Limits to Medicine: Medical Nemesis, the Expropriation of Health

Medicine has become an all encompassing ideology that limits political freedoms (e.g., COVID) and destroys lives through iatrogenic disease (e.g. the hidden epidemic of benzodiazepene brain injury). Medical practitioners are granted far too much license and cultural capital in our historical moment. Illich sensed what was coming long ago, and his critique still has incredible relevance today.

Illich begins his book with: "The medical establishment has become a major threat to health", and he coins a term for this threat, "iatrogenesis". His critique isn't limited to particular aspects of modern medicine that have become excessive; he views modern medicine as fundamentally flawed and causing more harm than good. He would be happy to do away with the whole institution. The problem, he says, lies not with medicine itself but with the medical establishment's existence as a dimension of modern industrial society. "Iatrogenesis will be controlled only if it is understood as but one aspect of the destructive dominance of industry over society, as but one instance of that paradoxical counterproductivity which is now surfacing in all major industrial sectors." Thus medical reform is but one aspect of a necessary larger social reform.I suppose it's possible to pick out some worthy aspects of Illich's critique without adopting wholesale his larger societal critique. One of his major complaints with modern medicine is that it deprives the individual of self-determination in treatment, that treatment is taken over by a technocratic bureaucracy which tends to declare everyone to be in need of treatment, and which "gives treatment" as opposed to assisting the patient with self-treatment. Another of Illich's complaints is that the medical establishment supplants traditional cultural means for understanding pain, suffering, and death with a judgemental technocratic bureaucracy that engages in a nihilistic effort to eliminate pain and prolong life.These are legitimate points and the medical establishment would do well to alter its game to respect patient self-determination. But I don't think I'm ready for Illich's counterproposal of rusticated primary care, like the "barefoot doctors" in China. He also believes that pain and suffering are not to be avoided but to be understood, that this is a basic part of human existence, denied to patients of modern medicine which attempts to eliminate pain and suffering. But it seems that there is enough pain and suffering in life, even with modern medicine, to not chase after extra helpings of it.And in some ways it seems inappropriate to identify a few of Illich's points as meritorious while ignoring the overarching philosophy from which he derives them. It wouldn't really do them justice to try to incorporate them into a medical system that Illich says is corrupt to the core. His objections run deep; he criticizes Descartes, Bacon, and much of Enlightenment thought for the current dilemma while pointing to "primitive" societies and underdeveloped (basically pre-industrial) countries as models. And his recommendations go far beyond the fine-tuning of the existing medical establishment. I don't think you need a condemnation of industrial society as a whole to see that there are excesses in modern medicine that need to be reined in, neither do you need to reject modern medicine as a whole to reform it. So Illich's book is interesting but of limited use unless you're wanting a large-scale social critique.

First the bad: I believe that the first edition of this book was written in 1974 and it was revised in 1995. Which makes it old and older news. The book was not rewritten; long sections of notes were added to the bottoms of each page. In some cases; there are more notes than the original draft. This makes it hard to really enjoy the book having to stop and go while you read. An alternative would be to read the original then read all of the notes.Now the good: This book is probably the first to mention the unspeakable - physician caused illness and death. Doctors kill or injure people by misdiagnosis and by prescribing the wrong medications. This was in 1995; how many drug recalls have we had since then?To hear news about medical issues that are unbiased by big pharma; I recommend subscribing to Mercola This book does not really go into vaccine damage; probably because it was published about the same time parents were organizing against the DPT vaccination. To learn more about vaccination damage and death; I recommend checking out NVIC.The book is unique in describing the exalted positions we give to doctors and subordinate our responsibility to them over every phase of life. I have never read this anywhere else. Stand on your own feet people. Take charge of your own health. You are just a number to most of these people and they really don't care about any pain or suffering you might experience.It is better for the medical establishment for you to be sick. It is better for all concerned if you spend any money you might accumulate on prescription drugs. Do you think that the Cancer Foundation actually wants to find a cure? There are a lot of people making a lot of money in these organizations.This book does not really go after the big fish; it seems to concentrate more on private practice. The book is lacking in some areas; however, still worth reading. SDSerf

The book is dated but the argument against the medicalization of society is even more pressing now than it was in the 1970's. Our world is turning into a medical dystopia and we need to listen to the voices that predicted the current crisis as we attempt go reclaim our humanity.

