Theoretical Janus: Ideological Iatrogenesis: Oneirography of Wrong Dreams

"Beyond a certain level of industrial hubris, nemesis must set in, because progress, like the broom of the sorcerer’s apprentice, can no longer be turned off." – I. Illich

Illich has few reservations against wielding the portentous Greek mythos. He is eager to apply Nemesis, the mythical functionary of retribution against hubris, to further his argumentative ends. I would take similar license to personify Janus, the two-headed god of dualities and new beginnings, to describe a particular quality of aporetic argument. Janus is invoked when confused ideology (bad beginnings/“wrong dreams”) wields the spear of critical analysis such that every forward advance also threatens back toward itself. To date I have yet to encounter another work in which every accusation of “inhumanity” or “unfreedom” or “idealism” is uncritically reflected in the same text, often on the same page, paragraph or even the preceding sentence.

“Beyond a certain level of ideological aporia, Janus must set in, because argument, like the ouroboros, is gorged upon itself.” – J. Olipo

In this review I would like to discuss Ideological Iatrogenesis, the unspoken fourth term in Illich’s argumentative triptych, which implicates the first three: Clinical, Social, and Cultural Iatrogenesis.

What is Ivan Illich thinking? Perhaps it’s possible to extrapolate Illich’s perspective from the following emblematic statement, and to begin our analysis with a few questions regarding his use of terms such as “People”, “[Natural] Limits”, and “Minimal Bureaucratic Interference”:

"Healthy people are those who live in healthy homes on a healthy diet in an environment equally fit for birth, growth, work, healing, and dying; they are sustained by a culture that enhances the conscious acceptance of limits to population, of aging, of incomplete recovery and ever-imminent death. Healthy people need minimal bureaucratic interference to mate, give birth, share the human condition, and die."

Where do Illich’s “People” function as “Non-Persons”? Where do “subaltern groups” exist in his analysis, e.g. “women” “BIPOC”, “Gender and Sexual Minorities”, and most significantly “The Unhealthy” i.e. those disproportionately impacted by iatrogenesis, and who are conspicuously excluded from the term “healthy people”. Illich is not interested in extending the analysis of iatrogenesis to consider specific groups within the multitude other than “the rich” and “the poor”, which is striking in the setting of a discussion of healthcare disparities within the United States. Illich begs the question in both senses of the phrase. Even the inattentive reader must ask, “What about the Not-Healthy?” In the other sense, Illich is already past this discussion, building his analysis upon the assumption that such life is not worth living. For the disabled, congenitally malformed, old, and mentally ill, the answer is – and trust that I do not exaggerate – “Just let them die.”

On the Old: “A new myth about the social value of the old was developed. Primitive hunters, gatherers, and nomads had usually killed them, and peasants had put them into the back room, but now the patriarch appeared as a literary ideal. Wisdom was attributed to him just because of his age. It first became tolerable and then appropriate that the elderly should attend with solicitude to the rituals deemed necessary to keep up their tottering bodies.”

On the Young: “The engineering approach to the making of economically productive adults has made death in childhood a scandal, impairment through early disease a public embarrassment, unrepaired congenital malformation an intolerable sight, and the possibility of eugenic birth control a preferred theme for international congresses in the seventies.”"

On the Suicidal: “I know of a woman who tried, unsuccessfully, to kill herself. She was brought to the hospital in a coma, with a bullet lodged in her spine. Using heroic measures the surgeon kept her alive, and he considers her case a success: she lives, but she is totally paralyzed; he no longer has to worry about her ever attempting suicide again."

On the Dialysis-Dependent: "The modern fear of unhygienic death makes life appear like a race towards a terminal scramble and has broken personal self-confidence in a unique way. It has fostered the belief that man today has lost the autonomy to recognize when his time has come and to take his death into his own hands."[…] "Complex bureaucracies sanctimoniously select for dialysis maintenance one in six or one in three of those Americans who are threatened by kidney failure. The patient-elect is conditioned to desire the scarce privilege of dying in exquisite torture."

