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Editor's Choice

A system reset for the campaign against too much medicine

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1466 (Published 16 June 2022) Cite this as: BMJ 2022;377:o1466

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More to Illich than Overtreatment

Dear Editor

While the revival of interest in Ivan Illich’s work is welcome, there is a danger that only the parts endorsed by the medical world get incorporated into the discussion. As David Horrobin (1) pointed out at the time, Illich’s critique of medical practice depended heavily on material produced by the profession itself about unnecessary surgery, inappropriate prescription and treatments that lacked a real evidence base.

The genuine radicalism of Illich’s work lay in the wider questions he raised about the social and cultural damage that was resulting from what others were already calling medical imperialism. The management of the Covid pandemic in many countries should have reminded us of these concerns. Illich was critical of the way in which biomedicine had promoted the idea that a good society was defined purely by the health of its people in terms defined largely by the medical profession. The result was a culture that was losing its capacity to deal with the inevitability of pain, suffering and death. There is abundant evidence of both phenomena in the ways in which the collateral societal harms of pandemic management have been dismissed as unworthy of consideration and the cult of zero-infection has skewed debates over NPIs and childhood vaccination.

As Rene Dubos (2), for example, saw, health and illness are moments in evolutionary time, where the continual adjustments between humans and other species reach a particular balance. Sometimes we can dampen the fluctuating fortunes of humans and their commensals but often we cannot. If we forget this, then, as Illich saw, the result is an unbalanced society, where medical authority displaces other desirable features, like the rule of law, and citizens suffer from biomedicine’s implied promise of immortality.

Illich did not have the last word on many of these issues and his approach reflects his Jesuit past in ways that others would, and did, contest. Nevertheless, the questions that he asked have taken on a new relevance as we reflect on what went right and wrong with pandemic management. This should be the real reason to revive interest in his work.

Robert Dingwall

1. Horrobin DF. Medical hubris: a reply to Ivan Illich. Edinburgh: Churchill Livingstone; 1978.
2. Dubos R. Mirage of Health: Utopias, Progress and Biological Change. New York: Harper & Row; 1959.

Competing interests: No competing interests

20 June 2022
Robert Dingwall
Consulting Sociologist
Nottingham