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    Illich Medical Nemesis PDF

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    Medical Nemesis The Expropriation of Health Ivan Illich Sa PANTHEON BOOKS ‘A Divison of Radom Hose, New York Fen Ameria Eatin coprig ©1976 by Random Hou, fe. Al gh mee unde iterations an Pa Awecan Cop Conentone Pubs pte Used Sate by ‘ore Oral pb in Gat Bea Cadar Boyar i, Laon Cope © 195 by a ih Manuticred ate Usied Sate of Amen bray Compe: Ctl Card Numer 15:8118 ISNT oops Introduction “The medical establishment has become a major threat to health The Gaabling impact of profesional control over medicine has reached the proportions of an epidemic Tatmgonas, the name fr this new epidemic, comes frm fata, the Greek word for “physician.” and gine, mean. ing “origin.” Discusion ofthe dicate of medical progres fas moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of Giagnods and therapy, and reports on paradosical damage ‘cused by cutes for sicknes take up increasing space in Inedical dopesheets. The health professions ate on the brink of an unprecedented. housecleaning. “campaign "Clubs of Coy named ater the Greek Island of Doctor, have sprung up here and there, gathering pl doried. druggits, and their industrial sporsore a8 the Club of Rome has gathered “analyse” under the aegis of Ford, Fiat, and Volkswagen. Purveyors of medical services fallow the example of ther colleagues in other fel in teding the stick of “limits to growth” to the cart of ever more desirable vehicles and therapies. Limits to pole: ‘ional health care area rapidly growing politcal suc. In rose interest these lite will work wl depend toa large Extent on who takes the initiative in formulating the need for them: people organized for politcal action ‘that challenges satueque profesional power, or the health 3 ‘Medial Nemesis profesions intent on expanding their monopoly even further "The public has been alerted to the perplerity and uncertainty ofthe best among its hygienic eareakers, The newspaper are full of reports on ele fae manipulations of medical leaders: the pioneers of yesterday’ so-called breakthroughs searn their patients agains the dangers of the miracle cures they have only just invented. Politicians ‘who have propered the emulation of the Russian, Swedish, ‘or English model of ocalzed medicine are embarrased that recent events show their pet systems to be highly sffcient in producing the same pathogenio—that is, Sickening—cures and care that capitalist medicine, albeit with less equal acces, produces. A crss of confidence in rmodeen medicine is upon us. Merely to inst on it would be to contribute further to selling prophey, and to posribe panic ‘Tis book argues that panic is out of place, Thoughtful public discussion of the latrogenie pandemic, beginning With an insistence upon demyttfcntion of all medical matter, will aot be dangerous to. the commonweal Indeed, what is dangerous is a pasive pubic that hat come to rely on superiial medical houreleanings. The crisis in medicine could allow the layman effectively to reclaim his own contr over medical pereption, clas fication, and decision-making. ‘The laicization of the ‘Aesculapian temple could lead! to 8 delegtimiing ofthe basi religious tenets of modcin medicine to which indus trial societies, ftom the left tothe right, now subcribe, ‘My argument is tha the Iayman and not the physician has the potential perspective and efective power to stop the current iatrogenic epidemic. This book offers the lay reader a conceptual femework within which to ase the seamy side of progres agains its more publicized benefit. 4 renbaie Te uses a model of social asscxment of technological Drogtes that T have aplled oat clrewhere! and applied Previously to education? and transportation and that I now apply to the criticism of the profesional monopoly and of the scents in health care that previl in all ations that have organized for high levee of instialica- tion Tm my opinion, the sanitation of medicine spare and parcel ofthe socio-conomie inversion with which Part IV ofthis book deals ‘The footnotes refect the nature of thie tet. assert the right to break the monopoly that academia has exercised overall small print at the bottom of the page. Some footnotes document the information 1 have wed to elabo- rate and to verily my own preconceived paradigm for optimally limited healthcare, a perspective that did not necesarily have any place within the ming of the person ‘who collected the corresponding data. Ocesionlly, 1 quate my source only as an eyewitness account that is incidentally ofered by the expert aor, while reusing to accept what he say a expert ttinony on the grounds that i i heanay and therefore ought not to infaence the relevant public deisions “Many more footnotes provide the reader with the kind of bibliographical guidance that I would have appreciated when Test began, as an outsider, to delve ito the subject (of health care and tied to acquire competence in the potical evaluation of medicine's efctiveness. These notes Fefer to Iibeary tools and reference works that 1 have learned to appreciate in year of singl-handed explora tion. They ab i readings, fom technical monograph to tovel, that have beea of we to me Finally, [have used the feotnotes to deal with my own taf mma Ys Harpe Re 1979 Beige fre Aten Oe at Rage Re Reprod a an Yas Hcg & a 10) Medical Nemes parenthetical, supplementary, and tangential suggestions land question, which would have distracted the sealer if kept in the main tex. The layman in medicine, for whom this book is writes, veil himwelf have to acquire the competence to evaluate the impact of medicine on healt ‘are: Among all our contemporary experts, physicians are ‘those trained to the highest lve! of specialized incompe tence for this urgently needed pursuit "The recovery fom socity-wide iatrogenic diease is a political tas, nota profesional one. It mun be bared on a ‘rasoots consensus about the balance between the cv Hibery to heal and the evil right to equitable healthcare. During the last generations the medical monopoly ever Ipalth care has expanded without checks and has en croached on our iberty with regard to our own bodies Society has transfered to physicians the exclusive right to determine what constitutes sicknes, who is of might become sick, and sthat shall be done to such peopl, Deviance le'now “legitimate” only when it merits and ultimately justifies medieal interpretation and interven- tion. The socal commitment to provide all citizens with almost unlimited outputs from the medical system threatens to detroy the environmental and cultural conditions needed by people to live a life of constant autonomous healing. Thi trend mut be recognized and eventually be reverted ‘Limits to medicine must be something other than profesional selflimitation, 1 will demonstrate that the insistence ofthe medical guild on its unique qualications to cure medicine ive is based on an illusion, Profesional power it the rest of political delegation of autonomous Sutbority to the health occupations which wat enacted uring our century by other ecto of the university trained bourgeoisie: it cannot now be revoked by thov ‘who conceded it it ean only be delegitimized by popular 6 agreement about the malignancy of this power. ‘The sell medication ofthe medical system cannot but fal a Public, panicked by gory reelationy, were browbeaten to farther apport for more expert control ever expert i health-care prediction, tha would only intensify sickening care. 1 must now be understood that what fas turned health eate into a sickmaking enterprie ie the very inensity of an engineering endeavor that has translated human survival ftom the performance of organisms into the result of technical manipulation, “Health,” ater all, i simply an everyday word that is used to designate the intensity with which individvals cope With their internal sater and thei environmental condi tions. In Home aspimg, “healthy” is an adjective that (quale ethical anv political actions. In part atleast, the Ibealth of a. population depends on the way in. which political ations condition the milieu and create those Sreumstancer that favor slfreiance, autonomy, and Aiguty for all, parculary the weaker, In consequence, halt levels willbe at thelr optimum when the environ ‘ment brings out autonomous personal, responsible coping ability. Health levels can only decine when survival comet to depend beyond a certain point on the heterone ‘mous (other directed) regulation of the