, operating supply items, and semifinished products) and fixed constant capital (the value of the utilized machines,

buildings, and equipment; Marx 1885, chap. 8). The value of the employed labor power is termed variable capital (v). Constant capital is transfused to the product, but it doesn’t create new value. Only living labor increases value—labor produces more value than it needs for its own reproduction.

In production, due to the effects of living labor onto the object of labor, surplus value (s) is produced. This means that in the economic system an autocreative process takes place: Living labor (i.e., human subjects) makes use of the objective, material part of the system in order to produce some-thing new; a new good emerges. This good is more than the sum of the parts of the old system. A surplus that is due to living labor power is objectified in it. This creative process is itself a self-organization process within the overall economic autopoietic cycle; something new emerges. The value of a produced commodity is Cb = c + v + s; this value is larger than the value of the invested capital (C = c + v). The difference of Cb and C ('C) exists due to the production of surplus value and is itself surplus value. In the production process (the upward arrow in the economic cycle of fig. 3.2), living labor within class relations produces surplus value that is objecti-fied in commodities. Surplus value is transformed into profit (surplus value is “realized”) and value into money capital by selling the produced com-modities on the market. By the sale and purchase of comcom-modities, the latter are allocated to human consumers (the downward arrow in the economic cycle of fig. 3.2); consumption helps reproducing activities in society such as labor power. A further (re)production process is started by capital by the repurchase of labor power and means of production; labor again produces surplus value and commodities that are first sold so that profit is realized and then consumed so that new production processes are enabled, and so on. This is a dynamic process in which there is an overall self-reproduction and self-transformation of the economic system, that is, the accumulation of capital (see fig. 3.3).

This autopoietic process is based on exploitation, alienation, and estrangement. In capitalism, social structures are alienated social tures; they aren’t controlled by their immediate producers but are struc-tures of the dominating groups. They are imposed on the individuals as interest “alien” to them and are to a certain extent independent of them in the sense that they can’t control them. This is not only true for the economy but for all realms of modern society. The self-reproducing (i.e., self-increasing, self-valorizing, self-expanding) cycle of capital just outlined exists in and through agency, that is, human labor: The actors enter social relationships and with the help of their labor power produce emergent properties (surplus value, commodities, profit). Human labor produces and reproduces surplus value and ever more money capital as structure that is accumulated in antagonistic class relations. Capital as structural moment is based on human action (labor) and can only reproduce itself autopoieti-cally by reflexive actions that are enabled and constrained by the repro-duced structures.

Not necessarily can all produced commodities be sold; hence, not all surplus value is necessarily transformed into profit. But normally after the whole process there is more money capital than has been invested into pro-duction, and such “surplus value generating money” is termed money capi-tal and is partly reinvested into new production (accumulation). Modern society is an antagonistic system; it can’t reproduce itself permanently and steadily. So self-reproduction, that is, self-expansion and self-valorization, only occurs in a phase of stabile (economic, political, or cultural) accumula-tion. Due to the antagonistic character of this process, the system is from time to time driven into crisis: crisis means discontinuity and disruption of accumulation.

Capital Accumulation and Competition in the Modern Political System

In modern society, the state system is the organizational unit of politi-cal self-organization. It is based on organized procedures and institutions (representative democracy in many cases) that form the framework of the competition for the accumulation of power and political capital. Various groups compete for gaining power; an increase of power for some groups automatically means a decrease of power for other ones. The state is based Figure 3.3 The economic self-reproduction of capital: The expanded reproduction cycle of capital.

on asymmetrical distributions of power, domination, the permanent con-stitution of codified rules (laws) in the process of legislation (deciding), the sanctioning and controlling execution of these rules, and the punishment of the disobedience and violation of these rules (jurisdiction, executing). Politi-cal parties/groups want to shape these processes according to their own will and hence compete for influence and the accumulation of power.

The basic process of the state is based on competitive relationships between political groups that result in a certain distribution of power and the permanent emergence of new features of this distribution (laws, regula-tions, cases, filling of public offices and civil services according to specific political interests, etc.). These new emergent qualities enable and constrain political practices, political engagement for stabilizing or changing a cer-tain constellation of power. Political practices that constitute the modern state include running for political offices, elections, parliamentary debates, the working out of bills, the passing of laws, political discussions (also in everyday life), political media coverage (press, television, radio, Internet, etc.), protests (petitions, demonstrations, strikes, etc.). Existing laws, politi-cal institutions, and politipoliti-cal events (the outcomes of the enactment of laws and the processes of establishing new laws) stimulate political organization;

they result in new, emergent properties on the level of political groups, that is, in new ways of thinking and acting that try to stabilize or change the existing distribution of power. The development of the state is not a static but a dynamic process; it is based on the permanent political interactions of various political groups that result in the emergence of new political capital, that is, decision-oriented power structures that stimulate further political actions which try to stabilize or change the existing distributions of power.

Competition and accumulation of power are fundamental aspects of the dynamics of the modern nation-state.

Elections are important mechanisms for stabilizing and changing existing distributions of power within the state. Political parties compete for votes that determine the distribution of power within the system of rule. Elec-tions and economic markets have certain similarities. Both the economic and the political system of modern society are based on accumulation and competition. A central feature of modern representative democracy is the accumulation of power and votes; the central motive of politicians is the pursuit of power in order to realize their political ideas and programs. Poli-tics in modern society is oriented on its exchange value: Political decisions and positions that are based on a certain amount of votes are exchanged for an increase or decrease of votes in the next elections. The political process that is based on elections can be described in the form V–D–Vb or P–D–Pb:

votes–decisions–more votes, power–decisions–more power. However, the accumulation of power is uncertain because an election is an evaluation of the work of politicians, and only if the voters are satisfied with a gov-ernment will they increase the govgov-ernment’s power. This means that in the

votes–decisions–more votes, power–decisions–more power. However, the accumulation of power is uncertain because an election is an evaluation of the work of politicians, and only if the voters are satisfied with a gov-ernment will they increase the govgov-ernment’s power. This means that in the