In his 1961 farewell speech, outgoing US President Dwight D. Eisenhower famously coined the phrase “military-industrial complex”. As an ex-US Army general and departing Commander-in-Chief of one of the two superpowers of the Cold War, Eisenhower was obviously complicit in that complex and its expansion. His warning about the rising influence of armaments manufacturing on the economy and about inherent conflicts of interest was accordingly prescient.
Inspired by Eisenhower, only a few years later, the term medical-industrial complex was conceived by academics Barbara and John Ehrenreich to describe the emerging industrialization of healthcare, notably within capitalist societies such as the US, and the healthcare sector’s growing relevance to the economy.
In 1980, the epithet “medical-industrial complex” was redeployed by the then editor of the New England Journal of Medicine, Dr Arnold Relman, to address profiteering within the American healthcare system. More recently, the phrase has been used to encompass the growing influence of pharma and of the manufacturers of medical products and technologies, and in particular the cosy relationships among private companies and scientific researchers, healthcare systems and physicians, but also government regulatory bodies.
The term medical-industrial complex has been used to encompass in particular the cosy relationships among private companies and scientific researchers, healthcare systems and physicians, but also government regulatory bodies.
Over the decades, healthcare has continued to grow. Costs for governments, insurance companies and individuals have steadily increased, a trend established well before Covid, and are projected to continue to rise. This has led to much consternation about healthcare systems’ sustainability, and to the sinister accusation that an aging population is at the root of the problem.
Naturally, older people are more likely to have greater healthcare needs than younger people, but the most significant healthcare costs an individual generates are within their final year or months of life, usually bearing little relation to the age at which they die. This underlines how predicting and accepting the time of death is fiendishly difficult. It should also demonstrate that medical technologies and their development and deployment—not aging populations per se—are the key drivers of increasing healthcare costs. As medical technologies have grown more sophisticated, there have often been promises of a “game-changing” reversal of this economic trend. The reality, however, rarely meets the hype.
One example is advances in diagnostics, which (for now) are still reliant on paid human workers to operate and interpret them. So far, the essential role of the human factor has limited the scaling of such medical technologies. Nevertheless, the political and social desire to detect and prevent disease at an ever earlier stage lends itself to increasing justification for the surveillance of healthy people, as opposed to care of the sick, opening new markets.
Unsurprisingly, this has led to businesses not traditionally aligned with healthcare, such as big tech, but also the alternative health scenes, trying to get a slice of the ever growing pie. As the mass self-testing during Covid, with its blurring of advocacy for viral suppression and profiteering, showed, healthcare is open to supplier-induced demand. When it comes to making money in healthcare, the fastest route to new markets is often the expansion of disease.
That said, over-diagnosis and medicalization remain explicit concerns for many, both inside and outside the medical-industrial complex. Prior to Covid, there were several initiatives within medical academia aimed at reducing over-diagnosis and “too much medicine”, such as the international Choosing Wisely campaign. This campaign aimed to teach both patients and clinicians that non-intervention is often the wisest course of action, and that both parties regularly over-estimate the effectiveness of drugs and under-estimate their side-effects.
“The medical establishment has become a major threat to health”.-Ivan Illich
Obviously, the sudden volte-face with the appearance of Covid, the drive to immediately do something, anything, everything, adding layer upon layer of interventions in a futile attempt to stop an airborne germ, shows that these principles are lightly held by many. The oppressive nature of the Covid response has reignited interest in critiques of the medical enterprise, none more famous than that of renegade Catholic priest and polyglot Ivan Illich. His seminal 1974 book Medical Nemesis (also titled Limits to Medicine) offered an abrasive and supremely researched attack on biomedicine, starting with its memorable opening line: “The medical establishment has become a major threat to health”.
