" To protect us against doctors there is no law against ignorance, no example of capital punishment.Doctors learn at our risk, they experiment and kill with sovereign impunity, in fact the doctor is the only one who may kill.They go further and make the patient responsible: they blame him who has succumbed" Plenius Secundus

"Doctor - inflicted pain and infirmity have always been a part of medical practice. Professional callousness, negligence, and sheer incompetence are age-old  forms of malpractice".

" The medical diagnosis of substantive disease entities that supposedly take shape in the individual's body is a surreptitious and amoral way of blaming the victim. The physician, himself a member of the dominating class, judges that the individual does not fit into an environment that has been engeneered and is administered by other professionals, instead of accusing  his colleagues  of creating environments into which the human organism cannot fit. Substantive disease can thus be interpreted  as the materialization of a politically convenient myth, which takes on substance within the individual's body when this body is in rebellion against the demands that industrial society makes upon it."

"The French Revolution gave birth to two great myths: one that physicians could replace the clergy; the other, that with political change society will return to a state of original health.Sickness became a public affair. In the name of progress, it has now ceased to be a concern of those who are ill ".

" The sudden emergence of the doctor as savior and miracle worker was due not to the proven efficacy of new technicuques but to the need for a magical ritual that would lend credibility to a persuit at which a political revolution had failed. If "sickness" and "health" were to lay claim to public resources, then these concepts had to be made operational. Ailments had to be turned into objective diseases that infested mankind, could be transplanted and cultivated in the laboratory, and could be fitted into wards, records, budgets, and museums. Disease was thus accommodated to administrative management; one branch of the elite was entrusted by the dominant class with autonomy in its control and elimination. The object of medical treatment was defined by a new, though submerged, political ideology and acquired the status of an entity that existed quite seperately from both doctor and patient ".

" We tend to forget how recently disease entities were born. In the mid-nineteenth century, a saying attributed to Hippocrates was still quoted with approval: ' You can discover no weight no form no calculationto which to refer your judgement of health and sickness.In the medical arts there exists no certainty except in the physician's senses'. Sickness was still personal suffering in the mirror of the doctor's vision.The transformation of thi medical portrait into clinical entity represents an event in medicine that corresponds to the achievement of Copernicus in astronomy: man was catapulted and estranged from the center of his universe. Job became Prometheus ".

"Before sickness came to be perceived primarily as an organic or behavioral abnormality, he who got sick could still find in the eyes of the doctor, a reflection of his own anguish and some recognition of the uniqueness of his suffering. Now, what he meets is the gaze of a biological accounant engaged in in-put/output calculations.His sickness is taken away from him and turned into the raw material for an institutional enterprise. His condition is interpreted according to a set of abstract rules in a language he cannot understand. He is taught about alien entities that the doctor combats, but only just as much as the doctor considers necesarry to gain the patient's cooperation. Language is taken over by the doctors: the sick person is deprived of meaningful words for his anguish, which is thus further increased by linguistic mystification. Before scientific slang had come to dominate language about the body, the repertory of ordinary speech in this field was exceptionally rich."

" When the evidence about the simplicity of effective modern medicine is discussed, medicalized people usually object by saying that sick people are anxious and emotionally incompetent for rational self-medication, and that even doctors call in a colleague to treat their own sick child; and furthermore, that malevolent amateurs could quickly organize into monopoly custodians of scarce and precious medical knowledge. These objections are all valid if raised within a society in which consumer expectations shape attitudes to service, in which medical resources are carefully packaged for hospital use, and in which the mythology of medical efficiency prevails. They would hardly be valid in the world that aimed at the effective pursuit of personal goals that an austere use of technology had put within the range of almost everyone".

" The image of a 'natural death', a death which comes under medical care and finds us in good health and old age, is a quite recent ideal. In five hundred years it has evolved through five DISTINCT STAGES, and is NOW ready for a sixth. Each stage has found its iconographic expression: 1)the fiftheenth century ' dance of the dead'; 2) the Renaissance dance at the bidding of the skeleton man, the so-called 'Dance of Death'; 3) the bedroom scene of the aging lecher under the Ancien Regime; 4) the 19th century doctor in his struggle against the roaming phantoms of consumption and pestilence; 5) the mid-twentieth century doctor who steps between the patient and his death; and 6) death under intensive hospital care . At each stage of its evolution the image of natural death has elicited a new set of responses that increasingly acquired a medical character. the history of natural death is the history of the medicalization of the struggle against death."

" The ability to survive longer, the refusal to retire before death, and the demand for medical assistance in an incurable condition had joined forces to give rise to a new concept of sickness: the type of health to which old age could aspire." [...]

"By contrast, a reverse judgement now could be made on the ailments of the poor, and the ills from which they had always died could be defined as untreated sickness.It did not matter at all if the treatment doctors could provide for these ills had any effect on the progress of the sickness; the lack of such treatment began to mean that they were condemned to die an unnatural death, an idea that fitted the bourgeois image of the poor as uneducated and unproductive. From now on the ability to die a 'natural' death was reserved to one social class: those who could afford to die as patients."

