medical nemesis introduction

8/13/2019 Medical Nemesis Introduction

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Doctors < ffectiveness=an Illusion+seless 3edical :reatment Doctor*Inflicted In>uriesDefenseless Patients

'ART II( )ocial Iatro&enesis

orities

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'ART III( Cultural Iatro&enesis

Introduction 1


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Industriali;ed NemesisFrom Inherited 3#th to Res"ectful Procedure:he Ri$ht to HealthHealth as a ?irtue

IndeC 9'&

A)out the Author 96&

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Introduction

3he medical esta(lishment has (ecome a ma5or threat to health# 3he disa(ling impact o$pro$essional control over medicine has reached the proportions o$ an epidemic#Iatro$enesis, the name $or this new epidemic, comes $rom iatros, the reek word $or@physician,@ and $enesis, meaning @origin#@ )iscussion o$ the disease o$ medical progress

has moved up on the agendas o$ medical con$erences, researchers concentrate on thesick-making powers o$ diagnosis and therapy, and reports on parado.ical damage caused(y cures $or sickness take up increasing space in medical dope-sheets# 3he healthpro$essions are on the (rink o$ an unprecedented housecleaning campaign# @Clu(s o$Cos,@ named a$ter the reek Island o$ )octors, have sprung up here and there, gatheringphysicians, glori$ied druggists, and their industrial sponsors as the Clu( o$ Rome hasgathered @analysts@ under the aegis o$ Aord, Aiat, and 4olkswagen# Purveyors o$ medicalservices $ollow the e.ample o$ their colleagues in other $ields in adding the stick o$ @limitsto growth @ to the carrot o$ ever more desira(le vehicles and therapies# imits topro$essional health care are a rapidly growing political issue# In whose interest theselimits will work will depend to a large e.tent on who takes the initiative in $ormulating theneed $or them/ people organi2ed $or political action that challenges status-Buopro$essional power, or the health

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pro$essions intent on e.panding their monopoly even $urther#

3he pu(lic has (een alerted to the perple.ity and uncertainty o$ the (est among itshygienic caretakers# 3he newspapers are $ull o$ reports on volte*face manipulations o$medical leaders/ the pioneers o$ yesterday s so-called (reakthroughs warn their patientsagainst the dangers o$ the miracle cures they have only 5ust invented# Politicians whohave proposed the emulation o$ the Russian, *wedish, or ;nglish models o$ sociali2edmedicine are em(arrassed that recent events show their pet systems to (e highly

e$$icient in producing the same pathogenicDthat is, sickeningDcures and care thatcapitalist medicine, al(eit with less eBual access, produces# % crisis o$ con$idence inmodern medicine is upon us# Merely to insist on it would (e to contri(ute $urther to asel$-$ul$illing prophecy, and to possi(le panic#

3his (ook argues that panic is out o$ place# 3hought$ul pu(lic discussion o$ the iatrogenicpandemic, (eginning with an insistence upon demysti$ication o$ all medical matters, willnot (e dangerous to the commonweal# Indeed, what is dangerous is a passive pu(lic thathas come to rely on super$icial medical housecleanings# 3he crisis in medicine could allowthe layman e$$ectively to reclaim his own control over medical perception, classi$ication,and decision-making# 3he laici2ation o$ the %esculapian temple could lead to adelegitimi2ing o$ the (asic religious tenets o$ modern medicine to which industrial

societies, $rom the le$t to the right, now su(scri(e#


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My argument is that the layman and not the physician has the potential perspective ande$$ective power to stop the current iatrogenic epidemic# 3his (ook o$$ers the lay reader aconceptual $ramework within which to assess the seamy side o$ progress against its morepu(lici2ed (ene$its#

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It uses a model o$ social assessment o$ technological progress that I have spelled outelsewhere and applied previously to education < and transportation, : and that I now applyto the criticism o$ the pro$essional monopoly and o$ the scientism in health care thatprevail in all nations that have organi2ed $or high levels o$ industriali2ation# In myopinion, the sanitation o$ medicine is part and parcel o$ the socio-economic inversion withwhich Part I4 o$ this (ook deals#

