does the word "iatrogenic" mean?
Iatros means physician in Greek, and -genic,
meaning induced by, is derived from the International Scientific
Vocabulary. Combined, of course, they become iatrogenic, meaning
physician-induced. Iatrogenic disease is obviously, then, disease
which is caused by a physician.
Or perhaps it is not so obvious. The growing complexity of
modern life (and medicine) has promoted the elasticity of language. In
common usage, then, iatrogenic disease is now applied to any adverse effect
associated with any medical practitioner or treatment. The practitioner
need not be a physician, he might be a nurse or a radiology technician,
or any one of the scores of differentiated healthcare workers encountered
in hospitals, clinics, nursing homes, or offices, or for that matter in
the ambulance on the way to one of those places. For those who advance
the language to the frontier, iatrogenic disease can be caused by practitioners
whose association with medicine is negligible or antithetical, such as
homeopaths, chiropractors, and psychologists (especially now that they
are lobbying for the authority to write drug prescriptions). Or perhaps
even Grandma, if she is the one handing out the pills.
Treatment is a term stretched beyond reason. It might
refer to something as tangible as surgery or as subtle as a conversation,
if the person conducting the conversation is considered a health specialist.
(And who isn't?) It might be a potent drug or a placebo. It might be effective
or worthless, real or imaginary. While iatrogenic has retained at least
a modicum of comprehensibility, treatment has been utterly debased
both in word and deed. Therapy is in pretty much the same rundown
shape since it was linked to the prefix psycho-.
Because of the intrusion of the Therapeutic State into every cranny
of modern life, we have now made iatrogenic illness refer to any
adverse reaction caused by anyone thought or claiming to be a health specialist,
using any treatment (or lack thereof if the thereof lacking causes the
illness) in any setting. With the heavy burden we have loaded onto the
word, it is essential for any use of iatrogenic to include clear
directions as what the user intends. That way we can distinguish between
a person who is dying from an infection obtained from a physician's contaminated
hands and a person who sues his doctor for not informing him that skydiving
is a dangerous hobby.
Now that we have entered the time of physicians intentionally killing
their patients and calling it "physician assisted suicide," iatrogenic
takes on a whole new meaning. To understand that we need to look at Germany
in the 1940s.
Nicolas S. Martin
American Iatrogenic Association
American Iatrogenic Association
2513 S. Gessner #232
Houston, Texas 77063-2096
Copyright 1999 by Fred E. Foldvary. All rights reserved.
No part of this material may be reproduced or transmitted in any form or
by any means, electronic or mechanical, which includes but is not limited
to facsimile transmission, photocopying, recording, rekeying, or using
any information storage or retrieval system, without giving full credit
to Fred Foldvary and The Progress Report.
Fred E. Foldvary, Senior Editor
"Iatrogenic" means "caused by medical treatment." The term "iatro"
comes from the Greek word "iatros" for medical or medicinal.
Iatrogenic death occurs when people die due to errors or negligence
by doctors and pharmacists. The reported yearly death rate from medical
error is over 120,000. This compares to around 44,000 deaths from motor
vehicles and only a few hundred from commercial aviation. You should be
far more worried about dying in a hospital than from an airplane crash.
The high death rate from hospitals was revealed by the release of data
from the Medical College of Pennsylvania Hospital. During the past decade,
hundreds of patients at this hospital suffered serious injury, and at least
66 died because of medical "mistakes." Some of the patients were never
told that the injuries were caused by the doctors, and no disciplinary
action was taken on any of the doctors involved in these incidents.
These records became publicized because of bankruptcy proceedings, when
the new owner filed a detailed account of the 598 incidents from 1989 to
1998. This level of iatrogenic death and injury is typical of hospitals
in the United States. A study by Harvard University professor Lucian Leape,
reported by Knight Ridder newspapers, found that one million patients are
injured by errors during hospital treatment annually, with some 120,000
deaths. One out of every 200 patients in hospitals in New York State had
an iatrogenic death. Less than 10 percent of the medical mistakes are reported
to hospital authorities.
I won't go into the gory details of these cases, but clearly, many of
these errors are due to negligence, injuries which can be prevented. Since
hospitals pay millions of dollars in malpractice awards and to legal costs,
the administrators are either very bad businessmen or else they calculate
that it would cost more to prevent the injuries than to pay compensation.
Less than ten percent of iatrogenic cases result in lawsuits, often because
the doctors keep quiet about the errors or negligence.
This high rate of medical negligence is a national scandal. As always,
to find a remedy, we need to examine the cause. Is the market failing here,
or is there not a truly free market? To answer this, we need to ask, how
would a pure market work?