organism's homeo: Stasis. Beyond critical level of intensity, ineiutonal health care-—no matter if it taker the form of cure prevention, or environmental engineering —is equivalent to ystematic health denial The threat which current medicine represents to the health of populations is analogous to the threat which the volume and intensity of tafe represent to mobility, the threat which education and the media represent 10 learning, and the thteat which wbanization represents to ‘competence in homemaking. In each eases major init tional endeavor has turned counterproducive. Time-con 7 Medica Nemesis ‘suming acceleration in trafic, noisy and confsing com- munications education that trains ever more people for {ver higher level of technical competence and specialized forms of generalized incompetence: thee ate all phe romena parallel tothe production by medicine of itr {enc disease In each expen major institutional sector has Femoved society fom the speeitic purpse for which that fector was created and technically instrumented Tatrogencsis cannot be wndertood unless itis seen asthe speifially medical manifestation of spf contd {p, Specific or paradonical counterproductvity isa negi- tive weial indicator for a diaeconomy which remains locked within the ayster that produces Tes 3 measure ofthe confusion delivered by the news media, the incom: petence fated by educator, or the timesos represented by a more powerful ear, Speci counterproductivty i an ‘unwanted tideeffect of increasing iostutonal outputs that remain internat the system which tulferiginated the specific value. [tis a social measure for objective frustration. This study of pathogenic medicine was under taken in order to illustrate in the health-care fet the various aspects of counterproducivgy that can be ob- feved ia all major scctor of industrial society in its present age. A similar anys could be undertaken in ther lel of industrial production, but the urgency i the eld of medicine, «traditionally revered and selGcongrat- ‘latory service profesion, i particularly great Ballin iatrogenesis now affecs all social relations. I is the teult of internalized colonization of liberty by alluence. In rich crualeies medical colonization has Teached sickening proportions; par countries are quickly following suit. (The siren of one ambulance can destroy Suinaritan attitudes in = whole Chilean town) This proce, which T-shall call the “mediclization of life! ‘eerves articulate pliieal recognition. Medicine could 8 become a prime target fr polities action that aims at an inversion of industial society. Only people who have recovered the ability for motial welfare and have learned to combine it with dependence on the application of contemporary technology will be ready to limit the Inhral mode of production i other major areas os well, ‘A professional and physciaa-based health-care system that has grown beyond crical bounds is sickening for twee reasons: it must produce clinical damage that ‘outweigh its potential Benes; it cannot but enhance ‘even at it obweires the politcal conditions that render foviety unhealthy; and i tends to mystify and to expr priate the power of the individual to heal hirself and to fhape his or her environment. Contemporary medical {ystems have outgrown thew tolerable bounds. The ene Cal and paracnedical monopoly over hygienic methodology And technology i glaring example ofthe political mise ‘of scentfc achievement to strengthen industrial rather than personal grow. Such medicine is but a deviee to tonvince thov who are sick ad tired of society that iis they who ar il impotent, and in need of technieal repair [il deal with these three levels of sickening medial Jmpact im the frst thre pars ofthis book, "The balance sheet of achievement in medical techno ‘oy wil be drawn up in the Gt chapter. Many people are Steady apprehensive about doctors, hospital, and the Grug industry and only need data to substantiate their misgivings, Doctors already find it necesary to bolster their credibility by demanding that many treatments now ‘common be formally outlawed. Restictins on medical perirmance which profesionals have come to consider mandatory ae often so radical that they are ot accept- able othe majority of politicians. The ack of effectiveness ‘Of contly ad high-risk medicine i a now widely diseased fact om which I start not key fue T want 1 dell on, Medial Nemesis Part I deals with the diretly health-denying effets of medicine's social organization, and Part IT with the disabling impact of medieal ideology on personal stamina Under three separate headings I desribe the transforma: tion of pain, impairment, and death fiom a persona challenge into a technical problem, Pact IV interprets health-denying medicine as pica of the counterprotuctvity of oveindustralized. culation and analyze five type of poiial response which const fue tactically usefol remedies that are all strategically fate. It datinguishes between eo modes in which the person eelatex and adapts fo his environment: autonomous ie, seligoverning) coping and heteronomous (ic sd Iinistered) maintenance and management. It concludes by demonstrating that ony a politcal program aimed at the limitation of profesional management of heath will tenable people to recover their powers fr health care, and that euch a program integral to a society.wide enti land retrain of the industrial mode of production PART | Clinical Iatrogenesis 1 ‘The Epidemics of Modern Medicine Dig he tthe eon te ene Wh lawns mst ng! Rae ae tr ong et SAS cme pe sayeth a cre 1S acne sana te dees ot Sp sing wen an or ainsi ereae Fee "age ls ae ge pe wi ace tg sd ooo i eh ee Al ane ene belo SSS Riese ac isnt ae Ui aero cae onic nuns seth neaeta he anes ve ag ty oy tne mies SS a pesca maton ence tin a ars oelaea aint Sache eenanwars Sceciones mar Severe Re en pe ema ey epee en apie te mene meres Sees depen variables of pals! and ele! wan ‘Sato, which inn are ated eet today tay te nt spbany oad hee that que te propionate and coy eee inte he hei rofaons ke pes ena cxptaing propor af hen ie of Sea ae {Steen yea be reat obeedoa ec ne it et of pee sho aca nie eee aeons ‘tert contury 6 pect of medal opts and comatose coment) wlan cee Sa Sate rte ty ten omen rn ry epee dn eb cy ess, one Ervine hrerutanacans micieetay ‘ld isd fan inde Peace Mids opal Pas Mpc ie Serene Me ee ier Se Rayer romnemmnees SS aie “neta he Duy, a Papi: Sede, 121 age (ates feme keke Rey fromthe Sci of haa gay Spe w lady nets (Scot de tle pa fey ane an ‘Spang the aca pds isch Sermon te Mel Cn SK defen tang J ar ih, et whe eee thet Rad Bah ln! Cay 9 oe a ok (Gea te enna 5) erik ae nt a i FSM Ty See Yack he Epon of Maton Meine have not been important in producing the changes in life expectancy that have occurred. A vast amount of conte: pracy clinical care is incidental tothe curing of disease, but the damage dove by medicine to the heals of individuals and populations s very significant, These facts are obvious, well documented, and well repressed Doctors’ Effectiveness—An Illusion ‘The study ofthe evolution of disease patterns provides cvideace that during the Inet century doctors have affated «epidemics no more profoundly than did. picts during catier times. Epidemics came and went, imprecated by both but touched by nether. They are not modified any more decisively by the ital performed in medical eine ‘han by those customary at religious shines! Discussion of the future of healeh care might useflly begin with the recognition of thi fact. ‘The infections that prevailed at the outset of the ‘industrial age ilustrate How moticine came by its eps ‘ion? Tuberculois, for instance, reached a peak ovet Oro ‘generations. in New York in 1812, the death rate wat ‘ekiinated oe higher chan 700 per 10,000; by 1882, when Koch first isolated. and cultured the bacllay f had Already declined 10370 per 10,00. The rate wat dven to 180 when the fist sanatorium wat opened in 1910, even ‘hough “consumption” still held second place inthe mortality tables After World War Il, but belore anti inset Rds pie Le acre ae La Seta pce io Rpt sear ene ye rgd ade Weir,” Batt Beha G90) ae B55, Gate a tyme eng fotes became routine, it had slipped into eleventh place with 2 rate of 48. Cholera!" dynentery,* and typhoid similarly peaked and dwindled outside’ the physlian’s ‘ontral By the time ther etiology wat undersoad and ther therapy had become specie, thee diveses had lot much of their virulence and hence their socal importance The combined death rate from scaciet fever, diphtheria, whooping