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Causes of iatrogenesis
include chance, medical error, negligence,
social control and the adverse effects or interactions of prescription
drugs. In the United States, an estimated 44,000 to 98,000 deaths per
year may be attributed in some part to iatrogenesis.
Etymologically, the term "iatrogenesis" means "brought forth by a
healer" (iatros means healer in Greek); as such, in its earlier forms, it
could refer to good or bad effects. Literally meaning "physician-indu-
ced," the term
iatrogenic
describes diseases inadvertently resulting from
medical treatments or procedures.
Since at least the time of Hippocrates, people have recognized the
potential damaging effects of a healer's actions. The old mandate "first
do no harm" (primum non nocere) is an important clause of medical
ethics, and iatrogenic illness or death caused purposefully, or by avoida-
ble error or negligence on the healer's part became a punishable offense
in many civilizations.
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, and better surgical techni-
ques have been developed to decrease iatrogenic mortality.
Examples of iatrogenesis imply: risk associated with medical inter-
ventions adverse effects of prescription drugs over-use of drugs, (cau-
sing - for example - antibiotic resistance in bacteria) prescription drug
interaction, medical error, wrong prescription, perhaps due to illegible
handwriting, typos on computer, negligence, faulty procedures, tech-
niques, information, methods, or equipment.
An iatrogenesis can be caused by:
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–
Absence of confidential contact.
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Misses in speech of the doctor, it is especial at the first occu-
rring.
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The unreasonable use of medical terminology.
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 ad-
verse effects of a medical treatment are iatrogenic. For example, radia-
tion therapy and chemotherapy, due to the needed aggressiveness of the
therapeutic agents, frequently produce iatrogenic effects such as hair
loss, anemia, vomiting, nausea, brain damage, lymphedema, infertility,
etc. The loss of functions resulting from the required removal of a disea-
sed organ also counts as iatrogenesis, thus we find (for example) iatro-
genic diabetes brought on by removal of all or part of the pancreas.
Other situations may involve actual negligence or faulty procedu-
res, such as when pharmacotherapists produce handwritten prescriptions
for drugs.
A very common iatrogenic effect is caused by drug interaction, i.e.,
when pharmacotherapists fail to check for all medications a patient is ta-
king and prescribe new ones which interact agonistically or antagonisti-
cally (potentiate or decrease the intended therapeutic effect). Such situa-
tions can cause significant morbidity and mortality. Adverse reactions,
such as allergic reactions to drugs, even when unexpected by pharmaco-
therapists, 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 over prescription of antibiotic drugs. Certain drugs are toxic in their
own right in therapeutic doses because of their mechanism of action.
In psychology, iatrogenesis can occur due to misdiagnosis. Condi-
tions hypothesized as partially or completely iatrogenic include bipolar
disorder, dissociative identity disorder, fibromyalgia, somatoform disor-
der, chronic fatigue syndrome, posttraumatic stress disorder, substance
abuse ,etc.. The degree of association of any particular condition with ia-
trogenesis is unclear and in some cases controversial. The over-diagno-
sis of psychological 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, espe-
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cially when no alternatives outside of the diagnostic naming process
have been considered.
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