The increasing trend toward the privatisation of medicine has its roots in the privatisation of illness as such – and in the massive corporate profits that can be derived therefrom.
Yet to reduce illness to the private property of an individual’s body is to wholly ignore the role played in illness by the sickness of the world and planet they live in – whether in the form of economic deprivation, ecological destruction, environmental poisoning and – last but not least, worldwide wars.
Then again, endless political debates about how to deal with the ever-increasing costs of funding for national or private health provision all fail to get the central point – namely, that in capitalist economies, the medical diagnosis and treatment of illness is essentially big business and money-driven – exploited for the promotion of new medical drugs and technologies. That is why the big pharmaceutical companies make more profits than all the Fortune 500 corporations put together.
What is conventionally regarded as ‘science-based’ or ‘evidence-based’ medicine is actually nothing of the sort – given the corners cut by Big Pharma in testing new drugs, in informing the public on their true and often minimal efficacy, in warning them of their side-effects and often serious dangers – not to mention the massive sums of money spent not on costly ‘R&D’ but purely on marketing the latest drugs and treatments to doctors and surgeons. Even the most reputable medical professionals and ‘experts’ are now regularly paid to have articles offering misleading ‘evidence’ for the efficacy and ‘safety’ of new drugs and medical technologies published in their name – whether or not they have participated in that research or even so much as read the articles sent for their signature. In reality, modern medicine and its treatments have been acknowledged by the Journal of the American Medical Association itself to be the third leading cause of death after cancer and diabetes.
Money-driven medicine has effectively turned patients themselves into commodities for sale by their physicians – offering a source of profit not just through drugs but through expensive hi-tech testing and ‘treatment’ technologies. All this at massive expense to national health services and/or to the profit of private health providers milking health insurance companies or even public health services.
The truth is that illness is essentially big business, that ‘Big Pharma is Big Bucks and Bad Medicine’, and that today’s ‘evidence-based’ medicine is essentially Money-Driven Medicine. Indeed any drug or new medical technology that actually ‘cured’ a disease would be fatal for the profits of the entire Medical-Industrial Complex. Nevertheless the promise of cure is constantly promoted by this multi-trillion dollar medical industry – one with vast lobbying power and almost complete monetary control of regulatory organisations such as the Food and Drug Administration in theU.S.A.
“The pharmaceutical companies have become the favourite whipping boy in discussions about the corrupting influence of money in medicine. And the companies deserve a lot of the criticism they receive … but I want to be clear that they are not the only problem. The larger truth is that creating new patients and making more diagnoses benefits an entire medical-industrial complex that includes Pharma but also manufacturers of medical devices and diagnostic technologies, freestanding diagnostic centers, surgical centers, and even academic medical centers.”
Dr. H. Gilbert Welch, Over-Diagnosed – making people sick in the pursuit of health
To put it bluntly, there are surely understandable reasons for people feeling or even getting seriously anxious, depressed or sick if they can’t earn a living wage, can’t rent or pay for housing, if their homes are threatened with foreclosure, if they face a daily threat of joblessness – or can see no chance of realising their life potentials. Yet modern ‘scientific’ medicine consistently ignores such reasons for both mental and physical illnesses, instead reducing them to a result of chemical imbalances in the brain or biological ‘causes’ of one sort or another. In this way it totally denies all life-meaning to illness – and its relation to the innate sickness and sickness-generating effects of capitalism itself.
Complementary medicine and proponents of alternative psychosomatic, psychoanalytic and existential understandings of illness frequently either ignore or downplay its social, political and economic dimensions. For capitalism also profits from illness in another way – by manufacturing it on an industrial scale through the dis-ease generated by what Marx called wage-slavery. This is the prostitution of the individuals’ ‘labour power’ i.e. their bodies – to make profits for an employer, only for the employee to be casually disposed of through unemployment at times of economic downturn.
Yet what ‘employment’ itself means in capitalism is that anyone from skilled and experienced workers, to unemployed graduates, budding artists, musicians or scientists whose education or training, skills, interests and actual work has no current ‘market value’ can be forced into employment in the form of any low-paid job offered to them, even if it doesn’t pay them a minimum or living wage – or in no way actually ‘employs’ their true skills, gifts or potentials.
In these circumstances, illness can thus serve as a form of mute political protest at the economic demands imposed by capitalism and the distress this imposes on people. For it offers the individual time to temporarily reclaim their body as their own, and allow it to embody and symbolically register their felt dis-ease and distress in what, for most, is the only socially acceptable way – through medical disease symptoms. The problem is then that their bodies are immediately reclaimed by medical professionals and the medical-industrial complex, in a way that actively furthers the process of translating and transforming an individual’s felt ‘dis-ease’ into some
medically diagnosable ‘disease’. The patient’s body is perceived and treated as a biological machine – rather than as a living embodiment of the human being. And as with any other machine, the aim is to repair it and restore its economic functionality.
For just as capitalism identifies work solely with ‘employment’ that profits an employer, so also it identifies ‘health’ solely with an individual’s economic ‘functionality’, i.e. the capacity for ‘employment’ in the labour market rather than the capacity to engage in personally meaningful activity or work – irrespective of its ‘market value’. Similarly capitalism recognises as ‘illness’ only that which in interferes with the mechanical functioning of body and mind in the performance of mechanical tasks, physical or mental. All this has recently become ever clearer through governments making receipt of welfare benefits for the dependent on tests designed only to show that (totally irrespective of the individual’s medical condition and indeed even if they are terminally ill) they are still capable of employment of some sort – even if they can’t get a job, even if that job does not pay a living wage and even if it is clearly damaging to both their medical health and their essential ‘health’ i.e. their capacity for living a meaningful and fulfilled life.
The role of the doctor in what is ever-more evidently a money-driven medicine is – paradoxically – to rule out entirely from consideration the larger life context in which an illness first manifests – not least its economic context and the effect of the latter on the patient’s social world and relationships. Thus, loss of housing, jobs or life opportunities of the sort that lead to disheartenment and loss of heart on the part of patients count for nothing – until and unless this loss of heart manifests as diagnosable symptoms of ‘heart disease’. These are then, like all other forms of illness, cold-heartedly treated as if they had nothing to do with the patient’s actual life whatsoever. The role of the biomedical doctor is principally to act and do – to treat patients and not to talk with them – and certainly not to listen to them, to hear and feel their inner ‘dis-ease’ and learn about the health of their lives and relationships. The seemingly idealistic aim of improving patients’ health and ‘saving’ or ‘extending’ patients’ lives through medical tests and treatments of all sorts is pursued at any cost to their bodies as a result of serious side-effects and at whatever expense to their real health i.e. their quality of life.
The result is a veritable epidemic of ‘preventative’ screening – at high cost to public health services – but resulting in over-diagnosis and over-treatment, even of people with no symptoms whatsoever. This leads in turn to widespread ‘iatrogenetic’ (medically caused) illnesses – which then require yet further medical treatments. A prime example is screening men for prostate cancer by conducting blood tests which measure their level of ‘PSA’ (Prostate Specific Antigen). If this is found to be above a set figure, intrusive biopsies are then regularly conducted. These can produce the very symptoms of prostate cancer they were supposed to prevent from emerging – as well as increasing the likelihood of any actual cancer spreading through the body. Yet as many doctors admit, most men die with and not from prostate cancer – whereas surgical and drug treatments for it can and often do dramatically reduce their quality of life, for example through making them impotent or incontinent.
Constant government, media and press propaganda regarding ‘health risks’ of all sorts, together with mass screening programs, serve a vital role in maintaining money-driven medicine and the medical-industrial complex – creating a type of mass hypochondria which feeds it with new patients to be medically processed or peddled with new drugs. No better was this pathological state of affairs expressed than by Illich:
“People who are angered, sickened and impaired by their industrial labour and leisure can escape only into a life under medical supervision and are thereby seduced or disqualified from political struggle for a healthier world.”
“A professional and physician-based health-care system that has grown beyond critical bounds is sickening for three reasons: it must produce clinical damage that outweighs its potential benefits; it cannot but enhance even as it obscures the political conditions that render society unhealthy; and it tends to expropriate the power of the individual to heal himself and shape his or her environment.”
“More and more people subconsciously know that they are sick and tired of their jobs and of their leisure passivities, but they want to hear the lie that physical illness relieves them of social and political responsibilities. They want their doctor to act as lawyer and priest. As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest, he becomes the patient’s accomplice in creating the myth that he is an innocent victim of biological mechanisms rather than a lazy, greedy or envious deserter of a social struggle for control over the tools of production. Social life becomes a giving and receiving of therapy: medical, psychiatric, pedagogic or geriatric.”
“Medicine has the authority to label one man’s complaint a legitimate illness, to declare a second man sick though he does not himself complain, and to refuse a third social recognition of his pain, his disability and even his death. For rich and poor … life is reduced to a ‘span’, to a statistical phenomenon which, for better or worse, must be institutionally planned and shaped. This life-span is brought into existence with the pre-natal check-up…and it will end with a mark on a chart…”
Illich, Ivan Medical Nemesis – the Expropriation of Health
Life Medicine and Life Doctoring 