Re: MEDICAL NEMESIS: THE EXPROPRIATION OF HEALTH - IVAN ILLICH

ahhh...again written over a century ago

relevance to nothing..

sorta like you


"rpautrey2" <rpautrey2@xxxxxxxxx> wrote in message
news:c4ca2429-5cf0-443f-a2ec-55cab4be7687@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
This is a very good book about
the fraud of orthodox medicine.
Buy it and read it, or find it online.

Paul

--------------------------------------------

IVAN ILLICH



MEDICAL NEMESIS
THE EXPROPRIATION OF HEALTH


PANTHEON BOOKS, NEW YORK

Copyright© 1976 by Random House, Inc.

All rights reserved under International and Pan-American Copyright
Conventions. Published in the United States by Pantheon Books, a
division of Random House, Inc., New \brk. Originally published in
Great Britain by Calder & Boyars, Ltd., London. Copyright© 1975 by
Ivan Illich.

Library of Congress Cataloging in Publication Data

Illich, Ivan, 1926
Medical nemesis.
Includes bibliographical references and indexes.
1. Social medicine. 2. Medicine?Philosophy
3. Medical care. 4. latrogenic diseases. I. Title. [DNLM: 1.
Delivery of health care. 2. Ethics, Medical. 3. latrogenic disease.
4. Philosophy, Medical. 5. Politics. 6. Social medicine.
WA 30129m 1976a]
[RA418.I441982] 362.1 82-47952
ISBN 0-394-71245-5 (pbk.) AACR2

Manufactured in the United States of America





Acknowledgments

My thinking on medical institutions was shaped over several years in
periodic conversations with Roslyn Lindheim and John McKnight. Mrs.
Lindheim, Professor of Architecture at the University of California at
Berkeley, is shortly to publish The Hospitalization of Space, and John
McKnight, Director of Urban Studies at Northwestern University, is
working on The Serviced Society. Without the challenge from these two
friends, I would not have found the courage to develop my last
conversations with Paul Goodman into this book.


Several others have been closely connected with the growth of this
text: Jean Robert and Jean P. Dupuy, who illustrated the economic
thesis stated in this book with examples from time-polluting and space-
distorting transportation systems; Andre Gorz, who has been my
principal tutor in the politics of health; Marion Boyars, who with
admirable competence published the draft of this book in London and
thus enabled me to base my final version on a wide spectrum of
critical reaction. To them and to all my critics and helpers, and
especially to those who have led me to valuable reading, I owe deep
gratitude.

This book would never have been written without Valentina
Borremans. She has patiently assembled the documentation on which it
is based, and refined my judgment and sobered my language with her
constant criticism. The chapter on the industrialization of death is a
summary of the notes she has assembled for her own book on the history
of the face of death.

IVAN ILLICH

Cuernavaca, Mexico
January 1976




Contents


Introduction


PART I. Clinical latrogenesis

1. The Epidemics of Modern Medicine
Doctors' Effectiveness?an Illusion
Useless Medical Treatment
Doctor-Inflicted Injuries
Defenseless Patients 32


PART II. Social latrogenesis

2. The Medicalization of Life
Political Transmission of Iatrogemc Disease
Social latrogenesis
Medical Monopoly
Value-Free Cure?
The Medicalization of the Budget
The Pharmaceutical Invasion
Diagnostic Imperialism
Preventive Stigma
Terminal Ceremonies
Black Magic
Patient Majorities


PART III. Cultural latrogenesis

Introduction

3. The Killing of Pain

4. The Invention and Elimination of Disease

5. Death Against Death
Death as Commodity
The Devotional Dance of the Dead
The Danse Macabre
Bourgeois Death
Clinical Death
Trade Union Claims to a Natural Death
Death Under Intensive Care


PART IV. The Politics of Health

6. Specific Counterproductivity

7. Political Countermeasures
Consumer Protection for Addicts
Equal Access to Torts
Public Controls over the Professional Mafia
The Scientific Organization?of Life
Engineering for a Plastic Womb

8. The Recovery of Health
Industrialized Nemesis
From Inherited Myth to Respectful Procedure
The Right to Health
Health as a Virtue



Introduction

The medical establishment has become a major threat to health. The
disabling impact of professional control over medicine has reached the
proportions of an epidemic. Iatrogenesis, the name for this new
epidemic, comes from iatros, the Greek word for "physician," and
genesis, meaning "origin." Discussion of the disease of medical
progress has moved up on the agendas of medical conferences,
researchers concentrate on the sick-making powers of diagnosis and
therapy, and reports on paradoxical damage caused by cures for
sickness take up increasing space in medical dope-sheets. The health
professions are on the brink of an unprecedented housecleaning
campaign. "Clubs of Cos," named after the Greek Island of Doctors,
have sprung up here and there, gathering physicians, glorified
druggists, and their industrial sponsors as the Club of Rome has
gathered "analysts" under the aegis of Ford, Fiat, and Volkswagen.
Purveyors of medical services follow the example of their colleagues
in other fields in adding the stick of "limits to growth" to the
carrot of ever more desirable vehicles and therapies. Limits to
professional health care are a rapidly growing political issue. In
whose interest these limits will work will depend to a large extent on
who takes the initiative in formulating the need for them: people
organized for political action that challenges status-quo professional
power, or the health professions intent on expanding their monopoly
even further.