cough, and messes among childeen up often shows that nearly 90 percent of the total decline. in ‘mortality between 1860 and 1963 had oocurred before the introduction of antibiotics and widespread immuniza- tion In pare this ection may be attributed to improved housing and toa decrease inthe virulence of mico-organ ims, but by far the moat important factor was 8 higher hostresistance due to beter nutrition. In poor countries today, diarthea and upper-respratory.tret infections ‘occur more frequently, lait longer, and led to higher ‘mortality where nuvition i por, no matter how much ot how litle medical eate is availabe. In England, by the middle ofthe nineteenth century, infectious epidemics had been replaced by major malnutrition syndromes such as rickets and pellagra. These in turn peaked snd vanished, to be replaced by the disease of early childhood and, somewhat later, by an increase in duodenal ulcer in re pening intr tb or Ne ork ‘The Epidemics of Maden Medicine young men. When these declined, the modern epidemics Took over: coronary heat divest, emphysema, bronchitis, obesity, hypertension, cancer (cpecially of the lungs), Artits, diabetes and so-called mental diorders. Despite Intensive research, we have no complete explanation for the genesis of these changes’ But two things are certain: the profeional practice of physician cannot be credited ‘wth the elimination of ld forms of mortality or morbid ity, nor should it be Blamed forthe increased expectancy of ie epont in suffering from the new dears, For more than a century, analysis of disease trends has shown that the envionment i the primary determinant ofthe state of general health of any population." Medical geography,” on Came “Phil ee = Rr wo Sim” Ana me tort Gi Cate a ie ‘Erte foe, ev eet Baty ome Mee Mave Serene ec Narayan ‘on te meen, Cer” Pee th ln ‘ites Nf nn Ca io 9) ol ey tha ‘iy ber wa a ng nl tor et et eh ‘Siar y ster ns temas en ee ‘Bike nd i Dania a ie ‘otto eres Csr Unchingt Aotoe t poeta ie Peat: PUT Va La Mei —— oti dec! et ante ad he si tose aes nt fal te nd etn wi ee saree eeeeeeeeeeeeeeeeenaes Saeco tere cain are eee eee ae eve eas Pee te rm on Se eee aeiglie aay a a ame Bator Rea of hater Saat eS Sot an Mesa ‘ee Sere ts gst Etec at sco a tel oh 1575 Hane} Tenn and ner Wega tr dn fp Ineo eo USE ete a el pain Sse lubes nln cea a oe Sechgas ieee i nee echone neato ‘Stan on he mtd wed a Cay ie “Ne es oe ‘ace an ep ICH, Gap aes The MIN ee: Ieee: at Presta iHome et A 1 Hepes Pa aN ng SO al Essar aeons ta nce Ain a ‘Rent Waar ame Rage, Wye Coe har Ret Rte ‘Phe Biden of Modes Meio sociopolitical equality and the ealural mechanisms that make it ponible to keep the population stable play the opens aah Laces Wi loss Dae Tv Hh oe ‘nt ot Wi Cn ef hy Ha, Pinot Arf eT, Rees itn ee ae oo Pe Siow 10 (10) 73-99 Pol Dea ay Mm i “tate cml men oii anu eK net i ni Geko em Joey 12% Th ee tok Sauty kena bic shl hve Beem pba anda, Oi {Sh glue fun Bain Tegra itch kp Cage pun 2 Coen ot ‘yates i ot Was Cogn oe Feet NAIR tan uy a Fee sa and ent Snes in Ass kat New ot Gut 9 (nebo) Bisnis cst leas crn ofan wee a mar Canon, doar Beem, a Chou, 1994, m2 pp. SS Ey Medical Nemes Aecisive role in determining how healthy grown-ups fel fad at what age adult tnd to dic. As the elder cases of Aiseate rene, new kind of malnusrtion is becoming the ‘most rapidly expanding modern epidemic One-third of humanity survives on a level of undernourishinent which ‘would formerly have been lethal, while more and more Fick people abmorb ever greater amount of ponone and ‘mutagen in ther food” ‘Some modern techniques, offen developed with the help of actors, and optimally effective when they become part (ofthe culture and environment or when they are applied independently of profesional delivery, have also effected ‘chaiges in general health, but to a lsser degree. Among, ‘these can be included contraception, smallpox vaccination of infants, and sich nonmedical health measures a2 the ‘uealment of water and sewage, the wie of sap and sekzors bby midwives, and some antibacterial and invectcidal procedures. The importance of many of these practices tras first recognized and stated by docion-—ofien cour iecus dissidents who alfred for their recommendations Sep See tae yee ie Rite eames