3he $ootnotes re$lect the nature o$ this te.t# I assert the right to (reak the monopoly thatacademia has e.ercised over all small print at the (ottom o$ the page# *ome $ootnotesdocument the in$ormation I have used to ela(orate and to veri$y my own preconceivedparadigm $or optimally limited health care, a perspective that did not necessarily haveany place within the mind o$ the person who collected the corresponding data#Eccasionally, I Buote my source only as an eyewitness account that is incidentally o$$ered(y the e.pert author, while re$using to accept what he says as e.pert testimon# on thegrounds that it is hearsay and there$ore ought not to in$luence the relevant pu(licdecisions#

Many more $ootnotes provide the reader with the kind o$ (i(liographical guidance that Iwould have appreciated when I $irst (egan, as an outsider, to delve into the su(5ect o$health care and tried to acBuire competence in the political evaluation o$ medicine se$$ectiveness# 3hese notes re$er to li(rary tools and re$erence works that I have learnedto appreciate in years o$ single-handed e.ploration# 3hey also list readings, $romtechnical monographs to novels, that have (een o$ use to me#

Ainally, I have used the $ootnotes to deal with my own

FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF1 :ools for !onvivialit# G+ew Hork/ 6arper Row, 178:J#< Deschoolin$ ociet# , Ruth +# %nshen, ed# G+ew Hork/ 6arper Row, 1781J#: ner$# and uit# G+ew Hork/ 6arper Row, 178=J#

parenthetical, supplementary, and tangential suggestions and Buestions, which wouldhave distracted the reader i$ kept in the main te.t# 3he layman in medicine, $or whomthis (ook is written, will himsel$ have to acBuire the competence to evaluate the impacto$ medicine on health care# %mong all our contemporary e.perts, physicians are thosetrained to the highest level o$ speciali2ed incompetence $or this urgently needed pursuit#

3he recovery $rom society-wide iatrogenic disease is a political task, not a pro$essionalone# It must (e (ased on a grassroots consensus a(out the (alance (etween the civilli(erty to heal and the civil right to eBuita(le health care# )uring the last generations themedical monopoly over health care has e.panded without checks and has encroached onour li(erty with regard to our own (odies# *ociety has trans$erred to physicians the

e.clusive right to determine what constitutes sickness, who is or might (ecome sick, andwhat shall (e done to such people# )eviance is now @legitimate @ only when it merits andultimately 5usti$ies medical interpretation and intervention# 3he social commitment to


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provide all citi2ens with almost unlimited outputs $rom the medical system threatens todestroy the environmental and cultural conditions needed (y people to live a li$e o$constant autonomous healing# 3his trend must (e recogni2ed and eventually (e reversed#

imits to medicine must (e something other than pro$essional sel$-limitation# I willdemonstrate that the insistence o$ the medical guild on its uniBue Buali$ications to curemedicine itsel$ is (ased on an illusion# Pro$essional power is the result o$ a politicaldelegation o$ autonomous authority to the health occupations which was enacted duringour century (y other sectors o$ the university-trained (ourgeoisie/ it cannot now (erevoked (y those who conceded it0 it can only (e delegitimi2ed (y popular

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agreement a(out the malignancy o$ this power# 3he sel$-medication o$ the medicalsystem cannot (ut $ail# I$ a pu(lic, panicked (y gory revelations, were (row(eaten into$urther support $or more e.pert control over e.perts in health-care production, this wouldonly intensi$y sickening care# It must now (e understood that what has turned healthcare into a sick-making enterprise is the very intensity o$ an engineering endeavor thathas translated human survival $rom the per$ormance o$ organisms into the result o$technical manipulation#

@6ealth,@ a$ter all, is simply an everyday word that is used to designate the intensity withwhich individuals cope with their internal states and their environmental conditions# InHomo sa"iens, @healthy@ is an ad5ective that Buali$ies ethical and political actions# In partat least, the health o$ a population depends on the way in which political actionscondition the milieu and create those circumstances that $avor sel$-reliance, autonomy,and dignity $or all, particularly the weaker# In conseBuence, health levels will (e at theiroptimum when the environ-ment (rings out autonomous personal, responsi(le copinga(ility# 6ealth levels can only decline when survival comes to depend (eyond a certainpoint on the heteronomous Gother-directedJ regulation o$ the organism s homeostasis#'eyond a critical level o$ intensity, institutional health careDno matter i$ it takes the $ormo$ cure, prevention, or environmental engineeringDis eBuivalent to systematic healthdenial#

