Long after Ivan Illich (1977) denounced professional expansionism it continues unchecked. Governments struggle to contain the prohibitive cost of health services, but do nothing about its most blatant waste, the recurrent epidemics of pseudo-illness. Illich invented the term iatrogenesis, doctor-generated complaint. In its most expensive form and in different disguises it sweeps across communities in epidemics of pseudo-illness. Some pseudo-illnesses become an almost constant problem. These days iatrogenic illness exceeds real illness thanks to the opportunity it opens for gain (see Fostering victim mentality), not so much for the professions as for the people who exploit its potential for compensation and invalidism. The prospect of electoral unpopularity explains why government avoids tackling it head on.
Typical of bandwagon iatrogenesis, an issue of the Medical Journal of Australia in April 2012 heralds “Suffering in silence, Australia’s unmanaged pain crisis”. And what is that crisis? More real pain? Hardly likely in a peaceful community. Of course a bandwagon need not spread vapid frivolities or bankrupt philosophies only. The same journal has pushed a particular cause more often than any other, indigenous health. In respect of its less worthy crusades it shares with all leading journals much the same mindless subservience to the catch cry of the moment. To take perhaps the most popular of mental health issues in recent decades, its full issue on depression mouthed all of the platitudes that have fostered the epidemic growth of the complaint and the enormous consumption of antidepressant drugs, while excluding any critical insight or worrying anomaly.
Only one aside in the issue on pain puts a revealing concern: “a limited referral base” or more specifically “a reluctance of general practitioners to refer patients”. Could pain clinics have been around long enough to make GPs aware of their ineffectiveness? My own clinical experience reveals the inevitable failure of an approach based on a totally incorrect principle (see Chap. 9, “Pain”, in “Welcome to the Loony Bin” or the Resource “Pain” in this blog). By addressing the symptom of pain instead of seeking out the cause of complaint pain specialists take to an extreme the atheoretical approach to diagnosis. An effect does not indicate the cause. Diagnosis that does not identify cause serves no useful purpose.
In one other aside the issue refers to the “complex regional pain syndrome”, which had its most spectacular appearance as repetitive strain injury (RSI) in Australia. The fact that the pain localises to a region betrays that it is “all in the mind” (see the section Chronic Pain Syndrome in “Pain”). To this day the profession does not admit its error. In 1971 the same journal published the paper by Ferguson that first put RSI on the map. It published the papers that promoted the epidemic that began in 1981 only in 1987 to denounce in an editorial its real nature as “mass hysteria”, oddly enough written by the same professor who invented it (Ferguson, 1987). I described it as an iatrogenic epidemic (Bell, 1986) in a paper that the editor blocked for publication for 18 months, not on grounds of invalidity but his apprehension that it lacked interest. After publication it became the most widely cited paper I have written. The more recent issue on depression provides no hint of the journal’s contribution to iatrogenesis. But then bandwagon journalism does not have that degree of insight or honesty.