During the past three generations the diseases afflicting Western societies have undergone dramatic changes.1 Polio, diphtheria, and tuberculosis are vanishing; one shot of an antibiotic often cures pneumonia or syphilis; and so many mass killers have come under control that two-thirds of all deaths are now associated with the diseases of old age. Those who die young are more often than not victims of accidents, violence, or suicide.2
These changes in health status are generally equated with a decrease in suffering and attributed to more or to better medical care. Although almost everyone believes that at least one of his friends would not be alive and well except for the skill of a doctor, there is in fact no evidence of any direct relationship between this mutation of sickness and the so-called progress of medicine.3 The changes are dependent variables of political and technological transformations, which in turn are reflected in what doctors do and say; they are not significantly related to the activities that require the preparation, status, and costly equipment in which the health professions take pride.4 In addition, an expanding proportion of the new burden of disease of the last fifteen years is itself the result of medical intervention in favor of people who are or might become sick. It is doctor-made, or iatrogenic?