Viro­lo­gy as Ideo­lo­gy – Part 2: The Mili­ta­ry-Aca­de­mic-Indus­tri­al-Med­ico-Sci­en­ti­fic com­plex (MAIMS)

Lese­zeit45 min

This is the second install­ment of a four part essay seria­li­zed in the Mag­Ma. It con­ta­ins the fol­lo­wing parts: 

  1. Sci­ence and Class Society
  2. The Mili­ta­ry-Aca­de­mic-Indus­tri­al-Med­ico-Sci­en­ti­fic Com­plex (MAIMS)
  3. Viro­lo­gy as Ideology 
  4. Their Sci­ence and Our Science

Part 2: The Mili­ta­ry-Aca­de­mic-Indus­tri­al-Med­ico-Sci­en­ti­fic Com­plex (MAIMS)

What do the­se enemies of the human race look like? Do they wear on their fore­heads a sign so that they may be told, shun­ned and con­dem­ned as cri­mi­nals? No. On the con­tra­ry. They are the respec­ta­ble ones. They are hono­red. They call them­sel­ves, and are cal­led, gen­tle­men. What a tra­ves­ty on the name, Gen­tle­men! They are the pil­lars of the sta­te, of the church, of socie­ty. They sup­port pri­va­te and public cha­ri­ty out of the excess of their wealth. They endow insti­tu­ti­ons. In their pri­va­te lives they are kind and con­side­ra­te. They obey the law, their law, the law of pro­per­ty. But the­re is one sign by which the­se gent­le gun­men can be told. Threa­ten a reduc­tion on the pro­fit of their money and the beast in them awa­kes with a snarl. They beco­me ruthl­ess as sava­ges, bru­tal as mad­men, remor­se­l­ess as exe­cu­tio­ners. Such men as the­se must peri­sh if the human race is to con­ti­nue. The­re can be no per­ma­nent peace in the world while they live. Such an orga­niza­ti­on of human socie­ty as per­mits them to exist must be abolished.

The­se men make the wounds.

Nor­man Bethu­ne, Wounds[1]

Sci­ence is a pro­duct of the socie­ty that owns it. Whe­re does that lea­ve us? As sci­en­tists, on the one hand, we are see­kers of know­ledge, that’s what brought us into sci­ence in the first place, we’re peo­p­le wan­ting to alle­via­te suf­fe­ring. On the other hand, we’re employ­ed – we worry about jobs, worry about fun­ding, in that sen­se, we are the wage-labo­rers of the theo­ry-mines, not too dif­fe­rent from the wea­vers of Lan­cashire, and other sec­tions which were first, ori­gi­nal­ly free pro­fes­si­ons, and then gra­du­al­ly beca­me pro­le­ta­ria­ni­zed, so that now con­tin­gent labor, part-time labor, adjunct labor, is part of the pro­cess of the loss of inde­pen­dence. We alre­a­dy do not con­trol the agen­da of our rese­arch or the con­di­ti­ons of work. We cer­tain­ly do not con­trol what beco­mes of the pro­ducts of our labor.

Richard Levins, »The Two Faces of Science«

Cor­po­ra­te Sna­ke Oil

We must first over­co­me a super­fi­ci­al and ina­de­qua­te cri­tique that pre­vails in many Left­wing cir­cles, and which tends to ser­ve as a sort of thought-ter­mi­na­ting cli­ché which hin­ders a deeper exami­na­ti­on of real his­to­ri­cal cir­cum­s­tances. Cor­po­ra­te medi­cal and sci­en­ti­fic firms are often accu­sed of pro­fi­te­e­ring – e.g., over­char­ging for valuable com­mo­di­ties through patents, mono­po­lies, regu­la­to­ry cap­tu­re etc. They are also accu­sed of rest­ric­tion and con­trol of medi­cal infor­ma­ti­on, for the pur­po­se of main­tai­ning mono­po­ly posi­ti­ons and extra­c­ting rents– thus ser­vices like Libra­ry Gene­sis of Z‑Library, which obvious­ly would lead to more sci­ence being pro­du­ced, par­ti­cu­lar­ly by sci­en­tists in the third-world, are ruthl­ess­ly per­se­cu­ted. The­re is much truth to the­se cri­ti­cisms, and they cer­tain­ly com­ple­ment the gene­ral argu­ment that cur­rent con­di­ti­ons are not sui­ta­ble to sci­en­ti­fic flourishing.

Howe­ver, the major flaw in the­se cri­ti­ques which this sec­tion will seek to address, is the assump­ti­on that the com­mo­di­ties pro­du­ced by what I will call the MAIMS (Mili­ta­ry-Aca­de­mic-Indus­tri­al-Med­ico-Sci­en­ti­fic) com­plex always car­ry a genui­ne use-value for con­su­mers. It is here that a full under­stan­ding of mono­po­liza­ti­on, finan­cia­liza­ti­on, and impe­ria­lism seems to fade away, and a quaint pic­tu­re of hal­cyon capi­ta­list com­pe­ti­ti­on takes its place, con­scious­ly or not. Such cri­ti­ques tend to ima­gi­ne that con­su­mers are in a rela­tively decent posi­ti­on to assess whe­ther med­ico-sci­en­ti­fic com­mo­di­ties are in fact good for them (in the short, medi­um, or long term); that govern­ment agen­ci­es tend to make purcha­ses in the inte­rest of their popu­la­ti­ons, acqui­ring (and even impo­sing upon them) pro­ducts and ser­vices that do bene­fit them; and that infe­ri­or, or at the very least, use­l­ess and dan­ge­rous pro­ducts will not sur­vi­ve the test of both regu­la­ti­on and the com­pe­ti­ti­ve market.

As will be shown below, howe­ver, this could not be far­ther from rea­li­ty. Inde­ed, the car­te­liza­ti­on which cha­rac­te­ri­zes this sphe­re is so pro­found and per­va­si­ve that it real­ly demands a new con­cept– becau­se it also ent­ails the mas­si­ve regu­la­to­ry cap­tu­re of agen­ci­es sup­po­sedly tas­ked with scru­ti­ni­zing the­se indus­tries, such that they are in fact total­ly behol­den to them. Moreo­ver, a lar­ge and ever gro­wing por­ti­on of medi­cal pro­ducts and ser­vices are not cho­sen by con­su­mers at all, but by pro­vi­ders, insu­r­ers, and govern­ments (often and ever-incre­asing­ly in col­lu­si­on). Pro­ducts such as vac­ci­nes are direct­ly or indi­rect­ly forced upon con­su­mers by govern­ments, employ­ers, and schools. Ivan Illich tra­ced some of the pecu­li­ar cha­rac­te­ristics of medi­cal care as com­mo­di­ty which made it, one the one hand, some­what ill sui­ted to sub­sump­ti­on under nor­mal capi­ta­list rela­ti­ons, while on the other, uni­que­ly appro­pria­te to the super-mono­po­ly and super-mon­op­so­ny rela­ti­ons that cha­rac­te­ri­ze capi­ta­lism today:

Medi­cal care is uncer­tain and unpre­dic­ta­ble; many con­su­mers do not desi­re it, do not know they need it, and do not know in advan­ce what it will cost them. They can­not learn from expe­ri­ence. They must rely on the sup­pli­er to tell them if they have been well ser­ved, and they can­not return the ser­vice to the sel­ler or have it repai­red. Medi­cal ser­vices are not adver­ti­sed as other goods, and the pro­du­cer dis­cou­ra­ges com­pa­ri­son. Once he has purcha­sed, a con­su­mer can­not chan­ge his mind mid-tre­at­ment. By defi­ning what con­sti­tu­tes ill­ness the medi­cal pro­du­cer has the power to sel­ect his con­su­mer and to mar­ket some pro­ducts that will be forced on the con­su­mer, if need be, by the inter­ven­ti­on of the poli­ce: the pro­du­cers can even sell for­ci­b­le intern­ment for the dis­ab­led and asyl­ums for the men­tal­ly retard­ed. Mal­prac­ti­ce lawsuits have miti­ga­ted the layman’s sen­se of impo­tence on seve­ral of the­se points, but basi­cal­ly, they have rein­forced the patient’s deter­mi­na­ti­on to insist on tre­at­ment that is con­side­red ade­qua­te by infor­med medi­cal opi­ni­on.[2]

This can­not be redu­ced to simp­le capi­ta­list relations.