tbr SEE ee tea pate at 8 deg en alee preg ee rere Riva ieenaeeer erm Boece tan eres” ako Sg Gantt TLE mame 7207 ste Sakceidra gan heccaa mena aes Saha aa tecamoreas and shan Soon He Ef ond Wok etapa Rady Te Epics of Mode Mine but this does not consign soap, pincer, vaccination needles, delowsing preparations or condom to the cate ory of “medical equipment.” The mast recent sits ia Inortalty from younger to older groupe can be explained by the incorportion of thee procedures and devices into the lays culture. Tn contrast to envionment improvements and modern onprofsional health measute, the specifically medical treatment of people ie never significantly related 10 a tecline inthe compound disease burden oF toa rie in lie fxpectancy.® Neither the proportion of doctors in a population nor the clinical tole at thie disposal nor the rrumber of hospital beds ie a causal factor in the striking Changes in overall patterns of disease. ‘The new tech niques for recognizing and treating such conditions 25 petniciows anemia and hypertension, or for correcting Eengeital enalformatione by surgical intervention, re- ‘define but donot reduce morbidity. "The fact that the ‘doctor pepulation ie higher where certain diseases have bbeome! rare has litle #9 do with the doctor’ ability to contol or eliminate them Ie simply means that doctors Toy naan he iu pete nec renters SEs Te heeled oly fom prea feeb & eto 3 PEI Pi pt emo nn ey iawn Henan preventing. pote wt) and nein Se eS sn Et, i De en Se tng lesen be USA bere gh itor ett el pte ad» Ng of mney SESSA ac petcan Beng p e coa cei, ‘Suimsrur thet open ses pe atc ef gn cricket aay ie tp egal pf bona act fale els mate oe ay te de Meal Nemesis deploy themeelver ax they like, move 20 than other profesional, and that they tend gather where the climate is healthy, where the water is clean, and where people are employed and can pay for thee services" Useless Medical Treatment ogee a een re San Ri wand tenn dre il fen ego pene ot Spy hina Rena Fh ce Ns Pot {ng of Mable Yr eration Pet The Epon of Mate Mein iaease is due to new mores, not (9 ineffectual medicine "The reappearance of malaria i de to the development of pesticide resistant monquitocs avd not 1 aay lack of ne Sovimalarial druge? Immunization has almost wiped out patalytie poliryelit « dee of developed countries, fed vaccines have certainly contributed 40 the decline of ‘shooping cough and meses" thar seeming to confirm the popular belie in “medical progres.” ® But for mort ter infections, medicine can show no comparable rx Drug treatment har helped to reduce mortality from taberculotis, tetanus, diphtheria, and scarlet fever, but in the total decline of morality oF morbidity fom these scares, chemotherapy played tsinor and. possibly insignificant role2® Malaria, eiheaniai, and sieping Schres indecd receded fr a time under the ondaught of ‘herncalaxack, but are now on the rive again.” is i em Gp TE ‘hme of dacs} H Aen Sy at fins DLs Pa, [By hee hectic byte sn wen ree eva hone Mar te Rice eae ae ‘Syne cab snare my meme How the ngs ‘cara and Mion, The Coe Tg eer nts make i 3 Medial Nemesis ‘The eectivenes of medical intervention in combatting nnoninfectons diseases is even more questionable. In some situations and for some conditions eflzctve progress has fed been demonstrated: the partial prevention of cares ‘through fuoriation of water is posible, though at a cost not filly understood ™ Replacement therapy lessens the dliret impact of diabetes, though only in the short run.” "Through intravenous feeding, blood tansfsions, and sungical techniques, more of thore who get tothe hpi survive trauma, but survival rates for the most common types of cancer those which make up 90 percent of the ceaseshave remained virwally unchanged over the lat ‘orem five years This fact hat consistently been clouded bby announcements from the American Cancer Society reminiscent of General. Westmoreland’s proclamations from Vietnam. On the other hand, the diagnostic value of the Papanicolaoa vaginal smear text has been proved i the tet are given four times a year, ely intervention for cervical cancer demonstrably increases the Five-year su vival rate, Some skin-cancer treatment is highly effective. But there is fit evidence of effective treatment of most ‘other cancers. The five-year survival rate in breat-ca EES Sate orc se tenes tne ain “ain Bata Cuno Paning Ubinas cg Barbs cn ie Nv BG Se ‘tend ap he sal cn pp at pies Te “ECT Nene Say ie ten a ype Agi. ‘slr Conan Ps wt Ah Oo Baas. Ma SH. Ones, Krktngng fan dai (Sr The, 170 ‘Tao my Rog hw lon fe Re The Bidens of Mader Mabe cer cases is 50 percent, regardles of the frequency of medical check-ups and regardless ofthe weatment wed! Noristhere evidence thatthe rate fers from that amos, tuneated women. Although practicing doctors and the publicist ofthe medical etablshment rire the impor: tance of early deteton and treatment of this and several ‘ther types of cancer, epidemioigits have begun to doubt that carly intervention ean alter the rate of survival Surgery and chemotherapy for rae congeaital and thea: ratte heart deare have increased the chances for an ctv life for some of those who slr from degenerative ‘anditions.® The medical weatment of common carciovae lsease and the intensive treatment of heart airnes of tt teatent Se tee NE Mek oT Spare fee ere eerie caiman diene et Bese es Senha ae gmat SS ee Se at enlin fer Soe re ay Pts eee he Nn ph Se oem statin Pee ees cee Ren Dimer i Cts Goa Tat Nao Ly ad 8 Medical Nereis disease,® however, are elective only when rather excep ‘al circumstances combine that are outside the phys can's control. The drug teatment of high blood prestre ie efective and warrants the risk of side-eect in the fee in whom itis a mafigaant condition, it represenss 2 ‘considerable rik of serous harm, fr outweighing any proven benefit, forthe 10 t0 20 million Americans on whom rash artry-plumbers are trying to fos ie! Doctor-Inflicted Injuries cea teeter Be ee eee eee crn panty cone” dnb col sath Tete toe eee erste ea arse ee ae eae eee er ees ee aaa uae doar Aen Se coe ee aan ee eens ae net carer oe igre ae oy noe wats tae ak ae ae, tert fg fom rea Hee Nae es ern Jamal of Matin 38 (C3tober 1963): 634-8. ‘eetenio! = Rae SSERS yer we ey Seeere eee eee eeRee EERE Sa ee: eee ‘Tar, 190) Coy Decoy fe Reg nese (Pare Dn 1964) Seo eres eee 6 The Biden of Mode Maine about if sound and profesional recommended Weatment had nt cen applied © Within this defaition, a patient ‘could rue hie therapet if the latter, in the cours of is management, filed to apply recommended treatment that nthe pyscian’ opinion, would have risked making him’sick, IR 2 more general and more widely accepted sense, clinical iatrogenic. disease comprises. all einial ‘conditions for which remedies physicians, o hospitals are ‘he pathogens, oF “sickening” agents will call this plethora of therapestic sie eflects init intgeness. They fre as old st medicine sel and have always been a tubject of medical stadies®> ‘Medicines have always been potentially paionous, but Ahir unwanted side-effects have increased with their owes! and widespread use Every twenty-four to thirty- Seca mee as z sae eres ore SEENEES (i 9 theeiganene er of a on ee ‘pan wih ree ian te ood Dreier eters ‘Bea Noe Vine the Powe to Hea Al Demy fr Tat ot SE cee ernmet errno mecca Ben Seeeceeyans Sasha discs seaes ae ty Gpetacen mee eeerenene Scaherrgs gerade ae Wen Adri Beat Te, x ary gray of ies rm approximately 3400 ceo teteiere mec Saul “SE surly Ieee Dae Aa Bedi Pep” ‘ae rt Het soe 10 Metical Nemes six hous, fom 80 40 80 percent of adults inthe United Stats and the United Kingdon swallow 0 meialy presided chemical Some ake the wrong uy ees et Anal ora contaminate batch, and wets countertet® her ake Several drgsin dangerous combinations" ad Sil others reece ington with improperly seraed Srtinges® Some drugy are addictive, thers lating, and others matageni although perp nly in combing. ion with ed coloring or imecicier tn ome patents ntbiotc alter the noma bac Hore ane dace Sipetinetion, permitting ore veitam organ prolirate and invade the hor. Other drugs conte the beeing of drugs strain of bacteria Sue Ends of pooaing thus have spread even faster than the bewildering variety and wbiguty of stuns Unnece sary surgery isa standard procedure Dowling mdse eee ay er nnn ng Sarpy gerne connoe seed nl eae eo [foes paar ae et Sse dr paca Fowtenocnaer seein oateoees Oi mm Sees eee adage aon eka sn aon et "Smet

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