A pure market consists of voluntary economic activity, without any force
or fraud. To accomplish this, there needs to be a basic market rule: all
products are presumed to be safe and effective, unless the known faults
are fully disclosed. Hospitals should therefore disclose their rate of
iatrogenic deaths and injuries. Patients need to know this not just when
they get sick or injured, but also beforehand, when they choose a medical
plan and the hospital to which they would usually be sent to.
Another intervention that prevents medical care from being a pure market
is that many of the customers do not directly choose and pay for medical
service. Typically, insurance and medical plans are offered and paid for
by employers. The employee might have a choice among a few plans, but he
cannot get paid insurance outside these options, and there is little incentive
for hospitals to honor consumer sovereignty if the patient is not paying.
The reason employers pay for the medical treatment is that the cost is
deductible from the employer's taxes, but not from the employee's taxes,
so the incentive is for employer-provided plans.
Even if the patients directly paid for the medical care and insurance,
and hospitals were required to report all iatrogenic incidents, doctors
would still have an incentive to avoid reports that raised their malpractice
insurance and damaged their reputation. What is needed to avoid such fraud
is monitoring by neutral parties - representatives of insurance companies
as well as patient's rights groups should be there observing operations
and checking the records. There should be stiff penalties for fraud and
the failure to report such incidents.
So it's not that the medical market is not working well, but that the
medical market is skewed and larcenous, rather than free and pure. We have
what economist James Buchanan calls "constitutional chaos." To escape this
dangerous chaotic condition of massive medical negligence and fraud, we
need to implement that basic market rule: all goods are services are to
be safe unless otherwise reported! We also need to shift to a loser-pays
system of lawsuits, and standardized malpractice awards.
Finally, to have a truly free market in medicine, we need to abolish
the income tax, with its perverse incentives, and shift to public revenue
that does not hamper consumer choice. The best base for consumer-neutral
public finance is land rent, a payment that is fixed during the fiscal
year, leaving consumers free to choose the services they desire, with no
extra tax cost.
We can see that ending the medical nightmare of iatrogenic death and
injury requires not just better hospital care but big changes in the legal
and tax system to shift the whole health-care business towards accountability
to the patients. Meanwhile, we can be alert to the iatrogenic danger. When
you get a prescription, make sure you understand the medicine and dose,
and then check the label. If possible, check on the safety record and complaint
records of your doctors and hospitals. Since most doctors mean well, we
should not be too cynical, but it is prudent to be wary and skeptical.
Little data are available on peritonitis due to procedures in patients
on PD. We reviewed our experience to determine the frequency of iatrogenic
peritonitis. Our policy was to give prophylactic antibiotics for colonoscopy
and dental work as per the AHA guidelines for valvular disease.
Results: From 1992 to 1 September 1997 there were 679 patients
on PD, total time 1109 dialysis years, with 902 peritonitis episodes (composite
rate 0.8/yr). Eleven (1% of all peritonitis) occurred within a few days
of the procedure and were considered to be secondary:
||Episodes (N) Organisms
1 Hemoperitoneum preceded peritonitis in 1.
2 Catheter removed in 1 case.
Prophylactic antibiotics were not given except to one
of the patients who had colonoscopy + polypectomy with subsequent Bacteroides
peritonitis. The patient with the uterine biopsy did not drain prior to
procedure and was not given antibiotics. The patient who underwent cholecystectomy
developed bile peritonitis, followed by enterococcal peritonitis.
In summary, colonoscopy, cholecystectomy, dental procedures,
uterine and liver biopsy can all lead to peritonitis. We attribute our
low rate of iatrogenic peritonitis due to our policy of prophylactic antibiotics.
We recommend giving antibiotic prophylaxis prior to all such procedures,
although this does not invariably prevent peritonitis.
Piraino B., Rasool A., Bernardini J. Renal Electrolyte
Division, University of Pittsburgh, Pittsburgh, PA, U.S.A.
(Reactions caused by drugs, operations, and invasive procedures)
Statistics show that many who visit a physician
suffer symptoms due to drugs or invasive medical procedures. Some of these
procedures may be needed at the times, but unfortunately, the outcomes
are often ignored. Many of these people end up in hospitals or back in
the doctor's office, but are given little true help. Homeopaths have studied
reactions to allopathic drugs for 190 years and documented a iatrogenic
phenomenon called the suppression syndrome. The suppression syndrome goes
far beyond the normal concept of "side-effects" and records the acute,
latent and chronic states caused by unskillful medical intervention and
immunizations. This theory forms a fundamental part of homeopathic philosophy
and has been empirically confirmed many times in practice. This is a deep
study that is an integral part of constitutional homeopathy. For our study
we will be taking up the acute reactions that are encountered due to common
ARNICA (2). This remedy is useful before and after medical procedures
that such as surgery, invasive testing or dental work. It prevents the
mental shock and trauma as well as potential infections.
