Is it time for an Illich Collaboration to make available information on the harms of medical care?

Editor—The editor’s choice on the dark side of medicine¹ has prompted me to ask if it is perhaps time to establish an Illich Collaboration (on the lines of the Cochrane Collaboration) to make readily available objective evidence of harms of medical care. The harms go beyond the side effects of drugs or inappropriate use of high intensity treatments to the social and psychological consequences of unchecked medicalisation of the aspects of modern life of which Illich warned.² Archie Cochrane’s salutary challenge for proof of effectiveness to the medical profession³ took nearly a quarter of a century to be taken seriously. Illich’s challenge appeared again in the perceptive warning in the last chapter of Roy Porter’s brilliant account of medical history, in which he writes that the irony is that the healthier Western society becomes the more medicine it craves.⁴ His allegation is that doctors and consumers are becoming locked within a fantasy that all people have something wrong with them and that everyone and everything can be cured.

It would be naive to leave Illich’s medical nemesis in the category of “doctor bashing” literature because unless the arguments are taken seriously they are likely to return as greater challenges. Today, with the ever higher expectations of society, professional error or incompetence, drug side effects, and unexpected harms of medical intervention are tragically more significant.

A new debate is urgently needed about the fundamental issue of the meaning of health and health care and the need to redefine consumer expectations. It is questionable whether market consumerism can be translated to cover healthcare issues. A readily accessible source of information in the Cochrane Library (or elsewhere) of harms as well as effectiveness⁵ for healthcare professionals, the users of care services, and society at large would inform a responsible debate about the appropriate use of care services and the need to avoid unnecessary interventions to avoid harm to individual people and waste of resources to society.

A foundation of mutual trust necessary for this debate would be encouraged by the idea of stakeholder altruism—that is, joint ownership and responsibility for the NHS—so that reciprocal altruism can be a sustainable reality.