3he threat which current medicine represents to the health o$ populations is analogous tothe threat which the volume and intensity o$ tra$$ic represent to mo(ility, the threatwhich education and the media represent to learning, and the threat which ur(ani2ationrepresents to competence in homemaking# In each case a ma5or institutional endeavorhas turned counterproductive# 3ime-con-

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suming acceleration in tra$$ic, noisy and con$using communications, education that trainsever more people $or ever higher levels o$ technical competence and speciali2ed $orms o$generali2ed incompetence/ these are all phenomena parallel to the production (ymedicine o$ iatrogenic disease# In each case a ma5or institutional sector has removedsociety $rom the speci$ic purpose $or which that sector was created and technicallyinstrumented#

Iatrogenesis cannot (e understood unless it is seen as the speci$ically medicalmani$estation o$ s"ecfic counter"roductivit#. *peci$ic or parado.ical counterproductivity isa negative social indicator $or a diseconomy which remains locked within the system thatproduces it# It is a measure o$ the con$usion delivered (y the news media, theincompetence $ostered (y educators, or the time-loss represented (y a more power$ulcar# *peci$ic counterproductivity is an unwanted side-e$$ect o$ increasing institutionaloutputs that remains internal to the system which itsel$ originated the speci$ic value# It is


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a social measure $or o(5ective $rustration# 3his study o$ pathogenic medicine was under-taken in order to illustrate in the health-care $ield the various aspects o$counterproductivity that can (e o(served in all ma5or sectors o$ industrial society in itspresent stage# % similar analysis could (e undertaken in other $ields o$ industrialproduction, (ut the urgency in the $ield o$ medicine, a traditionally revered and sel$-congratulatory service pro$ession, is particularly great#

'uilt-in iatrogenesis now a$$ects all social relations# It is the result o$ internali2edcoloni2ation o$ li(erty (y a$$luence# In rich countries medical coloni2ation has reachedsickening proportions0 poor countries are Buickly $ollowing suit# G3he siren o$ oneam(ulance can destroy *amaritan attitudes in a whole Chilean town#J 3his process, whichI shall call the @medicali2ation o$ li$e,@ deserves articulate political recognition# Medicinecould

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(ecome a prime target $or political action that aims at an inversion o$ industrial society#Enly people who have recovered the a(ility $or mutual sel$-care and have learned tocom(ine it with dependence on the application o$ contemporary technology will (e readyto limit the industrial mode o$ production in other ma5or areas as well#

% pro$essional and physician-(ased health-care system that has grown (eyond critical(ounds is sickening $or three reasons/ it must produce clinical damage that outweighs itspotential (ene$its0 it cannot (ut enhance even as it o(scures the political conditions thatrender society unhealthy0 and it tends to mysti$y and to e.propriate the power o$ theindividual to heal himsel$ and to shape his or her environment# Contemporary medicalsystems have outgrown these tolera(le (ounds# 3he medical and paramedical monopolyover hygienic methodology and technology is a glaring e.ample o$ the political misuse o$scienti$ic achievement to strengthen industrial rather than personal growth# *uchmedicine is (ut a device to convince those who are sick and tired o$ society that it is theywho are ill, impotent, and in need o$ technical repair# I will deal with these three levels o$sickening medical impact in the $irst three parts o$ this (ook#

3he (alance sheet o$ achievement in medical technology will (e drawn up in the $irstchapter# Many people are already apprehensive a(out doctors, hospitals, and the drugindustry and only need data to su(stantiate their misgivings# )octors already $ind itnecessary to (olster their credi(ility (y demanding that many treatments now common(e $ormally outlawed# Restrictions on medical per$ormance which pro$essionals havecome to consider mandatory are o$ten so radical that they are not accept-a(le to thema5ority o$ politicians# 3he lack o$ e$$ectiveness o$ costly and high-risk medicine is a nowwidely discussed $act $rom which I start, not a key issue I want to dwell on#