ACONITE (2). Fear, anxiety of panic before or during a medical procedure.
They are fearful of death and predict the time of their death. Sudden
invasion of hot, dry fever. The patient is very restless and thirsty.
Wounds or stitches become sensitive with "Acon" fever symptoms.
AVENA SATIVA (3 - narcotics). Withdrawal from morphine, heroine,
and other opiates. Usually use in tincture or low potencies. A very
good "tonic" after nervous debility after exhausting diseases.
BELLIS P. (3 - after operations). First remedy in injury to deeper
tissues, especially after major operations. Traumatism to pelvic organs.
Soreness of the abdominal walls. Injury to nerves with intense soreness
and intolerance of cold bathing. Arn. can be given before the operation
and Bell-p. after.
CALENDULA (3). Promotes rapid healing of damaged tissue and prevents
infection. Comes in after Bell-p. has removed the deep trauma. The
trio of Arn., Bell-p., and Calendula are often used routinely during convalescence
after surgical intervention.
CHINA (2). Helps restore fluid balance and strength after excessive
bleeding or loss of vital fluids through burns, discharges, vomiting, diarrhea,
sweating, etc.. Useful after gall bladder removal.
HYERICUM (3-dental). Injury due to dental work. Nerve feels as if it
is exposed. Bleeding after extraction. Pain in an injection site that radiates
upward alone the path of the nerve. Acute side-effects of immunization.
IPECAC (1). Persistent nausea in which vomiting does not relieve,
especially after chemotherapy and radiation treatments. Clean white tongue
with gastric complaints.
LEDUM (3). Acute pain in an injection sight. Part feels numb and cold.
Acute side-effects of immunizations.
NUX VOMICA (3). Useful where there has been excessive use of cathartics,
liver pills, herbal patent medicines, stimulants, tonic, etc.. Also
useful in over use of allopathic medicines and narcotics. Addictive
personality. The sufferer's digestive system is upset, they are irritable
and angry and constipated.
PHOSPORUS (3- ailment from anesthesia). An excellent remedy to remove
the side-effects of anesthesia. Also useful for excessive bleeding
after a tooth extraction or surgery.
STAPHISAGRIA (2). Useful in pain surgical lesions, after operations
of the female organs, and the use of urinary catheters.
THUJA (3 - immunization). Proven very useful in the side-effects of
immunizations and vaccines.
anesthesia, ailments, from- Acet-ac., am-c., Carb-v., Chlf., hep, ph-ac.,
antibiotic, worse from - apis, ars., chin., lyc., nat-p., Nit-ac.,
chemicals, hypersensitive to - apis., ARS., Coff., med., Merc., nat-c.,
Nit-ac., nux-v., PHOS., psor., sul-ac., sulph..
chemotherapy, treatment, side-effects of - ars., CAD-S., chin., Ip.,
digitalis, abuse of - chin., dig., nit-ac..
drugs, abuse of - ars., AVEN, hydr., Ip., NUX-V., Puls., Sulph..
weakness, from drugging - aven., carb-v., laur., Mosch., Op..
purgatives, abuse of - aloe., hydr., Nux-v., op., sulph..
herbs, abuse of - camph., NUX-V..
immunizations, side-effects, acute reactions, from - acon., apis.,
arn., bell., calen., cic., hep., HYPER., LED., pyrog., Thuja.
preventative, for side-effects - Hyper., Led., sil., sulph., Thuja.,
radiation, sickness of, side effects of - ars., CADM-S., calc-f., chin.,
nux-v., phos., rad-br., SOL., x-ray..
sensitive, wounds, with fever - Acon..
surgery, complication, from- acet-ac., Acon., ARN., BELL-P., CALEN.,
Carb-v., Chin., Chlf., Op., Phos., Piloc., STAPH., Stront-c..
adhesions, after - calc-f., calen., sil.
bleeding after- calen., Phos..
cancer - Coca..
colic, after lithotomy or ovariotony - Staph..
fistula, operation of, berb, calc., calc-f., calen, caust, graph.,
sil ., sulph., thuj.
gall bladder surgery, after removal- CHIN., lyc..
healthy granulations, to promote healing, prevent infection - CALEN..
hernia, for pain in abdomen, after - Hyper..
inflammation, from., acon., Anthr., arn., ars., Bell., bell-p., calc-s.,
CALEN., Hep., hyper., Pyrog., rhus-t., Sil., Staph..
intestine, paralysis of after laparotmoy - Op..
joints - bry., calen., hyper.,
mastectomy, after -calen., bell-p., x-ray..
orifices, on - calen., coloc., Staph..
sensitive, wounds painfully, fever - Acon.,
skin is drawn tight over the wound, when - kali -p..
stretching of tissue, with - staph..
extraction, bleeding, after - arn., calen., ferr-p., Phos..
pain, after - ., Hyper., staph..
filling, pain, after - ARN., hyper., merc., Merc-i-f., NUX-V., sep..
injury from dental work - HYPER..
nerve, as if exposed - Cham., coff., Hyper., Kalm..
neuralgic pains -BELL., CHAM., COFF., Coloc., hyper., MAG-P., Nux-m.,
wounds, of CALEN., Staph.. (refer to infected wounds).
