I thought Ronald Dworkin’s essay on Illich and medicine was thoughtful, fair, and critical in all the right places. This paragraph especially was a useful sympathetic summary:

Illich went beyond simple conspiracy theories to explain these events. It was more than just doctors or pharmaceutical companies pushing medicines to make money, he said, although that was part of it. More important, he suggested, was an iron triangle of support for the new approach: a public that wanted the quickest and surest route to happiness (“unrealistic expectations on the part of patient majorities”), doctors aspiring to manage everyday unhappiness scientifically—as if unhappiness were an engineering problem—and pharmaceutical companies eager to meet the new demand while putting their fingers on the scale when regulators tested their products.

Followed by this long paragraph:

Here is one application of Marx’s ideas to contemporary American health that follows Illich’s approach. A growing population needs more food. The market produces mass quantities of cheap, highly processed food to satisfy the need. This leads to more cases of obesity, type 2 diabetes, and high cholesterol. The market invents diabetes and high-cholesterol medications to meet these new needs, tying patients closer to medicine. Persistent obesity also leads to low self-esteem and depression among the population. To meet these needs the market invents diet food and regimens, as well as therapists and counselors to attack the problem of low self-esteem directly. But crash diets and diet food often make people hungrier and cause even more weight gain. Meanwhile, therapists and counselors—whose services allow people to shed friends and family as confidants—can be expensive. Inevitably, more new needs arise. The market addresses the need for more urgent weight loss through Ozempic-like medications; for cheaper self-esteem through antidepressants; for cheaper companionship and counseling through telehealth and chatbots. Patients are tied even more closely to market solutions and professional medicine. Yet these solutions, of course, create new problems, such as “Ozempic face” stemming from rapid fat loss, and therefore new needs. The market comes to the rescue with new plastic surgeries for repair, including new dermal fillers to return volume to people’s faces—and the dialectical cycle goes on and on. Illich deserves credit for applying early Marxian ideas to the medical profession. He didn’t invent the intellectual paradigm, but he applied it in an original and insightful way to diagnose new problems.