MEDICAL NEMESIS
IVAN ILLICH
PART ONE
MODERN MEDICINE NOT SO VALUABLE
§ 90% of the reduction in the worst diseases had come before widespread immunization or antibiotics. P 16
§ Nutrition and disease link is much better p. 17
§ Environment is everywhere the most important way to control disease and promote health 17
§ Current nutrition levels would have been fatal except for hygiene 17-18
§ Some medical related developments have increased health: contraceptives, treatment of water and excrement, use of soap and scissors by midwives, small pox vaccinations of infants, antibacterial washing and insecticides. 18
§ Rate of doctors in a population, number of hospital beds, nor their clinical tools relates to increasing health if other factors are considered. 18
§ Supply of doctors does not relate to prevalence of disease, rather doctors live where they like and they like to live where it is healthy, where people work and are healthy and can pay them. 19
USELESS MEDICAL TREATMENT
§ Some medical treatments have been useful, but they are generally inexpensive.
§ Infectious diseases: drugs reduce deaths by pneumonia, gonorrhea, and syphilis. 19
§ Malaria and typhoid are easily cured now. 19-20 Coming back because of pesticide resistant mosquitoes.
§ Vaccines have contributed to big declines in: polio, whooping cough, and measles. 20
§ Non-infectious diseases: tooth decay through fluoridation. 20
§ Cancer: cervical cancer, skin cancer highly effective. 20
§ Breast cancer stays at 50% no matter what. 20
§ Early detection increases the amount of time you survive because it is early detection. 21
§ Some heart treatments increase activity levels after diagnosis, but not necessarily survival rates or longevity. 21
§ High blood pressure medication helps some but not most. 21
DOCTORS DO DAMAGE
§ What kills people? Malnutrition, traffic, work, war. Medical damage is up there with all except war. 22
§ Medicines can be poisonous 22 arm, addiction, and mutagenic effects.
§ Antibiotics can work, but then increase resistance. Many now are no longer helpful. 23
§ Unnecessary surgery: more cardiac damage to children than cardiac disease. 24
§ Professional callousness, negligence and incompetence. 24
§ Malpractice now has a new respectable status. 24
§ Malpractice only applies when you go against the accepted medical code, specified by doctors. 25
§ 7% of all patients suffer compensatable injuries but few report them. 25
§ Accidents kill children, most accidents are in hospitals. 25
§ 2% of children in hospitals suffer an accident requiring additional treatment 25
§ 20% of patients in teaching hospitals are injured. Half from drugs, 10% from diagnosis damage. 25
§ With a similar record of performance a military commander, restaurant or amusement center would be stopped. 25
THREE KINDS OF IATROGENESIS:
See handout.