Define what Porter means by the “medical industrial complex” and the “medicalization of society.” For what reasons did these occur in the 20th century?
Porter's exhaustive and detailed analysis of medicine's history concludes with an analysis of the modern predicament. In Porter's mind, the modern setting of medicine involves material reality and social interests that overshadow the clinical pursuit envisioned by thinkers like Hippocrates. One aspect of this is what Porter sees as the medical industrial complex, a reflection of the collusion between economic interests and medical pursuits:
Modern health care has turned into a colossal service industry, in both state and private sectors; in many nations it claims a greater share of the gross national product than any other item - these days a staggering 15 percent in the U.S.A. Critics call it a juggernaut, an institution out of control, or at least one driven less by patient need than by profit and professional power. The personal touch so essential to healing, has been lost! This transition from small man to corporate enterprise is the result, in part, of those giant strides in basic and clinical research, and the pharmacological and surgical revolutions discussed in the preceding chapters... The medical machine has acquired an extraordinary momentum.
Porter sees "relentless growth and destructive development" in the West as having infiltrated the realm of medicine. In the 20th Century, this pattern has been undeniable. Porter asserts that the medical industrial complex is one in which current economic realities of medicine have become as dominant, if not more, than its therapeutic ones. Porter points to how this has transformed the language in medicine. No longer are the subjects of doctor's care called "patients." Rather, they are called "consumers" and doctors are "providers," who are often part of a "health management organization." This shift underscores the loss of the "personal touch" once intrinsic to medicine.
Porter sees "market interests" as having largely supplanted the historical narrative that he outlined. The emergence of wealth and power related to it in the 20th Century has helped to create this condition. Porter sees this convergent reality as reflective of the medical industrial complex. Financial and social interests supplant medical ones, as the influence of both begin to overcome the issue of public health. Porter speaks to the strange silence of the medical establishment on the issue of tobacco use. It had been common knowledge even within the industry that tobacco use had distinct and real negative health side effects. However, the medical establishment did not show leadership in seeking to remedy this condition. For Porter, the presence of the medical industrial complex is reflected in the tobacco issue, as well as the delayed backlash to its health realities. Porter does not offer a particular solution to this reality. However, it is clear that he recognizes the "immense pressures" brought about by the medical industrial complex to issues such as public health and safety.
Porter concludes his vision with the idea that medicine might be "prisoner to its own success." For so long, medical foresight and vision has been critical in resolving issues seen as threatening. Porter uses the words of Lewis Thomas to help articulate this reality:
...the major threats to human life were tuberculosis, tetanus, syphilis, rheumatic fever, pneumonia, meningitis, polio, and septicemia of all sorts. These things worried us the way cancer, heart disease, and stroke worry us today. The big problems of the 1930s and 1940s have literally vanished.
Porter sees medicine as having established a particular standard in which all threats to human existence can be easily "wiped out" as public memory fades in regards to the difficulty of the predecessors of disease. For example, we no longer see polio as a threat today. One dismisses its threat today. However, reflection demonstrates how deadly the disease was. Children afflicted with polio in their youth were seen as being sentenced to death. Medicine made this transition possible. However, the success that medicine faced in the past has created a demand for similar patterns today when confronting the latest strand of ebola fever or cholera. The expectation of success in fighting diseases like cancer, Alzheimer's, and diabetes is magnified and when it is not immediate, medical research is criticized. This is one aspect of the medicalization of society in that the successes of its past has created an almost artificial demand that medicine replicate the same victorious triumph with ease. Few "bow before death" because of an infallibility associated with medicine.
Porter sees this reality as manifesting in another socialization element regarding medicine. The ease with which medicine is approached has made individuals more likely to embrace it without cautious study and rigorous reflection. Porter is delicate in his assertion, but by including the medicalization of society as well as the medical industrial complex in his conclusions, it is almost intimated that both feed off one another. Consumers are bombarded with medical advertisements for drugs and doctors have almost become reduced to mere suppliers of drugs. Commercials that insist that lay people "ask their doctors" about the latest miracle drug combined with the proliferation of the web to self- diagnose just about anything has created a reality where medicalization is easily embraced. At times, Porter feels that it is too easily embraced, forgoing the rigor and sense of diagnosis that had been present throughout the history of "the greatest benefit to mankind." The expansion of the scope of "treatable" illnesses through medicine has contributed to the medicalization of society:
People are bamboozled into lab tests, often of dubious reliability. Thanks to diagnostic creep or leap, ever more disorders are revealed. Extensive and expansive treatments are then urged, and the physician who chooses not to treat may expose himself to malpractice accusations. Anxieties and interventions spiral upwards like a space- shot off course... Doctors and 'consumers' are becoming locked within a fantasy that everyone has something wrong with them, everyone and everything can be cured.
For Porter, the reality of "medical consumerism" that has been the byproduct of the medical industrial complex has created a "medicalization of society." It is for this reason that Porter sees the medicalization of "normal events like menopause" and "treating trivial complaints with fancy procedures" as a reality of the modern setting. In this manner, the medicalization of society refers to the current landscape that forms as a result of the convergence between consumerism and medicine.