Illich hovers between willful ignorance and partisan denial of the healthcare needs of women, most conspicuously regarding prenatal medical care and hospital delivery, and most anachronistically against women in the workforce.

"Although physicians did pioneer antisepsis, immunization, and dietary supplements, they were also involved in the switch to the bottle that transformed the traditional suckling into a modern baby and provided industry with working mothers who are clients for a factory-made formula."

This is one step removed from the modern left-misogynist meme phrasing "👏More👏Women👏 Factory👏Workers👏". The only mention of BIPOC is the following, which actually appears to subsume “race” entirely within the idea of “the poor” and then appears to conflate “poor” and “black”.

"While in gross infant mortality the United States ranks seventeenth among nations, infant mortality among the poor is much higher than among higher-income groups. In New York City, infant mortality among the black population is more than twice as high as for the population in general, and probably higher than in many underdeveloped areas such as Thailand and Jamaica."

Where do “[Natural] Limits” function as “[Arbitrary Socially-Determined] Limits”? To the question of “Who deserves care,” Illich answers indirectly via return to Hippocrates in brief:

“For the sick,” Hippocrates said, “the least is best.”

For Hippocrates, the Asclepian ideal of medicine is a return to Nature. Yet, in the particular context of the Greek polis in which this perspective arises, the concept of “Natural” medicine was, even at its moment of conception, socially determined. Throughout the work, Illich cites how “Traditional Cultures” approach medicine in ways that imply this is the “Natural” way such things should be handled. Although he heaps significant praise on “China’s program of Barefoot Doctors”, he remains vague regarding how these cultures specifically approach the social and cultural aspects of medicine and speaks mostly in generalities.

"Duty, love, fascination, routines, prayer, and compassion were some of the means that enabled pain to be borne with dignity. Traditional cultures made everyone responsible for his own performance under the impact of bodily harm or grief. "People knew that they had to heal on their own, to deal on their own with their migraine, their lameness, or their grief."

[…]

"Traditional cultures and technological civilization start from opposite assumptions. In every traditional culture the psychotherapy, belief systems, and drugs needed to withstand most pain are built into everyday behavior and reflect the conviction that reality is harsh and death inevitable." […] "The sufferings for which traditional cultures have evolved endurance sometimes generated unbearable anguish, tortured imprecations, and maddening blasphemies; they were also self-limiting."

Curiously, Illich appears to reify the un-reflected judgment of the worst, most alienated physicians who observe "undignified pain" in the patient with a not insignificant quantity of disgust. Here I am actually in agreement with Illich that the Natural state is already capable of bearing any pain. Even literally unbearable pain can be borne in the Natural state because it occurs behind closed doors as a private holocaust. Imagine the woman literally torn apart from the inside during delivery of a fetus in transverse lie. That Nature maintains this unimaginable depth within itself in an incommunicable state is the other interpretation of Alice Goodman’s libretto: If every scar / on this poor back / could only speak, / these walls would crack. Any appeal to nature in this setting is complicity with worse torture than Illich wants to prevent.

Illich's proscription against “modern medicine” produces ideological surplus in the form of artificial socially-determined limits extending beyond their original justification.

"Powerful medical drugs easily destroy the historically rooted pattern that fits each culture to its poisons; they usually cause more damage than profit to health, and ultimately establish a new attitude in which the body is perceived as a machine run by mechanical and manipulating switches."

Ignoring the nebulous terminology (what does “powerful” mean?) there is no basis for opposition to safe and effective medications in the frame of Clinical Iatrogenesis. Bizarrely, the antipathy for the “Unnatural” extends to birth control, an instance in which the Catholic ideology peaks through the Marxist cloth:

"Oral contraceptives, for instance, are prescribed “to prevent a normal occurrence in healthy persons."

Where does Illich’s “Minimal Bureaucratic Interference” function as “Domination”? In his dogged insistence that “modern healthcare” is bad (although still true in some aspects) he would paternalistically deny access to this system to those who want it. Non-Persons living in “Traditional Cultures” are invited to simply die with dignity.

