*2.1. Markets*

Marketization is based on selling, buying and competition; generating the profits which can enrich shareholders and can also be used to fund innovation and the production, polishing, advertising and selling of a variety of reliable products and services, including an increasing plethora of financial services in the increasingly lucrative rentier economy. Freidson drew several examples from his field [8] (medicine, in the United States), exploring, for example, how patients could no longer trust that the intervention was really for their good as opposed to lining the pockets of private doctors and the pharmaceutical industry, but acknowledging that profits could also fund the discovery, development and testing of better treatments. He may not have even imagined the new level of power or the concomitant lowering of trust, as O'Neill puts it [7], that the impact of markets on professionals' work has helped to bring about today. These are evident in both pervasive progress and widespread disruption. For example, they appear in the development of extraordinary and transformative computing technologies, which have put powerful computers into the hands of billions of people but also in the damage wrought in the opioid crisis in the United States, as well as the mass outward migration of professionals from poorer countries to those where they can build better careers and lifestyles. Volunteers and philanthropists, driven inter alia by ideology, politics and sheer expediency, may seem benign or even altruistic, but are sometimes deployed in ways which are neither.

Giridharadas [15] describes the impact of rampant capitalism (Moneyworld) in creating a few large, rich and powerful global corporations**,** and in high levels of inequality (mapped vividly by Dorling [16] which mean that money can now wield a new Metapower, which can be both highly exclusive and very destructive, even while, like the doctor, seeming to do good. The apparent benevolence of large-scale philanthropy allows the super-rich to intervene in the work of professionals, as Knox and Quirk said, to 'pay to play' [17], despite their lack of expertise. If your education, medical, social care system is funded by such people, then professionals may feel powerless to o ffer criticism. This level of trust-without-challenge was once given to the most powerful professionals too, the cardinals, professors, judges and medical consultants. Even as some of these most exclusive professionals have been shown to have feet of clay, they have been replaced at the top of hierarchies of deference by the very wealthy who distinctively support only those interventions which are designed on the basis of a business model described by Giriharadas [15] as 'win-win'. These are interventions which bring some societal benefits, but which also further enrich the benefactors, and, crucially, do nothing to disturb or rectify the iniquitous problems that they have created and which sustain their wealth and power. Even the most powerful professionals are, it seems, increasingly defenseless against Moneyworld and, in their powerlessness, can then seek to abdicate their responsibility. They can do likewise in respect of the impacts of bureaucracy too, particularly, perhaps, where this is technologized ... computer says no!