" As a member of the medical profession the individual physician is an inextricable part of scientific team. Experiment is the method of science, and the records he keeps-if he likes it or not-are part of the data for a scientific enterprise. Each treatment is one more repetition of an experiment with a statistically known probability of success. As in any operation that constitutes a genuine application of science, failure is said to be due to some sort of ignorance: insufficient knowledge of the laws that apply in the particular experimental situation, a lack of personal competence in the application of method and principles on the part of the experimenter, or else his inability to control that elusive variable which is the patient himself. Obviously, the better the patient can be controlled, the more predictable will be the outcome in this kind of medical endeavor. And the more predictable the outcome on a population basis, the more effective will the organization appear to be. The technocrats of medicine tend to promote the interest of science rather than the needs of society".

" There are two aspects to health: freedom and rights. Above all, health designates the range of autonomy within which a person exercises control over his own biological states and over the conditions of his immediate environment".

" One sure way to extinguish freedom to speak, to learn, or to heal is to delimit them by transmogrifying civil rights into civic duties. The freedom of the self-taught will be abridged in an overeducated society just as the freedom to health care can be smothered by overmedicalization. Any sector of the economy can be so expanded that for the sake of more costly levels of equality, freedoms are extinguished."

 "The economics of health is a curious discipline, somewhat reminiscent of the theology of indulgences which flourished before Luther. You can count what the friars collect, you can look at the temples they build, you can take part in the liturgies they indulge in, but you can only guess what the traffic in remission from purgatory does to the soul after death."

"Medical care is uncertain and unpredictable; many consumers do not desire it, do not know they need it, and cannot in advance what it will cost them. They cannot learn from experience. They must rely on supplier to tell them if they have been well served, and they cannot return the service to the seller or have it repaired".

 "Curiously, death became the enemy to be defeated at precisely the moment at which megadeath came upon the scene.Not only the image of 'unnecessary' death is new, but also our image  of the end of the world. Death, the end of my world, and apocalypse, the end of the world, are intimately related; our attitudes towards both has clearly been deeply affected by the atomic situation. The apocalypse has ceased to be just a mythological conjecture and has become a real contingency. Instead of being due to the will of God, or man's guilt, or the laws of nature, Armageddon has become a possible consequence of man's direct decision. Cobalt, like hydrogen bombs, creates an illusion of control over death. Medicalized social rituals represent one aspect of social control by means of the self-frustrating war against death".

" the cost of coordinating the treatment of the same patient by several specialists grows exponentially with each added competence, as does the risk of mistakes and the probability of damage due to the unexpected combinations of different therapies. As the number of patient relationships outgrows  the elements in the total population, the occupations dealing with medical information, insurance, and patient defense multiply unchecked. Of course, physicians lord it over these fiefts and determine what work these pseudo-professions should do. But with the recognition of some autonomy many of these specialized groups of medical pages, ushers, footmen, and squires have also gained some power to evaluate how well they do their own work. By gaining the right to self-evaluation, according to special criteria that fit its own view of reality, each new speciality generates for society at large a new impediment to evaluating what its work actually contributes to the health of patients. Organized medicine has practically ceased to be the art of healing the curable, and consoling the hopeless has turned into a grotesque priesthood concerned with salvation and has become a law unto itself. The policies that promise the public some control over the medical endeavor tend to overlook the fact that to achieve their purpose they must control a church, not an industry."

" The multiplications of paraprofessional specialists further decreases what the diagnostician does for the person who seeks his help, while the multiplication of generalist auxiliaries tends to reduce what uncertified people may do for each other or for themselves. Institutional licensing would indeed permit a more efficient deployment of personnel, a more rational health-manpower mix, and a greater opportunity for advancement. But if it became the model for the over-all health care, it would be equivalent to the creation of a medical Ma Bell. Lay control over an expanding medical technocracy is not unlike the professionalization of the patient: both enhance medical power and increase its nocebo effect. As long as the public bows to the professional monopoly in assigning the sich-role, it cannot control hidden health hierarchies that multiply patients".

" The issue of social iatrogenesis is often confused with the diagnostic authority of the healer. To defuse the issue and to protect their reputation, some physicians insist on the obvious: namely, that medicine cannot be practiced without the iatrogenic creation of disease. Medicine always creates illness as a social state. The recognized healer transmits to individuals the social possibilities for acting sick. Each culture has its own characteristic perception of disease and thus its unique hygienic mask. Disease takes its features from the physician who casts the actors into one sick of the avaiable roles. To make people legitimately sick is as implicit in the physician's power as the poisonous potential of the remedy that works. The medicine man commands poisons and charms. The Greek's only word for 'drug'-pharmakon-- did not distinguish between the power to cure and the power to kill.
Medicine is a moral enterprise and therefore inevitably gives content to good and evil. In every society, medicine, like law and religion, defines what is normal, proper, or desirable. Medicine has the authority to label one man's complaint a legitimate illness, to declare a second man sick though he himself does not complain, and to refuse a third social recognition of his pain, his disability, and even his death."

" It is medicine which stamps some pain 'merely subjective' , some impairment as malingering, and some deaths--though not others-- as suicide. The judge determines what is legal and who is guilty. The priest declares what is holy and who has broken a taboo. The physisian decides what is a symptom and who is sick. He is a moral entrepreneur, charged with inquisitorial powers to discover certain wrongs to be righted. Medicine, like all crusades, creates a new group of outsiders each time it makes a new diagnostic stick. Morality is as implicit in sickness as it is in crime or in sin."

"The delivery of remedies and access to services is unequal and arbitrary; it depends either on the patient's money and rank, or on social and medical prejudices ".