Friday, March 15, 2013

 The Rise and Fall of Pharmacracy

By Christopher Kent, DC, JD

Psychiatrist Thomas S. Szasz (1) has written extensively on the
medicalization of American politics. Medicalization is defined as a
process or tendency whereby the phenomena, which had belonged to another
field such as education, law, religion, and so on, have been redefined as
medical phenomena. (2) Thus, medicalization is a process by which the
medical profession asserts authority over a sphere of life previously
overseen by guardians of morality.

Szasz describes the ideologies of legitimization: theocracy (God’s will);
democracy (consent of the governed); socialism (economic equality); and
pharmacracy (the therapeutic state). The emergence of the therapeutic
state is a product of the 20th century.

The Rise of Government in Health Care

From 1776 to 1914, the federal government played no role in civilian
medicine. In 1914, the first antinarcotic legislation was enacted. As the
century progressed, the federal government’s role in medicine exploded.

Szasz offers the following statistics:

    In 1950, funding for the National Institute for Mental Health was
less than $1 million. In 1992, it reached $1 billion.

    In 1965, when Medicare and Medicaid were enacted, their cost was
approximately $65 billion. In 1993, it was nearly $939 billion.

    Between 1960 and 1998, the public expenditure on health care
increased more than 100 times, from $35 to $3,633.

    In addition to these expenditures, government spending in general
went from a budget of $13.6 billion in fiscal 1941, to $1.65 trillion in

One of Szasz’s greatest insights is his description of the process where

coercion is transformed into medical therapy:

    1. The subject’s “condition” is diagnosed as a disease.
    2. The intervention imposed is defined as a treatment.
    3. Legislators and judges ratify these categorizations as “diseases”
and “treatments.”

Coercion Becomes a Public Health Measure

The traditional role of coercion as a public health measure dealt with
the transmission of communicable diseases. Persons with communicable
diseases were quarantined (as in measles) or banished (as in leprosy).
Yet as a growing number of behaviors were defined as “diseases” coerced
treatment was added to the armamentarium of public health and state

Medicalized conditions include such diverse conditions as gambling (3),
smoking (4), gun violence (5), and racism (6). Coercion is used not
merely to isolate those with communicable diseases, but to force
treatments on persons with tuberculosis, alcoholism, and a plethora of
mental illnesses where the subject is deemed a threat to “self and
others.” Children are particularly susceptible to coerced medical
interventions, ranging from vaccination to behavior modifying drugs for
such dubious diagnoses as ADD/ADHD. Even when parents elect alternative
courses of health care, courts have ordered dangerous treatments against
the wishes of both parents. Pharmacracy has led to an uncritical
deference for allopathic intervention by the legislatures and the courts.

Thankfully, pharmacracy is a 20th century paradigm. As we approached the
turn of the century (and the new millennium), a subtle revolution was
building steam. Despite economic disincentives, and medicine’s cultural
authority, Americans sought to reclaim control over their lives and
turned to “alternative” care in unprecedented numbers.

A study by Eisenberg (7) found that in 1990, 34 percent of the people
surveyed used at least one “unconventional” intervention in the past
year. Indeed, their visits to “alternative” practitioners exceeded visits
to primary care medical physicians in that year. A follow-up study (8) in
1997 reported that utilization of “alternative” health care had increased
to 42.1 percent. Total out-of-pocket expenditures doubled.

The trend is growing. Kessler (9) reported that 67.6 percent of those

surveyed had used at least one “complementary” or “alternative” approach
to health care in their lifetime. According to the article, utilization
by Baby Boomers is about half, and use by post-Baby Boomers (who have
reached the age of 33) is 70 percent.

A Wellness Revolution

The true revolution, however, is not in seeking different techniques for
treating disease. It is the emergence of a different perspective on the
human condition. This is the distinction between “alternative treatment”
and “wellness.” People have realized that valuable as medical treatment
may be in its proper context, it does not address vital, core issues
concerning the human condition.

Legendary economist Paul Zane Pilzer (10) has written, “What we call the
‘health care’ business is really the sickness business. The $1.4 trillion
we spend on medical care is concerned with treating the symptoms of
sickness. It has very little to do with being stronger or healthier.”
Pilzer predicts that wellness is destined to become a trillion dollar

Pilzer wrote, “I define ‘wellness’ as money spent to make you feel
healthier, even when you’re not ‘sick’ by any standard medical terms ...
As much as we focus on the financial and lifestyle benefits of the
business, the real benefit is what you can do to change a life -- and the
lives of all people who are touched by that life.”

Chiropractic is perfectly positioned to provide the leadership for the
wellness movement, which is both a revolution and a renaissance. We have
the opportunity to bring more fullness and joy to humanity than ever
before. Will we rise to the challenge, or abdicate our birthright by
limiting our vision? Open your mind, open your heart, and let your light
shine. Embrace the challenge and change the world.

Thank You   Christopher Kent, DC, JD

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