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Part II deals with the directly health-denying e$$ects o$ medicine s social organi2ation, andPart III with the disa(ling impact o$ medical ideology on personal stamina/ under threeseparate headings I descri(e the trans$ormation o$ pain, impairment, and death $rom apersonal challenge into a technical pro(lem#

Part I4 interprets health-denying medicine as typical o$ the counterproductivity o$overindustriali2ed civili2ation and analy2es $ive types o$ political response whichconstitute tactically use$ul remedies that are all strategically $utile# It distinguishes(etween two modes in which the person relates and adapts to his environment/autonomous Gi#e#, sel$-governingJ coping and heteronomous Gi#e#, ad-ministeredJmaintenance and management# It concludes (y demonstrating that only a politicalprogram aimed at the limitation o$ pro$essional management o$ health will ena(le people


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to recover their powers $or health care, and that such a program is integral to a society-wide criticism and restraint o$ the industrial mode o$ production#

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'ART I

Clinical Iatro&enesis

The Epidemicsof Modern Medicine

)uring the past three generations the diseases a$$licting estern societies haveundergone dramatic changes# Polio, diphtheria, and tu(erculosis are vanishing0 one shoto$ an anti(iotic o$ten cures pneumonia or syphilis0 and so many mass killers have comeunder control that two-thirds o$ all deaths are now associated with the diseases o$ oldage# 3hose who die young are more o$ten than not victims o$ accidents, violence, orsuicide# to ? percent a$ter sulphonamides and anti(iotics cameon the market# *yphilis, yaws, and many cases o$ malaria and typhoid can (e curedBuickly and easily# 3he rising rate o$ venereal

'ut $or most other in$ections, medicine can show no compara(le results#)rug treatment has helped to reduce mortality $rom tu(erculosis, tetanus, diphtheria,and scarlet $ever, (ut in the total decline o$ mortality or mor(idity $rom these diseases,chemotherapy played a minor and possi(ly insigni$icant role# :9 Malaria, leishmaniasis, andsleeping sickness indeed receded $or a time under the onslaught o$ chemical attack, (utare now on the rise again# :8


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(ene$it, $or the 1K to 1 and widespread use# >< ;very twenty-$our to thirty-

K to ?K percent o$ adults in the &nited *tates and the &nited "ingdomswallow a medically prescri(ed chemical# *ome take the wrong drug0 others get an old ora contaminated (atch, and others a counter$eit0 >: others take several drugs in dangerouscom(inations0 >= and still others receive in5ections with improperly sterili2ed syringes# >>*ome drugs are addictive, others mutilating, and others mutagenic, although perhapsonly in com(ination with $ood coloring or insecticides# In some patients, anti(iotics alterthe normal (acterial $lora and induce a superin$ection, permitting more resistantorganisms to proli$erate and invade the host# Ether drugs contri(ute to the (reeding o$drug-resistant strains o$ (acteria# >9 *u(tle kinds o$ poisoning thus have spread even

$aster than the (ewildering variety and u(iBuity o$ nostrums#>8

&nnecessary surgery is astandard procedure# >? Disa)lin$ nondiseases


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gence, and sheer incompetence are age-old $orms o$ malpractice# 9< ith thetrans$ormation o$ the doctor $rom an artisan e.ercising a skill on personally knownindividuals into a technician applying scienti$ic rules to classes o$ patients, malpracticeacBuired an anonymous, almost respecta(le status# 9: hat had $ormerly (een consideredan a(use o$ con$idence and a moral $ault can now (e rationali2ed into the occasional(reakdown o$ eBuipment and operators# In a comple. technological hospital, negligence(ecomes @random human error @ or @system (reak-down, @ callousness (ecomes @scienti$icdetachment, @ and incompetence (ecomes @a lack o$ speciali2ed eBuipment#@ 3hedepersonali2ation o$ diagnosis and therapy has changed malpractice $rom an ethical intoa technical pro(lem# 9=

loss o$ the master s income during his protracted sickness# Citi2ens were not covered (ythese statutes, (ut could avenge malpractice on their own initiative#

