Essay Focus 698 www.thelancet.com Vol 369 February 24, 2007 In Medical Nemesis , 1 perhaps the most inﬂ uential def nition oF medicalisation ever written, historian-philosopher Ivan Illich argued that by overextending its scientif c and cultural authority, modern medicine had itselF become a threat to health, a Fount oF “doctor inﬂ icted injuries” and “iatrogenic disease”. 1 Although Illich’s 1975 book Focused mainly on the role oF the medical proFession in creating these problems, he suggested that the ill e± ects oF medicalisation might well be reversed by the actions oF a long “passive public”, now beginning to recover its “will to selF-care”. 1 The deepening crisis oF modern medicine presented new opportunities For “the layman e± ectively to reclaim his own control over medical perception, classif cation, and decision-making,” a “laicisation oF the Temple oF Aesculapius” that Illich believed held great promise For the reForm oF modern medicine. 1 Read aFresh in 2006, Illich’s emphasis on laicisation seems remarkably prescient in some ways. Since the 1970s, patient activists in the USA and Europe have aggressively asserted their claims to be regarded as experts on their own illnesses and to play a more active part in health-care decision-making. Patient initiatives have resulted in monumental changes in the practice oF
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Physician, modern medicine, Ilich I. Limits, Nancy Tomes, late modern medicine