Toward a Critique of Industrial Medicine

Introduction

The medical industry is often counted as one of the great achievements of modernity. Certainly some medical technologies are amazingly effective, and a few are indispensible for modern man in modern conditions. Nevertheless, I do not think it is an overstatement to say that the medical industry has, on the whole, been a net negative for man. Three reasons: (1) the medical industry specifically cannot stand apart from the effects of industry as a whole; (2) the apparent achievements of the medical industry are more often the result of improved environmental conditions and nutrition, which industry as a whole was responsible for degrading; (3) the medical industry’s bureaucratic system tends to create many problems that are not present in traditional, community-driven, or self-care healing methods.

None of this is to say that modern man can, in his current conditions, replace all industrial medical solutions with traditional ones. Many of the illnesses industrial development has caused can now only be addressed with industrial technology (see Repent to the Primitive, pp. 93-94 for comments on how artificialization works). While modern man must be shielded from the effects of a toxic world, primitive medicine focused mostly on maintaining a man’s strength and preventing illness. Furthermore, since a great deal of the traditional medical approach relied on proper nutrition, and most industrial citizens have no choice but to accept their industrial community’s food, full adherence to traditional models of medicine is only possible with a change in material conditions, that is to say, the collapse of industry.

You Can’t Separate the Good From the Bad

The medical industry cannot be extricated from the industrial environment as a whole: it relies on transportation systems, computer technologies, communications technologies, scientific labs and research, universities, energy companies… If we say the good of industry is not worth the bad, then we must be willing to dispense of industrial medicine (see Repent to the Primitive, p. 33; and “A Critique of the Hunter / Gatherer Ideal,” sec. “Uses and Alternatives to the Ideal”)

Medicine, Environment, and Nutrition

Many of the purported achievements of industrial medicine are actually due to structural and infrastructural changes in society. This point has been argued most forcefully by Ivan Illich in Medical Nemesis, but others support the thesis (see “Sources” below). For example, the death rate of tuberculosis decreased from higher than 700 per 10,000 in 1812 to 370 per 10,000 in 1882, the year Koch “first isolated and cultured the bacillus.” It fell to 180 per 10,000 by 1910, when the first sanatorium opened. This would indicate that neither the bacillus nor the sanatorium were the primary reasons for the decline of tuberculosis; it was on the decline already, independent of medical advancement. Illich writes:

Cholera, dysentry, and typhoid similarly peaked and dwindled outside the physicians control. By the time their etiology was understood and their therapy had become specific, these diseases had lost much of their virulence and hence their social importance. The combined death rate from scarlet fever, diphtheria, whooping couch, and measles among children up to fifteen shows that nearly 90 percent of the total decline in mortality between 1860 and 1965 had occurred before the introduction of antibiotics and immunization.

For more on similar evolutionary trends, see Repent to the Primitive, pp. 45-48 and “Technical Autonomy.”

Illich and others argue that the decline in infectious illnesses can be best explained by improved environmental conditions, such as waste and sewage systems that resolved many problems with cities during and after the Industrial Revolution. This is supported even by evidence in our contemporary world, with its wildly diverging material conditions between nations: “In poor countries today, diarrhea and upper-respiratory-tract infections occur more frequently, last longer, and lead to higher mortality where nutrition is poor, no matter how much or how little medical care is available.”

It is important to note that Illich is not the first the mention this hypothesis, only the first, to my knowledge, to consolidate the evidence. It is a rather old idea. In the 800s and 900s AD, for example, the medical chief of a Baghdad hospital, Al-Razi wrote several books on the problem of civilized medical care. The books have not survived history, but the titles indicate his stance well enough: The Mistakes in the Purpose of Physicians; On Purging Fever Patients Before the Time is Ripe; The Reason Why the Ignorant Physicians, the Common People, and the Women in Cities Are More Successful Than Men of Science in Treating Certain Diseases and the Excuses Which Physicians Make for This; “Why a Clever Physician Does Not Have the Power to Heal All Diseases, for That Is Not Within the Realm of the Possible.

Iatrogenic Illness

Apart from the effects of specific medical treatments and technologies, bureaucratic medical practice often inhibits healing. Consider the stale conditions of the hospital; the practice of lumping all the sick and diseased together in close quarters; unnecessary medical procedures; the alliance of medicine with a profit-motivated drug industry; the terrible nutritional quality of hospital cafeterias… “…[T]he frequency of reported accidents in hospitals is higher than in all industries but mines and high-rise construction.” All of these negative effects have been studied extensively, and wait only for an independent agent to synthesize them.

Bureaucracy also tends to protect those who harm patients through mistreatment or malpractice:

In 1971, between 12,000 and 15,000 malpractice suits were lodged in United States courts. Less than half of all malpractice claims were settled in less than eighteen months, and more than 10 percent of such claims remain unsettled for over six years. Between 16 and 20 percent of every dollar paid in malpractice insurance went to compensate the victim; the rest was paid to lawyers and medical experts.

An Unanswered Call

It is widely recognized among common people, that is to say, those not in the elite sectors of society, that the medical industry is more about extracting profit from them than healing them. Fortunately, there is a huge amount of evidence supporting this idea, and it is the task now of rewilders to synthesize it and present it in the particular domains of the world they occupy. This will both serve to delegitimize industrial medicine’s drawbacks, and will encourage further investigation into alternative healing practices.

