Medical Nemesis: The Expropriation of Health

Although Ivan Illich's rhetoric at times suggests otherwise,Medical Nemesisis not primarily an attack against greed for power on the part of physicians nor against "therapeutic greed" on that of patients. The book is rather an extension of Illich's ongoing critique of the impersonal and, to him, inhuman, "sociopolitical system of capital-intensive industrial production," as it applies to health care. (Hospital-based medicine is capital-intensive because it relies on the huge capital outlay of the centralized plant. Illich cites China's "barefoot medicine" as an example of the decentralized labor-intensive form of health care.) Illich focuses his principle of "counterproductivity" on the health care industry to demonstrate how medical technology, through the influence of capital-intensive methods, has burgeoned beyond the point of fulfilling legitimate human health care needs to become a powerful agent of dehumanization. He argues that technological expertise in medicine operates by a self-aggrandizing inner logic to dictate to