Lessons from Ivan Illich.

Almost 30 years have passed since the initial publication of Ivan Illich’s Limits to Medicine. Medical Nemesis: The Expropriation of Health. A medieval historian who has been described as one of the world’s great thinkers, Illich introduced his iconoclastic work with the indictment, “the medical establishment has become a major threat to health.” The book makes a passing reference to radiology when the author argues in favour of a new ethical imperative to “act so that the effect of your action is compatible with the permanence of genuine human life,” giving the concrete application, “do not raise radiation levels unless you know that this action will not be visited on your grandchild.” The advice seems prescient in view of our recent concerns about the radiation dose from helical computed tomography (CT) scanning. However, for the most part Illich’s criticisms are more general and are aimed at the medical establishment as a whole.