• health care
• demand
• medical humanities
• health
• Ivan Illich

The death last year of Ivan Illich is an opportunity for us to reflect on his controversial “Nemesis” challenge in 1974 that too much dependence on modern medicine is harmful to the health of the individual and society.¹ It followed the challenge by Archie Cochrane² for evidence of the effectiveness of treatment offered by doctors. Both these challenges were largely unheeded at the time. Medical science progressed much as analysed in the book Little Science, Big Science and Beyond.³ Now we are well into the uncertainties of De Solla Price’s “beyond” in what Beck calls the “risk society”,⁴ with all that means for fear of unknown risks and incurable diseases. Medical science is indeed making health care more powerful and successful than ever, but the potential for harm, as iatrogenic disease and medical accidents (what Illich identified as direct medical harms) is also greater.⁵

In admiration of the success of the Cochrane Collaboration in catalysing the current …