The terms iatrogenesis and iatrogenic artifact refer to inadvertent adverse effects In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical or complications Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A medical treatment, such as drugs or surgery may caused by or resulting from medical Medicine is the science and art of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Before scientific medicine, healing arts were practised in accordance with alchemical treatments and ritual practices that developed out of religious and cultural traditions treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists There are many different types of psychologists, as is reflected by the 56 different divisions of the American Psychological Association . Psychologists are generally described as being either "applied" or "research-oriented". The common terms used to describe this central division in psychology are "scientists" or &, therapists Psychotherapy, or personal counselling with a psychotherapist, is an intentional interpersonal relationship used by trained psychotherapists to aid a client or patient in problems of living, pharmacists Pharmacists are health professionals who practice the science of pharmacy. In their traditional role, pharmacists typically take a request for medicines from a prescribing health care provider in the form of a medical prescription, evaluate the appropriateness of the prescription, dispense the medication to the patient and counsel them on the, nurses A nurse is a healthcare professional who, in collaboration with other members of a health care team, is responsible for: treatment, safety, and recovery of acutely or chronically ill individuals; health promotion and maintenance within families, communities and populations; and, treatment of life-threatening emergencies in a wide range of health, dentists Dentistry, which is a part of stomatology, is the branch of medicine that is involved in the evaluation, diagnosis, prevention, and surgical or non-surgical treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely, and others. Iatrogenesis is not restricted to conventional medicine: it can also result from complementary and alternative medicine In Western culture, alternative medicine is any healing practice "that does not fall within the realm of conventional medicine", or "that which has not been shown consistently to be effective." It is often opposed to evidence based medicine and encompasses therapies with an historical or cultural, rather than a scientific, treatments.

Some iatrogenic artifacts are clearly defined and easily recognized, such as a complication following a surgical procedure. Some less obvious ones can require significant investigation to identify, such as complex drug interactions A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind . However, interactions may also exist between drugs & foods (drug-food interactions), as well as. Furthermore, some conditions have been described for which it is unknown, unproven or even controversial whether they be iatrogenic or not; this has been encountered particularly with regard to various psychological and chronic-pain conditions. Research in these areas continues.

Causes of iatrogenesis include chance, medical error Medical error is an inaccurate or incomplete diagnosis and/or treatment of a disease; injury; syndrome; behavior; infection or other ailment, negligence Negligence is a legal concept in the common law legal systems mostly applied in tort cases to achieve monetary compensation (damages) for physical and mental injuries (not accidents), social control Social control refers generally to societal and political mechanisms or processes that regulate individual and group behavior, leading to conformity and compliance to the rules of a given society, state, or social group. Many mechanisms of social control are cross-cultural, if only in the control mechanisms used to prevent the establishment of and the adverse effects In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical or interactions A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind . However, interactions may also exist between drugs & foods (drug-food interactions), as well as of prescription drugs. In the United States, from 120,000 to 225,000 deaths per year may be attributed in some part to iatrogenesis.^[1]

History

Etymologically, the term "iatrogenesis" means "brought forth by a healer" (iatros means healer In Western culture, alternative medicine is any healing practice "that does not fall within the realm of conventional medicine", or "that which has not been shown consistently to be effective." It is often opposed to evidence based medicine and encompasses therapies with a historical or cultural, rather than a scientific, basis in Greek Greek , an independent branch of the Indo-European family of languages, is the language of the Greeks. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. In its ancient form, it is the language of classical ancient Greek literature and the New Testament of); as such, in its earlier forms, it could refer to good or bad effects.

Since at least the time of Hippocrates Hippocrates of Cos or Hippokrates of Kos - Greek: Ἱπποκράτης; Hippokrátēs was an ancient Greek physician of the Age of Pericles (Classical Athens), and is considered one of the most outstanding figures in the history of medicine. He is referred to as the Western father of medicine in recognition of his lasting contributions to the, people have recognized the potential damaging effects of a healer's actions. The old mandate "first do no harm" (primum non nocere Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better to do nothing than to do something) is an important clause of medical ethics Bioethics is the philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy, and iatrogenic illness or death caused purposefully, or by avoidable error or negligence on the healer's part became a punishable offense in many civilizations.^{[citation needed]}

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.^{[citation needed]} The infection mechanism was first identified by Ignaz Semmelweis Ignaz Philipp Semmelweis ,[Note 1] was a Hungarian physician described as the "savior of mothers", who discovered by 1847 that the incidence of puerperal fever could be drastically cut by use of hand washing standards in obstetrical clinics. Puerperal fever (or childbed fever) was common in mid-19th-century hospitals and often fatal,.