"In many a village in Mexico I have seen what happens when social security arrives. For a generation people continue in their traditional beliefs; they know how to deal with death, dying, and grief. The new nurse and the doctor, thinking they know better, teach them about an evil pantheon of clinical deaths, each one of which can be banned, at a price. […] By their ministration they urge the peasants to an unending search for the good death of international description, a search that will keep them consumers forever."

[…]

"However, delivery of effective basic health services for the entire population is cheap enough to be bought for everyone, provided no one could get more, regardless of the social, economic, medical, or personal reasons advanced for special treatment. If priority were given to equity in poor countries and service limited to the basics of effective medicine, entire populations would be encouraged to share in the demedicalization of modern health care.”

Social security, socialized medicine, and organized labor unions are recurring villains in his narrative. In direct opposition to the stated principle of self-determination, Illich would dissolve these organizations, or at least deny the medical care desired by their members (even if it provided qualitative improvements in health). This dissonant note extends beyond the stated objective of this work and into the realm of ideology (according to which workers’ rights perpetuate the bad conscience of Capitalism precisely by making it tolerable) where it is opposed to the goal of improving individual-collective health this work ostensibly promotes.

"But the fundamental reason why these costly bureaucracies [socialized medicine] are health-denying lies not in their instrumental but in their symbolic function: they all stress delivery of repair and maintenance services for the human component of the megamachine, and criticism that proposes better and more equitable delivery only reinforces the social commitment to keep people at work in sickening jobs. "

[…]

"As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest, he becomes the patient’s accomplice in creating the myth that he is an innocent victim of biological mechanisms rather than a lazy, greedy, or envious deserter of a social struggle for control over the tools of production."

[…]

"In every society the classification of disease—the nosology—mirrors social organization. The sickness that society produces is baptized by the doctor with names that bureaucrats cherish. […] The more convincing the diagnosis, the more valuable the therapy appears to be, the easier it is to convince people that they need both, and the less likely they are to rebel against industrial growth.”

I would like to conclude this review with a discussion of Illich’s presentation of Clinical-Social-Cultural Iatrogenesis. In discussing Clinical Iatrogenesis, the first, and most striking section of this work, Illich demonstrates the power of supplementary statistics toward a material historical analysis. Herein Illich argues that modern medical care is not only too expensive, but also does not produce improved health outcomes by the numbers. Yet by extending beyond the orthodox ground of "incommensurability", the statistical ground on which he stakes his claim is moving beneath his feet. Perhaps an emblematic quotation from this section:

"Medicine just cannot do much for the illness associated with aging, and even less about the process and experience of aging itself. It cannot cure cardiovascular disease, most cancers, arthritis, advanced cirrhosis, not even the common cold."

Ironically, since the 1970’s we have new and highly-effective treatments for these diseases including, briefly, percutaneous coronary intervention, drug eluting stents, heart transplant, autologous bone marrow transplant, DMARDs, arthroplasty, and liver transplant. Effective treatment that quantifiably improves mortality and quality of life (in some circumstances) has been developed for each disease in this this “index damnatorum” except the common cold.

The above amounts to a "systemic critique" of the medical establishment which can be solved by adjusting the numbers a little bit (morbidity, mortality, out-of-pocket costs). One is reminded of the screaming discontent of a certain frictive element of the social media discourse for whom the ardent demand for complete destruction of the “Capitalist system” is merely the rephrased demand for a 25% raise in pre-tax income and matched 401k contribution.

Culturally, “End of Life Care” continues to be an issue (unresolved), however there is no indication this cannot be improved via the quantification of end of life outcomes vs stated desires and the incremental implementation of quality improvement projects directed at integrating palliative options into frank “goals of care” discussions with patients and family members. One improvement already evident toward this goal is the withdrawal of the physician from his prior paternalistic role via the implementation of “patient-centered care” schemata beginning in the late 1980s. This paternalism is precisely the force which proscribed avenues of “self-care” in the past, and which Illich would now like to wield toward his own ends by direct interdiction of medical decisions which protract painful/"Unnatural" life.

