An editorial in the British Medical Journal has called for a reappraisal of the criticism of overtreatment by Ivan Illich, a commentator on cultural issues who had a considerable influence in the late 1960s and 1970s. My response notes that this part of Illich’s work relies on reflexive work by the medical profession itself. Focussing on it means that the more radical aspects of Illich’s critique of the social and cultural authority of biomedicine are disregarded. These negative cultural implications raise important questions about the management of the Covid pandemic. Although Illich’s proposed answers remain controversial, reflecting his past as a Catholic priest, few dispute the value of the questions. Overtreatment is driven by the interests and values promoted by biomedicine rather than being a simple technical matter. Any discussion that does not refer to these simply misses the point.