Medical Nemesis: The Expropriation of Health (1975)

From the Introduction:
full notes at:Medical Nemesis Illich

Ivan Illich, 1926-2002 (

Introduction: The medical establishment has become a major threat to health.  The disabling impact of professional control over medicine has reached the proportions of an epidemic.

Thoughtful public discussion of the iatrogenic [“physician caused”, iatros=physician & genus=birth] pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal.  Indeed, what is dangerous is a passive public that has come to rely on superficial medical housecleaning.

My argument is that the layman, not the physician, has the potential perspective and effective power to stop the current iatrogenic pandemic.

During the last generations the medical monopoly over health care (HC) has expanded without checks and has encroached on our liberty with regard to our own bodies.  Society has transferred to physicians the exclusive right to determine what constitutes sickness, who is or might become sick, and what shall be done to such people. The social commitment to provide to all citizens with almost unlimited outputs from the medical system threatens to destroy the environmental and cultural conditions needed by people to live a life of constant autonomous healing. [see:] [This “output” is not given to all. Persons without medical insurance and those on welfare receive second-rate care and do not get the basic minimum.]

Limits to medicine must come from something other than professional self-limitation. The insistence of the medical guild on its unique qualifications to cure medicine itself is based on an illusion. It must be understood that what has turned HC into a sick-making enterprise is the very intensity of an engineering endeavor that has translated human survival from the performance of organisms into the result of technical manipulation.

Built-in iatrogenesis now affects all social relations.  It is the result of internalized colonization of liberty by affluence.  In rich countries medical colonization has reached sickening proportions and poor countries are quickly following suit (today, drug companies, hospitals and insurance companies have joined physicians in the expropriation of health — DJE) Illich calls this “the medicalization of health.”

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About David Elpern

The Online Journal of Community and Person-Centered Dermatology (OJCPCD) is a free, full text, open-access, online publication that addresses all aspects of skin disease that concern patients, their families, and practitioners. ​It was founded in 2012 by Dr. David J. Elpern, M.D. in Williamstown, MA. with technical help from Inez Tan.

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