Medical Nemesis

(Literary Masterpieces, Volume 19)

Ivan Illich claims that modern medicine has reached the stage where, in itself, it has become a major threat to health. Such a provocative theme is one in a series of books on the plight of modern man by Illich: Celebration of Awareness (1969), Deschooling Society (1971), Tools for Conviviality (1973), and Energy and Equity (1974).

In his foreword to the current work, Illich states not only that the medical establishment has become a major threat to health, but that it now affects all social relations. He further states that he will demonstrate that only a political program aimed at the limitation of professional management of health will enable people to recover their own powers for health care, and that such a program is integral to a society-wide criticism and restraint of the industrial mode of production.

The book is divided into four parts. The first three deal with three different types of iatrogenesis, or physician-originated disease, the clinical, social, and cultural. The fourth section deals with the political solution to the problem.

In the first section, on clinical iatrogenesis, Illich argues that improvement in the health of the human population has not come about through the efforts of physicians, but through changes in the human environment. Through extensive footnotes (pugnaciously defended in the foreword) he purports to demonstrate that most diseases were on the wane just as they were finally understood and thereafter “cured.” He contends that the general improvement in the health of a population has not had any real relationship to the amount of health care available, but rather on such things as better awareness of sanitation on the part of the populace, coupled with improved environmental and nutritional factors. He raises many provocative questions, puts forth many intriguing generalizations, but fails to make a strong and logical case, despite his footnotes. Medical Nemesis is not cluttered with facts, for they are relegated to the fine print at the bottom of the page. This is not to say, however, that there is not the ring of truth to many of the generalizations, nor that the author has not researched his subject. His is a philosophical argument following from a basically humanistic concern for the individual and that individual’s right to be human. It is this “civil” right that he sees violated, the increase in malpractice suits being symptomatic of the depersonalization of diagnosis and treatments that has changed medical care from an ethical practice to a purely technical and callous one. The second section of this first part, although headed “Defenseless Patients,” is a restatement of the scope of the chapters to follow, in a remarkably similar construction to that of the foreword.

The second major part deals with social iatrogenesis, which is the level of iatrogenic disease at which the medical establishment sponsors sickness, reinforcing societal trends that would encourage people to become consumers of medicine. Such trends include creating ill-health by increasing stress or by multiplying disabling dependence. Illich is distressed that all “normal suffering” such as birth, sickness, and death have become occurrences to be dealt with by the establishment in a hospital rather than by the individual at home. Underlying this distress is the author’s concern for the individual’s loss of the ability to deal with these most human of experiences, and consequently the loss of part of his own humanity and ultimately his freedom and independence. Much of this message is over-elaborated upon however, by militant political rhetoric.

Illich is rightfully indignant over the proportion of the average man’s budget which is now spent on the purchase of medical care, and peppers his discussion with much-needed statistics. The role of insurance coverage in the escalation of health care and particularly hospital costs is a telling one. Illich shows that such disproportionate costs are not confined to the United States alone, nor even to the other developed Western nations. In fact, he does a creditable job of proving that the same problem occurs in all countries, regardless of their level of development.

The pharmaceutical industry is another object of Illich’s concern. Drugs today are much more powerful and much easier to get, but the directions for usage that used to accompany them for the enlightenment of the layman have now...

(The entire section is 1830 words.)


(Literary Masterpieces, Volume 19)

America. CXXXV, September 25, 1976, p. 174.

Christian Century. XCIII, September 29, 1976, p. 818.

Commonweal. CIII, February 27, 1976, p. 153.

Critic. XXXV, Winter, 1976, p. 73.

New York Review of Books. XXIII, September 16, 1976, p. 3.

Village Voice. XXI, March 29, 1976, p. 42.