“Clinical Iatrogenesis” remains a significant concern in modern medical practice, however there is no indication that incremental quality improvements within the current “evil” scheme could not eventually overcome the institutional inertia which perpetuates the worst abuses. Yet Illich would not be satisfied with this approach even if its success were guaranteed. As we have already demonstrated, Illich’s position overlies the ground of revolutionary Marxist-Catholic ideology which often strikes backward against his stated desire to improve clinical-social-cultural outcomes. Materially improving illness, wages, and working conditions, ostensibly the policy goals of this piece, are sequentially discarded as window dressing when push comes to shove. For Illich, any individual instance of such improvement can be shown to be harmful to the extent that it puts off the Revolution of the Proletariat. Consequently, lest the reader not be seduced by the notion of hard-fought incremental progressive improvements, Illich presents a bombastic vision of the apocalypse – a vision which becomes increasingly difficult to entertain:

"With rising levels of induced insensitivity to pain, the capacity to experience the simple joys and pleasures of life has equally declined. Increasingly stronger stimuli are needed to provide people in an anesthetic society with any sense of being alive. Drugs, violence, and horror turn into increasingly powerful stimuli that can still elicit an experience of self. Widespread anesthesia increases the demand for excitation by noise, speed, violence—no matter how destructive."

[…]

"Now an increasing portion of all pain is man-made, a side-effect of strategies for industrial expansion. Pain has ceased to be conceived as a “natural” or “metaphysical” evil. It is a social curse, and to stop the “masses” from cursing society when they are pain-stricken, the industrial system delivers them medical pain-killers. Pain thus turns into a demand for more drugs, hospitals, medical services, and other outputs of corporate, impersonal care and into political support for further corporate growth no matter what its human, social, or economic cost. Pain has become a political issue which gives rise to a snowballing demand on the part of anesthesia consumers for artificially induced insensibility, unawareness, and even unconsciousness."

[…]

"Famine will increase until the trend towards capital-intensive food production by the poor for the rich has been replaced by a new kind of labor-intensive, regional, rural autonomy."

I concede that Illich is correct in his premise that there is something deeply wrong with modern medicine in the United States. Since the 1970's the cost of care has continued to rise at an astounding rate. Some of the most expensive therapies are also some of the least effective. End-of-life in the ICU remains an exquisite form of torture. Yet, while one face of the work appears to point toward these problems, the other strikes back in dangerous aporia against those most in need of protection. I must conclude this is someone who should never, under any circumstances, be given control of our medical apparatus. ( )

review of
Ivan Illich's Medical Nemesis
by tENTATIVELY, a cONVENIENCE - July 15-24, 2021

For my complete review go here to "Backlash to Arrogance": https://www.goodreads.com/story/show/1354634-backlash-to-arrogance?chapter=1

1st, this bk is truly brilliant. I've been hearing about Illich for a long time, mainly in connection w/ his Deschooling Society, but it wasn't until I finally read this that I realized that he's a thinker who seriously rethinks major institutions in society in a way that's incredibly well-researched & very, VERY thorough. Medical Nemesis was published in 1976. I remember having revelations about things like preplanned obsolescence in the early '70s - thinking that it was such an obviously bad thing that corporations wd be forced to stop structuring their profits around it. No such luck, preplanned obsolesence is worse than ever now BY FAR. The same applies to all of the problems that Illich points out about medicalization & iatrogenesis. Not only have they not gone away, they've reached a sort of melting point in today's day & age.

I read recently someone's opinion that the saying 'Those who don't know history are doomed to repeat it' (credited in various forms to various people) isn't true b/c even people who do know history are doomed to repeat it anyway - & that's the way I feel about the times I'm currently living in. I, e.g., understand the way that the mass media manipulates public opinion as a form of mind control but I also see it working time & again regardless of how much I point out things that I, at least, think are obvious. The result is that I'm stuck in a 'reality' where history repeats itself not b/c I don't remember but b/c the majority of the people around me are so easily kept in a destructive loop that goes unquestioned. Illich has done the questioning about as intelligently as any human being can be expected to - but very few people I know wd ever read one of his bks & even if they did their minds wd gloss over at the lack of sound-bytes & simple talking points. The absence of oversimplification in Medical Nemesis is just too challenging for people whose mindset is Good Guys vs Bad Guys - if everything isn't reduced to the good guys wearing white hats & the bad guys wearing black ones then how can anyone understand it, eh?! Put sadists & vampires in white coats & it's all good, right?!

