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Iatrogenesis
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Iatrogenesis (from the Greek for "brought forth by the healer") refers to any effect on a
person, resulting from any activity of one or more persons acting as healthcare professionals
or promoting products or services as beneficial to health, that does not support a goal of the
person affected.
Some iatrogenic effects are clearly defined and easily recognized, such as a complication
following a surgical procedure (e.g., lymphedema as a result of breast cancer surgery). Less
obvious ones, such as complex drug interactions, may require significant investigation to
identify.
While some have advocated using 'iatrogenesis' to refer to all 'events caused by the health
care delivery team', whether 'positive or negative', consensus limits use of 'iatrogenesis' to
adverse, or, most broadly, to unintended outcomes.
Causes of iatrogenesis include:

side effects of possible drug interactions

complications arising from a procedure or treatment

medical error

negligence

unexamined instrument design

anxiety or annoyance in the physician or treatment provider in relation to medical
procedures or treatments

unnecessary treatment for profit
Unlike an adverse event, an iatrogenic effect is not always harmful. For example, a scar
created by surgery is said to be iatrogenic even though it does not represent improper care
and may not be troublesome.
Professionals who may cause harm to patients include physicians, pharmacists, nurses,
dentists, psychologists, medical laboratory scientists and therapists. Iatrogenesis can also
result from complementary and alternative medicine treatments.
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Globally as of 2013 an estimated 20 million negative effects from treatment occurred. It is
estimated that 142,000 people died in 2013 from adverse effects of medical treatment up
from 94,000 in 1990.
Sources
Examples of iatrogenesis:
*Risk associated with medical interventions

Adverse effects of prescription drugs

Over-use of drugs, (causing - for example - antibiotic resistance in bacteria)

Prescription drug interaction
*Medical error
*Wrong prescription, perhaps due to illegible handwriting, typos on computer.
*Negligence
*Nosocomial infections
*Faulty procedures, techniques, information, methods, or equipment.
Causes and consequences
Medical error and negligence
Iatrogenic conditions do not necessarily result from medical errors, such as mistakes made in
surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact,
intrinsic and sometimes adverse effects of a medical treatment are iatrogenic. For example,
radiation therapy and chemotherapy — necessarily aggressive for therapeutic effect —
frequently produce such iatrogenic effects as hair loss, anemia, vomiting, nausea, brain
damage, lymphedema, infertility, etc. The loss of function resulting from the required
removal of a diseased organ is iatrogenic, as in the case of diabetes consequential to the
removal of all or part of the pancreas.
The incidence of iatrogenesis may be misleading in some cases. For example, ruptured aortic
aneurysm is fatal in most cases; the survival rate for a ruptured aortic aneurysm is under 25%.
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Patients who die during or after an operation will still be considered as iatrogenic deaths, but
the procedure itself remains a better bet than the 100% probability of death if left untreated.
Other situations may involve actual negligence or faulty procedures, such as when
pharmacotherapists produce handwritten prescriptions for drugs.
Adverse effects
A very common iatrogenic effect is caused by drug interaction, i.e., when pharmacotherapists
fail to check for all medications a patient is taking and prescribe new ones that interact
agonistically or antagonistically (potentiate or attenuate the intended therapeutic effect). Such
situations can cause significant morbidity and mortality. Adverse reactions, such as allergic
reactions to drugs, even when unexpected by pharmacotherapists, are also classified as
iatrogenic.
The evolution of antibiotic resistance in bacteria is iatrogenic as well. Bacteria strains
resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs.
Certain drugs are toxic in their own right in therapeutic doses because of their mechanism of
action. Alkylating antineoplastic agents, for example, cause DNA damage, which is more
harmful to cancer cells than regular cells. However, alkylation causes severe side-effects and
is actually carcinogenic in its own right, with potential to lead to the development of
secondary tumors. In similar manner, arsenic-based medications like melarsoprol for
trypanosomiasis can cause arsenic poisoning.
Adverse effects can appear mechanically. The design of some surgical instruments may be
decades old, hence certain adverse effects (such as tissue trauma) may have never been
properly cauterized.
Psychiatry
In psychiatry, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false
condition as was the case of hystero-epilepsy). An example of a partially iatrogenic condition
due to common misdiagnosis is bipolar disorder, especially in pediatric patients. Other
conditions such as somatoform disorder and chronic fatigue syndrome are theorized to have
significant sociocultural and iatrogenic components. Posttraumatic stress disorder is
hypothesized to be prone to iatrogenic complications based on treatment modality. The
psychiatric treatment of some conditions and populations, such as substance abuse and
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antisocial youths are regarded as carrying significant risks for iatrogenesis. At the other end
of the spectrum, dissociative identity disorder is considered by a minority of theorists to be a
wholly iatrogenic disorder with the bulk of diagnoses arising from a tiny fraction of
practitioners.
The degree of association of any particular condition with iatrogenesis is unclear and in some
cases controversial. The over-diagnosis of psychiatric conditions (with the assignment of
mental illness terminology) may relate primarily to clinician dependence on subjective
criteria. The assignment of pathological nomenclature is rarely a benign process and can
easily rise to the level of emotional iatrogenesis, especially when no alternatives outside of
the diagnostic naming process have been considered. Many former patients come to the
conclusion that their difficulties are largely the result of the power relationships inherent in
psychiatric treatment, leading to the rise of the anti-psychiatry movement.
Iatrogenic poverty
Meessen et al. used the term "iatrogenic poverty" to describe impoverishment induced by
medical care. Impoverishment is described for households exposed to catastrophic health
expenditure or to hardship financing. Every year, worldwide, over 100,000 households fall
into poverty due to health care expenses. A study reported that in USA in 2001, illness and
medical debt caused half of the personal bankruptcy. Especially in countries in economic
transition, the willingness to pay for health care is increasing, and the supply side does not
stay behind and develops very fast. But the regulatory and protective capacity in those
countries is often lagging behind. Patients easily fall in a vicious cycle of illness, ineffective
therapies, consumption of savings, indebtedness, sale of productive assets, and eventually
poverty.
Social and cultural iatrogenesis
The 20th century social critic Ivan Illich broadened the concept of medical iatrogenesis in his
1974 book Medical Nemesis: The Expropriation of Health by defining it at three levels. First,
clinical iatrogenesis is the injury done to patients by ineffective, unsafe, and erroneous
treatments as described above. In this regard, he described the need for evidence-based
medicine 20 years before the term was coined. Second, at another level social iatrogenesis is
the medicalization of life in which medical professionals, pharmaceutical companies, and
medical device companies have a vested interest in sponsoring sickness by creating
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unrealistic health demands that require more treatments or to treat non-diseases that are part
of the normal human experience, such as age-related declines. In this way, aspects of medical
practice and medical-associated industries can produce social harm in which society members
ultimately become less healthy, excessively dependent on institutional care. He argued that
medical education of physicians contributes to medicalization of society because they are
trained for diagnosing and treating illness therefore they focus on disease rather than on
health. Iatrogenic poverty (above) can be considered a specific manefestation of social
iatrogenesis. Third, cultural iatrogenesis refers to the destruction of traditional ways of
dealing with, and making sense of, death, suffering, and sickness. In this way the
medicalization of life leads to cultural harm as society members lose their autonomous
coping skills. It is worth noting that in these critiques "Illich does not reject all benefits of
modern society but rejects those that involve unwarranted dependency and exploitation."
Epidemiology
Globally it is estimated that 142,000 people died in 2013 from adverse effects of medical
treatment up from 94,000 in 1990.
In the United States estimated deaths per year include:

12,000 due to unnecessary surgery

7,000 due to medication errors in hospitals

20,000 due to other errors in hospitals

80,000 due to nosocomial infections in hospitals

106,000 due to non-error, negative effects of drugs
Based on these figures, iatrogenesis may cause 225,000 deaths per year in the United States
(excluding recognizable error). An earlier Institute of Medicine report estimated 230,000 to
284,000 iatrogenic deaths annually.
History
The term iatrogenesis means brought forth by a healer, from the Greek ἰατρός (iatros,
"healer") and γένεσις (genesis, "origin"); as such, in its earlier forms, it could refer to good or
bad effects.
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Since at least the time of Hippocrates, people have recognized the potentially damaging
effects of medical intervention. "First do no harm" (primum non nocere) is a primary
Hippocratic mandate in modern medical ethics. Iatrogenic illness or death caused
purposefully or by avoidable error or negligence on the healer's part became a punishable
offense in many civilizations.
The transfer of pathogens from the autopsy room to maternity patients, leading to shocking
historical mortality rates of puerperal fever (A.K.A "childbed fever") at maternity institutions
in the 19th century, was a major iatrogenic catastrophe of that time. The infection mechanism
was first identified by Ignaz Semmelweis.
With the development of scientific medicine in the 20th century, it could be expected that
iatrogenic illness or death would be more easily avoided. Antiseptics, anesthesia, antibiotics,
better surgical techniques, evidence-based protocols and best practices continue to be
developed to decrease iatrogenic side effects and mortality.
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