The nai­ve view also for­gets (in a high­ly sel­ec­ti­ve fashion) the peren­ni­al human phe­no­me­non of sna­ke-oil: that in the sphe­re of medi­cal care in par­ti­cu­lar, humans are vul­nerable to decep­ti­on and fraud. As the his­to­ri­an of medi­ci­ne Roy Por­ter obser­ved, »the pro­mi­nence of medi­ci­ne has lain only in small mea­su­re in its abili­ty to make the sick well. This was always true, and remains so today.«[3] While decep­ti­ve prac­ti­ces are ack­now­led­ged, and the sup­pres­si­on of side-effects at least used to be a very com­mon cri­ti­cism lever­a­ged by lef­tists (befo­re such con­side­ra­ti­ons were prompt­ly ban­ned with the roll out of Covid vac­ci­na­ti­ons), few are wil­ling to con­tem­p­la­te the true ext­ent of fraud at the very core of much medi­cal sci­ence. This is despi­te the remar­kab­ly tel­ling fact that, quite open­ly, most phar­maceu­ti­cal indus­tries spend more on mani­pu­la­ting the popu­la­ti­on into buy­ing their pro­ducts than they do on rese­arch and deve­lo­p­ment. For ins­tance, nine out of ten major phar­maceu­ti­cal indus­tries spent more – often sub­stan­ti­al­ly more- on sales and mar­ke­ting than on rese­arch and deve­lo­p­ment in 2013.[4]

It is important, moreo­ver, to not nai­vely ana­ly­ze this as invest­ment mere­ly in per­sua­ding peo­p­le through adver­ti­se­ments. As Lopez notes, »a lot of the mar­ke­ting the­se com­pa­nies do is spe­ci­fi­cal­ly tar­ge­ted toward phy­si­ci­ans,«[5] i.e., brib­ing health-care pro­vi­ders, who­se power of pre­scrip­ti­on, not to men­ti­on their per­so­nal influence as ›trus­ted figu­res‹ pro­found­ly com­pli­ca­tes the nexus bet­ween appa­rent ›buy­er‹ and ›sel­ler‹ in such an equa­ti­on. The com­po­nent spent on osten­si­bly con­ven­tio­nal adver­ti­sing, like com­mer­cials, can­not be uncri­ti­cal­ly or nai­vely trea­ted here eit­her. Major news pro­vi­ders sell not only the ›eyes and ears‹ of view­ers for spe­ci­fic com­mer­cials, but more important­ly favorable covera­ge (pro­pa­gan­da). This is why the mono­po­ly aspect and the ext­ent of con­cen­tra­ti­on is essen­ti­al to app­re­cia­te. In 2018, for ins­tance, the lar­gest adver­ti­ser for every major cable news pro­vi­der in the USA was haw­king some osten­si­bly medi­cal pro­duct.[6] This amounts to awe­so­me influence over news covera­ge, and a major source of bias and self-censorship.

What is par­ti­cu­lar­ly gla­ring in this respect is that tho­se most unwil­ling to con­tem­p­la­te the depth of fraud and decep­ti­on under­ta­ken by the MAIMS com­plex con­sis­t­ent­ly dis­miss, per­emp­to­ri­ly and wit­hout the sligh­test inves­ti­ga­ti­on, all cri­ti­ques of it as dri­ven by fraud and grift. Honest, decent prac­ti­tio­ners of alter­na­ti­ve medi­ci­ne or nut­ri­ti­on are slan­de­red and denoun­ced. Vac­ci­ne skep­ti­cism is per­sis­t­ent­ly and absurd­ly attri­bu­ted to the pro­fi­te­e­ring sche­mes of some alter­na­ti­ve health grift­ers, while of cour­se the inten­ti­ons of the major vac­ci­ne pro­du­cers – despi­te all being, as cor­po­ra­te per­sons, con­vic­ted cri­mi­nals – are assu­med to be as pure as the dri­ven snow (or in more sophisti­ca­ted forms, assu­med to be effec­tively forced by the mar­ket or regu­la­tors to pro­du­ce good pro­ducts which they mere­ly over­char­ge for). The­re is, wit­hout a doubt, fraud, deceit, and grift in the natu­ral and alter­na­ti­ve health world. Howe­ver, it is not­hing com­pared to that which exists in sup­po­sedly legi­ti­ma­te cor­po­ra­te-con­trol­led main­stream medi­cal sci­ence. This, among other reasons, is becau­se of the much more genui­ne and com­pe­ti­ti­ve mar­ket, aimed at a much more cri­ti­cal class of con­su­mers, towards which the for­mer is oriented.

The aut­hor dis­cus­ses his views in the abo­ve pod­cast from »What’s Left?«

Yet a mas­si­ve and high­ly effec­ti­ve psy­cho­lo­gi­cal ope­ra­ti­on has mana­ged to utter­ly invert com­mon sen­se here, and instill the absurd idea in many that anyo­ne try­ing to make an honest living sel­ling alter­na­ti­ve health care of any sort must be a mali­cious fraud, whe­re­as the cra­ven, oppor­tu­ni­stic sci­en­tists and doc­tors who work for the MAIMS com­plex can sim­ply tell no lies. Health­ca­re pro­vi­ders, sci­en­tists, and rese­ar­chers who work for MAIMS are pic­tu­red as idea­li­stic lovers of huma­ni­ty, and are for­gi­ven of all sins of embroilm­ent in the mar­ket wit­hout a second thought.

On the other hand, sci­en­tists, rese­ar­chers, and health-care pro­vi­ders who deci­de to cri­ti­ci­ze, or even­ly sim­ply pre­sent an alter­na­ti­ve to MAIMS face over­whel­ming social and eco­no­mic risks: they face pen­ury, the loss of medi­cal licen­ses, lawsuits backed (open­ly or covert­ly) by govern­ments and cor­po­ra­ti­ons, social ost­ra­ciza­ti­on, or even, as in the case of Bran­dy Vaug­han, pos­si­ble ass­as­si­na­ti­on. Yet when such indi­vi­du­als make even the most mode­st attempts to secu­re their own exis­tence and liveli­hoods, the self-same defen­ders of cor­po­ra­te lackeys break out into the most hys­te­ri­cal indi­gna­ti­on at »pro­fi­te­e­ring grift­ers.« It is extre­me­ly dif­fi­cult to reason with the­se »lovers of sci­ence,« espe­ci­al­ly if one tou­ch­es upon issues in which they have deep­ly ent­rai­ned psy­chic invest­ments, such as vac­ci­nes. One can hard­ly be sur­pri­sed by this fact, howe­ver – tho­se »adver­ti­sing« bud­gets have cer­tain­ly not gone to waste.

Medi­cal Society

In his 1975 work Medi­cal Neme­sis, Ivan Illich laun­ched a powerful cri­tique of the pro­gres­si­ve cor­rup­ti­on of wes­tern socie­ties by indus­tria­li­zed medi­ci­ne, which is worth quo­ting from here at some length. As he obser­ved, socie­ty was being »rear­ran­ged for the sake of the health-care sys­tem,« with the con­se­quence that it was beco­ming »incre­asing­ly dif­fi­cult to care for one’s own health. Goods and ser­vices lit­ter the domains of free­dom.«[7] He tra­ced this back to the strong pre­dis­po­si­ti­on towards ato­miza­ti­on and rei­fi­ca­ti­on which have cha­rac­te­ri­zed the bour­geois era:

Anti­qui­ty knew no yard­stick for dise­a­se. Galileo’s con­tem­po­r­a­ri­es were the first to try to app­ly mea­su­re­ment to the sick, but with litt­le suc­cess. Sin­ce Galen had taught that uri­ne was secre­ted direct­ly from the vena cava and that its com­po­si­ti­on was a direct indi­ca­ti­on of the natu­re of blood, doc­tors had tas­ted and smel­led uri­ne and assay­ed it by the light of sun and moon. After the 16th cen­tu­ry, alche­mists had lear­ned to mea­su­re spe­ci­fic gra­vi­ty with con­sidera­ble pre­cis­i­on, and they sub­jec­ted the uri­ne of the sick to their methods. Dozens of distinct and dif­fe­ring mea­nings were ascri­bed to chan­ges to read dia­gno­stic and cura­ti­ve mea­ning into any new mea­su­re­ment they lear­ned to per­form. The use of phy­si­cal mea­su­re­ments pre­pared for a belief in the real exis­tence of dise­a­ses and their onto­lo­gi­cal auto­no­my from the per­cep­ti­on of doc­tor and pati­ent. The use of sta­tis­tics under­pin­ned this belief. It ›show­ed‹ that dise­a­ses were pre­sent in the envi­ron­ment and could inva­de and infect peo­p­le.[8]

We note in pas­sing here the inte­res­t­ing his­to­ri­cal fact that the first cli­ni­cal test using sta­tis­tics, which pur­por­ted to pro­vi­de »hard data indicat[ing] that small­pox was threa­tening Mas­sa­chu­setts and that peo­p­le who had been ino­cu­la­ted were pro­tec­ted against its attacks« were car­ri­ed out in 1721 by Cot­ton Mather.[9] Mather’s spi­ri­ted cam­paign for both qua­ran­ti­ne and ino­cu­la­ti­on to com­bat small­pox eli­ci­ted inten­se resis­tance from the popu­la­ti­on of Bos­ton, cul­mi­na­ting in a gre­na­de attack on his home.[10] That vac­ci­na­tio­nists don’t more fre­quent­ly cele­bra­te this illus­trious for­ebear of theirs may have some­thing to do with the fact that histo­ry had ten­ded to remem­ber him chief­ly for his invol­vement in the Salem Witch Tri­als and zea­lous defen­se of the exis­tence of wit­ches. The ent­an­gle­ment of both Witch-Hun­ting and the Sci­en­ti­fic Revo­lu­ti­on with the gene­ral strugg­le to sub­or­di­na­te and pro­le­ta­ria­ni­ze the res­ti­ve peas­an­try has been bril­li­ant­ly explo­red by Sil­via Fede­ri­ci in her work Cali­ban and the Witch. The­re, she noted that

In Mecha­ni­cal Phi­lo­so­phy we per­cei­ve a new bour­geois spi­rit that cal­cu­la­tes, clas­si­fies, makes distinc­tions, and degra­des the body only to ratio­na­li­ze its facul­ties, aiming not just at inten­si­fy­ing its sub­jec­tion but at maxi­mi­zing its social uti­li­ty … Cer­tain­ly, neither Hob­bes nor Des­car­tes spent many words on eco­no­mic mat­ters, and it would be absurd to read into their phi­lo­so­phies the ever­y­day con­cerns of the Eng­lish or Dutch mer­chants. Yet we can­not fail to see the important con­tri­bu­ti­on which their spe­cu­la­ti­ons on human natu­re gave to the emer­ging capi­ta­list sci­ence of work. To pose the body as mecha­ni­cal mat­ter, void of any intrin­sic teleo­lo­gy … was to make intel­li­gi­ble the pos­si­bi­li­ty of sub­or­di­na­ting it to a work pro­cess that incre­asing­ly reli­ed on uni­form and pre­dic­ta­ble forms of beha­vi­or. Once its devices were decon­s­truc­ted and it was its­elf redu­ced to a tool, the body could be ope­ned to an invi­te mani­pu­la­ti­on of its power and pos­si­bi­li­ty. One could inves­ti­ga­te the vices and limits of ima­gi­na­ti­on, the vir­tu­es of habit, the uses of fear, how cer­tain pas­si­ons can be avo­ided or neu­tra­li­zed, and how they can be more ratio­nal­ly uti­li­zed. In this sen­se, Mecha­ni­cal Phi­lo­so­phy con­tri­bu­ted to incre­asing the ruling-class con­trol over the natu­ral world, con­trol over human natu­re being the first, most indis­pensable step. Just as natu­re, redu­ced to a ›Gre­at Machi­ne,‹ could be con­que­r­ed … like­wi­se the body, emp­tied of its occult forces, could be ›caught in a sys­tem of sub­jec­tion,‹ wher­eby its beha­vi­or could be cal­cu­la­ted, orga­ni­zed, tech­ni­cal­ly thought and inves­ted of power rela­ti­ons.[11]

It is important to stress that, of cour­se, the mecha­ni­stic and ato­mi­stic model of the world did yield novel and real insights, did real­ly enable the more effi­ci­ent explo­ita­ti­on of natu­re and man. This does not fore­c­lo­se it beco­ming, sub­se­quent­ly, a fet­ter to fur­ther sci­en­ti­fic deve­lo­p­ment, nor does it mean we can ful­ly under­stand its emer­gence and per­sis­tence wit­hout con­tex­tua­li­zing it the histo­ry of the bourgeoisie’s strugg­le for social, poli­ti­cal, and eco­no­mic dominance.

Illich notes that as late as the mid-1800s, one could still find Galen quo­ted with appr­oval in decla­ring that »You can dis­co­ver no weight, no form nor cal­cu­la­ti­on to which to refer your judgment of health and sick­ness. In the medi­cal arts the­re exists no cer­tain­ty except in the physician’s sen­ses.«[12] Robert Koch’s famous for­mu­la­ti­on of the Germ Theo­ry towards the end of the cen­tu­ry – which, as Lewon­tin notes, it had no impact that can be detec­ted in any gene­ral metrics of health or well-being[13] – marks an evi­dent sea-chan­ge. Illich traces a transformation

as the doctor’s inte­rest shifted from the sick to sick­ness, the hos­pi­tal beca­me a muse­um of dise­a­se … the rea­liza­ti­on that the hos­pi­tal was the logi­cal place to stu­dy and compa­re ›cases‹ deve­lo­ped towards the end of the 18th cen­tu­ry … The cli­ni­cal approach to sick­ness gave birth to a new lan­guage which spo­ke about the dise­a­ses at the bedside, and to a hos­pi­tal reor­ga­ni­zed and clas­si­fied by dise­a­se for the exhi­bi­ti­on of ailm­ents to stu­dents … During the enti­re nine­te­enth cen­tu­ry, patho­lo­gy remain­ed over­whel­mingly the clas­si­fi­ca­ti­on of ana­to­mic­al anoma­lies. Only towards the end of the cen­tu­ry did the pupils of Clau­de Ber­nard also begin to label and cata­log the patho­lo­gy of func­tions. Like sick­ness, health acqui­red a cli­ni­cal sta­tus, beco­ming the absence of cli­ni­cal sym­ptoms, and cli­ni­cal stan­dards of nor­ma­li­ty beca­me asso­cia­ted with well-being.[14]

By 1975, howe­ver, Illich argued that

the age of hos­pi­tal medi­ci­ne, which from rise to fall las­ted no more than a cen­tu­ry and a half, is come to an end. Cli­ni­cal mea­su­re­ment has been dif­fu­sed throug­hout socie­ty. Socie­ty has beco­me a cli­nic, and all citi­zens have beco­me pati­ents who­se blood pres­su­re in con­stant­ly being wat­ched and regu­la­ted to fall ›within‹ nor­mal limits. The acu­te pro­blems of man­power, money, access, and con­trol that beset hos­pi­tals ever­y­whe­re can be inter­pre­ted as sym­ptoms of a new cri­sis in the con­cept of dise­a­se. This is a true cri­sis becau­se it admits of two oppo­sing solu­ti­ons, both of which make pre­sent hos­pi­tals obso­le­te.[15]

Like an ever con­stric­ting vice, cor­po­ra­te wes­tern medi­ci­ne has ela­bo­ra­ted a bat­tery of tests, metrics, mea­su­res, and other dia­gno­stics which have ser­ved to incre­asing­ly pre­clude, ost­ra­ci­ze, or even cri­mi­na­li­ze an unme­di­ca­ted exis­tence. This occurs through not just mar­ke­ting or pres­su­re from (well-sub­si­di­zed and hea­vi­ly indoc­tri­na­ted) health­ca­re pro­fes­sio­nals, but through col­lu­si­on with insu­rance com­pa­nies, poli­cy-makers, social ser­vices pro­vi­ders, edu­ca­tio­nal insti­tu­ti­ons, and the judi­cia­ry. Inva­ria­bly, this is refrac­ted through modern capitalism’s other tech­no­lo­gies of social con­trol, impac­ting most bru­t­ally racial, gen­der, and sexu­al mino­ri­ties, as well as women and child­ren. Ina May Gas­kin and Jen­ni­fer Mar­gu­lis[16], for ins­tance, have docu­men­ted in powerful terms how the pro­cess of birth in wes­tern capi­ta­list nati­ons has been trans­for­med by cor­po­ra­te medi­ci­ne into a cruel, irra­tio­nal, dehu­ma­ni­zing, and trau­ma­tiz­ing gaunt­let for women and their child­ren (befo­re and after birth). Illich obser­ves that:

An advan­ced indus­tri­al socie­ty is sick-making becau­se it dis­ables peo­p­le from coping with their envi­ron­ment and, when they break down, sub­sti­tu­tes a ›cli­ni­cal‹ or the­ra­peu­tic, pro­sthe­sis for the bro­ken rela­ti­onships. Peo­p­le would rebel against such an envi­ron­ment if medi­ci­ne did not explain their bio­lo­gi­cal dis­ori­en­ta­ti­on as a defect in their health, rather than as a defect in the way of life which is impo­sed on them or which they impo­se on them­sel­ves.[17]

It is important here to stress the dif­fe­rence bet­ween this cri­tique and the social-dar­wi­nist argu­ment that a socie­ty wea­k­ens its­elf by trea­ting the ill or dis­ab­led. The point is not that peo­p­le should not be trea­ted or cared for, but that the cur­rent social arran­ge­ments dic­ta­te that the tre­at­ment and care they are likely to recei­ve is ina­de­qua­te and often coun­ter-pro­duc­ti­ve, and that they can and should be cared for bet­ter. And the best way to ensu­re that is pre­cis­e­ly by ensu­ring that they are maxi­mal­ly enfran­chised, infor­med, and invol­ved in their own tre­at­ment. By con­trast, one could not hard­ly ima­gi­ne an arran­ge­ment less likely to pro­du­ce good tre­at­ment than one, like our own, in which tho­se recei­ving tre­at­ment or care are maxi­mal­ly dis­em­powered and sub­jec­ted to a health­ca­re appa­ra­tus which is mas­si­ve­ly incen­ti­vi­zed to do them harm. Inde­ed, it is a remar­kab­le – and mas­si­ve­ly sup­pres­sed – fact that an incre­di­ble pro­por­ti­on of modern medi­cal care exists sim­ply to cor­rect the ills cau­sed, direct­ly or indi­rect­ly, by pri­or medi­cal inter­ven­ti­ons. Illich, for ins­tance, cites a »seni­or offi­ci­al of the U.S. Depart­ment of Health, Edu­ca­ti­on, and Wel­fa­re« who reti­red in 1973 who obser­ved that »80 per­cent of all funds chan­ne­led through his office pro­vi­ded no demons­tra­ble bene­fits to health and that much of the rest was spent to off­set iatro­ge­nic dama­ge.«[18] Illich fur­ther con­ten­ded that:

The over­whel­ming majo­ri­ty of dia­gno­stic and the­ra­peu­tic inter­ven­ti­ons that demons­tra­b­ly do more good than harm have two cha­rac­te­ristics: the mate­ri­al resour­ces for them are extre­me­ly cheap, and they can be packa­ged and desi­gned for self-use or appli­ca­ti­on by fami­ly mem­bers. For exam­p­le, the cost of what is signi­fi­cant­ly health-fur­the­ring in Cana­di­an medi­ci­ne is so low that the­se same resour­ces could be made available to the enti­re popu­la­ti­on of India for the amount of money now squan­de­red the­re on modern medi­ci­ne. The skills nee­ded for the appli­ca­ti­on of the most gene­ral­ly used dia­gno­stic and the­ra­peu­tic aids are so ele­men­ta­ry that the careful fol­lo­wing of ins­truc­tions by peo­p­le who are per­so­nal­ly con­cer­ned would pro­ba­b­ly gua­ran­tee more effec­ti­ve and respon­si­ble use than medi­cal prac­ti­ce ever could. Most of what remains could pro­ba­b­ly be hand­led bet­ter by ›bare­foot‹ non­pro­fes­sio­nal ama­teurs with deep per­so­nal com­mit­ment than by pro­fes­sio­nal phy­si­ci­ans, psych­ia­trists, den­tists, mid­wi­ves, phy­sio­the­ra­pists, or ocu­lists.[19]

Illich, here, pro­ba­b­ly bends the stick too far – it is of cour­se pos­si­ble that more com­plex medi­cal ser­vices could be desi­ra­ble and bene­fi­ci­al, but for them to be so, we would need a social arran­ge­ment in which such com­ple­xi­ty did not com­pro­mi­se trans­pa­ren­cy or demo­cra­tic popu­lar con­trol. We will expand upon this pro­s­pect in Part 4. Illich’s pre­sen­ta­ti­on is also cha­rac­te­ri­zed by an ultra-left devia­ti­on which ascri­bes too much agen­cy to self-per­pe­tua­ting cul­tu­ral trends, rather than pro­per­ly con­tex­tua­li­zing them in a mate­ria­list account of the class strugg­le. This is cha­rac­te­ristic of Fou­cal­di­an-style genea­lo­gies, and has the upshot of exces­si­ve­ly bla­ming the mas­ses them­sel­ves for their sup­po­sed com­pli­ci­ty in what is impo­sed upon them.

Within the move­ment which has coale­s­ced around resis­ting the Coro­na mea­su­res, this mis­an­thro­pic per­spec­ti­ve has found a signi­fi­cant base in pet­ty-bour­geoi­sie ›dis­si­dents‹ and ›cri­tics,‹ who are always attrac­ted to a frame­work which enables them to bla­me the mas­ses and excul­pa­te the ruling class. This per­spec­ti­ve, howe­ver, can only be main­tai­ned by a deni­al of the over­whel­ming power and influence of the MAIMS com­plex (and the ruling class them­sel­ves, who wield it in pur­su­it of their own interests).

Con­cen­tra­ti­on, Car­te­liza­ti­on, Cor­rup­ti­on: Grounds for Medi­cal Nihilism?

It is not mere­ly in the direct­ly mar­ket-facing sec­tors of the MAIMS com­plex that fraud, deceit, and cor­rup­ti­on are the norm. Any sort of tho­rough eco­no­mic ana­ly­sis of the mono­po­ly trends in this sphe­re is bey­ond the scope of this paper, and an exis­ting stu­dy cove­ring this mate­ri­al is unknown to the aut­hor (its­elf, per­haps, a tel­ling fact). For the pre­sent pur­po­ses, howe­ver, it should be suf­fi­ci­ent here to mere­ly cite some of the more signi­fi­cant evi­dence for the fact that an inter­lin­ked net­work of car­tels have achie­ved a degree of con­trol, not only over the mar­ket, but over a wide array of regu­la­to­ry mecha­nisms, such as to con­sti­tu­te a rela­ti­onship which tran­s­cends mono­po­ly tra­di­tio­nal­ly conceived.

This has rea­ched such a point that even bour­geois scho­lars, rese­ar­chers, sci­en­tists, and doc­tors from within or adja­cent to MAIMS have been pushed to fun­da­men­tal­ly ques­ti­on the basic trust­wort­hi­ness of modern medi­cal rese­arch tout court. In his 2018 work Medi­cal Nihi­lism, Jacob Ste­genga per­sua­si­ve­ly defends the radi­cal pro­po­sal that the ext­ent and pro­fun­di­ty of cor­rup­ti­on in medi­cal sci­ence, along with a dearth of mecha­nisms for rec­ti­fy­ing it, mean that »the­re are fewer effec­ti­ve medi­cal inter­ven­ti­ons than most peo­p­le assu­me and that our con­fi­dence in medi­cal inter­ven­ti­ons ought to be low, or at least much lower than is now the case.«[20] We will return in more depth to Stegenga’s core argu­ments sub­se­quent­ly, for now, his sur­vey of skep­ti­cal state­ments from pro­mi­nent figu­res is worth quo­ting at length:

The work writ­ten by phy­si­ci­ans, epi­de­mio­lo­gists, and sci­ence jour­na­lists sup­port­ing medi­cal nihi­lism is vast (Recent examp­les include books by Mar­cia Angell (The Truth About Drug Com­pa­nies, 2004) Moy­ni­han and Cas­sels (Sel­ling Sick­ness, 2005) Carl Elliott (White Coat, Black Hat, 2010), Ben Gold­a­cer (Bad Phar­ma, 2012), and Peter Gøtz­sche (Dead­ly Medi­ci­nes and Orga­ni­zed Crime, 2013), and artic­les by epi­de­mio­lo­gists such as John Ioann­idis, Lisa Bero, Peter Jüni, and Jan Van­deb­rou­cke). The­se thin­kers are not cran­ky out­si­ders, but rather are among the most pro­mi­nent and respec­ted phy­si­ci­ans and epi­de­mio­lo­gists in the world. For ins­tance, the for­mer edi­tor of one of the top medi­cal jour­nals has clai­med that ›only a handful of tru­ly important drugs have been brought to mar­ket in recent years‹ while the majo­ri­ty are ›drugs of dubio­us bene­fit‹ (Angell 2004). Or con­sider the posi­ti­on of the epi­de­mio­lo­gist John Ioann­idis, sug­gested by the title of his important artic­le: ›Why Most Published Rese­arch Fin­dings Are Fal­se‹ (2005). The cur­rent edi­tor of ano­ther emi­nent medi­cal jour­nal recent­ly had this to say about con­tem­po­ra­ry medi­cal sci­ence: ›Aff­lic­ted by stu­dies with small sam­ple sizes, tiny effects, inva­lid explo­ra­to­ry ana­ly­ses, and fla­grant con­flicts of inte­rest , tog­e­ther with with an obses­si­on for pur­suing fashionable trends of dubio­us importance, sci­ence has taken a turn towards dark­ness‹ (Hor­ton, ›Off­line‹ 2015).[21]

What pre­cis­e­ly is the reason for such skep­ti­cism? First, let’s con­sider the cor­rup­ti­on of regu­la­to­ry agen­ci­es. A 2006 JAMA stu­dy found that in the FDA, in »73 per­cent of mee­tings at least one mem­ber of the con­sul­ting team in ques­ti­on had con­flicts of inte­rest« and that they, unsur­pri­sin­gly, »influen­ced voting beha­vi­or: When panel mem­bers with con­flicts of inte­rest were excluded from voting, the judgment of the pro­duct in ques­ti­on was much less favorable.« Despi­te this fact, »panel mem­bers with rele­vant con­flicts of inte­rest were dis­qua­li­fied in only 1 per­cent of cases.«[22] It is not mere­ly a mat­ter of sepa­ra­te indi­vi­du­al inte­rests, howe­ver. Thanks to legis­la­ti­on like the 1992 Pre­scrip­ti­on Drug User Fee Act, the govern­ment agen­ci­es which are meant to regu­la­te the phar­maceu­ti­cal indus­try have beco­me depen­dent on them for their own fun­ding. So cor­po­ra­te­ly, as an enti­ty, the enti­re FDA is com­pro­mi­sed: the more pro­fi­ta­ble the firms it regu­la­tes are, the more fun­ding the sup­po­sed regu­la­tors enjoy.[23] A full 45 per­cent of its bud­get curr­ent­ly comes from the indus­try.[24] The FDA is moreo­ver, depen­dent upon stu­dies con­duc­ted by the indus­try its­elf, and is tas­ked with sim­ply asses­sing the infor­ma­ti­on they pro­vi­de. It does not have the staff or capa­ci­ty to run its own stu­dies, or to try and repli­ca­te the stu­dies sub­mit­ted to it (and so, such stu­dies are vir­tual­ly never replicated).

The Natio­nal Child­hood Vac­ci­ne Inju­ry Act, pas­sed under Rea­gan in 1986, is even more illus­tra­ti­ve of the pro­found dyna­mic this paper, in con­junc­tion with my ear­lier pie­ce on impe­ria­lism,[25] seeks to high­light. In the 1970s, public con­cerns about ence­pha­lo­pa­thy were dri­ving down vol­un­t­a­ry upt­ake of the DPT vac­ci­ne, and vac­ci­ne rela­ted lawsuits were on the rise. By 1985, vac­ci­ne manu­fac­tu­r­ers were strugg­ling to obtain lia­bi­li­ty insu­rance. So, con­gress inter­ven­ed, remo­ving all lia­bi­li­ties from manu­fac­tu­r­ers and trans­fer­ring them to the govern­ment– which is to say, to the popu­la­ti­on, as tax-base, its­elf.[26] As a con­se­quence of the act, the U.S. Depart­ment of Health and Human Ser­vices (HSS) must defend appro­ved vac­ci­nes against any cla­im that they cau­se inju­ry in court, giving them a direct, strong incen­ti­ve to sup­press (or, at the very least, fail to fund and publish) any infor­ma­ti­on which could be used against them the­r­ein. Engel­brecht et. al. note the 2009 decis­i­on of Tom Insel, a high level HHS offi­ci­al, to kill a 16 mil­li­on stu­dy on the asso­cia­ti­on of vac­ci­na­ti­on and autism, upon the expli­cit grounds that it could be used against the HSS in vac­ci­ne court.[27]

The trans­fer of lia­bi­li­ty on to the popu­la­ti­on, and simul­ta­neous incen­ti­vi­za­ti­on of that population’s sup­po­sed regu­la­to­ry body to not expo­se any ills cau­sed by vac­ci­nes, have cer­tain­ly hel­ped save a com­mo­di­ty which in non-mono­po­ly con­di­ti­ons would’ve been houn­ded from the mar­ket. Inde­ed, sin­ce 1986, the num­ber of recom­men­ded ino­cu­la­ti­ons in the US went from 12 shots of 5 vac­ci­nes to 54 shots of 13, taking vac­ci­nes from a bil­li­on dol­lar side­line to a 50 bil­li­on dol­lar indus­try.[28] As Robert F. Ken­ne­dy Jr. has observed:

Sin­ce vac­ci­nes are lia­bi­li­ty-free – and effec­tively com­pul­so­ry to a cap­ti­ve mar­ket of 76 mil­li­on child­ren – the­re is a meager mar­ket incen­ti­ve for com­pa­nies to keep them safe … The four com­pa­nies that make vir­tual­ly all of the recom­men­ded vac­ci­nes are all con­vic­ted fel­ons. Coll­ec­tively they have paid over $35 bil­li­on sin­ce 2009 for defrau­ding regu­la­tors, lying to and brib­ing govern­ment offi­ci­als and phy­si­ci­ans, fal­si­fy­ing sci­ence, and lea­ving a trail of inju­ries and deaths from pro­ducts they knew to be dan­ge­rous and sold under pre­ten­se of safe­ty and effi­ca­cy.[29]

It should be noted that HHS employees them­sel­ves can direct­ly, per­so­nal­ly coll­ect up to 150,000$ annu­al­ly in royal­ties. For exam­p­le, key offi­ci­als coll­ect money on every sale of Merck’s HPV vac­ci­ne.[30] Robert F. Ken­ne­dy Jr. notes that:

The FDA recei­ves 45 per­cent of its annu­al bud­get from the phar­maceu­ti­cal indus­try. The World Health Orga­niza­ti­on (WHO) gets rough­ly half its bud­get from pri­va­te sources, inclu­ding Phar­ma and its allied foun­da­ti­ons. And the CDC, frank­ly, is a vac­ci­ne com­pa­ny; it owns 56 vac­ci­ne patents, and buys and dis­tri­bu­tes $4.6 bil­li­on in vac­ci­nes annu­al­ly through the Vac­ci­nes for Child­ren pro­gram, which is over 40 per­cent of its total bud­get.[31]

Nota­b­ly, a full 10 per­cent of the WHO’s bud­get comes from the Bill and Melin­da Gates Foun­da­ti­on alo­ne, making it the second lar­gest donor, just behind the USA.[32]

If regu­la­to­ry agen­ci­es can­not be trus­ted, some might argue that we can at least rely on science’s own inter­nal mecha­nisms and esprit de corp. This is hard­ly the case. A 2005 sur­vey of sci­en­tists in Natu­re found that a majo­ri­ty »admit­ted they would not avo­id decep­ti­ve acti­vi­ties, and would sim­ply brush to the side any data that did not suit their pur­po­ses.«[33] A 2006 report by Trans­pa­ren­cy Inter­na­tio­nal found that 40 per­cent of medi­cal stu­dies from 2005 were demons­tra­b­ly faked or mani­pu­la­ted by their spon­sors.[34] A point which this paper will no doubt bela­bor should none­thel­ess be recal­led here: medi­cal doc­tors and sci­en­tists were hea­vi­ly over-repre­sen­ted in the Nazi par­ty, which car­ri­ed out a prac­ti­ce groun­ded in the gro­tes­que pseu­do­sci­ence of euge­nics which was the domi­nant »sci­en­ti­fic con­sen­sus« in the capi­ta­list world at the time.

In his lec­tu­re on »The Two Faces of Sci­ence,« Richard Levins obser­ved that »the basic stra­te­gic pro­blem for the owners of sci­ence« is that »they need inno­va­ti­on … wit­hout the skep­ti­cism and the ico­no­clasm of the enligh­ten­ment.«[35] In short, they need what he terms a »bour­geois revo­lu­ti­on in sci­ence, but not in cul­tu­re.«[36] He argues that the prin­ci­ple way they achie­ve this is

by con­cen­t­ra­ting stu­dents in pro­gres­si­ve­ly nar­rower fields, rus­hing you through your trai­ning, saddling you with suf­fi­ci­ent debt so that you’ll be well beha­ved, and pre­ten­ding that that’s the expan­si­on of know­ledge… at the pre­sent time most bio­lo­gy depart­ments deal with the bio­lo­gy of a small spe­ci­es of orga­nisms, the­re are stu­dents who have got­ten their degrees in bio­lo­gy who have never wal­ked through a rain­fo­rest, or snor­ke­led a coral reef– who’ve never got­ten down, and wat­ched the litt­le crit­ters scat­ter in all direc­tions, or sat in the forest for a day and wat­ched the red­woods grow.[37]

Engel­brecht et. al. make a simi­lar obser­va­ti­on, not­ing that

most doc­tors them­sel­ves… have hard­ly more than a lay under­stan­ding of the con­cepts that loom on the hori­zons of mole­cu­lar bio­lo­gy … if you asked most doc­tors to defi­ne the unmist­aka­ble cha­rac­te­ristics of retro­vi­ru­s­es … they’d most likely shrug their should­ers or throw out a bewil­de­ring cryp­tic respon­se.[38]

Here we encoun­ter a struc­tu­ral con­tra­dic­tion which lies at the heart of sci­en­ti­fic pro­gress its­elf: the grea­ter the body of exis­ting sci­en­ti­fic know­ledge, the more anyo­ne wan­ting to pro­du­ce new sci­ence must learn by pro­xy rather than inde­pen­dent veri­fi­ca­ti­on– even at a secon­da­ry level or ter­tia­ry level. That is to say that not only can one not repro­du­ce and veri­fy the expe­ri­ments or stu­dies upon which one must rely, but one can­not even scru­ti­ni­ze tho­se stu­dies, or even suf­fi­ci­ent­ly scru­ti­ni­ze the media­ting insti­tu­ti­on which one must defer such scru­ti­ny too (e.g., a regu­la­to­ry or pro­fes­sio­nal body, a jour­nal, a uni­ver­si­ty, etc.). Inde­ed, even tho­se who want to advan­ce mere­ly as far as the alre­a­dy pro­du­ced limits within the nar­ro­west spe­cia­liza­ti­on must accept, wit­hout being able to veri­fy or even meaningful­ly assess, innu­me­ra­ble claims pro­du­ced in other fields.

The vali­ant defen­der of modern medi­cal sci­ence, by now no-doubt much aggrie­ved, sure­ly calls out in frus­tra­ti­on at this point: it is not a mat­ter of faith, or the ethics of indi­vi­du­al sci­en­tists! We have peer review! This insti­tu­ti­on is per­haps the most important pil­lar of the MAIMS mythos– yet how effec­ti­ve is it, actual­ly? Is it ade­qua­te to the task of rei­ning in the­se awe­so­me ten­den­ci­es towards cor­rup­ti­on and fraud? Richard Smith, the for­mer edi­tor of the high­ly estee­med Bri­tish Medi­cal Jour­nal (BMJ) obser­ved that »Peer review is slow, expen­si­ve, a prof­li­ga­te of aca­de­mic time, high­ly sel­ec­ti­ve, pro­ne to bias, easi­ly abu­sed, poor at detec­ting gross defects, and almost use­l­ess for detec­ting fraud.«[39] In 1991, he noted that the­re were

per­haps 30,000 bio­me­di­cal jour­nals in the world, and they have grown ste­adi­ly by 7 per­cent a year sin­ce the seven­te­enth cen­tu­ry. Yet only about 15 per­cent of medi­cal inter­ven­ti­ons are sup­port­ed by solid sci­en­ti­fic evi­dence … this is part­ly becau­se only 1 per­cent of the artic­les in medi­cal jour­nals are sci­en­ti­fi­cal­ly sound, and part­ly becau­se many tre­at­ments have never been asses­sed at all.[40]

Engel­brecht et. al. note that of all the cases of fraud docu­men­ted in Hor­ace Judson’s 2004 work The Gre­at Betra­y­al: Fraud in Sci­ence, not a sin­gle one was iden­ti­fied via the paper review sys­tem.[41] The simp­le fact is that peer review is sub­ject to the same cor­rupt­ing forces per­va­si­ve throug­hout the MAIMS com­plex dis­cus­sed abo­ve; it does not stand abo­ve them. The review­ers are, ulti­m­ate­ly, indi­vi­du­al sci­en­tists with pro­found per­ver­se incen­ti­ves. Par­ti­cu­lar­ly reve­al­ing in this respect was the decis­i­on of the high­ly pres­ti­gious New Eng­land Jour­nal of Medi­ci­ne (NEJM) to relax its rest­ric­tions on review­ers, per­mit­ting them to con­ti­nue to review even if they made up to 10,000$ a year from phar­maceu­ti­cal com­pa­nies – inclu­ding com­pa­nies who­se pro­ducts they direct­ly advo­ca­ted for in the jour­nal its­elf! What was the ratio­na­le for such a dubio­us poli­cy chan­ge ? The NEJM explai­ned that they were no lon­ger in a posi­ti­on to find enough experts wit­hout any finan­cial con­nec­tions to the phar­maceu­ti­cal indus­try.[42]

More hard­ly needs to be said. Engel­brecht et al. also note that the anony­mous natu­re of peer review is its­elf pro­ble­ma­tic: all it takes to sup­press an artic­le is one review­er with a direct per­so­nal inte­rest in not see­ing a stu­dy published, to stop it from being published! One must fur­ther­mo­re note that the role of peer review is not mere­ly as the unbi­a­sed adju­di­ca­tor over a more or less neu­tral body of published rese­arch, but over a body of published rese­arch which is alre­a­dy pro­found­ly bia­sed. For it must be recal­led that medi­cal and sci­en­ti­fic rese­arch in our cur­rent era is car­ri­ed out, not by demo­cra­ti­cal­ly accoun­ta­ble enti­ties in ser­vice of the public good, but ins­tead by opaque and secre­ti­ve forces in pur­su­it of pri­va­te pro­fit and pri­va­te con­trol. The­re are innu­me­ra­ble means by which stu­dies can be ske­wed to pro­du­ce a cer­tain desi­red result, and, once it is found, the­re is no incen­ti­ve at all to repli­ca­te the stu­dy in order to con­firm the results. If you have the results you desi­re, why look any clo­ser? This phe­no­me­non was expo­sed in John Ioannidis’s famous 2005 paper: »Why most published rese­arch fin­dings are fal­se.« The­re, he shows that »most published rese­arch does not meet good sci­en­ti­fic stan­dards of evi­dence… and many sci­en­ti­fic stu­dies are dif­fi­cult or even impos­si­ble to repro­du­ce … the grea­ter the finan­cial and other inte­rests and pre­ju­di­ces in a sci­en­ti­fic field, the less likely the rese­arch fin­dings are to be true.«[43]

The most important fact about rese­arch in the modern epoch is that the vast majo­ri­ty of it is not published. When a stu­dy pro­du­ces results other than tho­se desi­red by its fun­ders, tho­se results rare­ly see the light of day. Pri­ma­ri­ly, this is of cour­se becau­se a poten­ti­al harm or lack of effi­ca­cy in a pro­duct which might still mana­ge to get onto the mar­ket in some other form is hard­ly some­thing one would want to publi­ci­ze. But even if a firm does not plan to mar­ket a pro­duct, they have a signi­fi­cant incen­ti­ve to not publish data regar­ding its short­co­mings, becau­se, by doing so, they would help poten­ti­al com­pe­ti­tors, who may have to was­te pre­cious time and resour­ces under­ta­king the same, futi­le, expe­ri­ments. This is just one of the innu­me­ra­ble, gla­ring, struc­tu­ral inef­fi­ci­en­ci­es of pri­va­te, pro­fit-dri­ven (as well as covert mili­ta­ry-intel­li­gence dri­ven) sci­en­ti­fic research.

Bey­ond the obvious inef­fi­ci­en­cy, this phe­no­me­non has even more signi­fi­cant impli­ca­ti­ons when con­side­red at full sca­le. As Jacob Ste­genga argues in Medi­cal Nihi­lism, we must reco­gni­ze that every published stu­dy we encoun­ter is a small, visi­ble, and pro­found­ly unre­pre­sen­ta­ti­ve sam­ple cul­led from a vast body of unpu­blished rese­arch which we do not and can­not see. Of cour­se, that rese­arch which is published is mas­si­ve­ly bia­sed in two ways: it is almost inva­ria­bly rese­arch which sug­gests posi­ti­ve effi­ca­cy, and no-to-mini­mal harms, for wha­te­ver poten­ti­al­ly pro­fi­ta­ble pro­duct or ser­vice being stu­di­ed (or their pre­cur­sors, ele­ments, etc.). The much lar­ger pool of rese­arch which is not published tends to be that which shows the pro­ducts tes­ted are eit­her inef­fec­ti­ve, dan­ge­rous, or both. The signi­fi­can­ce of this fact is even grea­ter in the medi­cal and par­ti­cu­lar­ly phar­maceu­ti­cal sphe­re, whe­re effect sizes in gene­ral are extre­me­ly small. As Ste­genga argues, the tools for asses­sing medi­cal pro­ducts are also incre­di­bly mal­leable and sub­ject to con­scious and uncon­scious bias – all across the sup­po­sed hier­ar­chy from anec­do­te to obser­va­tio­nal stu­dy to meta-ana­ly­sis. And when one ade­qua­te­ly weighs the­se fac­tors, the obvious and unavo­ida­ble con­clu­si­on is that one’s atti­tu­de towards cur­rent sci­en­ti­fic rese­arch must be extre­me skepticism.

One might say that medi­cal sci­ence as curr­ent­ly prac­ti­ced is per­va­ded at a pro­found, struc­tu­ral level by an inbuilt base rate fall­a­cy. For tho­se unfa­mi­li­ar with this phe­no­me­non, a very brief, sim­pli­fied expl­ana­ti­on may be useful here. We can inde­ed use an exam­p­le which, by now, ever­yo­ne is inti­m­ate­ly fami­li­ar with: test­ing for dise­a­se. Ima­gi­ne you have a test with a fal­se posi­ti­ve rate of 5 per­cent, and a fal­se nega­ti­ve rate of zero. Now ima­gi­ne you app­ly that test to a popu­la­ti­on of 1000 peo­p­le, 40 per­cent of whom are real­ly ill with the dise­a­se in ques­ti­on. You would expect 430 posi­ti­ve results, and 570 nega­ti­ve results. All the nega­ti­ve results are true nega­ti­ves. 400 of the posi­ti­ve results would be true posi­ti­ves, and 30 would be fal­se posi­ti­ves. For many pur­po­ses, not a bad test. If a per­son recei­ved a posi­ti­ve test, they could have a 93 per­cent con­fi­dence that it was a true posi­ti­ve. Now con­sider you appli­ed the same exact test to a popu­la­ti­on of 1000 peo­p­le, only 20 ( i.e 2 per­cent) of whom were actual­ly dise­a­sed. You would expect 69 posi­ti­ve tests, and 931 nega­ti­ve tests. Of cour­se, as befo­re, all 931 nega­ti­ves are true nega­ti­ves. But 49 of the posi­ti­ves are fal­se posi­ti­ves, while only 20 are true posi­ti­ves. In such a sce­na­rio, the pro­ba­bi­li­ty that your posi­ti­ve test actual­ly means you are ill is only 29 per­cent.[44] If no one bore the dise­a­se, the­re would be 50 posi­ti­ve results, all of which would of cour­se be fal­se posi­ti­ves. The point of this illus­tra­ti­on is to empha­si­ze that wit­hout an ade­qua­te under­stan­ding of the broa­der body of which a pie­ce of data or infor­ma­ti­on is a sam­ple, that sam­ple can easi­ly be misinterpreted.

How is this fall­a­cy cha­rac­te­ristic of modern medi­cal sci­ence more gene­ral­ly? Let’s say you encoun­ter a stu­dy published in a peer-review­ed jour­nal. The stu­dy is excel­lent­ly desi­gned, and if it shows signi­fi­cant results; we may be incli­ned to assu­me tho­se posi­ti­ve results reflect a true phe­no­me­non. So if the stu­dy shows a drug works, for ins­tance, we assu­me the drug does in fact work. This is no dif­fe­rent, howe­ver, than loo­king at a sin­gle posi­ti­ve case from our very good test descri­bed abo­ve, and assum­ing it to be true posi­ti­ve based purely on the intrin­sic fal­se posi­ti­ve rate of the test its­elf. As we saw, even though the test its­elf is very accu­ra­te, if no one is actual­ly sick, you can still pro­du­ce a posi­ti­ve result if you test enough peo­p­le. Now con­sider that the drug, in fact, doesn’t work – this is com­pa­ra­ble to our sce­na­rio with no dise­a­se abo­ve. If you ran the stu­dy once, or even 10 times, you would expect that every time you ran the stu­dy, it would pro­du­ce a ’nega­ti­ve‹ result: it would accu­ra­te­ly indi­ca­te that the drug didn’t in fact work. But what if you ran the same stu­dy 50 times? Or a hundred? You could get a very good stu­dy to pro­du­ce the ›fal­se posi­ti­ve‹ you need.

The pro­blem with asses­sing rese­arch published in peer review jour­nals is that we have no idea of the true base­line. When we encoun­ter a stu­dy which indi­ca­tes that a drug is effec­ti­ve, or doesn’t cau­se harm, we have no idea how many times the same or com­pa­ra­ble stu­dies have been under­ta­ken which have indi­ca­ted other­wi­se. And as stres­sed abo­ve, the stu­dies we do see are of cour­se not sim­ply a ran­dom sam­ple of a pool which we can­not see, but an extre­me­ly unre­pre­sen­ta­ti­ve sam­ple, which mas­si­ve­ly skews towards the ›fal­se posi­ti­ves‹ of appa­rent effi­ca­cy, or the ›fal­se nega­ti­ves‹ or appa­rent safe­ty. And this is occur­ring in a con­text in which the stu­dies them­sel­ves are often alre­a­dy not very good in the first place![45] As Ste­genga con­cludes, under the curr­ent­ly pre­vai­ling con­di­ti­ons, on basic, epis­te­mic-struc­tu­ral grounds, we must thus have mini­mal con­fi­dence in the claims of medi­cal sci­ence regar­ding eit­her the safe­ty or effi­ca­cy of medi­cal pro­ducts. Ste­genga, who comes from a tho­rough­ly bour­geois, refor­mist per­spec­ti­ve, even ack­now­led­ges that tin­ke­ring around the edges of this pro­blem – bet­ter tools for meta ana­ly­sis, stric­ter stan­dards for under­ta­king rese­arch – can­not pos­si­bly over­co­me this pro­fund, struc­tu­ral problem.

His con­clu­si­on, in the face of this fact, howe­ver, is defea­tist: he makes a plea for a ›gent­le medi­ci­ne‹ to miti­ga­te the evi­dent and ever accu­mu­la­ting net harms pro­du­ced for the popu­la­ti­on by the poi­son medi­ci­ne of our cur­rent epoch. The pro­blem, howe­ver, is not sci­ence or medi­ci­ne per se, but their capi­ta­list fet­ters. At a cer­tain point, sci­ence under capi­ta­lism rea­ches an ine­vi­ta­ble inflec­tion point after which it incre­asing­ly dege­ne­ra­tes into its oppo­si­te. Intern­al­ly, this is becau­se as sci­en­ti­fic know­ledge increa­ses, the enti­re sci­en­ti­fic enter­pri­se beco­mes media­ted, more and more reli­ant on one’s abili­ty to trust insti­tu­ti­ons and pro­fes­sio­nal bodies to ensu­re know­ledge accu­mu­la­ted by others has its­elf been done so sci­en­ti­fi­cal­ly. Yet as capi­ta­lism evol­ves into impe­ria­list mono­po­ly capi­ta­lism, the capa­ci­ty of such insti­tu­ti­ons and bodies to with­stand direct sub­or­di­na­ti­on to the inte­rests (›con­spi­ra­ci­es‹) of the ruling class beco­mes ever more impos­si­ble. Fur­ther­mo­re, as the gre­at mass of the popu­la­ti­on is repres­sed, stul­ti­fied, and ban­ned from enga­ging in sci­ence them­sel­ves, it beco­mes impos­si­ble for the small, hyper-indoc­tri­na­ted, and hea­vi­ly disci­pli­ned and poli­ced seg­ment of popu­la­ti­on who are actively invol­ved in sci­ence to meta­bo­li­ze the actu­al know­ledge and infor­ma­ti­on pro­du­ced. As we have shown, this is not just theo­re­ti­cal spe­cu­la­ti­on, but can be empi­ri­cal­ly demons­tra­ted: the peer review sys­tem has been demons­tra­b­ly under­mi­ned by the super-mono­po­li­stic con­cen­tra­ti­on ten­den­ci­es within the MAIMS. Real sci­ence, bene­fi­ci­al to the mas­ses, at any­thing like the sca­le at which it is sup­po­sedly under­ta­ken today, would and will only be pos­si­ble under con­di­ti­ons in which it is direct­ly and trans­par­ent­ly con­trol­led and sub­or­di­na­ted to the direct demo­cra­tic inte­rests of the who­le popu­la­ti­on, and when that popu­la­ti­on is freed from drud­gery, armed with edu­ca­ti­on and inde­pen­dence, and them­sel­ves capa­ble, coll­ec­tively, of man­ning and ope­ra­ting the sorts of bodies and mecha­nisms which could actual­ly satis­fac­to­ri­ly media­te such a sca­le of infor­ma­tio­nal exch­an­ge. The ali­en­ated labor of a mino­ri­ty of ›experts‹, shack­led and cons­trai­ned by their sub­or­di­na­ti­on to the ruling class, must beco­me the intellec­tual­ly and spi­ri­tual­ly ful­fil­ling, coll­ec­ti­ve enter­pri­se of us all. The con­tin­ued flou­ris­hing of sci­ence is, in short, only pos­si­ble under communism.

For obvious reasons, the pet­ty-bour­geoi­sie ele­ments within the move­ment resis­ting the Coro­na pro­gram, and cri­ti­quing viro­lo­gy gene­ral­ly, are unin­te­res­ted in ack­now­led­ging this rea­li­ty. Ins­tead, they gene­ral­ly advo­ca­te absurd, imprac­ti­cal indi­vi­dua­li­stic solu­ti­ons, whe­re peo­p­le are expec­ted to somehow enga­ge inde­pendent­ly in this rese­arch them­sel­ves – every self-con­tai­ned bour­geois atom, start­ing pre­su­ma­b­ly with car­te­si­an medi­ta­ti­ons and working their way out to a com­pre­hen­si­ve self-ela­bo­ra­ted world­view. This is in fact typi­cal of the gene­ral pro­gram of ›resis­tance‹ offe­red by pet­ty-bour­geois ’skep­tics‹ and ›cri­tics‹: do your own rese­arch, gro­wy­our own food, rese­arch what you should or shouldn’t eat, get off the grid, etc. – it is all real­ly very easy, you just need bound­less lei­su­re time, infi­ni­te resour­ces, and no obli­ga­ti­ons or commitments!

The cur­rent, mise­ra­ble and degra­ded sta­te of affairs in which the gre­at mass of the glo­bal popu­la­ti­on now lives is not, pace the anti-Coro­na Right, becau­se of their own sin­ful­ness, lazi­ness, idio­cy, or cowar­di­ce. It is becau­se a tre­men­dous­ly coor­di­na­ted, cal­cu­la­ted, and ruthl­ess class strugg­le has been waged against them. Of cour­se, the mas­ses have resis­ted in turn – open­ly and covert­ly, actively and pas­si­ve­ly, across innu­me­ra­ble sites of strugg­le, lar­ge and small. Inde­ed, the main thing that has hin­de­red and limi­t­ed the suc­cess of this resis­tance is pre­cis­e­ly the idio­cy, cowar­di­ce, and nai­ve­ty of the pet­ty-bour­geois ele­ments who have instal­led them­sel­ves as lea­ders only to con­stant­ly derail it with their fan­ta­sies of recon­ci­lia­ti­on with the ruling class and indi­vi­du­al esca­pist solutions.

Once one grasps the true sca­le and natu­re of what we face, howe­ver, only one con­clu­si­on can be drawn: the only way to actual­ly main­tain and impro­ve our own health, and the health of others, is class strugg­le. The ruling class who con­trol the MAIMS com­plex – this vast, cruel machi­nery of domi­na­ti­on, explo­ita­ti­on, and debi­li­ta­ti­on – must be over­thrown once and for all. Wit­hout revo­lu­tio­na­ry theo­ry, ofcour­se, the­re can be no revo­lu­tio­na­ry move­ment – and that ent­ails expo­sing the ideo­lo­gies the ruling class employ to under­mi­ne, con­fu­se, and derail the popu­lar strugg­le against them. In Part 3, we will show why main­stream viro­lo­gy must be coun­ted among­st the most per­ni­cious of these.


[1] Nor­man Bethu­ne, The Wounds (Onta­rio: Litt­le Books of Hope), https://​mar​xist​le​ni​nist​.word​press​.com/​2​0​0​9​/​0​2​/​1​4​/​n​o​r​m​a​n​-​b​e​t​h​u​n​e​-​w​o​u​n​ds/

[2] Ivan Illich, Medi­cal Neme­sis: The Expro­pria­ti­on of Health (New York: Pan­the­on, 1976), Ch. 4.

[3] Jacob Ste­genga, Medi­cal Nihi­lism (Oxford: Oxford Uni­ver­si­ty Press, 2018) p. 7. (Hence­forth: Ste­genga, Medi­cal Nihi­lism).

[4] Ger­man Lopez, »9 Of 10 Top Drug­ma­kers Spend More on Mar­ke­ting than Rese­arch,« Vox (Febru­ary 11, 2015), https://​www​.vox​.com/​2​0​1​5​/​2​/​1​1​/​8​0​1​8​6​9​1​/​b​i​g​-​p​h​a​r​m​a​-​r​e​s​e​a​r​c​h​-​a​d​v​e​r​t​i​s​ing.

[5] Ibid.

[6] Chris Ari­ens, »Here Are the Big­gest Adver­ti­sers on Fox News, CNN and MSNBC,« TVNews­er (TVNews­er, March 9, 2018), https://​www​.adweek​.com/​t​v​n​e​w​s​e​r​/​h​e​r​e​-​a​r​e​-​t​h​e​-​b​i​g​g​e​s​t​-​a​d​v​e​r​t​i​s​e​r​s​-​o​n​-​f​o​x​-​n​e​w​s​-​c​n​n​-​a​n​d​-​m​s​n​b​c​/​3​5​9​0​57/

[7] Ivan Illich, Medi­cal Neme­sis: The Expro­pria­ti­on of Health (New York: Pan­the­on, 1976), Ch. 7.

[8] Ibid., Ch. 4.

[9] Ibid.

[10] Wiki­pe­dia con­tri­bu­tors, »Cot­ton Mather,« Wiki­pe­dia, The Free Ency­clo­pe­dia, https://​en​.wiki​pe​dia​.org/​w​/​i​n​d​e​x​.​p​h​p​?​t​i​t​l​e​=​C​o​t​t​o​n​_​M​a​t​h​e​r​&​o​l​d​i​d​=​1​1​3​0​2​1​7​017 (acces­sed Janu­ary 15, 2023).

[11] Sil­via Fede­ri­ci, Cali­ban and the Witch, (Brook­lyn: Auto­no­me­dia, 2004), pp. 139 – 140. (Quo­tes from Foucault).

[12] Ivan Illich, Medi­cal Neme­sis: The Expro­pria­ti­on of Health (New York: Pan­the­on, 1976), Ch. 4.

[13] Richard Lewon­tin, »Bio­lo­gy as Ideo­lo­gy,« Lec­tu­re 3.

[14] Ivan Illich, Medi­cal Neme­sis: The Expro­pria­ti­on of Health (New York: Pan­the­on, 1976), Ch. 4.

[15] Ibid.

[16] See Jen­ni­fer Mar­gu­lis, The Busi­ness of Baby (New York: Scrib­ner, 2013) and Ina May­Gas­kin, Ina May’s Gui­de to Child­birth (New York: Ban­tam, 2003).

[17] Ivan Illich, Medi­cal Neme­sis: The Expro­pria­ti­on of Health (New York: Pan­the­on, 1976), Ch. 4.

[18] Ibid., Ch. 7.

[19] Ibid. ch. 4

[20] Ste­genga, Medi­cal Nihi­lism, p. 184.

[21] Ste­genga, Medi­cal Nihi­lism, p. 5.

[22] Engel­brecht et al., Virus Mania, Introduction

[23] Ibid.

[24] Ibid., ch. 8.

[25] T. Mohr, »Impe­ria­lism Today is Con­spi­ra­cy Pra­xis,« Mag­ma- Maga­zin Der Mas­se, Sep­tem­ber 24 2022,‑mohr/imperialism-today-is-conspiracy-praxis/.

[26] Wiki­pe­dia con­tri­bu­tors, »Natio­nal Child­hood Vac­ci­ne Inju­ry Act,« Wiki­pe­dia, The Free Ency­clo­pe­dia, https://​en​.wiki​pe​dia​.org/​w​/​i​n​d​e​x​.​p​h​p​?​t​i​t​l​e​=​N​a​t​i​o​n​a​l​_​C​h​i​l​d​h​o​o​d​_​V​a​c​c​i​n​e​_​I​n​j​u​r​y​_​A​c​t​&​o​l​d​i​d​=​1​1​2​9​7​8​3​439 (acces­sed Janu­ary 14, 2023).

[27] Robert F. Ken­ne­dy Jr., »Dead­ly Immu­ni­ty,« in Engel­brecht et. al., Virus Mania. Ch. 8.

[28] Ibid.

[29] Ibid.

[30] Ibid.

[31] Ibid.

[32] Julia Craw­ford, »Does Bill Gates Have Too Much Influence in the Who?,« SWI (swis​s​in​fo​.ch, May 7, 2021), https://​www​.swis​s​in​fo​.ch/​e​n​g​/​p​o​l​i​t​i​c​s​/​d​o​e​s​-​b​i​l​l​-​g​a​t​e​s​-​h​a​v​e​-​t​o​o​-​m​u​c​h​-​i​n​f​l​u​e​n​c​e​-​i​n​-​t​h​e​-​w​h​o​-​/​4​6​5​7​0​526.

[33] Bri­an Mar­tin­son, »Sci­en­tists beha­ving bad­ly,« Natu­re, 9 June 2005, pp. 737 – 738 as cited in Engel­brecht et al., Virus Mania, Ch.2.

[34] Robert F. Ken­ne­dy Jr., »Dead­ly Immu­ni­ty,« in Ch. 8, Engel­brecht et. al., Virus Mania.

[35] Richard Levins, »The Two Faces of Science«

[36] Ibid.

[37] Ibid.

[38] Engel­brecht et. al., Virus Mania., Ch. 1.

[39] Ibid., Ch. 2

[40] Richard Smith, »Whe­re is the Wis­dom? The Pover­ty of Medi­cal Evi­dence ‚« Bri­tish Medi­cal Jour­nal 303, (Oct 5, 1991): p. 798.

[41] Ibid.

[42] Ibid.

[43] As quo­ted in Ibid.

[44] Exam­p­le adapt­ed from Wiki­pe­dia con­tri­bu­tors, »Base rate fall­a­cy,« Wiki­pe­dia, The Free Ency­clo­pe­dia, https://​en​.wiki​pe​dia​.org/​w​/​i​n​d​e​x​.​p​h​p​?​t​i​t​l​e​=​B​a​s​e​_​r​a​t​e​_​f​a​l​l​a​c​y​&​o​l​d​i​d​=​1​1​2​5​8​1​0​770

[45] All rea­ders are encou­ra­ged to read Richard Levins’ bril­li­ant paro­dy of modern medi­cal rese­arch, which effec­tively makes the point of this enti­re sec­tion in a suc­cinct page: »Sci­en­ti­fic Method for Today’s Mar­ket,« The Mathe­ma­ti­cal Intel­li­gen­cer, 37 (1), 47 – 47, 2015 (March 1).‑9488‑7.pdf?pdf=button

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This essay is pro­found­ly indeb­ted to the feed­back, com­men­ta­ry, and editing of Mol­ly Klein, Karel Svo­bo­da, and Hiero­punk. It is also exten­si­ve­ly infor­med by the cri­ti­cism and ana­ly­sis of Jacob Levich, as well as Phil Gre­a­ves and the net­work of com­men­ta­tors and rese­ar­chers around them.

Cover Image: Wound-man, 16th Cen­tu­ry, wiki­me­dia commons

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