Comments. For more details on the remedies refer to the Materia Medica
of First Aid or larger works for more information. For specific problem,
such as infected wounds, refer to their specific sections if relevant.
A few of the most commonly used remedies are listed below for easy reference.
The site invites the participation of medical, legal, and political
specialists, but it is designed for the general public and to be as free
of obfuscatory medical jargon as possible.
The American Iatrogenic Association
is devoted to the study and reporting of medical errors that lead to disease
In 2000, a presidential task force labelled medical errors a "national
problem of epidemic proportions." Members estimated that the "cost associated
with these errors in lost income, disability, and health care costs is
as much as $29 billion annually." That same year the Institute of Medicine
released an historic report, "To err is human: building a safer health
system." The report's authors concluded that 44,000 to 98,000 people die
each year as a result of errors during hospitalization. They noted that
"even when using the lower estimate, deaths due to medical errors exceed
the number attributable to the 8th-leading cause of death." The addition
of non-hospital errors may drive the numbers of errors and deaths much
higher. As the authors note, the hospital data "offer only a very modest
estimate of the magnitude of the problem since hospital patients represent
only a small proportion of the total population at risk, and direct hospital
costs are only a fraction of total costs."
Medical errors are the not only way that consumers are harmed. The Centers
for Disease Control and Prevention estimates that 2 million people annually
acquire infections while hospitalized and 90,000 people die from those
infections. More than 70 percent of hospital-acquired infections have become
resistant to at least one of the drugs commonly used to treat them, largely
due to the overprescribing of antibiotics by physicians. Staph, the leading
cause of hospital infections, is now resistant to 95 percent of first-choice
antibiotics and 30 percent of second-choice antibiotics. Poor staff hygiene
is considered the leading source for infections acquired during hospitalizations.
But efforts to get medical workers to improve safety through things as
simple as better and more frequent hand washing have met with little success.
There is much disagreement as to what constitutes iatrogenic illness.
For decades, peptic ulcers were said to be caused by an emotional disorder
which prevented afflicted people from managing "stress." Physicians instructed
many people with ulcers to change their lifestyles and, in some cases,
to take anti-anxiety medications. In recent years researchers determined
that most peptic ulcers were caused by a bacteria treatable with antibiotics.
Were the adverse emotional and treatment consequences of misdiagnosing
ulcers as a psychiatric illness iatrogenic? Similarly, for many years epilepsy
was said by medical experts to be evidence of pathological criminality.
Epileptics were imprisoned in "colonies," to isolate them from the general
population. Were the obviously damaging effects of this "treatment" iatrogenic?
Are the present large-scale drugging of children (mostly boys) diagnosed
with "Attention Deficit Hyperactive Disorder," and the former "treatment"
of homosexuals with electroconvulsive therapy (shock treatment), insulin
coma, and lobotomy examples of iatrogenic disease? Most physicians would
say they are not, yet the harm resulting from these erroneous diagnoses
and severe "treatments" are no less damaging for the people who suffered
AiA casts a bright light on this debate, opening up medicine's murky
side to public scrutiny and offering help to its victims. Our new web site
will accomplish this in various and evolving ways, including:
· the publishing of articles, essays, studies, book
· making recommendations that will protect you from iatrogenic
· publishing data on the risks of various medical procedures
· investigating ways that an iatrogenically harmed person might
be made well and, when appropriate, compensated for his or her disability
· legal referrals
· offering proposals for political and social changes that reduce
iatrogenic risk and hold perpetrators accountable
· an opportunity for iatrogenic victims to share their experiences
with our readers
Nicolas S. Martin, Executive Director
This site contains some files in the Acrobat (pdf) format. The free
Reader necessary to read these files can be downloaded here.
Our e-mail address: email@example.com
©2002, American Iatrogenic Association
"Insofar as the biologist or physician chooses to act as a scientist,
he has an unqualified obligation to tell the truth; he cannot compromise
that obligation without disqualifying himself as a scientist."
. . . "If we value personal freedom and dignity, we should, in confronting
the moral dilemmas of biology, genetics, and medicine, insist that the
expert's allegiance to the agents and values he serves be made explicit
and that the power inherent in his specialized knowledge and skill not
be accepted as justification for his exercising specific control over those
lacking such knowledge and skill."
Thomas S. Szasz, "The
Moral Physician," The Theology of Medicine