Past and Present Sources of European Union. A Comparative Historical-Institutionalist Analysis

This study sets out to explain why continental and southern Europe has beensignificantly more favourable to post-1945 European integration than the north. I arguethat this is an important problem for two reasons. First, the fact that there are more andless Europeanist member states has been and remains the most basic politicalconstraint on European integration. Second, I believe that by exploring this issue, I amable to present an innovative, comparative-historical analysis that not only advancesour theoretical understanding of European integration, but also sheds new light on theevolution of nationalism and the nation-state.In line with broad trends in political and social theory over the last twenty tothirty years, notably social constructivism, in the introductory discussion in Part 1 Iassume that a search for the sources of Europeanism - territorial and other - requiresan appropriate consideration of the role of ideas. I argue that the attitudes ofindividuals and collectivities to political issues like European integration reflect theirideological preferences as well as their material interests, both of which are in turnproducts of, and may be modified by, learning. Key concepts in the study are thus 'interest,' 'ideology,' and 'learning.' I assume that territorial-historical backgroundfundamentally structures how agents are influenced by these variables.Inspired by the Norwegian comparativist Stein Rokkan, I interpret Europeanintegration as a case of polity-building comparable to other instances of state- andnation-building in history. This approach suggests that integration is a fundamentallypolitical process with the issue of sovereignty at its core. Hence, regionallydifferentiated patterns of attitudes to European union may reflect territorially distinct,historically evolved ideas of sovereignty. On this assumption, I construct a 2x2 tabledefining four basic ideas of soverereignty - polity-ideas, or normative ideas about alegitimate political order - that structures the study's comparative-historical analysis:universalist-descending; particularist-descending; particularist-ascending; anduniversalist-ascending. I argue that each polity-idea is associated with a particular discourse, ideology,and even an ontological and epistemological paradigm. The main controversy in thepost-1945 European debate has been between what I term the national-liberal and theChristian-democratic paradigms of integration. The former is basically particularistand intergovernmentalist and is based in northern, Lutheran or Anglican Europe. Thesecond is inspired by Christian universalism, favours a federal or unitary Europe, andhas its mainstay in continental and southern, Catholic Europe.In Part 2, I examine existing integration and international relations as well asgeneral political science theory in order to identify theoretically possible sources ofEuropeanist attitudes. This discussion concludes with a working hypothesis based onRokkan's notion of the European city-belt. Could, as Rokkan himself explicitlysuggested, the city-belt, stretching roughly from Central Italy to the North Sea andrepresenting the historical core territory of the Catholic church and the Holy Roman Empire, be the home base or 'primary territory' of a European 'nation'? Could it in this sense play a similar historical polity-building role as that assigned by Karl W. Deutschto the Île de France as the hub of the French nation-state, to Leon-Castille in Spain,Savoy-Piemonte in Italy, Prussia in Germany, England in Britain etc.? If so, it is indeedworthwhile comparing contemporary European union-building to historical nationbuilding,Europeanism (pro-union ideology) to nationalism and Europeanness(European identity) to national identity.While conceding that his perspective is indeed valuable and relevant, the historical discussion in Part 3 criticises Rokkan's notion of the city-belt for nationalliberalreductionism. The Rokkanian-Deutschian thesis neglects the ancient andmedieval tradition for unity and universalism espoused by the Roman Church and theHoly Roman/Habsburg Empire and underrates the continued influence of theseinstitutions even after the Peace of Westphalia. Moreover, the thesis is too structuralist,implying that the European Union emerged more or less by default. Likeintergovernmentalist and neofunctionalist integration theory, it underestimates the roleof ideologically aware and reasoning human agency. Hence it is argued that Rome,represented by the Roman Church as well as by successive Roman empires, is a more important territorial and historical source of Europeanism than city-studded CentralEurope.Part 3 narrates how the ascendancy of particularist (or nationalist), discourseresulted from the fragmentation of unitary medieval Christendom into a modernEurope dominated by autonomous states. State-builders propagated the notion ofterritorial sovereignty, which eventually turned into the hegemonial, particularistascendingidea of national sovereignty. Here France and the Protestant states of north-western Europe were the pioneers, their kings' control of national churches being an important factor. Anglican and Lutheran Protestantism was particularly conducive toparticularism, which notably in the German context turned exclusivist and eventuallyracist. The particularist paradigm survived two World Wars in its more benign NorthAtlantic, liberal form. I submit that this paradigm has been a major source of Britishand Scandinavian ideological reluctance to post-war European integration.But the Holy See as well as the Holy Roman/Habsburg Empires continued torepresent a strong counterweight to particularist discourse even after the Reformationand the religious wars. The Papacy criticised nationalism as a political religion, andcame to terms with the modern, secular nation-state and national mass politics onlywith difficulty. Still, in the late nineteenth century Catholic parties were allowed toemerge and enabled Catholics to participate in secular, national politics. But theycontinued to look beyond the nation-state. The final Part 4 of the study narrates howtransnationally networked, Christian democratic parties of Western Continental Europejointly formulated a Europeanist-ascending programme for European union afterWorld War II. The European Union was launched on its supranational path when theseparties, led mainly by statesmen from Carolingian-Lotharingian Europe, dominated thegovernments of the six founding states from about 1945 to 1965. Their discourse inthis regard was heavily informed by ideology rooted in the universalist Europeanlegacy, whose mainstay remains Catholic, continental and southern Europe

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk