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14 November 2007

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.

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 1193, it was nearly $939 billion.

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

* In addition to these expenditures, government spending in general went from a budget of $13.6 billion is fiscal 1941, to $1.65 trillion in 1998.

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.”

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 authority.

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.

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 industry.

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.


1. Szasz TS: The therapeutic state: the tyranny of pharmacracy. The Independent Review 2001;5(4):485.
2. Sato A: Medicalization and medicalization theories.
3. Potenza MN, et al: Pathological gambling. JAMA 2001;286(2):141.
4. Antidepressant therapy may help COPD patients stop smoking. Reuters. London. 7/26/01.
5. New AMA president takes on gun lobby. Reuters. Chicago. 6/21/01.
6. Racism as mental illness. 6/1/01.
7. Eisenberg DM, et al: Unconventional medicine in the United States. Prevalence, costs, and patterns of use. New England Journal of Medicine 1993;328(4):246.
8. Eisenberg DM, et al: Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280(18):1569.
9. Kessler RC, et al: Long-term trends in the use of complementary and alternative medical therapies in the United States. Annals of Internal Medicine 3001;135(4):262.
10. The next trillion. Interview with Paul Zane Pilzer. Network Marketing 2001 3(5):40.


Anonymous said...

Excellent piece.
Nelson Borelli, MD

Dr Kevin Lau said...

Glad you enjoyed it!

Kevin Lau, DC