The subtitle of this bk is "The Expropriation of Health". As I understand Illich's position, & I hope I don't misrepresent it, that means that the less autonomy the individual has to deal w/ their own health in their own way b/c of the encroachment of domineering impersonal medical institutions, the more a person's health ceases to even be theirs anymore: it becomes the 'property' of 'caretakers' rather than 'caregivers' - thusly undermining what's truly healthy for the individual. Keep in mind that this review is my interpretation of Illich's highly articulated points. It's possible that I slant this interpretation too much one way or the another w/o intending to.

In the author's opening "Acknowledgments" he references what I think we cd all use more of: intelligent conversation between well-informed & thoughtful friends. I don't mean the regurgitation of what passes for such things amongst the lazy: viz. stock propaganda phrases from NPR of Fox News or whatever, I mean actual discourse between people who take their own opinions seriously enough to actually have them be their own instead of just dummy-speak provided by their ventriloquists.

"My thinking on medical institutions was shaped over several years in periodic conversations with Roslyn Lindheim and John McKnight. Mrs. Lindheim, Professor of Architecture at the University of California at Berkeley, is shortly to publish The Hospitalization of Space, and John McKnight, Director of Urban Studies at Northwestern University, is working on The Serviced Society. Without the challenge from these two friends, I would not have found the courage to develop my last conversations with Paul Goodman into this book." - p v

Lindheim's bk title struck my fancy but, alas, if it ever made it to publication I didn't find it online. Instead I found her Changing Hospital Environments for Children (1972) as her only available publication. Illich may very well have had a ms copy of The Hospitalization of Space.

"The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for "physician," and genesis, meaning "origin." Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness take up increasing space in medical dope-sheets." - p xi

"Dorland's Illustrated Medical Dictionary, 25th ed. (Philadelphia: Saunders, 1974): "Iatrogenic (iatro—Gr. physician, gennan—Gr. to produce). Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon."" footnote 5, pp 4-5

I've made myself very unpopular during the time of the QUARANTYRANNY by expressing opinions similar to this. Think of deaths caused by putting people on ventilators to hypothetically save their lives, think of drug addiction enabled by prescriptions of pain-killers, think of mental states changed negatively by an excessive medical tendency to diagnose 'disorders' that might've previously just been moods or temporary states of mind, think of people slotted into bureaucracies who get oversimplified as a result.

"This book offers the lay reader a conceptual framework within which to assess the seamy side of progress against its more publicized benefits. It uses a model of social assessment of technological progress that I have spelled out elsewhere1 and applied previously to education2 and transportation,3 and that I now apply to the criticism of the professional monopoly and of the scientism in health care that prevail in all nations that have organized for high levels of industrialization.

******

1 Tools for Conviviality (New York: Harper & Row, 1973).

2 Deschooling Society (New York: Harper & Row, 1971).

3 Energy and Equity (New York: Harper & Row, 1974)." - pp xii-xiii

I include the footnotes in the above for 2 main reasons: 1. the footnotes in this bk are very important, Illich references bks, journal articles, manuscripts, & even mimeographs in at least 5 languages: English, Spanish, French, German, & Italian - making this one of the most exhaustively researched things I've ever read - there're pages where the footnotes cover almost the entire page: that will be undoubtedly tedious & distracting for many or most readers but I appreciate the opportunity to be referred elsewhere; 2. these are the titles of 3 of his other bks, I shd probably read them to see what such an extraordinary mind is capable of coming up w/ in relation to other subjects.

"The layman in medicine, for whom this book is written, will himself have to acquire the competence to evaluate the impact of medicine on health care. Among all our contemporary experts, physicians are those trained to the highest level of specialized incompetence for this urgently needed pursuit." - pp xiii-xiv

Illich has an amazing ability to cut thru the bullshit. Note that he refers to "the impact of medicine on health care" - to many or possibly even most people "medicine" has come to be synonymous w/ "health care": an aspect of Illich's importance is that he's capable of separating the 2.