The public has been alerted to the perplexity and uncertainty of
the best among its hygienic caretakers. The newspapers are full of
reports on volte-face manipulations of medical leaders: the pioneers
of yesterday's so-called breakthroughs warn their patients against the
dangers of the miracle cures they have only just invented. Politicians
who have proposed the emulation of the Russian, Swedish, or English
models of socialized medicine are embarrassed that recent events show
their pet systems to be highly efficient in producing the same
pathogenic?that is, sickening?cures and care that capitalist medicine,
albeit with less equal access, produces. A crisis of confidence in
modern medicine is upon us. Merely to insist on it would be to
contribute further to a self-fulfilling prophecy, and to possible
panic.

This book argues that panic is out of place. Thoughtful public
discussion of the iatrogenic pandemic, beginning with an insistence
upon demystification of all medical matters, will not be dangerous to
the commonweal. Indeed, what is dangerous is a passive public that has
come to rely on superficial medical housecleanings. The crisis in
medicine could allow the layman effectively to reclaim his own control
over medical perception, classification, and decision-making. The
laicization of the Aesculapian temple could lead to a delegitimizing
of the basic religious tenets of modern medicine to which industrial
societies, from the left to the right, now subscribe.

My argument is that the layman and not the physician has the
potential perspective and effective power to stop the current
iatrogenic epidemic. This book offers the lay reader a conceptual
framework within which to assess the seamy side of progress against
its more publicized benefits. It uses a model of social assessment
of technological progress that I have spelled out elsewhere1 and
applied previously to education2 and transportation,3 and that I now
apply to the criticism of the professional monopoly and of the
scientism in health care that prevail in all nations that have
organized for high levels of industrialization. In my opinion, the
sanitation of medicine is part and parcel of the socio-economic
inversion with which Part IV of this book deals.

The footnotes reflect the nature of this text. I assert the right
to break the monopoly that academia has exercised over all small print
at the bottom of the page. Some footnotes document the information I
have used to elaborate and to verify my own preconceived paradigm for
optimally limited health care, a perspective that did not necessarily
have any place within the mind of the person who collected the
corresponding data. Occasionally, I quote my source only as an
eyewitness account that is incidentally offered by the expert author,
while refusing to accept what he says as expert testimony on the
grounds that it is hearsay and therefore ought not to influence the
relevant public decisions.

Many more footnotes provide the reader with the kind of
bibliographical guidance that I would have appreciated when I first
began, as an outsider, to delve into the subject of health care and
tried to acquire competence in the political evaluation of medicine's
effectiveness. These notes refer to library tools and reference works
that I have learned to appreciate in years of single-handed
exploration. They also list readings, from technical monographs to
novels, that have been of use to me.

Finally, I have used the footnotes to deal with my own
parenthetical, supplementary, and tangential suggestions and
questions, which would have distracted the reader if kept in the main
text. The layman in medicine, for whom this book is written, will
himself have to acquire the competence to evaluate the impact of
medicine on health care. Among all our contemporary experts,
physicians are those trained to the highest level of specialized
incompetence for this urgently needed pursuit.

The recovery from society-wide iatrogenic disease is a political
task, not a professional one. It must be based on a grassroots
consensus about the balance between the civil liberty to heal and the
civil right to equitable health care. During the last generations the
medical monopoly over health care has expanded without checks and has
encroached on our liberty with regard to our own bodies. Society has
transferred to physicians the exclusive right to determine what
constitutes sickness, who is or might become sick, and what shall be
done to such people. Deviance is now "legitimate" only when it merits
and ultimately justifies medical interpretation and intervention. The
social commitment to provide all citizens with almost unlimited
outputs from the medical system threatens to destroy the environmental
and cultural conditions needed by people to live a life of constant
autonomous healing. This trend must be recognized and eventually be
reversed.

Limits to medicine must be something other than professional self-
limitation. I will demonstrate that the insistence of the medical
guild on its unique qualifications to cure medicine itself is based on
an illusion. Professional power is the result of a political
delegation of autonomous authority to the health occupations which was
enacted during our century by other sectors of the university-trained
bourgeoisie: it cannot now be revoked by those who conceded it; it can
only be delegitimized by popular agreement about the malignancy of
this power. The self-medication of the medical system cannot but fail.
If a public, panicked by gory revelations, were browbeaten into
further support for more expert control over experts in health-care
production, this would only intensify sickening care. It must now be
understood that what has turned health care into a sick-making
enterprise is the very intensity of an engineering endeavor that has
translated human survival from the performance of organisms into the
result of technical manipulation.

