Prescription by Polemic

By Peter Stoler

MEDICAL NEMESIS

by IVAN ILLICH

294 pages. Pantheon. $8.95.

With only a few notable exceptions, such as some senior officials of the American Medical Association, almost everyone agrees that modern medicine is as sick as the patients it treats. Increasing specialization has sent the old -and often romanticized -doctor-patient relationship the way of such medical artifacts as the mustard plaster and the house call. New medical technology and a complicated insurance system have turned much of medicine from a profession into a business, reducing doctors to entrepreneurs and their patients to "medical consumers," who must be sold on the benefits of 20th century health care very much as television viewers are sold on the questionable advantages of detergents or deodorants.

Still, few men take as harsh a view of medicine as Ivan Illich, 51, a Viennese-born priest who now makes his home in Cuernavaca. Mexico. An iconoclast who has already attacked another major institution in his 1971 diatribe Deschooling Society, Illich zeroes in on the health industry in his newest attack and leaves no doubt as to how he regards the target. "The medical establishment," he writes in Medical Nemesis opening sentence, "has become a major threat to health."

Illich supports his thesis with a recitation of medicine's best-known faults: unnecessary surgery, the unforeseen long-term effects of certain "miracle" drugs, equipment malfunctions, malpractice. However justified, they add little if anything new to the case against modern medicine. Illich's attack is more telling when he takes up the extent to which medicine induces people to forgo control over their own lives in favor of getting as much treatment as they can. Says Illich: "Until proved healthy, the citizen is now presumed to be sick." The result, he points out, is "a morbid society that demands universal medicalization and a medical establishment that certifies universal morbidity."

Illich's diagnosis of medicine's mal ady is correct. But his prescription is both polemical and disappointing. He rejects such political and economic solutions as national health insurance and closer regulation. Instead, he proposes a return to conservatism, a sort of spiritual recognition that suffering is unavoidable in life, a facing up to the inevitability of death as well as the limits of medicine. There is no question that Illich's approach would decrease man's dependence on a medical establishment that already exerts great influence over him. Unfortunately, in the long run it would probably also deny him medicine's benefits.

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