Is Medicine Society's Nemesis?

‘The medical establishment has become a major threat to health.’

The line is taken from the opening paragraph of the introduction to Ivan Illich’s book, Limits to Medicine. First published in 1975, the book takes a philosophical and cynical look at what Illich classes as the rituals of medicine, the lack of evidence supporting the idea that medical interventions have played a major part of the increase in life expectancy, the senselessness of the medico-political game of football, and the inconsequentiality of most contemporary medical care in curing disease. I thought it was a book I would hate reading. As it was, I found myself warming to the argument and, by the time I reached the final page, I had become a distant admirer of Illich, if not a converted acolyte.

Limits to Medicine concludes by stating that ‘only a political program aimed at the limitation of professional management of health will enable people to recover their powers for health care.’ Of course, that view would not find any supporters amongst the current political health reformers. However, I suspect that Illich, eccentric social commentator that he was, had a good point. The basis to his argument is the concept that the curing of disease is often coincidental to medical care; an argument that raises a question about modern western society’s fixation on seeking a GP’s advice for every ailment, however minor the condition may be.

For most GPs this argument will be nothing new. We know that our surgeries are full with people who do not really need to see a doctor. That is not the same as saying that we do not care. The point is would you really seek the assistance of a bank manager to count the change in your purse, or a tree surgeon to dead-head your roses, or a car mechanic to top-up your windscreen washer bottle? No, of course you wouldn’t. So why do people take trivial issues to their doctor? By ‘trivial’, I mean complaints that will either be self-limiting or that the person could do something about themselves without the assistance of a highly trained professional (not to mention one who is an expense to society).

To some extent, our modern society is to blame. We have become used to the concept that there is an answer for everything, and that someone else will provide that answer (preferably free of charge). Over successive generations we have forgotten how to think for, and look after, ourselves. Self-care is nothing new to those living in the remote islands of Scotland, or even on Lundy (referred to in my column last week) where a visit to a GP requires a two-hour boat ride across an often rough Bristol Channel, followed by another two-hour nausea-inducing crossing to get back home. The inhabitants do not seem any the worse off for their isolation from the NHS; they are a hardy bunch, some of whom I have known for the past twenty years. They just use common-sense and good wholesome home remedies or over-the-counter preparations for most of life’s minor illnesses. For them, an urgent condition is one that requires the input of an air-ambulance; anything else they deal with without immediate medical assistance.

In Illich’s view, what society needs is the de-professionalisation of medicine and a fostering of people’s will to self-care. His ideas may not be before time, as by 2020 it is estimated that there will be a European Union shortfall of one million doctors and nurses (BMA News, 23 July 2011). Even now, 37% of UK-registered doctors have been trained over-seas. However, the last word must surely go to Voltaire, a 17th century philosopher who reached the same view two hundred years before Illich when he said: ‘The art of medicine consists in amusing the patient whilst nature cures the disease’. Time for some NHS sponsored clowns, perhaps?

(This article was first published in the Scunthorpe Telegraph, Monday 8th August 2011)