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 Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antiseptics are generally distinguished from antibiotics by the latter's ability to be transported through the lymphatic system to destroy bacteria within the body, and from disinfectants, which destroy, anesthesia Anesthesia, or anaesthesia , has traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. It is a pharmacologically induced reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes and/or decreased stress response. This allows patients to, antibiotics In common usage, an antibiotic is a substance or compound that kills bacteria or inhibits their growth. Antibiotics belong to the broader group of antimicrobial compounds, used to treat infections caused by microorganisms, including fungi and protozoa, and better surgical techniques have been developed to decrease iatrogenic mortality Death is the termination of the biological functions that define a living organism. The word refers both to a particular process and to the condition that results thereby. The nature of the latter has been for millennia a central concern of the world's religious traditions and of philosophical enquiry. Belief in some kind of afterlife or rebirth.

Sources of iatrogenesis

Examples of iatrogenesis:

• Risk Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A medical treatment, such as drugs or surgery may associated with medical interventions
  • adverse effects In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical of prescription drugs
  • over-use of drugs, (causing - for example - antibiotic resistance Antibiotic resistance is a specific type of drug resistance when a microorganism has the ability of withstanding the effects of antibiotics. Antibiotic resistance evolves via natural selection acting upon random mutation, but it can also be engineered by applying an evolutionary stress on a population. Once such a gene is generated, bacteria can in bacteria The bacteria ( [bækˈtɪəriə] ; singular: bacterium)[α] are a large group of single-celled, prokaryote microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals. Bacteria are ubiquitous in every habitat on Earth, growing in soil, acidic hot springs, radioactive waste,)
  • prescription drug interaction A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind . However, interactions may also exist between drugs & foods (drug-food interactions), as well as
• medical error Medical error is an inaccurate or incomplete diagnosis and/or treatment of a disease; injury; syndrome; behavior; infection or other ailment
• wrong prescription A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist. Commonly, the term prescription is used to mean an order, perhaps due to illegible handwriting Penmanship or handwriting is the art of writing with the hand and a writing instrument. Styles of handwriting are also called hands or scripts
• negligence Negligence is a legal concept in the common law legal systems mostly applied in tort cases to achieve monetary compensation (damages) for physical and mental injuries (not accidents)
• faulty procedures, techniques, information, or methods

Causes and consequences

Medical error and negligence

Iatrogenic conditions do not necessarily result from medical errors Medical error is an inaccurate or incomplete diagnosis and/or treatment of a disease; injury; syndrome; behavior; infection or other ailment, such as mistakes made in surgery Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, and sometimes for religious reasons. An act of performing surgery may be called a surgical procedure, operation, or simply, or the prescription or dispensing of the wrong therapy, such as a drug A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease. In fact, intrinsic and sometimes adverse effects In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical of a medical treatment are iatrogenic. For example, radiation therapy Radiation therapy , or radiotherapy (in the UK and Australia) also called radiation oncology, and sometimes abbreviated to XRT, is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). Radiotherapy may be used for and chemotherapy Chemotherapy, in its most general sense, is the treatment of disease by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen. In its non-oncological use, the term may also refer, due to the needed aggressiveness of the therapeutic agents, frequently produce iatrogenic effects such as hair loss Alopecia is the medical description of the loss of hair from the head or body, sometimes to the extent of baldness. Unlike the common aesthetic depilation of body hair, alopecia tends to be involuntary and unwelcome, e.g., androgenic alopecia. However, it may also be caused by a psychological compulsion to pull out one's own hair or the unforeseen, anemia Anemia is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency, vomiting Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure. The feeling that one is about to vomit is called nausea, which usually precedes, but does not always lead to,, nausea Nausea , is a sensation of unease and discomfort in the upper stomach with an urge to vomit. An attack of nausea is known as a qualm, brain damage 'Brain damage' is a term no longer used today and has been replaced in recent decades by 'brain injury' ; meaning the destruction or degeneration of brain cells, often with an implication that the loss is significant in terms of functioning or conscious experience. It is a common and very broad in scope, such that in medicine a vast range of. lymphedema Lymphedema , also known as lymphatic obstruction, is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, infertility, etc. The loss of functions resulting from the required removal of a diseased organ also counts as iatrogenesis, thus we find (for example) iatrogenic diabetes Diabetes mellitus, often simply referred to as diabetes—is a condition in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria , polydipsia (increased thirst) and polyphagia ( brought on by removal of all or part of the pancreas.

