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Medical Nemesis

Medical Nemesis

Medical establishment has become a major threat to health, not through negligence or drug reactions but due to arrogance of profession. Medicine has assumed the authority to label one man’s complaint a legitimate illness, to declare a second man sick though he himself does not know, and to refuse a third; recognition of his pain. In urban elite set ups this power expands to bureaucratic, rude, inhuman approach. Here medicine is exercised by specialists who control large populations by means of institutions. The total control on the health matters by the medical community is dangerous. Yet it would be inaccurate to blame the inflation in medicare on the greed of the medical professionals alone. It was in 1976 that a book written by Evan Illich with the title ‘Medical Nemesis’ was published, which emphasized the virtue of humility over Hubris (overwhelming pride), in the physician’s character. She argued that modern doctor’s over-confidence in the curative magic of medicine amounts to hubris.  She focused on the ‘inevitable toll in the proliferation of diseases caused by medical procedures and drugs (iatrogenesis- caused by physician), growing burden of medical expenses to all societies, and in the loss of ability of individual persons and families to cope with the reality of pain, suffering and death. Is it true that most patients have no say in the treatment and that they are tools in the hands of nurses and doctors? The unethical practices that have crept in the sacrosanct area of doctor-patient relationship have heightened the nemesis- inescapable medicalization of health. Medically sponsored behaviour and delusions restrict the autonomy of patient and his kin by undermining their competence in care, or when medical intervention cripples personal responses to pain, disability and death.” “The most dramatic medical interventions: Pipes in different orifices of the body, radical surgery, dialysis, organ transplants add untold agony to the patient’s life and use up most societies’ resources at a rate all out of proportion to the benefit they provide.”  Aged and terminally ill patients in tertiary care hospitals, do not survive or lead a productive life in most cases, but are a great drain on the national resources, besides distress to the patient and her kin.

In the past, medicine labeled people in two ways: those for whom cures could be attempted, and those who were beyond repair, such as lepers, cripples, oddities, and the dying-not anymore. Highly Medicalized procedures now create a third way. It turns the physician into an officially licensed magician whose prophecies often come out untrue,browbeat the sick and his family- who get command repeatedly to deposit advance money and forget the rest. This seems easy to refute when one considers pacemakers, cardiac prosthetic valves, prosthetic hip joints, positive pressure breathing machines, ventriculo-cardiac shunts and many other examples-leaving out entirely the advances in such areas as infection control with antibiotics, blood products, anticonvulsants and other medicines. From 70 percent to 80 percent of the entire public health budget goes to medical/surgical treatment as opposed to more important public health education and preventive services.   All countries want hospitals, and many want them to have the most exotic modern equipment. India has also announced setting up of several AIIMS like hospitals without provision of budget and adequate faculty. The poorer the country, the higher the real cost of each item on their inventories. Modern hospital beds, incubators, laboratories, respirators, and operating rooms cost even more in India than their counterparts in Germany or France where they are manufactured: they also break down more easily here and are more difficult to service, and are often out of order. The overconsumption of medical drugs is rampant in our societies. Old age has been medicalized disproportionately; 28 percent of the medical budget is spent on the 10 percent of the population who are over sixty-five.

This “caring” function in distinction to the “curing” function enables physicians to relieve, to support, to rehabilitate, to make life not only tolerable but rich and useful even in the presence of continuing disease. “The well being of men and women increases with their ability to assume personal responsibility for pain, impairment, and in their attitude to death.” Says she ‘death is a calm, natural event which has since been subjected to ‘medicalization’ robbing the modern individual of dignity at the end of his life.” She exhorts for a return to personal responsibility for health care. She wants people to drop out and to organize for a less destructive way of life in which they have more control of their environment. She would shift full burden of responsible use of drugs and procedures onto the sick person and his next of kin. Legislation should define each man’s right to his own treatment.  Illich made points, which are coming into focus more and more, regarding the finite resources that each society has in caring for its people. Technological medicine, and its batteries of machines, has to be restricted. There is simply not enough money to make it feasible for all who might benefit from it. In fact, it is always being rationed and probably always will be because of the cost. Therefore, priorities must be developed and physicians must lead the way. Fully realizing the finite level of resources, an active program of health education becomes one of the dominant priorities that society must accept, concentrating on adjusting the individual person’s habits and life-style so as to avoid factors known to predispose toward serious disease. If everyone would stop smoking, the incidence of cancer lung would go down. Similarly is about alcohol abuse and other toxic substances; but how can this be accomplished?


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