One particular area of medicine that I have not mentioned, because I have not extensively researched it, is care for pregnant women and the alternatives women have to industrial medical technologies. The research on this, however, does exist. See, e.g., the midwivery movement and various countercultural zines from the anarcho-primitivist and rewilding movements. This point is absolutely essential to address. Because of the particularly strenuous demands of the female biology, women more than men are dependent on the medical practices of their community to take care of themselves. For example, while women in traditional communities have opportunities to separate from their people and commune with each other during menstruation, this is hard to do in industrial social arrangements. While women in traditional communities may be able to substitute tampons for more primitive techniques, or forego the use of tampons entirely, modern society’s tabboos make this a difficult thing to enact. While pregnant women in traditional societies received special care and treatment that adequately addressed their needs during that time, pregnant women in modern societies can only receive sporadic support because of the individualization inherent in modern economic life. This often means the task of caring for the pregnant woman is offloaded in an unbalanced way on the husband, family, and close friends of the woman, many of whom are entirely unfit for the task.

I will personally write no more on the ills of medical technology, trusting that my readers will take up the task themselves. “Not blind-eyed opposition to progress, but wide-eyed opposition to progress!”

Tip: If any of you write an essay that condenses Illich’s analysis, I suggest submitting it to the Dark Mountain Project.

Sources

  • Medical Nemesis, Illich
  • Rene Dubos, The Mirage of Health: Utopian Progress and Biological Change
  • Robert H. Moser, The Disease of Medical Progress: A Study of Iatrogenic Disease
  • David M. Spain, The Complications of Modern Medical Practices
  • F. Darcy and J.P. Griffin, Iatrogenic Disease
  • P.E. Sartwell, “Iatrogenic Disease: An Epidemiological Perspective,” International Journal of Health Services 4 (winter 1974): 89-93
  • J. T. McLamb and R. R. Huntley, “The Hazards of Hospitalization,” Southern Medical Journal 60 (1967).
  • Ralph Audy, “Man-made Maladies and Medicine,” California Medicine, Nov. 1970.
  • L. Meyler, Side Effects of Drugs
  • R. R. Porter, The Contribution of the Biological and Medical Sciences to Human Welfare, Presidential Address to the British Association for the Advancement of Science, Swansea Meeting, 1971, p.95
  • Charles S. Cameron, “Lung Cancer and Smoking: What We Really Know”
  • Thomas McKeown, Gordon McLachlan, Medical History and Medical Care: A Symposium of Perspectives
  • John Powles, “On the Limitations of Modern Medicine,” Science, Medicine and Man 1:1-30 (1973)
  • Rick Carlson, The End of Medicine
  • Jean-Claude Polack, La Medecine du capital
  • Heinrich Schipperges, Utopien der Medizin: Geschichte und Kritik der artzlichen Ideologic des 19. Jh.
  • Derek J. de Solla Price, Little Science, Big Science
  • “Clericalisme de la fonction medicale? Medecine et politique. Le ‘Sacerdoce’ medical. La Relation therapeutique. Psychanalyse et christianisme,” Le Semeur, suppl. 2 (1966-67)
  • “Inequality and Health,” de Kadt
  • “Physical Illness in Response to Stress,” Cassel
  • The Cholera Years: The United States in 1832, 1849, 1866, Rosenberg
  • The White Plague: Tuberculosis, Man and Society, Dubos
  • The Nutrition Factor: Its Role in National Development, Berg
  • Interactions of Nutrition and Infection, Scrimshaw, Taylor, Gordon
  • Therapeutics: From the Primitives to the Twentieth Century, Ackerknecht
  • “Health and Industrialisation in Britain: The Interaction of Substantive and Ideological Change,” Powles, in Colloquium on the Adaptability of Man to Urban Life for the First World Congress on Environmental Medicine and Biology
  • Mechanization Takes Command: A Contribution to Anonymous History, Giedion
  • Thomas McKeown and R. G. Ricord, “Reasons for the Decline in Mortality in England and Wales During the Nineteenth Century,” Population Studies 16 (1962): 94-122.
  • Edwin Chadwick, Report on the Sanitary Condition of the Labouring Population of Great Britain, 1842
  • Max von Petterkofer, The Value of Health to a City: Two Lectures Delivered in 1873
  • Erwin H. Ackerknecht, “Zur Geschichte der iatrogenen Krankhei-ten,” Gesnerus 27 (1970): 57-63.
  • Nicholas Wade, ‘Drug Regulation: FDA Replies to Charges by Economists and Industry,’ Science 179 (1973): 775-7.
  • U.S. House of Representatives Committee on Interstate and Foreign Commerce, An Overview of Medical Malpractice, 94th Cong., 1st Sess. March 17, 1975
  • Charles Butterworth, ‘Iatrogenic Malnutrition,’ Nutrition Today, March-April 1974
  • J. Mayer, ‘Iatrogenic Malnutrition,’ New England Journal of Medicine 284 (1971): 1218.
  • J.P. Frank, Akademische Rede vom Volkselend als der Mutter der Krankheiten
  • George H. Lowrey, “The Problem of Hospital Accients to Children,” Pediatrics 32 (1963): 1064-8

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