"The recovery from society-wide iatrogenic disease is a political task, not a professional one. It must be based on a grassroots consensus about the balance between the civil liberty to heal and the civil right to equitable health care. During the last generations the medical monopoly over health care has expanded without checks and has encroached on our liberty with regard to our own bodies. Society has transferred to physicians the exclusive right to determine what constitutes sickness, who is or might become sick, and what shall be done to such people." - p xiv

&, as w/ so much in this bk, I find that to be extremely prescient of the present tension (2020-2021). Talk of forced vaccination & vaccine passports foisted upon the public against our will but ostensibly 'for our own good'. I'm reminded of forced sterilizations & the testing of dangerous birth-control devices on people in '3rd world' countries by drs in more industrialized nations. There's always some 'superior' person who 'knows what's best' for the people they pretend to care about but actually look down upon.

Belief in mass-media hysteria, the cowardice of conformity to peer-pressure, & the overmedication of people who simply don't have the mental resourcefulness or strength to cope w/ their own lives are things that've led to a phenomenal level of stupidity. This particular stupidity doesn't necessarily cut across all intellectual activities, only the ones dominated by fear. A lack of fear doesn't necessarily mean damage to the amygdala or even bravery, simply a common-sensical ability to see thru lies that contradict one's own experience. A friend of mine recently informed me that I'm 100 times more at risk for not being vaccinated - &, yet, he's still alive & I'm still alive. One might think that being 100 times more at risk wd've killed me off by now. IMO, a sensible person wd recognize the ridiculousness of such "100 times" nonsense simply by seeing how many people are still alive who defy such illogic - but, no, the fear is too compelling for logic to take hold.

""Health," after all, is simply an everyday word that is used to designate the intensity with which individuals cope with their internal states and their environmental conditions."

[..]

"Health levels can only decline when survival comes to depend beyond a certain point on the heteronomous (other-directed) regulation of the organism's homeostasis. Beyond a critical level of intensity, institutional health care—no matter if it takes the form of cure, prevention, or environmental engineering—is equivalent to systematic health denial." - p xv

& it's this basic premise of the bk that many people are likely to find challenging. Illich's position is that health is dependent on autonomy, the individual is healthiest when they're self-regulating - if self-regulation becomes undermined by the imposition of both toxic environmental conditions & an external health system that's essentially invasive then the individual becomes deprived of their ability to cope. 'Health' that's imposed is no longer health at all b/c it's not natural to itself, it's parasitic to the host organism.

"This study of pathogenic medicine was undertaken in order to illustrate in the health-care field the various aspects of counterproductivity that can be observed in all major sectors of industrial society in its present stage." - p xvi

People seem to have a tendency to respect power as having been earned. As such, domineering institutions can be taken for granted as somehow 'deserving' their place. If the propaganda shield around these institutions is omnipresent & effective enuf then they become even less subject to paradigm-shifting criticisms. Illich is a paradigm-shifter. It's about time that more people realized that the medical industry's self-promotion as a wholy benevolent phenomena is glossing over greed, sadism, reckless experimentation, & substantial harm.

"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"

[..]

"3 René Dubos, The Mirage of Health: Utopian Progress and Biological Change (New York: Anchor Books, 1959), was the first to effectively expose the delusion of producing "better health" as a dangerous and infectious medically sponsored disease. Thomas McKeown and Gordon McLachlan, eds., Medical History and Medical Care: A Symposium of Perspectives (New York: Oxford Univ. Press, 1971), introduce the sociology of medical pseudo-progress. John Powles, "On the Limitations of Modern Medicine," in Science, Medicine and Man (London: Pergamon, 1973), 1:1-30, gives a critical selection of recent English-language literature on this subject. For the US situation consult Rick Carlson, The End of Medicine (New York: Wiley Interscience, 1975)." - pp 3-4

"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"

[..]

