bureaucratic gobbledegook
’, could be
seen to be a bad development on Illich’s (1975) account. The position I just
described is not, I presume, a position that Illich (1975) would endorse, yet it very
well illustrates the problem with applying his and similar critiques. Finally, it is
possible for all of those effects to be present simultaneously, making the evaluation
of whether medicalization is a desirable or undesirable process a very murky
evaluation.
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Moreover, according to Illich (1975), clinical iatrogenesis involves serious side-
effects which may be worse than the burden of the original condition. Clinical
iatrogenesis include the harmful side effects of seemingly beneficial and advisable
intervention, post-intervention complications, the negative effects of wrongly
prescribed medication, bacterial resistance developed as a result of widespread use
of antibiotics, hospital-acquired infections and harm resulting from negligent
medical errors. Although some of the iatrogenic effects may be obvious, the burden
of others may be difficult to calculate (e.g. the harmful effects of drug interactions
that overlap with the progression of a disease or aging). One of the contributing
reasons is the under-reporting of side-effects, as happened in the case of SSRIs,
Rofecoxib (Avorn, 2012) and Lariam (Croft, 2007; Ritchie et al. 2013).
Finally, there may be a difficulty with detecting the full burden of side effects,
including the causally related yet difficult to measure harms – such as the long-
lasting impact on the social interaction of moderately depressed people taking
SSRIs and the impact of a Caesarean section on early formation of the mother-
infant attachment and its consequences. The cost-benefits analysis only makes
sense on a case-by-case basis. Even when the cost-benefit analysis is performed,
we have to be cognizant of the incompleteness of our view, the incompleteness that
is reinforced and shaped by the ‘intangibility’ of some kinds of relevant side
effects.
17
While indirect and intangible costs of a disease are often explicitly
referred to, often the indirect and intangible costs of drug use are not mentioned.
It is important that direct, indirect and intangible costs of medical and non-medical
solutions need to be compared, and accounted for to the extent possible. Intangible
costs might sometimes give us a reason to choose a more expensive and perhaps
non-medical solution to a problem, for example moral education over biomedical
means of modifying empathetic ability. For example, if there was a cheap drug that
would achieve an effect similar in this regard to a semester of moral education, we
might see a drug as a cost effective solution. However, if it turned out that the drug
affects adversely the ability to form and enjoy lasting relationships (as some reports
17
‘Intangible costs’ usually refer to costs that cannot be directly expressed in monetary
values, such as happiness or anxiety due to a disease. ‘Intangibility’ is perhaps an
unfortunate term, since it implies that there is no way of measuring the impacts of those
factors. I do not mean to suggest that those side effects are impossible to measure or
estimate in any way, but I will follow the term used in the literature. See: Leukefeld et al.
(2011).
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on the side effects of SSRIs suggest), the balance of costs and benefits might
change. In this case, more time and resources consuming moral education might be
a better solution.
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