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Medical nemesis and childhood ITP

Thirty years ago the philosopher and theologian Ivan Illich accused the medical establishment of being a major threat to health. He argued that it was responsible for a growing epidemic of iatrogenic morbidity, and referred to this as a form of medical nemesis (Illich, 1974). He would doubtless say that little has changed, and, as far as childhood idiopathic thrombocytopenic purpura (ITP) is concerned, he would be right. I believe that doctors often make matters worse in the way they manage this condition. They prescribe mostly unpleasant, frequently unnecessary and sometimes dangerous therapy. They also offer self-defensive and over-cautious advice on risk management, creating what amounts to an anxiety state in some parents. To support these allegations, in this article I take a critical look at the real risk of dying from ITP, consider its lack of morbidity, and reflect on how little the multitude of plied therapies over the last century has actually achieved. I also suggest some organizational changes to improve the way affected children are managed in future.