"8 On the clerical nature of medical practice, see "Cléricalisme de la fonction médicale? Médicine et politique. Le 'Sacerdoce' médical. La Relation thérapeutique. Psychanalyse et christianisme," Le Semeur, suppl. 2 (1966-67)." - p 5

"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." - p 7

That seems accurate enuf to me. If you live in an industrialized area where there's air & water pollution is it any surprise that you're sick? &, yet, if you went to a dr about a cough wd s/he advise shutting down the locally air polluting company? Or wd s/he give you some sort of medicine to make yr throat more insensitive to the damage being done to it?

There are paradoxes & ironies.

"27 J. E. Davies and W. F. Edmundson, Epidemiology of DDT (Mount Kisco, N.Y.: Future, 1972). A good example of paradoxical disease control from Borneo: Insecticides used in villages to control malaria vectors also accumulated in cockroaches, most of which are resistant. Geckoes fed on these, became lethargic, and fell prey to cats. The cats died, rats multiplied, and with rats came the threat of epidemic bubonic plague. The army had to parachute cats into the jungle village (Conservation News, July 1973)." - footnote, p 11

A similar example wd be the importation of cane toads to Australia to eat cane beetles. This backfired. "The long-term effects of toads on the Australian environment are difficult to determine, however some effects include "the depletion of native species that die eating cane toads; the poisoning of pets and humans; depletion of native fauna preyed on by cane toads; and reduced prey populations for native insectivores, such as skinks."" (https://en.wikipedia.org/wiki/Cane_toads_in_Australia) It seems to be more common for the natural environment to have its own checks & balances although some people, such as the author Michael Crichton (see my review of his State of Fear here: http://www.goodreads.com/book/show/15860.State_of_Fear ), mock these. In recent times (2020-2021) there seems to be an anti-naturist mvmt that somehow believes itself to be rooted in science w/o, as far as I can tell, any real substance to that belief.

"28 A good example of medical persecution of innovators is given by G. Gortvay and J. Zoltan, I. Semmelweis, His Life and Work (Budapest: Akademiai Kiado, 1968), a critical biography of the first gynecologist to use antiseptic procedures in his wards. In 1848 he reduced mortality from puerperal fever by a factor of 15 and was thereupon dismissed and ostracized by his colleagues, who were offended at the idea that physicians could be carriers of death. Morton Thompson's novel The Cry and the Covenant (New York: New American Library, 1973) makes Semmelweis come alive." - footnote, p 11

This review isn't very saucy - am I getting too serious in my old age?

"31 Alain Letourmy and François Gibert. Santé, environnement, consommations médicales: Un Modèle et sonestimation à partir des données de mortalité; Rapport principal (Paris, CEREBE (Centre de Recherche sur le Bien être), June, 1974). Compares mortality rates in different regions of France: they are unrelated to medical density, highly related to the fat content of the sauces typical of each region, and somewhat less to alcohol consumption." - footnote, p 12

Even tho I prefer to not be vaccinated, I'm not entirely against vaccines. One of the reasons for this is that I was born in 1953 & was vaccinated against polio. I've had friends who were born slightly before me who weren't vaccinated b/c the vaccine didn't exist yet & who got polio. Some of them have disabled legs as a result. Illich addresses this.

"The reappearance of malaria is due to the development of pesticide-resistant mousquitoes and not any lack of new anti-malarial drugs.33 Immunization has almost wipred out paralytic poliomyelitis, a disease of developed countries, and vaccines have certainly contributed to the decline of whooping cough and measles,34 thus seeming to confirm the popular belief in "medical progress."35 But for most other infections, medicine can show no comparable results." - pp 13-14

The perceptive reader will've noted by now that I'm only up to page 14 but I've already quoted an enormous amt. That gives you an idea of how important I think every statement in this bk is.

For my complete review go here to "Backlash to Arrogance": https://www.goodreads.com/story/show/1354634-backlash-to-arrogance?chapter=1 ( )

The most explosive, uncompromising, thoroughly researched attack on the gravest health hazard we face today: our medical system. In this landmark book, one of the most brilliant social critics of our time exposes the many ways modern medicine is robbing us of power, money, dignity---even life itself.

Radical views on medicine, enlightening for those in the profession ( )

In the powerful team with Szasz and Foucault.