A few passages from Limits to Medicine, Medical Nemesis: The Expropriation of Health by Ivan Illich, 1974:
"A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes, on a healthy diet, in an environment equally fit for birth, growth, work, healing, and dying; they are sustained by a culture that enhances the conscious acceptance of limits to population, of aging, of incomplete recovery and ever-imminent death."
“Man's consciously lived fragility, individuality and relatedness make the experience of pain, of sickness and of death an integral part of his life. The ability to cope with this trio autonomously is fundamental to his health. As he becomes dependent on the management of his intimacy, he renounces his autonomy and his health must decline.”
“The more time, toil, and sacrifice spent by a population in producing medicine as a commodity, the larger will be the by-product, namely, the fallacy that society has a supply of health locked away which can be mined and marketed.”
"Health designates a process of adaptation. It is not the result of instinct, but of an autonomous yet culturally shaped reaction to socially created reality. It designates the ability to adapt to changing environments, to growing up and to aging, to healing when damaged, to suffering and to peaceful expectation of death. Health embraces the future as well, and therefore includes anguish and the inner resources to live with it".
""Health," after all, is simply an everyday word that is used to designate the intensity with which individuals cope with their internal states and their environmental conditions. The society which can reduce professional intervention to the minimum will provide the best conditions for health."
>Drugs can be the least of healing, and the idea that therapies must be something that you swallow or inject...
This quite resonates with the current zeitgeist, there's no patience and "we" want always instant relief. If I have a cold of fill ill I just rest and recover (which happens seldom luckily). I'm also lucky as my workplace understands this quite good, some days recovery and rest are always better than gonging to work, have a sub par performance and risk infecting others (in an office setting)
disclaimer: I work in switzerland, so I have theoretically plenty of paid sick leave
The thing is that in the US and increasingly in the UK, if you're sick it's considered your own fault, responsibility, and expense. Employers do not care about you, if you do not work they do not want you.
From a purely utilitarian / capitalist viewpoint it makes sense, why pay for a service (an employee) if they do not provide? But there's a difference between an employee and a contractor. And it's not a human way to deal with things.
So in the US, since people lose their income and possibly their job, they can't afford to take rest, they'll take some medication to power through it.
In my own country, thankfully, we get paid time off if we're sick. If we're sick long-term (I don't know what the cutoff is), the employer has to pay us 70% of wages for a year, after which the government takes over (this used to be two years). It really blows for the employer, but in a lot of cases, it's the job that makes you long-term sick in the first place - workplace accidents, overwork, etc. Overwork / stress was the one for my previous employer, the department managers had multiple roles (people management, account management, hiring, finances, etc) they had to juggle simultaneously and for quite a few, it became too much within 6-12 months. To manage it, the employer offered a subscription to some meditation app, instead of reducing workload or making it OK to go offline outside of working hours.
I mean I remember getting a text message at 3 in the morning from a manager telling everyone to not forget to bring some post-its and sharpies to the all-hands meeting the next day. That guy ended up sick for 6+ months after which he quit and became a manager somewhere else.
> The thing is that in the US and increasingly in the UK, if you're sick it's considered your own fault, responsibility, and expense. Employers do not care about you, if you do not work they do not want you.
Totally, I used to work for a UK stock market listed company, would always get ill due to their physically toxic working environment, and because it was such a toxic criminal environment to work in I had to leave!
The organised crime operating within the company and outside of it follows you around for the rest of your life because smart criminals are relentless, its like a parallel universe with more money than you can imagine.
The accounts on www.reddit.com/r/antiwork/ are so typical of what goes on, but people are in fear of their jobs so they dont speak out, only now I think we have reached a tipping point in history.
grewing up in germany I also remember that my parents/grandparents regularly went "on a cure" somewhere in germany (on top of vacation), often somewhere near the sea, which where prescribed and paid partially by health insurance ("parent-child-cures" where also quite common).
that somehow changed a lot in my generation...
protip for the german people here... you can claim up to 10 days "bildungsurlaub" every 2 years (in some states paid/in some unpaid) and yoga retreats or similiar are also possible ;)
> In my own country, thankfully, we get paid time off if we're sick. If we're sick long-term (I don't know what the cutoff is), the employer has to pay us 70% of wages for a year, after which the government takes over
1y sounds like a long time, esp for smaller companies (like if you have say 5 ppl on a payroll). I wonder if they can insure against such a risk (say if an insurer can cover the salary if absence longer than a month).
In Poland this is 70% (if in hospital), 80% (if general sick leave), and 100% (pregnancy related). Your employer covers this for 34 days, then the social insurance takes over. IIRC if the absence is over 6 months, then the social insurance stops paying % of your salary and pays some low fixed disability benefit.
> 1y sounds like a long time, esp for smaller companies (like if you have say 5 ppl on a payroll). I wonder if they can insure against such a risk (say if an insurer can cover the salary if absence longer than a month).
Yes, there are insurance packages available for this. In the Netherlands, for instance, where the support period is two years, it's common for businesses to take out verzuimverzekering or 'absence insurance'. It usually only applies to line employees though, not those are director level or above.
"It really blows for the employer, but in a lot of cases, it's the job that makes you long-term sick in the first place"
So because some employers are bad apples, everybody has to pay up? For many employers, that would be the end of it. Employers are also just people in most cases.
As an example, I suddenly became employer when my kids joined a privately run kindergarden. The parents all together were the employer, and there were two nannies. Any nanny becoming pregnant would already be a huge strain on the whole organization.
People like to think of "companies" as black boxes with infinite money supply, but that usually is not the case.
In practice it's not a common occurrence, and companies have options in place like company doctors to manage things like burnout and avoid those scenarios from happening in the first place.
No, you provided an unusual, very specific example, and strongly implied that you would fire any of the nannies you employ if they became pregnant. That says a lot about your mindset.
Fact is, there are certain fundamental costs and risks you quite rightly have to bear when employing others. In most countries that includes a reasonable amount of maternity leave, sick leave, paid vacation, and so on. If your business can't sustain those costs then it's not healthy enough to be employing people.
Long term paid illness at 70% of a person's salary is something fewer countries have but there, again, there's reasonably-priced insurance that you can take out that's specifically targeted at and priced for small businesses. Large businesses don't need it.
Nobody is assuming that businesses have infinite resources, and this is no different to any other regulation that affects the cost of doing business. We accept them because the overall societal benefits are worth it even if it means some small percentage of small companies makes less profit or may not exist in the first place.
> Also if a job makes you sick, you should switch.
That's a terrible argument. Not only is switching not always an option, especially for low-wage jobs, but if we allow widespread abuse of employees then there usually aren't better options to switch to.
"No, you provided an unusual, very specific example, and strongly implied that you would fire any of the nannies you employ if they became pregnant. That says a lot about your mindset."
I never said anything about firing pregnant employees, it says a lot about YOUR mindset that you think I did. And it is not a unusal example, there are a lot of kindergardens in the world.
In my country (public) health insurance takes over paying sick people (or pregnant) people after a certain amount of time.
You keep claiming there is cheap insurance, which I rather doubt. In any case, it shouldn't have to be the responsibility of the employer. All that does is make employers reluctant to hire sickly people or people who are at risk of becoming pregnant.
"That's a terrible argument. Not only is switching not always an option, especially for low-wage jobs, but if we allow widespread abuse of employees then there usually aren't better options to switch to."
That is the usual leftist claim, which is just bullshit. Employers have to compete for workers, too, also they don't have absolute power giving out goodies to slave like employees, as leftists claim. People can take responsibility for themselves.
There are many, many leftists - are you saying they all would treat their employees badly, if they were to start companies? Or are leftists somehow incapable of starting companies?
I'm surprised by the negative reaction to this in some of the comment. I don't think this is an attack on modern medicine or drugs, but I think it resonates because it highlights the impersonal, 1 sized fits all approach we often encounter in modern medicine.
I suffered a spontaneous pneumothorax (collapsed lung) at the end of 2020, and it was a difficult case that ended up with me spending 5 weeks in the hospital, a major thoracic surgery and home with a chest tube for 3 more weeks.
I'm extremely grateful to modern medicine. 100 years ago I would have just lost function of the lung and probably eventually died. 30 years ago I probably would have lived, but the surgery would have involved spreading open my ribcage and my recovery would have been much longer and harder. All the pain medications are way more effective than willow bark. So yes, profoundly grateful and happy we have modern medicine.
My doctors and nurses were all generally compassionate and professional, and overall I can say my care was good.
However;
The experience really highlighted to me how mental health or consideration of the whole person is not considered in today's medical environments. Most people intuitively knows that it's harder to recover, or even avoid falling ill when your environment is oppressive, never mind recover from major trauma. The lack of plants, fresh air, art or any other kind of environmental beauty, 24/7 artificial light, never getting more than 4 hours of sleep in a stretch etc. I don't blame the hospitals given the current environment they operate in, but it's clear we focus only on the person's issues in isolation, and try to forget they are a person, and the disposition of a persons spirit and mental state can either aid or hinder healing. This is true in an outpatient sense too, and even in family medicine (at least in Canada) where quality of life issues are rarely considered important.
Anyway, this is a long winding way of saying I think we can both appreciate the advantages of modern medicine while appreciating and desiring a move towards a more wholistic view of a person's quality of life and subjective experience while dealing with health issues.
This is very true. I feel that the modern medicine disregards the connection between mind and body. Especially for chronic conditions, improving the patient's quality of life helps better manage the condition.
I've been experimenting with aromatherapy, music therapy and massage lately and I find that the overall quality of my life greatly improved.
Ahead of a planned surgery, visited the internist who would be taking care of things post surgery. He stated flat out that doctors and medicine do not heal. His idea was that the body heals itself. He saw it as his goal to make sure that any medical interventions did not prevent that. Excellent doctor.
> Every illness is unique, which means that all recoveries must also be in some sense unique. There is no one-size-fits-all to getting better
When I had my cardiac arrest due to Ventricular Fibrillation, I was very glad that the bystanders immediately applied a generic off-the-shelf solution (CPR and a public defibrillator) and in doing so kept me alive without brain damage due to lack of oxygen. Rather than treating me as a unique individual who needed a tailored solution.
It is very old wisdom, though. In the traditional art of healing with herbs, there were no strict formulas either. Like this plant for this sickness and this for that. It was usually a mixture always mixed for that one patients unique condition.
I am pretty sure modern medicine knows that, too. That fine graining therapy to the individual provides better results. But that approach is simply too expensive as it requires much more time for every patient.
> Like this plant for this sickness and this for that. It was usually a mixture always mixed for that one patients unique condition.
Sure, and that's because they mostly had no idea what they were doing. If you have a bacterial infection today, you can take an antibiotic. If you have a dangerous viral infection, an anti-viral may help (though there are few of those). If you have a parasite, you get a very specific anti-parasite.
And on and on: there are many many diseases for which we have specific, targeted remedies that work with very high accuracy - well over 99%.
No woo woo plant energy "healing" achieves anything close to that.
"No woo woo plant energy "healing" achieves anything close to that."
Well, for starters, many medicines are just extraction of a plant or a synthesis of it. And they surely work, too.
And no doubt modern medicine is very good at targeting very specific diseases. And if I would suffer from a specific bacteria and I am too weak, I surely take modern antibiotics as well.
But the body is a very complex system - and there is the danger of only targeting symptoms and not solving the root cause.
Than I would have just fought a symptom and messed up my digestion system, that might further harm myself.
Traditional medicine had more the target of getting the whole system in order again. Removing the root causes for getting sick in the first place, or rather help the body achieve it to do on its own.
And not make him dependant on pills for all eternity.
In my perception, the systematic wholesome thinking is more and more replacing the old mechanistic approach in modern medicine and I like that.
Modern medicine is hamstrung by nearly universal application of "evidence based medicine" - which started as a commendable approach but has been twisted into: "we diagnose A and then find therapy B with the most institutional buy-in, and if that fails or is inapplicable, we call the patient crazy and/or employ other tactics to make the patient go away".
Especially in the age of complex and poorly understood chronic illness, doctors should guide the patient through a process of "clinical experimentation" while also counseling them to improve environmental and lifestyle factors. But western health systems are laughably underresourced for this. So they remain competent when it comes to cut-and-dry situations, and misery-makers elsewhere.
Checkout the documentary 'Ayurveda: the art of being' by Pan Nalin. Very much speaks about this ancient tradition, how everything is energy and healing with herbs. Recommended.
This was a very refreshing read and interesting how hostile many commenters get at the mere suggestion that a pull, an injection or even surgery may not always be the right answer.
Maybe it is because she seems to hint that many patients have too much faith in the MD.
Considering how curated we have been for the past 30 years ( I just picked a number there that firs my personal narrative ) to dogmatize science this of course can feel like a personal attack.
I am extremely happy to seee younger doctors embrace personal responsibility, environment and other factors than just chemical compounds when it comes to health.
We are complex beings and we know for a fact we are overweight, overmedicated and depressed.
At least in europe.
North europeans especially in the Nordics suffer from lonliness.
There are a myriad of side effects attributed to lonliness, elevated bloodpressure and increased risk of heart attack is one.
I am not sourcing this, there are so many high quality studies on this. A small search will get you dozens of good results.
Anyway, my point was.
If your bloodpressure is elevated because you are depressed and lonely.
The classic “yeah science” person gets the blood pressure medication from the MD.
He will never be cured by that medication.
He will possibly suffer side effects.
Had he been lucky enough tontalk to this woman, she might have identified his bp in a holistic way and suggested social settings.
In this instance his high bp would have been cured.
Holistically if he is obese.
A smoker or high stress job.
We all know the answer to curing the bp in that case.
None involve tablets or injections.
But then there are of course cases where the bp is for example caused by other life saving medication.
Cancer medication can can cause extremely high blood sugar levels.
You dont tell the cancer patient to just change their diet and start taking the stairs.
Holistic means just that I think.
It is way overdue we start taking a little responsability of our own bodies and use our best judgement when to seek an MD.
Modern medicine is designed to solve a problem, but create many new ones through side effects. That's how they get patients always coming back and more money.
The more meds you take over time, the bigger those other health issues become. Soon you're taking more meds to solve the new issues, while creating newer issues. The cycle never ends.
This is why the right way to heal any illness is to take the long-term approach that involves sleep, correct dieting, herbs, stress relief, etc. It takes more time and effort, but you benefit by not creating more health problems.
> Modern medicine is designed to solve a problem, but create many new ones through side effects. That's how they get patients always coming back and more money.
Come on. No one is designing for side effects to bring in repeat business.
The truth is we barely understand how anything works and there is a lot of two steps forward and one step back… or sideways.
My dad likes to tell this story of building a house:
First you start with the a beautiful, pristine plot of land.
Then you dig a giant hole in the ground and cause a giant mess.
So to fix that, you pour a big concrete foundation.
But you are still left with a big hole in the ceiling, and that is no good.
So now you hire some contractors to put up framing and a roof.
But you are still left with some big holes in the wall, and that is no good.
So now you hire more contractors to put up exterior walls and siding.
But you are still left with some small door-shaped and window-sized holes in the wall, and that is still no good.
And they left lots of little holes behind inside too:
The electrician cuts holes to put in outlets.
The doors and windows offer no privacy.
The shower leaks.
The bathroom is just a series of open pipes.
So you hire more contractors, to add all of those details...
And you still have lots of holes!
The windows and doors are drafty without their trim.
The drywall seams look unseemly.
So you hire more contractors, to fix all of those details...
And now the walls have paint, the doors have trim, and the roof keeps you dry.
Was it worth it? You spent a lot of money chasing new problems that you created as a side effect of trying to solve the old problems. Was not the original plot of natural land already perfect, and could have simply be tended to?
Perhaps with some careful forestry, you could have enmeshed the branches to keep out most of the rain. It may takes more time and effort, but maybe you could have really benefited by not building a house!
This, of course, works incredibly well for tuberculosis and HIV, for but two example.
This comes from a flawed assumption that the human body has evolved to solve for all sicknesses. It turns out that it's remarkably frail. Yes, there are cases where side effect medical chains exist, but in many of those cases, we manage the side effects because the body wasn't able to fix itself.
Yes, you can make the case for type 2 diabetes or high blood pressure, but those are not every case.
"A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes, on a healthy diet, in an environment equally fit for birth, growth, work, healing, and dying; they are sustained by a culture that enhances the conscious acceptance of limits to population, of aging, of incomplete recovery and ever-imminent death."
“Man's consciously lived fragility, individuality and relatedness make the experience of pain, of sickness and of death an integral part of his life. The ability to cope with this trio autonomously is fundamental to his health. As he becomes dependent on the management of his intimacy, he renounces his autonomy and his health must decline.”
“The more time, toil, and sacrifice spent by a population in producing medicine as a commodity, the larger will be the by-product, namely, the fallacy that society has a supply of health locked away which can be mined and marketed.”
"Health designates a process of adaptation. It is not the result of instinct, but of an autonomous yet culturally shaped reaction to socially created reality. It designates the ability to adapt to changing environments, to growing up and to aging, to healing when damaged, to suffering and to peaceful expectation of death. Health embraces the future as well, and therefore includes anguish and the inner resources to live with it".
""Health," after all, is simply an everyday word that is used to designate the intensity with which individuals cope with their internal states and their environmental conditions. The society which can reduce professional intervention to the minimum will provide the best conditions for health."