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Iatrogenesis literally means "brought forth by a healer" (''iatros'' means ''' (sometimes referred to as ''complementary medicine'') may be considered an equal source of iatrogenesis for the same reasons. HISTORY Since Hippocrates 's time, the potential damaging effect of a healer's actions has been recognized. The old mandate "do no harm" is an important clause of Medical Ethics , and iatrogenic illness or death caused purposefully, or by avoidable error or negligence on the healer's part became a punishable offence in many civilizations. Before medicine was a more exact and scientific subject, however, most medical actions were outright detrimental to the patient. Until the discovery of Anesthesia and Asepsis , going to Hospital s was a truly dangerous thing, due to the Trauma of Surgery and the ever present risk of Nosocomial Infection . With the development of scientific medicine in the 20th Century , it could be expected that iatrogenic illness or death would be more easily avoided. With the discovery of Antiseptic s, Anesthesia , Antibiotic s, and new and better surgical techniques, iatrogenic Mortality decreased enormously. However, as the complexity of pharmaceuticals and medical procedures increase, iatrogenesis has become an unavoidable result of medical care. SOURCES OF IATROGENESIS There are many sources of iatrogenesis:
Iatrogenic conditions do not necessarily result from Medical Error s, 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, Cancer Therapy by Radiation Therapy or Chemotherapy , due to the needed aggressiveness of the therapeutic agents, frequent effects are Hair Loss , Anemia , Vomiting , Nausea , etc.. In other situations, ''' Negligence ''' or faulty procedures are involved, such as when drug prescriptions are handwritten by the pharmacotherapist. It has been proved that poor handwriting can lead a pharmacist to dispense the wrong drug, worsening a patient's condition. A very common iatrogenic effect is caused by Drug Interaction , i.e., when pharmacotherapists fail to check for all medicaments a patient is taking and prescribe new ones which interact agonistically or antagonistically (potentiate or decrease the intended therapeutic effect). Significant Morbidity and Mortality is caused because of this. 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 sometimes is called iatrogenic as well. Bacteria strains resistant to antibiotics have evolved in response to what some call the overprescription of Antibiotic drugs. In some parts of the world, antibiotics are prescribed much more frequently than in others, partly because people have come to expect them to be effective and thus to demand them from doctors. The habit of some patients to discontinue an antibiotic regimen as soon as their Symptoms abate -- rather than taking the full course to ensure the bacteria are wiped out -- can also accelerate Bacterial evolution towards resistance. Radical or unproven medical treatments may also be considered a source of iatrogenic illness or death. This is the case of "cure or kill" or "desperate cure" approaches which were used in the past, such as Psychosurgery (especially the Lobotomy fad), some forms of Shock Therapy , and Colostomy for treating recurrent infections. It is estimated that tens of thousands of individuals were unnecessarily operated upon, undergoing health risks, suffering other diseases and health problems, and even death, as a consequence. Another example, with incalculable damages caused by treating therapists, is the delay of treatments known to be effective ( Evidence-based Medicine ) in favour of treatment of unproven efficacy. There is increasing evidence that the assignment of Mental Illness nomenclature can cause an iatrogenic pathology. Dissociative Identity Disorder , formerly known as Multiple Personality Disorder , and Recovered Memory Syndrome are examples where the assignment of a name to a subjectively observed circumstance may be an additional and significant difficulty for a patient. Additionally, there are some patients, initially displaying behaviors believed to be consistent with Depression or Post-traumatic Stress Disorder , respond to suggestion by the therapist by filling in the other expected symptoms of these disorders. A very significant portion of mental health patients in the U.S. who receive counseling which is reimbursed by health insurance are given the designation of Adjustment Disorder . The very assignment of a mental illness name may be very problematic for persons who, though experiencing minor distresses, are functioning well, attending work or school very regularly, and enjoy the benefits of normal organization in their lives. The entire mental illness treatment industry in the United States utilizes the Diagnostic And Statistical Manual Of Mental Disorders or DSM IV , a compilation of disorders based on psychiatric plebiscite, not on specific biological