Other situations may involve actual negligence Negligence is a legal concept in the common law legal systems mostly applied in tort cases to achieve monetary compensation (damages) for physical and mental injuries (not accidents) or faulty procedures, such as when pharmacotherapists produce handwritten prescriptions for drugs. It has been proven that poor handwriting can lead a pharmacist to dispense the wrong drug, worsening a patient's condition.^{[citation needed]}

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 which interact agonistically or antagonistically (potentiate or decrease the intended therapeutic effect). Such situations an 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.^[2] Bacteria strains resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs.^{[citation needed]}

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, potentially leading to the development of secondary tumors. Similarly, arsenic-based medications like melarsoprol for trypanosomiasis cause arsenic poisoning.

Psychology

In psychology, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy^[3]). Conditions hypothesized as partially or completely iatrogenic include bipolar disorder,^[4] dissociative identity disorder,^[3][5] fibromyalgia,^[6] somatoform disorder,^[7] chronic fatigue syndrome,^[7] posttraumatic stress disorder,^[8] substance abuse,^[9] antisocial youths^[10] and others,^[11] though research is equivocal for each condition.^{[citation needed]} The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial. The over-diagnosis of psychological conditions (with the assignment of mental illness terminology) may relate primarily to clinician dependence on subjective criteria.^{[citation needed]} 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.^{[citation needed]}

Iatrogenic poverty

Meessen et al. used the term “iatrogenic poverty” to describe impoverishment induced by medical care^[12]. Impoverishment is described for households exposed to catastrophic health expenditure^[13] or to hardship financing^[14]. Every year, worldwide, over 100,000 households fall into poverty due to health care expenses. 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.

Incidence and importance

Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten were considered major, and in 2% of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications.^[15] In another study, the main factors leading to problems were inadequate patient evaluation, lack of monitoring and follow-up, and failure to perform necessary tests.^[16]

In the United States, figures suggest estimated deaths per year of^[1]:

• 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 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). These estimates are lower than those in an earlier IOM report, which might suggest from 230,000 to 284,000 iatrogenic deaths.^[1] These figures are likely exaggerated, however, as they are based on recorded deaths in hospitals rather than in the general population. Even so, the large gap separating these estimates deaths from cerebrovascular disease would still suggest that iatrogenic illness constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. And these estimates are for fatalities only, and do not include nonfatal harms associated with disability or discomfort.

See also

• Adverse drug reaction
• Adverse effect (medicine)
• Bedsore
• Bioethics
• Cascade effect
• Classification of Pharmaco-Therapeutic Referrals
• Complication (medicine)
• Fatal Care: Survive in the U.S. Health System (book)
• Journal of Negative Results in Biomedicine
• Medical error
• Nocebo
• Patient safety
• Placebo
• Polypharmacy
• Medical harm

