Skip to main content

Medical Nemesis: The Expropriation of Health by Ivan Illich

This book was profoundly useful, giving me a set of extraordinarily helpful lenses to better understand both the modern medical/healthcare industry, but also to better understand modernity itself. Although this book is primarily about healthcare, it is also prescient in identifying many of the alienating and atomizing aspects of modern civilization. This book may have been written in the early 1970s, but the author was decades ahead of his time.

One of the foundational concepts of this book is iatrogenesis, which essentially means “harm done by the healer.” I was first exposed to this word thanks to Nassim Taleb in his book Antifragile. In Medical Nemesis, Ivan Illich begins with a discussion of medical iatrogenics in the most basic sense, but then expands the concept into far broader terms, discussing three genres of iatrogenesis: 1) clinical iatrogenesis, 2) social iatrogenesis, and 3) cultural iatrogenesis: 

1) Clinical iatrogenesis is the “plain vanilla form” of iatrogenesis: damage done to a patient by a doctor. It can be caused by doctor incompetence, by accident, by a doctor to protect his own legal liability (by ordering tests or procedures that may or may not be necessary to the patient but serve to cover the doctor's legal risk), or by unknown reasons. 

2) Social iatrogenesis is a form of damage done when the medical practice or our government encourages or reinforces society to become greater and greater over-consumers of healthcare. This can come from overscreening, overmedicating, from disease-mongering or from labeling people as sick who may not actually be. This includes “breeding” new categories of patients, who can then be encouraged to pay for meds or treatment to “fix” them. Also, we are subject to various grooming practices, even from childhood, to encourage us to tolerate various behaviors: doctors who “use a foreign language” (medical terminology) while they discuss our case right in front of us; doctors who may perform tests or perform actions (even pain-inducing actions) without explanation or apology, etc.

3) Cultural iatrogenesis is when the healthcare industry interferes with people's potential to deal on their own with human weakness and vulnerability. Examples might be: interfering in healthy responses to suffering and impairment. Or, undermining the individual’s ability to face their reality and accept inevitable decline and death. Think of it like a second-order iatrogenesis that sickens and weakens us culturally. 

The modern phrase “evidence-based healthcare”--widely used by healthcare evangelists and propagandists--should trigger alarm bells in the mind of any competent critical thinker. Once anyone has even the most basic familiarly with the great crisis of reproducibility, to say nothing of the various other problems suffusing all “studies show” science findings (p-hacking, file drawer effects, statistical gerrymandering, overdependence on Gaussian/normal curve statistical analysis, etc.), one cannot no longer hear the words “evidence-based healthcare” without a sense of bitter irony. 

In the modern era we are trained to use money as a solution for everything, including our health. Thus we pay for meds, doctor’s appointments, surgeries, insurance... while we demand more and more government support and funding for “healthcare.” All of this, circularly, simply contributes to the desire to buy our way out of all situations, including buying our way out of reality--and even out of death itself. And of course along the way we have become an enormously overmedicated society. 

I also wonder what this author would think--as he laments the upward explosion of healthcare spending from 4% of GDP in the 1960s to 8% in the 1970s--to know that today healthcare costs exceed 20% of GDP (!) as life expectancy and life quality are actually declining.

It is slowly becoming clear to me that iatrogenesis is a feature, not a bug, of modern healthcare--and possibly of modern society in general. It is endemic in many more ways than we realize. And once you can “see” iatrogenics, you can never unsee it.

More Posts

Broken Money by Lyn Alden

Our money is broken, and the sooner we wrap our minds around the implications, the better. In Broken Money, Lyn Alden, a lucid writer and gifted teacher, offers a highly readable grand tour of monetary history: she explains the emergence of money, what makes a good or bad money, how money gradually became more and more "abstracted" away from gold, and how the modern fiat financial system evolved. Most importantly, she explains, clearly, how inflation, purposely designed into the modern system, is used as a wealth extraction tool: "...the financial system in its current form is designed in such a way that 1) the money supply continually inflates, 2) purchasing power is gradually siphoned away from savers and toward arbitrageurs who sit near the source of money creation, 3) the system rewards large and well connected entities at the cost of small and poorly connected entities, 4) liabilities gradually shift from the private sector to the public sector to keep the system f...

The Power of Your Subconscious Mind by Joseph Murphy

This is a blatantly repetitive and poorly-organized book, and yet it's still highly useful: filled with good tactics and reminders to observe and control your thinking--and more importantly, to be attentive to the implications of your thinking. Thoughts are things! How you think and the beliefs you hold play an enormous role in your reality. And so, despite its flaws, I think The Power of Your Subconscious Mind is still worthwhile. Think of it as a book-length practice of autosuggestion, or even a sort of extended mantra. The book's repetitiveness then becomes a benefit: it helps you practice and build good mental habits, it gives you plenty of examples of affirmations and mental scripts to apply to various life situations, and so on. A minor warning: if you consider NLP , autosuggestion or visualization and affirmation techniques to be useless woo-woo silliness, do not read this book. It's not for you. [A quick  affiliate link to readers to the book here . You ca...

The Best Short Stories of W. Somerset Maugham

This was my first experience reading this author. Competent short stories, some very good.  The author has a knack for creating a mood and for creating an arc of tension and release. See for example the short story "Rain" where the reader really feels the smothering monsoon on the islands of Samoa, or see the story "P.&O." with its atmosphere of genuine foreboding as one of the main characters lies ill in a ship's sick bay, but then an expiation and release of that tension as the story's central character puts her own mind right about a past wrong done to her. Finally, an auxiliary benefit to readers: we get a well-fleshed out picture of the British Empire in the early 20th century. If we had to name this era, maybe we could call it "post-peak UK." It was a time of clear class distinctions, obvious-but-unwritten proprieties and competent English functionality worldwide: on transcontinental train trips, on multi-week steamer passages--wherever ...