"Health," after all, is simply an everyday word that is used to
designate the intensity with which individuals cope with their
internal states and their environmental conditions. In Homo sapiens,
"healthy" is an adjective that qualifies ethical and political
actions. In part at least, the health of a population depends on the
way in which political actions condition the milieu and create those
circumstances that favor self-reliance, autonomy, and dignity for all,
particularly the weaker. In consequence, health levels will be at
their optimum when the environment brings out autonomous personal,
responsible coping ability. Health levels can only decline when
survival comes to depend beyond a certain point on the heteronomous
(other-directed) regulation of the organism's homeostasis. Beyond a
critical level of intensity, institutional health care?no matter if it
takes the form of cure, prevention, or environmental engineering?is
equivalent to systematic health denial.

The threat which current medicine represents to the health of
populations is analogous to the threat which the volume and intensity
of traffic represent to mobility, the threat which education and the
media represent to learning, and the threat which urbanization
represents to competence in homemaking. In each case a major
institutional endeavor has turned counterproductive. Time-consuming
acceleration in traffic, noisy and confusing communications, education
that trains ever more people for ever higher levels of technical
competence and specialized forms of generalized incompetence: these
are all phenomena parallel to the production by medicine of iatrogenic
disease. In each case a major institutional sector has removed society
from the specific purpose for which that sector was created and
technically instrumented.

Iatrogenesis cannot be understood unless it is seen as the
specifically medical manifestation of specific counterproductivity.
Specific or paradoxical counterproductivity is a negative social
indicator for a diseconomy which remains locked within the system that
produces it. It is a measure of the confusion delivered by the news
media, the incompetence fostered by educators, or the time-loss
represented by a more powerful car. Specific counterproductivity is an
unwanted side-effect of increasing institutional outputs that remains
internal to the system which itself originated the specific value. It
is a social measure for objective frustration. This study of
pathogenic medicine was undertaken in order to illustrate in the
health-care field the various aspects of counterproductivity that can
be observed in all major sectors of industrial society in its present
stage. A similar analysis could be undertaken in other fields of
industrial production, but the urgency in the field of medicine, a
traditionally revered and self-congratulatory service profession, is
particularly great.

Built-in iatrogenesis now affects all social relations. It is the
result of internalized colonization of liberty by affluence. In rich
countries medical colonization has reached sickening proportions; poor
countries are quickly following suit. (The siren of one ambulance can
destroy Samaritan attitudes in a whole Chilean town.) This process,
which I shall call the "medicalization of life," deserves articulate
political recognition. Medicine could become a prime target for
political action that aims at an inversion of industrial society. Only
people who have recovered the ability for mutual self-care and have
learned to combine it with dependence on the application of
contemporary technology will be ready to limit the industrial mode of
production in other major areas as well.

A professional and physician-based health-care system that has
grown beyond critical bounds is sickening for three reasons: it must
produce clinical damage that outweighs its potential benefits; it
cannot but enhance even as it obscures the political conditions that
render society unhealthy; and it tends to mystify and to expropriate
the power of the individual to heal himself and to shape his or her
environment. Contemporary medical systems have outgrown these
tolerable bounds. The medical and paramedical monopoly over hygienic
methodology and technology is a glaring example of the political
misuse of scientific achievement to strengthen industrial rather than
personal growth. Such medicine is but a device to convince those who
are sick and tired of society that it is they who are ill, impotent,
and in need of technical repair. I will deal with these three levels
of sickening medical impact in the first three parts of this book.

The balance *** of achievement in medical technology will be
drawn up in the first chapter. Many people are already apprehensive
about doctors, hospitals, and the drug industry and only need data to
substantiate their misgivings. Doctors already find it necessary to
bolster their credibility by demanding that many treatments now common
be formally outlawed. Restrictions on medical performance which
professionals have come to consider mandatory are often so radical
that they are not acceptable to the majority of politicians. The lack
of effectiveness of costly and high-risk medicine is a now widely
discussed fact from which I start, not a key issue I want to dwell on.

Part II deals with the directly health-denying effects of
medicine's social organization, and Part III with the disabling impact
of medical ideology on personal stamina: under three separate headings
I describe the transformation of pain, impairment, and death from a
personal challenge into a technical problem.

Part IV interprets health-denying medicine as typical of the
counterproductivity of overindustrialized civilization and analyzes
five types of political response which constitute tactically useful
remedies that are all strategically futile. It distinguishes between
two modes in which the person relates and adapts to his environment:
autonomous (i.e., self-governing) coping and heteronomous (i.e.,
administered) maintenance and management. It concludes by
demonstrating that only a political program aimed at the limitation of
professional management of health will enable people to recover their
powers for health care, and that such a program is integral to a
society-wide criticism and restraint of the industrial mode of
production.


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