Could have been written today, same problems in medicine persist.

I love the thinking of Ivan Illich and have recommended this book to many of my friends and family. However the production of this particular copy is shockingly bad. Every couple of pages comes loose from the binding, making for a frustrating reading experience. I’ve never experienced this with a book.

This book is the classic critique of our healthcare system and how it has alienated us from true well being. I would tend to disagree with some of his very Roman Catholic positions, but on the whole, you cannot get around this book if you want to start to understand why our healthcare system is so totally out of control.

Even though this book was written in 1975 it contains all the main issues related to the way the health industrie is structured and why at times creats more illness than what it is able to cure. It is one of the best critics I have read on the health industrie. Highly recommended.

To start with, I'd definitely recommend this to anyone who, like me doesn't trust the medical fraternity in general, and anything much that a doctor's got to say in particular. why is for another day; suffice to say that, although the prose comes from the 1970s and is, as a result, a little starchy, my best friend Ivan really sticks the knife in and keep on shoving. Wonderful stuff; I sent a copy to a friend who is a nurse, and got the point almost immediately.I picked up my copy from a copy of Fortean Times from a couple of years ago; most of their reviews are straight and to the point, so much so that I've bought books that they say are not worth toilet paper, just so as I can undeerstand the cringe of it. Nothing like this here and, which is a comfort from somebody who is clearly writing for the North American audience, a lot of the studies he quote were based in the UK. Sadly, for the health service, and those who have to suffer at its hands, most of what he says about the UK is still painfully true.Definitely one of my favourite books not because it says everything I don't know, but puts it all so very, very well. I'd put it on a class with another of my favourites, Richard Dawkins' "The God Delusion" for the same reasons; you didn't necessarily have to be a believer on either the god side or Dawkins', it was all so well-argued.I'd recommend this to anyone who wants to query the status quo where medicine is concerned and the bad that doctors do in particular. That's not to say doctors are necessarily bad people, although I've met a bunch who are pretty dreadful, it's just that they seem to believe, or have been trained to believe, that they've got a grip on everything related to sickness and treatment, when, truth be know the addage from the 17th century still pertain: visiting a doctor is more likely to be the death of you, rather than be good for your health.

If you are starting to have doubts about everything in Medicine (the efficacy of many things we do, the possible corruption of the "basics of medicine", the validity of the so called evidence based medicine, the manipulation of the information about new and not so new drugs and so on.....), you are ready for Medical Nemesis.Warning: as you read it you start to wonder what on earth are you still doing in Medicine or why you are not being more proactive against those barriers that stand between you and "proper ethical medicine"This book is the predecesor of Ben Goldenacre's books and depressing to see that it was written back in the 70s....a depressing state of affairs indeed.......Honestly, read it.

Very interesting book about the dangers of over-medicalisation, including how this could be used to limit peoples freedoms (who would have thought, eh?) Should be on the reading list of every student planning to go into healthcare. Highly recommend.

In the late 80's, whilst still at Medical School, I was advised to read this book. 20 years on, I finally got round to doing so. What a book! Basically, Illich argues that the medicine industry has taken health away from individuals, and it needs to be given back.With the NHS creaking despite £100bn being spent on it per annum, and also a further £100bn being spent on working age adults who say they are too ill to work, something drastic will need to change. I suspect the answers Illich identified in the 1970's will be part of the solution.

I bought this book as part of revision for an exam and it makes interesting reading.Ivan Illich is associated with his writings and the development of the concept of iatrogenesis but this book shows that there is more to Illich than just the one word.Although written in the 70s so much of the health service style and structure in UK has changed - the basic concepts remain sound and I suspect will do so for the foreseeable future as medicine gets more complex and dangerous and we continue our love affair with high tech hospital medicine.