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In 1781, (etween 1,KKK malpractice suits were lodged in &nited *tatescourts# ess than hal$ o$ all malpractice claims were settled in less than eighteen months,and more than 1K percent o$ such claims remain unsettled $or over si. years# 'etweensi.teen and twenty percent o$ every dollar paid in malpractice insurance went tocompensate the victim0 the rest was paid to lawyers and medical e.perts# 9> In suchcases, doctors are vulnera(le only to the charge o$ having acted against the medicalcode, o$ the incompetent per$ormance o$ prescri(ed treatment, or o$ dereliction out o$greed or la2iness# 3he pro(lem, however, is that most o$ the damage in$licted (y themodern doctor does not $all into any o$ these categories# 99 It occurs in the ordinarypractice o$ well-trained men and women who have learned to (ow to prevailingpro$essional 5udgment and procedure, even though they know Gor could and shouldknowJ what damage they do#

3he &nited *tates )epartment o$ 6ealth, ;ducation, and el$are calculates that 8percent o$ all patients su$$er compensa(le in5uries while hospitali2ed, though $ew o$ themdo anything a(out it# Moreover, the $reBuency o$ reported accidents in hospitals is higherthan in all industries (ut mines and high-rise construction# %ccidents are the ma5or causeo$ death in %merican children# In

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proportion to the time spent there, these accidents seem to occur more o$ten in hospitalsthan in any other kind o$ place# Ene in $i$ty children admitted to a hospital su$$ers anaccident which reBuires speci$ic treatment# 98 &niversity hospitals are relatively morepathogenic, or, in (lunt language, more sickening# It has also (een esta(lished that oneout o$ every $ive patients admitted to a typical research hospital acBuires an iatrogenicdisease, sometimes trivial, usually reBuiring special treatment, and in one case in thirtyleading to death# 6al$ o$ these episodes result $rom complications o$ drug therapy0ama2ingly, one in ten comes $rom diagnostic procedures# 9? )espite good intentions andclaims to pu(lic service, a military o$$icer with a similar record o$ per$ormance would (erelieved o$ his command, and a restaurant or amusement center would (e closed (y thepolice# +o wonder that the health industry tries to shi$t the (lame $or the damage causedonto the victim, and that the dope-sheet o$ a multinational pharmaceutical concern tellsits readers that @iatrogenic disease is almost always o$ neurotic origin# @ 97

*efenseless 'atients


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3he undesira(le side-e$$ects o$ approved, mistaken, callous, or contraindicated technicalcontacts with the medical system represent 5ust the $irst level o$ pathogenic medicine#*uch clinical iatro$enesis includes not only the damage that doctors in$lict with the intento$ curing or o$ e.ploiting the patient, (ut also those other torts that result $rom thedoctor s attempt to protect himsel$ against the

:J#

< Edin # %nderson and Monroe erner, 3easurin$ Health 0evels in the +nited tates, %&77*%&26, 6ealth In$ormation Aoundation Research *eries no# 11 G+ew Hork/ Aoundation,179KJ# Marc alonde, A New Pers"ective on the Health of !anadians4 A orkin$Document GEttawa/ overnment o$ Canada, %pril 178=J# 3his courageous Arench-;nglishreport (y the Canadian Aederal *ecretary $or 6ealth contains a multicolored center$olddocumenting the change in mortality $or Canada in a series o$ graphs#

: Ren )u(os, :he 3ira$e of Health4 +to"ian Pro$ress and Biolo$ical !han$e G+ew Hork/%nchor 'ooks, 17>7J, was the $irst to e$$ectively e.pose the delusion o$ producing @(etterhealth@ as a dangerous and in$ectious medically sponsored disease# 3homas Mc"eownand ordon Mc achlan, eds#, 3edical Histor# and 3edical !are4 A #m"osium ofPers"ectives G+ew Hork/ E.$ord &niv# Press, 1781J, introduce the sociology o$ medicalpseudo-progress# !ohn Powles, @En the imitations o$ Modern Medicine,@ incience,3edicine and 3an G ondon/ Pergamon, 178:J, 1/1-:K, gives a critical selection o$ recent;nglish-language literature on this su(5ect# Aor the *# situation consult Rick Carlson,:he nd of 3edicine G+ew Hork/ iley Interscience, 178>J# 6is essay is @an empirically(ased (rie$, theoretical in nature#@ Aor his indictment o$ %merican medicine he haschosen those dimensions $or which he had complete evidence o$ a nature he could

handle# !ean-Claude Polack, 0a 3 decine du ca"ital GParis/ Maspero, 178KJ# % critiBue o$the political trends that seek to endow medical technology with an e$$ective impact onhealth levels (y a @democrati2ation o$ medical consumer products#@ 3he author discovers


