iatrogenic What does the word mean
Iatrogenic Editorial
Iatrogenic Peritonitis
iatrogenic
The American Iatrogenic Association

What 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
Executive Director
American Iatrogenic Association
©2002, AiA

www.iatrogenic.org
American Iatrogenic Association
2513 S. Gessner #232
Houston, Texas 77063-2096

http://www.iatrogenic.org/define.html

Editorial 
 
Iatrogenic Death 

by 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. 

-- Fred Foldvary 

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.

Iatrogenic Peritonitis
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

Outcome

Colonoscopy	41	Gram-negative/Bacteroides	Resolved
Enemas	21	Gram-negative	Resolved2
Cholecystectomy	1	Enterococcus sp	Resolved
Radiation therapy	1	Gram-negative	Pt died
Uterine biopsy	1	Streptococcus viridans	Resolved
Dental procedure	1	Streptococcus salivarius	Pt died
Liver biopsy	11	Bacteroides sp	Resolved

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.
 

  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 medical practice.
Materia Medica
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.
Repertorium 
anesthesia, ailments, from- Acet-ac., am-c., Carb-v., Chlf., hep, ph-ac., PHOS..
antibiotic, worse from - apis, ars., chin., lyc., nat-p., Nit-ac., thuj..
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., nux-v..
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., vario..
radiation, sickness of, side effects of - ars., CADM-S., calc-f., chin., fl-ac., Ip.,
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..
teeth -
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., Sil..
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.
 

http://www.simillimum.com/FirstAid/TheFirstResponder/FirstAidin/Latrogenesis.html

The American Iatrogenic Association is devoted to the study and reporting of medical errors that lead to disease and death.

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 them.
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 excerpts
· making recommendations that will protect you from iatrogenic illness
· 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 and suffering
· 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

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.

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: aia@iatrogenic.org
©2002, American Iatrogenic Association
www.iatrogenic.org

"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