References

1. ^ ^{a b c} Starfield B (2000). "Is US health really the best in the world?". JAMA 284 (4): 483–5. doi:10.1001/jama.284.4.483. PMID 10904513.
2. ^ Finland M (1979). "Emergence of antibiotic resistance in hospitals, 1935-1975". Rev. Infect. Dis. 1 (1): 4–22. PMID 45521.
3. ^ ^{a b} Spanos, Nicholas P. (1996). Multiple Identities & False Memories: A Sociocognitive Perspective. American Psychological Association (APA). ISBN 1-55798-340-2.
4. ^ Pruett Jr, John R.; Luby, Joan L. (2004). "Recent Advances in Prepubertal Mood Disorders: Phenomenology and Treatment". Curr Opin Psychiatry 17 (1): 31–36. doi:10.1097/00001504-200401000-00006. http://www.medscape.com/viewarticle/466375_print. Retrieved 2008-05-04.
5. ^ Braun, B.G. (1989). Dissociation: Vol. 2, No. 2, p. 066-069: Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD (Morose Parasitic Dynamism). https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1425/1/Diss_2_2_3_OCR.pdf. Retrieved 2008-05-04.
6. ^ Hadler, N.M. (1997). "Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients?". Postgrad Med 102 (6): 43. http://www.ncbi.nlm.nih.gov/pubmed/9270707. Retrieved 2008-05-04.
7. ^ ^{a b} Abbey, S.E. (1993). "Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome". Ciba Found Symp 173: 238–52. http://www.ncbi.nlm.nih.gov/pubmed/8491101. Retrieved 2008-05-04.
8. ^ Boscarino, JA (2004). Evaluation of the Iatrogenic Effects of Studying Persons Recently Exposed to a Mass Urban Disaster. http://mailer.fsu.edu/~cfigley/IatrogenicEffectsfinal3p1.pdf. Retrieved 2008-05-04.
9. ^ Moos, R.H. (2005). "Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence , predictors, prevention" (abstract). Addiction 100 (5): 595–604. doi:10.1111/j.1360-0443.2005.01073.x. PMID 15847616. http://pt.wkhealth.com/pt/re/addi/abstract.00008514-200505000-00006.htm;jsessionid=LpCb6sF6cx1sMvkMlc5h62MCCWh1Gj5vyLBz0ydpfn36tl31Y8Kn!1379360954!181195629!8091!-1.
10. ^ Weiss, B.; Caron, A.; Ball, S.; Tapp, J.; Johnson, M.; Weisz, J.R. (2005). "Iatrogenic effects of group treatment for antisocial youths". Journal of Consulting and Clinical Psychology 73 (6): 1036–1044. doi:10.1037/0022-006X.73.6.1036. PMID 16392977. http://eric.ed.gov:80/ERICWebPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ734173&ERICExtSearch_SearchType_0=no&accno=EJ734173. Retrieved 2008-05-04.
11. ^ Kouyanou, K; Pither, CE; Wessely, S (1 November 1997). "Iatrogenic factors and chronic pain" (abstract). Psychosomatic Medicine 59 (6): 597–604. PMID 9407578. http://www.psychosomaticmedicine.org/cgi/content/abstract/59/6/597. Retrieved 2008-05-04.
12. ^ Meessen,B., Zhenzhong,Z., Van Damme,W., Devadasan,N., Criel,B., Bloom,G. (2003). "Iatrogenic poverty.". Tropical Medicine & International Health 8 (7): 581–4. doi:10.1046/j.1365-3156.2003.01081.x.
13. ^ Xu et al.; Evans, DB; Carrin, G; Aguilar-Rivera, AM; Musgrove, P; Evans, T (2007). "Protecting Households from Catastrophic Health Spending". Health Affairs 26 (4): 972–83. doi:10.1377/hlthaff.26.4.972. PMID 17630440.
14. ^ Kruk et al.; Goldmann, E.; Galea, S. (2009). "Borrowing And Selling To Pay For Health Care In Low- And Middle-Income Countries". Health Affairs 28 (4): 10056–66. doi:10.1377/hlthaff.28.4.1056. PMID 19597204.
15. ^ Steel K, Gertman PM, Crescenzi C, Anderson J (1981). "Iatrogenic illness on a general medical service at a university hospital". N. Engl. J. Med. 304 (11): 638–42. PMID 7453741.
16. ^ Weingart SN, Ship AN, Aronson MD (2000). "Confidential clinician-reported surveillance of adverse events among medical inpatients". J Gen Intern Med 15 (7): 470–7. doi:10.1046/j.1525-1497.2000.06269.x. PMID 10940133.

Further reading

• Valenstein, Elliot S. (1986). Great and desperate cures: the rise and decline of psychosurgery and other radical treatments for mental illness. New York: Basic Books. ISBN 0465027105.
• Rice, Stephen (1988). Some Doctors Make You Sick: The Scandal of Medical Incompetence. Sydney, Australia: Angus & Robertson. ISBN 0207159505.

External links

• interactive site for those with an interest in medical errors includes short videos telling one woman's story
• Patient Safety Network

Categories: Medical ethics | Healthcare quality | Medical error

See Also:

What Links Here:

• Home
• Iatrogenesis: Encyclopedia

Recently Viewed Pages:

• Home
• Referrers
• Search Terms
• Surgery: Encyclopedia
• Pharmaceutical: News
• Adverse Drug Reaction
• Adverse Effect
• Directory Sites
• Effective Dose
• Pharmacovigilance: Encyclopedia

Most Popular Pages:

• Home
• Norcolut Norethisterone 5mg: Answers
• Placebo: Answers
• Iatrogenesis: Web Search
• List of Medical Abbreviations
• What Is Norcolut Norethisterone 5mg : Answers
• Carbocisteine: Blogs
• Adverse Effect: Encyclopedia
• Surgery: Encyclopedia
• Rhinathiol: News

Related 'Iatrogenesis' Searches: