Why We Are Sick
How monopolized, industrialized, managerialist medicine is harming us and how we can remedy our ills.
Whether the influence of big pharma that profits from sickness, compromised public health agencies controlled by the very industries they are supposed to regulate, a biosecurity state that tends to jump from one declared health emergency to the next, medicine is now in danger of causing more sickness than it heals.
The year I was born, 1976, saw the publication if Ivan Illich’s prophetic book, Medical Nemesis, which opens with the startling claim, “The medical establishment has become a major threat to health.”[i] The book explores the epidemic of iatrogenic disease—that is, illnesses caused by medical interventions—which has only worsened in the nearly half century since this book was published. Most of the current research literature on iatrogenesis focuses on the problem of medical errors, and how to institute systems that can minimize errors. This is obviously important to address, but medical errors are only part of the story of how medicine is harming us.
Illich’s basic thesis was that some systems, including our healthcare system, improve outcomes only until they expand to a certain industrialized size, monopolized scope, and level of technological power. Once this threshold is reached, without intending to do so, these systems paradoxically cannot help but inflict harm and undermine their stated aims. Illich diagnosed “the disease of medical progress” in its early stages; I believe this disease has now reached its advanced stage. The problem is political and not merely professional: he argued that “the layman and not the physician has the potential perspective and effective power to stop the current iatrogenic epidemic.”[ii] Indeed, “among all our contemporary experts, physicians are those trained to the highest level of specialized incompetence for this urgently needed pursuit.”
Organized medicine has always carefully guarded its membership and monopoly on professional privileges, from ordering tests to prescribing medications. “The medical monopoly over health care has expanded without checks and has encroached on our liberty with regard to our own bodies.”[iii] In my previous book, The New Abnormal: The Rise of the Biomedical Security State, I explore how this tendency manifested during our disastrous response to covid. But the problem is not limited to that period of recent medical history, and the disastrous public health response was only a symptom of more widespread problems in our healthcare system.
The failed response to medicine’s ills so far has been more managerialism—more top-down control by more so-called “experts”—but this has only worsened the crisis, as I argued in a previous post. Likewise, demands for more medical care will, paradoxically, only exacerbate the problem. As Illich put it:
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.[iv]
A professionalized, physician-driven system of healthcare that expands beyond a critical limit causes illness for three reasons. First, an overly expansive healthcare system will tend to inflict clinical damage that eventually outweighs benefits. Second, the system tends to worsen the social conditions that render society unhealthy. Third, it tends to expropriate the power of the individual to heal himself. The solution therefore must involve a political program that facilitates the reappropriation of personal responsibility for health care, with sensible limits to the professional management of our health. To save medicine we must limit medicine. Strange to say, we need less, not more, professionalized health care.
Medicine has developed powerful, self-serving myths, to hide these inconvenient truths. But the epidemic of iatrogenic disease can no longer be hidden; people are waking up to realize that power over their health has been taken from them, and they want to reappropriate what they have given away to an ineffective healthcare system that no longer serves their needs. Physicians have become glorified data-gathering clerks, staring at a computer screen in the consulting room rather than engaging face-to-face with the patient. They ask a series of questions dictated by managers which have little or nothing to do with the patient’s chief complaint. Patients leave these encounters feeling bewildered, unheard, and unhelped.
Medicine now serves industrial, not personal, growth. It’s highest aim is not health efficiency—“throughput” in a favorite buzzword of hospital administrators, who copy the people-moving engineering of Disneyland to create a turnstile system that shuffles people through without helping them. Medicine has become about efficiently and predictably controlling bodies more than healing them.
Medicine has long exaggerated its effectiveness, though these myths have been thoroughly documented and debunked by historians of medicine and public health. A few examples will suffice, though these could be multiplied. Although we can now treat it with antibiotics, medicine did not cure tuberculosis: in New York in 1812 the death rate was 700 per 10,000; by the time the offending bacillus was isolated in 1882 the death rate was nearly half that at 370 per 10,000. In 1910 when the first sanitarium was opened it was 180, and following World War II but before antibiotics for TB were developed it was 48.
Other infectious diseases of the last hundred years, from cholera, dysentery, and typhoid to diphtheria, measles, and scarlet fever, likewise peaked and declined apart from medical therapies like antibiotics or vaccines.[v] This decline was due primarily to improved host resistance due to better nutrition, and secondarily to improvements in housing and other living conditions. In other words, the two main tools of the original Hippocratic physicians, who focused primarily on dietetics and environment and only secondarily on drugs and surgery. As Illich explained, “the professional practice of physicians cannot be credited with the elimination of old forms of mortality or morbidity, nor should it be blamed for the increased expectancy of life spent in suffering from the new diseases.” Instead, “food, water, and air, in correlation with the level of sociopolitical equality and the cultural mechanisms that make it possible to keep the population stable, play the decisive role in determining how healthy grown-ups feel and at what age adults tend to die.”[vi] Undernourishment in poor countries and poisons and mutagens in our ultra-processed food in rich ones are the major factors contributing to our current epidemic of chronic illness. Ozempic for everyone cannot cure our metabolic woes.
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