Biomedicine as
Money-Driven Medicine
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 the U.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.”
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
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.”
Illich, Ivan Medical
Nemesis, The Expropriation of Health
(see appendix 7)
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