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that these products themselves are shaped (y a repressive and alienating (ourgeois classstructure# 3o use medicine $or political li(eration it will (e necessary to @$ind in sickness,even when it is distorted (y medical intervention, a protest against the e.isting socialorder#@

= )aniel reen(erg, @3he L ar on Cancer / E$$icial Aiction and 6arsh Aacts,@ cience andovernment Re"ort, vol# = G)ecem(er 1, 178=J# 3his well-researched report to the

layman su(stantiates the view that %merican Cancer *ociety proclamations that cancer iscura(le and progress has (een made are @reminiscent o$ 4ietnam optimism prior to thedeluge#@

> Dorland


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1= +# *# *crimshaw, C# ;# 3aylor, and !ohn ;# ordon, Interactions of Nutrition and InfectionG eneva/ orld 6ealth Ergani2ation, 179?J#

1> !ohn Cassel, @Physical Illness in Response to *tress,@ %ntolog a %8, mimeographedGCuernavaca/ CI)EC GCentro Intercultural de )ocumentaciQnJ, 1781J#

19 Ene o$ the clearest early statements on the paramount importance o$ the environment is!# P# Arank, Akademische Rede vom ?olkselend als der 3utter der rankheiten GPavia,187K0 reprint ed#, eip2ig/ 'arth, 179KJ# 3homas Mc"eown and R# # Record, @Reasons$or the )ecline in Mortality in ;ngland and ales )uring the +ineteenth Century,@Po"ulation tudies 19 G179


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-7K#


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and Famil# Plannin$ G%nn %r(or/ &niv# o$ Michigan Press, 178KJ# Marital $ertility declinedeverywhere (e$ore the proportion o$ the population who married increased#)iscrimination against the illegitimate com(ined with restricted access to marriage mayhave served to control population# 3his hypothesis is rein$orced in !#- # Alandrin,@Contraception, mariage et relations amoureuses dans l Eccident chrNtien,@ Annales,1797, no# 9, pp# 1:8K-7K# )emographic data suggest no contraception within marriage$or 18th and 1?th-century Arance, (ut very low rates o$ illegitimacy# Contraception inmarriage was near heresy, conception outside marriage a scandal# Alandrin suggests thatduring the 17th century se.ual (ehavior (etween spouses (egan to (e modeled ontraditional (ehavior outside marriage# Contraception seems to have (ecome accepta(le$irst among peasant $amilies rich enough to keep in$ant mortality low/ see M# eridon,@A condit et mortalit in$antile dans trois villages (avarois/ &ne %nalyse de donn esindividualis es du UIUe siNcle,@Po"ulation 2 G1797J/ 778-1KK


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integral part o$ the human environment and unrelated to the e$$orts made to control anyspeci$ic disease#

:1 %lain etourmy and Arancois i(ert, ant , environnement, consommations m dicales4+n 3odKle et son estimation Q "artir des donn es de mortalit Ra""ort "rinci"al GParis/CWRX'; GCentre de Recherche sur le 'ien-YtreJ, !une 178=J# Compares mortality rates indi$$erent regions o$ Arance0 they are unrelated to medical density, highly related to the$at content o$ the sauces typical o$ each region, and somewhat less to alcoholconsumption#

:< 3he model study on this matter at present seems to (e %# # Cochrane, ffectiveness andfficienc#4 Random Reflections on Health ervices, +u$$ield Provincial 6ospitals 3rust,

178# %# Zuerido, fficienc# of 3edical !areG+ew Hork/ International Pu(lications, 179:J#

