From: unk...@googlegroups.com   
      
   Illich, Ivan. Medical Nemesis. New York: Pantheon Books, 1976.    
      
   Illich was an iconoclast the equal of Lundberg, who critically examined many   
   social issues, including medical care. He points out in excruciating precision   
   how "scientific" medicine causes as much sickness and suffering as it purports   
   to prevent whilst    
   interfering with the intrinsic dignity and freedoms of people. OUT OF PRINT.    
      
      
   The Epidemics    
      
   of Modern Medicine    
      
      
      During the past three generations the diseases afflicting Western societies   
   have undergone dramatic changes.1 Polio, diphtheria, and tuberculosis are   
   vanishing; one shot of an antibiotic often cures pneumonia or syphilis; and so   
   many mass killers have    
   come under control that two-thirds of all deaths are now associated with the   
   diseases of old age. Those who die young are more often than not victims of   
   accidents, violence, or suicide.2    
      
      These changes in health status are generally equated with a decrease in   
   suffering and attributed to more or to better medical care. Although almost   
   everyone believes that at least one of his friends would not be alive and well   
   except for the skill of    
   a doctor, there is in fact no evidence of any direct relationship between this   
   mutation of sickness and the so-called progress of medicine.3 The changes are    
      
      dependent variables of political and technological transformations, which   
   in turn are reflected in what doctors do and say; they are not significantly   
   related to the activities that require the preparation, status, and costly   
   equipment in which the    
   health professions take pride.4 In addition, an expanding proportion of the   
   new burden of disease of the last fifteen years is itself the result of   
   medical intervention in favor of people who are or might become sick. It is   
   doctor-made, or iatrogenic?    
      
      After a century of pursuit of medical Utopia,6 and contrary to current   
   conventional wisdom,7 medical services have not been important in producing   
   the changes in life expectancy that have occurred. A vast amount of   
   contemporary clinical care is    
   incidental to the curing of disease, but the damage done by medicine to the   
   health of individuals and populations is very significant. These facts are   
   obvious, well documented, and well repressed.    
      
   Doctors' Effectiveness--An Illusion    
      
      The study of the evolution of disease patterns provides evidence that   
   during the last century doctors have affected epidemics no more profoundly   
   than did priests during earlier times. Epidemics came and went, imprecated by   
   both but touched by neither.    
   They are not modified any more decisively by the rituals performed in medical   
   clinics than by those customary at religious shrines.8 Discussion of the   
   future of health care might usefully begin with the recognition of this fact.    
      
      The infections that prevailed at the outset of the industrial age   
   illustrate how medicine came by its reputation.9 Tuberculosis, for instance,   
   reached a peak over two generations. In New York in 1812, the death rate was   
   estimated to be higher than 700    
   per 10,000; by 1882, when Koch first isolated and cultured the bacillus, it   
   had already declined to 370 per 10,000. The rate was down to 180 when the   
   first sanatorium was opened in 1910, even though "consumption" still held   
   second place in the mortality    
   tables,10 After World War II, but before antibiotics became routine, it had   
   slipped into eleventh place with a rate of 48. Cholera,11 dysentery,12 and   
   typhoid similarly peaked and dwindled outside the physician's control. By the   
   time their etiology was    
   understood and their therapy had become specific, these diseases had lost much   
   of their virulence and hence their social importance. The combined death rate   
   from scarlet fever, diphtheria, whooping cough, and measles among children up   
   to fifteen shows    
   that nearly 90 percent of the total decline in mortality between 1860 and 1965   
   had occurred before the introduction of antibiotics and widespread   
   immunization.13 In part this recession may be attributed to improved housing   
   and to a decrease in the    
   virulence of micro-organisms, but by far the most important factor was a   
   higher host-resistance due to better nutrition. In poor countries today,   
   diarrhea and upper-respiratory-tract infections occur more frequently, last   
   longer, and lead to higher    
   mortality where nutrition is poor, no matter how much or how little medical   
   care is available.14 In England, by the middle of the nineteenth century,   
   infectious epidemics had been replaced by major malnutrition syndromes, such   
   as rickets and pellagra.    
   These in turn peaked and vanished, to be replaced by the diseases of early   
   childhood and, somewhat later, by an increase in duodenal ulcers in young men.   
   When these declined, the modern epidemics took over: coronary heart disease,   
   emphysema, bronchitis,    
   obesity, hypertension, cancer (especially of the lungs), arthritis, diabetes,   
   and so-called mental disorders. Despite intensive research, we have no   
   complete explanation for the genesis of these changes.15 But two things are   
   certain: 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. For more than a century,   
   analysis of disease    
   trends has shown that the environment is the primary determinant of the state   
   of general health of any population.16 Medical geography,17 the history of   
   diseases,18 medical anthropology,19 and the social history of attitudes   
   towards illness20 have shown    
   that food,21 water,22 and air,23 in correlation with the level of   
   sociopolitical equality24 and the cultural mechanisms that make it possible to   
   keep the population stable,25 play the decisive role in determining how   
   healthy grown-ups feel and at what    
   age adults tend to die. As the older causes of disease recede, a new kind of   
   malnutrition is becoming the most rapidly expanding modern epidemic.26   
   One-third of humanity survives on a level of undernourishment which would   
   formerly have been lethal, while    
   more and more rich people absorb ever greater amounts of poisons and mutagens   
   in their food.27    
      
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)