TWO books I read in my early thirties had quite an effect on me at the time: The Unmasking of Medicine by Ian Kennedy and Medical Nemesis by Ivan Illich. I was working in a large teaching hospital and I guess it was my career in healthcare that drew me to these two books. My wife and I were busy bringing up our four children so the ideas in these books didn’t hang around in my mind for long. I had very little time for pondering life, the universe and everything, including the effects of healthcare on society. Leave that to the academics.
However, in the intervening years these two writers and others I came across on the internet would enter my mind like ghostly figures trying to catch my attention. They came into sharp relief during the last three years or so.
Ian Kennedy (now Sir Ian) is an academic lawyer specialising in health and ethics. His book published in 1981 gave rise to some controversy and articles in medical journals. Kennedy was too much of a heavyweight to ignore and was well received by some in the medical profession and much criticised by others. His main concern was the political and social role of medicine. He argued in the book, among other things, that while the pre-eminent position of science in medicine has led to improved diagnosis and treatment, it has resulted in less consideration of the ethical and social roles within an increasingly powerful profession. This growing power over people’s lives seemed to be either not noticed or accepted by the majority.
Medical Nemesis was published seven years before The Unmasking of Medicine. Ivan Illich, an Austrian priest, theologian and philosopher, argued that what he called industrialised medicine had led to a lowering of the quality of life. Illich believed that over-medicalisation has led to the creation of pathologies out of conditions which were previously considered to be normal. This creates an over-dependency on medicine and gives doctors and the industries that support them greatly increased power. Illich showed that medicine often caused more harm than good and although he didn’t coin the term ‘iatrogenic’ (doctor-caused) illness – that was Florence Nightingale – he certainly gave it a wider circulation.
Over the intervening years much has been written on the themes in these two books, and some see them as prophetic. They were. There have been attempts to make medicine more holistic, to see health in terms of mind and body, community, family and lifestyle. Such efforts remain on the periphery of medicine. Indeed the growth of industrialised healthcare has accelerated so that it pervades society. The industry is a major contributor to the GDP of most Western countries and it has infiltrated the daily lives of almost everyone.
Some might believe this is a good thing: we’re living longer, infant mortality is much lower than in previous centuries and your chances of surviving an encounter with a bus are greater than with a horse and carriage in the 1900s. But we’re not healthier, are we? Chronic illness abounds: auto-inflammatory diseases, diabetes, asthma, autism, dementia, and let’s not get started on mental illness.
There are many reasons for this. Lifestyle is undoubtedly one but there’s more to it than that. In 1974 Illich suggested that we were over-medicalised. No prizes for guessing what he would think now. It’s hard to find someone over the age of 50 who isn’t on some kind of medication. Increasing numbers of children and adolescents are on pills and potions, and vaccinations go up every year. With a growing drugged population, even assuming that most of these medications do some good, there will be more adverse reactions – iatrogenic is currently the fifth leading cause of illness in the world.
With this massive incorporation of the healthcare industry into our society comes wealth to those who supply our ‘needs’. From this in turn comes power: to influence politicians, the media, the health bureaucrats, the scientists, the charities and the doctors. There’s money for election campaigns, directorships, advertising, grants and research funding; as Private Eye used to say, ‘trebles all round’.
Kennedy wondered why people were willing to give the medical profession so much power over their lives. The experience of the last three years has answered that question: it is fear. During the pandemic the healthcare industry marshalled all its resources, Big Pharma, public health authorities, medical journals, doctors, governments and scientists, to terrify us into submission, make us take the vaccine and collect billions.
We still are subject to an onslaught from the media, ostensibly aimed at encouraging us to be healthy, but it’s actually scaring us witless. You’ve all seen them: dramatic adverts from the charities telling us that half of us are going to get cancer, another percentage will develop heart problems or dementia. It’s not quite a protection racket where you’re told to hand over your money or bad things will happen, but I see a parallel in that it’s fear that makes us part with our cash. Then the NHS weighs in: ‘If you have blood in your urine, it could be cancer’ and ‘If you’ve had a cough for more than two weeks . . .’ I’m sure I saw one that said ‘If you’re not feeling right it could be something serious so see your doctor’. I bet the GPs love that one. The language and images of these messages has a kind of nocebo effect, the opposite of the placebo: they make us think we are going to become unwell, so we do. It may seem ironic that at a time when the NHS is scaring us into clamouring for more of its services, it is increasingly failing to provide those services. In many places it is near-impossible to see a GP and hospital waiting lists are at an all-time high. However the irony is only apparent. The fearful will demand that the politicians ‘keep them safe’ and provide the NHS with ever more cash, thus funnelling ever more taxpayers’ money into the healthcare industry.
It could be said that this relentless messaging is for our benefit: it’s all about keeping us safe. Quite clearly the healthcare industry benefits: more scans and blood tests requested, more pharmaceuticals sold and more healthcare professionals and managers employed. I believe that this overwhelming medical onslaught on our minds is a major reason for the rise in health anxiety that is all too evident in Western society, and we know that constant anxiety can generate physical and mental illness.
If Ivan Illich were alive now I’m sure he would be saying ‘I told you so’. Ian Kennedy is alive and, I hope, well. I don’t know if he has commented recently on current healthcare but I wouldn’t be surprised if it made him sad or even angry.