:: !acBues M# May, @In$luence o$ ;nvironmental 3rans$ormation in Changing the Map o$)isease,@ in M# 3aghi Aarvar and !ohn P# Milton, eds#,:he !areless :echnolo$# G ardenCity, +#H#/ +atural 6istory Press, 178J# Consulthistorical introduction $or literature# 3he e$$ectiveness o$ prevention in relation to anyspeci$ic disease must (e distinguished $rom its contri(ution to the volume o$ disease/ !#6# %lston, %New 0ook at Infectious Disease G ondon/ Pitman, 1798J, shows howin$ections are replaced (y new ones, without reduction in over-all volume# "eith Mellan(y,Pesticides and Pollution G+ew Hork/ Collins, 1798J, in an easily understanda(le waydemonstrates how the engineering mechanisms designed to reduce one in$ection $osterothers#

:> Repu(lica de Cu(a, Ministerio de la *alud P (lica, !u)a4 -r$ani;atiSn de los servicios #nivel de salud G6avana, 178=J, introduction (y Aidel Castro# %n impressive demonstrationo$ the shi$t in mortality and mor(idity patterns over one decade, during which ma5orin$ections on the whole island were signi$icantly a$$ected (y a pu(lic-health campaign#+guyen "hac 4ien, @ %nn es d activit s m dico-sanitaires,@tudes vietnamiennesG6anoiJ, no# , 178K#

:9 # E# *o$oluwe, @Promotive Medicine/ % 'oost to the ;conomy o$ )eveloping Countries,@:ro"ical and eo$ra"hical 3edicine and 179?, most curative measures used $or parasitic diseases and in$ections o$ theskin and respiratory organs and $or diarrhea have le$t @the pattern o$ mor(idity on thewhole unchanged#@

:8 In Aarvar and Milton, eds#, :he !areless :echnolo$#, several authors make this pointspeci$ically $or malaria, 'ancro$tian $ilariasis G6amonJ, schistosomiasis Gvan der *chalieJ,and genito-urinary in$ections GAarvarJ#

:? 'ruce Mitchel, Fluoridation Bi)lio$ra"h# , Council o$ Planning i(rarians ;.change'i(liography no#


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comments on the last two# 3hey suggest that giving tol(utamide and phen$ormin isde$initely disadvantageous in the treatment o$ mature dia(etes and that there is noadvantage in giving insulin rather than a diet#

=K 6# Eeser, re)s)ekGm"fun$4 Hoffnun$ und RealitGt G*tuttgart/ 3hieme, 178=J# 3his is so$ar, to my knowledge, the most use$ul introduction $or the general physician or layman toa critical evaluation o$ world literature on the e$$ectiveness o$ cancer treatment# *ee also+# ;# Mc"innon, @3he ;$$ects o$ Control Programs on Cancer Mortality,@!anadian 3edical

Association ournal ?< G179KJ/ 1:K?-1>, 1/>>>-8=#

== %l(ert +# 'rest, @3reatment o$ Coronary Ecclusive )isease/ Critical Review,@ Diseases ofthe !hest 82 G!anuary 179=J/ =K-=># Malcolm I# indsay and Ralph ;# *piekerman, @Re-evaluation o$ 3herapy o$ %cute Myocardial In$arction,@ American Heart ournal 98 G%pril179=J/ >>7-9=# 6arvey )# Cain et al#, @Current 3herapy o$ Cardiovascular )isease,@

eriatrics 1? G!uly 179:J/ >K8-1?#

=> 6# # Mather et al#, @%cute Myocardial In$arction/ 6ome and 6ospital 3reatment,@British3edical ournal, 1781, :/::=-?#

=9 Com(ined *ta$$ Clinic, @Recent %dvances in 6ypertension,@ American ournal of 3edicine:7 GEcto(er 179>J/ 9:=-?#

=8 Aor some o$ the standard te.t(ooks see Ro(ert 6# Moser, :he Disease of 3edicalPro$ress4 A tud# of Iatro$enic Disease, :rd ed# G*pring$ield, Ill#/ 3homas, 1797J# )avidM# *pain, :he !om"lications of 3odern 3edical Practices G+ew Hork/ rune *tratton,179:J# 6# P# "Smmerle and +# oossens, linik und :hera"ie der Ne)enwirkun$enG*tuttgart/ 3hieme, 178: [lst ed#, 179K]J# R# 6eint2, rkrankun$en durch Ar;neimittel4Dia$nostik, linik, Patho$enese, :hera"ie G*tuttgart/ 3hieme, 1799J# uy )uchesnay, 0eRis ue th ra"euti ue GParis/ )oin, 17>=J# P# A# ) %rcy and !# P# ri$$in,Iatro$enic DiseaseG+ew Hork/ E.$ord &niv# Press, 178


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=? Aor the evolution o$ 5urisprudence related to this kind o$ torts see M# +# Oald, @3he *ocialControl o$ eneral 6ospitals,@ in '# *# eorgopoulos, ed#, -r$ani;ation Research onHealth Institutions G%nn %r(or/ &niv# o$ Michigan, Institute $or *ocial Research, 178K *ee also ;rwin 6# %ckerknecht, @Our eschichte der iatrogenen "rankheiten,@ esnerus9' G178KJ/ >8-9:# 6e distinguishes three waves, or periods, since 18>K when the studyo$ iatrogenesis was considered important (y the medical esta(lishment# ;rwin 6#%ckerknecht, @Our eschichte der iatrogenen ;rkrankungen des +ervensystems,@:hera"eutische +mschauTRevue th ra"euti ue 9', no# 9 G178KJ/ :=>-9# % short surveyo$ medical awareness o$ the side-e$$ects o$ drugs on the central nervous system, startingwith %vicenna G7?K-1K:8J on mercury#

>1 # Meyler, ide ffects of Dru$s G'altimore/ illiams ilkins, 178< P# ;# *artwell, @Iatrogenic )isease/ %n ;pidemiological Perspective,@ International ournalof Health ervices 8 Gwinter 178=J/ ?7-7:#

>: Pharmaceutical *ociety o$ reat 'ritain, Indentification of Dru$s and Poisons G ondon/the *ociety, 179>J# Reports on drug adulteration and analysis# Margaret "reig, Black3arket 3edicine G;nglewood Cli$$s, +#!#/ Prentice-6all, 1798J, reports that an increasingpercentage o$ articles sold (y legitimate pro$essional pharmacies are inert counter$eitdrugs indistinguisha(le in packaging and presentation $rom the trademarked product#

>= Morton Mint2,B# Prescri"tion -nl#, J# Includes in$ormation oninactivation, incompati(ility, potentiation, and plasma (inding, as well as on inter$erencewith elimination, digestion, and test procedures#

>> '# Epit2 and 6# 6orn, @4erhStung iatrogener In$ektionen (ei *chut2imp$ungen,@Deutsches esundheitswesen


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>? ;ugene 4ayda, @% Comparison o$ *urgical Rates #in Canada and in ;ngland and ales,@New n$land ournal of 3edicine


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9: Aor erman internists, the time the patient can spend $ace-to-$ace with his doctor hasnow (een reduced to 1#8 minutes per visit# 6einrich ;rdmann, 6ein2- unther Everrath,and ol$gang and 3hure &.kull, @Erganisationspro(leme der Vr2tlichen"rankenversorgung/ )argestellt am 'eispiel einer medi2inischen &niversitVtsklinik,@Deutsches Mr;te)latt*Mr;tliche 3itteilun$en 81 G178=J/ :=#

99 3he maltreatment o$ patients has (ecome an accepted routine0 see Charles 'utterworth,@Iatrogenic Malnutrition,@Nutrition :oda#, March-%pril 178=# Ene o$ the largest pocketso$ unrecogni2ed malnutrition in %merica and Canada e.ists, not in rural slums or ur(anghettos, (ut in the private rooms and wards o$ (ig-city hospitals# !# Mayer, @IatrogenicMalnutrition,@New n$land ournal of 3edicine


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pay $or themselves and in the end will represent an important addition to income and+P# Implicitly the same argument is (eing made $or the health-care $ield (y the

proponents o$ no-$ault malpractice insurance#

8: 3he term was used (y 6onor )aumier G1?1K-87J# *ee reproduction o$ his drawing@+emesis m dicale@ in erner 'lock, Der Art;t und der :od in Bildern aus sechs

ahrhunderten G*tuttgart/ ;nke, 1799J#

medical nemesis introduction

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