findings. This alone makes the assignment of mental disorder names both controversial in medical circles and troublesome for persons seeking assistance and advice, not disease names. A related term is Nosocomial , which refers to an iatrogenic illness due to or acquired during Hospital care, such as an Infection . Sometimes, hospital staff can be unwilling transmitters of Nosocomial Infection s (in one of such instances, many hospitals have forbidden physicians to use long ties, because they transmitted bacteria from bed to bed when the doctor swept the tie over the patients when reclining upon them...). The most common iatrogenic illness in this realm, however, are nosocomial infections caused by unclean or inadequately sterilized Hypodermic Needle s, Surgical Instrument s, and the use of ungloved hands to perform medical or dental procedures. For example, a number of Hepatitis B and C infections caused by Dentist s and surgeons on their patients have been documented. One of the most horrid cases of massive death caused in recent times by iatrogenic infection has been reported on several bush hospitals in Zaire and Sudan , where the intensive reuse of poorly sterilized Syringe s and needles by nurses spread the Ebola virus, probably causing hundreds of deaths. Although very rare, iatrogenic illness or death can be attributed to mental, nervous, sensorial or muscular disease in physicians. This may range from the banal, such as trembling fingers in a surgeon causing slippages and errors, or long Medical Resident Work Hours causing Sleep Deprivation -induced errors, to extreme cases such as the sociopathic physicians and nurses who kill scores of their patients (such as the Death Angels Of Lainz , the British nurse Beverley Allitt and GP Harold Shipman ), and the bizarre case of German surgeon Prof. Ernst Ferdinand Sauerbruch (1875-1951), who became demented and continued to perform absurd operations on many patients, with fatal results, even after his colleagues detected the errors but were unable to stop him because of his fame and power. Medical Torture is an extreme form of iatrogenesis, i.e., the involvement and sometimes active participation of medical professionals in acts of Torture , to either to judge what victims can endure, to apply treatments that will enhance torture, or as torturers in their own right. Unfortunately, many episodes of humankind's history, such as the Nazi use of torturous human experimentation by physicians such as Josef Mengele , have also witnessed extreme iatrogenesis. Although these could be considered rare instances in medical history, unethical medical experimentation is much more common, i.e., use of involuntary subjects or the inadequate handling of Informed Consent in Clinical Trial s. Horrid perpetrations were recorded even in democratic countries, such as the famous episode of involuntary Syphilis inoculation in negros ( Tuskegee Syphilis Study ), or soldiers and sailors unwillingly subjected to radioactivity ( Operation Plumbbob ) in the USA . Controversial aspects of medical action, such as Assisted Suicide (by physicians such as Dr. Jack Kevorkian ) and ''' Medical Euthanasia ''' are considered iatrogenic death by some. A related concept is Institutional Damage but it can occur separately from the medical acts, even in a hospital. CASCADE IATROGENESIS Cascade iatrogenesis is a series of increasingly more severe effects on the health of patients, caused by medical interventions which were applied to solve the previous one. A good example was a real case of a patient who had severe . Chronic diabetes increased the patient's susceptibility to infections and activated a latent pulmonary Tuberculosis with Hemoptysis . Cortisone treatment was suspended and substituted by ACTH therapy, which provoked Adrenal Insufficiency and severe Osteoporosis , with painful spontaneous Bone Fracture s (including fracture of Rib s caused by an external Cardiopulmonary Resuscitation attempt. Generalized organ failure and infection followed, with death. INCIDENCE AND IMPORTANCE Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 "found that 36% of 815 consecutive patients on a general medical service of a university hospital had an iatrogenic illness. In 9% of all persons admitted, the incident was considered major in that it threatened life or produced considerable disability. In 2% of the 815 patients, the iatrogenic illness was believed to contribute to the death of the patient. Exposure to drugs was a particularly important factor in determining which patients had complications." (Steel ''et al.'', 1981). In another study, done in 101 adverse iatrogenic events in 84 patients, "the most commonly reported process of care problems were inadequate evaluation of the patient (16.4%), failure to monitor or follow up (12.7%), and failure of the laboratory to perform a test (12.7%)." (Weingart ''et al.'', 2000). SEE ALSO
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