THE transfer of pathogens from the autopsy room to maternity patients, leading to shocking historical mortality rates of puerperal fever or childbed fever at maternity institutions in the 19th century, was a major iatrogenic catastrophe of that time. The infection mechanism was first identified by Ignaz Semmelweis.

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, anaesthesia, antibiotics, and better surgical techniques have been developed to decrease iatrogenic mortality. Yet, it continues to this day throughout the world.

Examples of iatrogenesis include: risk associated with medical interventions; adverse effects of prescription drugs; overuse of drugs causing, for example, antibiotic resistance in bacteria; prescription drug interaction; medical error or misdiagnosis and prescription; wrong prescription, perhaps due to illegible handwriting, typos on computer, or mistakes; negligence; nosocomial infections; faulty procedures, techniques, information, methods, or equipment.

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 adverse effects of a medical treatment are iatrogenic. For example, radiation therapy and chemotherapy, which are by nature aggressive, frequently produce such iatrogenic effects as hair loss, anaemia, vomiting, nausea, brain damage, lymphedema, infertility, etc.

The loss of function resulting from the required removal of a diseased organ is iatrogenic, as in the case of diabetes consequential to the removal of all or part of the pancreas.

Other situations may involve actual negligence or faulty procedures, such as when pharmacotherapists produce handwritten prescriptions for drugs. Hint, if you can’t read it, your pharmacist may not be able to read it either.

A very common iatrogenic effect is caused by drug interaction, ie, when pharmacotherapists fail to check for all medication a patient is taking and prescribe new ones that interact agonistically or antagonistically. Such situations can 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. Bacterial strains resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs.

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 to regular cells. However, alkylation causes severe side effects and is actually carcinogenic in its own right, with potential to lead to the development of secondary tumors. In similar manner, arsenic-based medications like melarsoprol for trypanosomiasis can cause arsenic poisoning.

Adverse effects can appear mechanically. The design of some surgical instruments may be decade’s old, hence certain adverse effects, such as tissue trauma, may have never been properly cauterised. Some instruments that are long-standing parts of surgical kit would be unlikely to succeed if they were introduced anew; the collateral damage one expects to see with their use would be unacceptable in the modern world.

In psychology, iatrogenesis can occur due to misdiagnosis, including diagnosis with a false condition as was the case of hystero-epilepsy. Conditions hypothesised as partially or completely iatrogenic include bipolar disorder, dissociative identity disorder, somatoform disorder, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, antisocial youths and others, though research is equivocal for each condition. 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. 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.

LATROGENIC POVERTY

Meessen et al used the term “iatrogenic poverty” to describe impoverishment induced by medical care. Impoverishment is described for households exposed to catastrophic health expenditure or to hardship financing. Every year, worldwide, over 100,000 households fall into poverty due to health-care expenses. In the United States, medical debt is the leading cause of bankruptcy.

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 public awareness in those countries is often lagging behind. Patients easily fall into a vicious cycle of illness, ineffective therapies, consumption of savings, indebtedness, sale of productive assets, and eventually poverty. Remember, it is written that only the sick are in need of a doctor. Keep yourself healthy with a proper lifestyle, diet, and natural chiropractic care. This will lessen your chances of actually needing drugs or surgeries and will enhance the treatment protocol of the medical doctor if you do become sick, because the body system may be operating more optimally.

The 20th century social critic Ivan Illich broadened the concept of medical iatrogenesis in his 1974 book Medical Nemesis: The Expropriation of Health by defining it at three levels. First, clinical iatrogenesis is the injury done to patients by ineffective, unsafe, and erroneous treatments as described above. In this regard, he described the need for evidence-based medicine 20 years before the term was coined. Second, social iatrogenesis is the medicalisation of life in which medical professionals, pharmaceutical companies and medical device companies have a vested interest in sponsoring sickness by creating unrealistic health demands that require more treatments or to treat non-diseases that are part of the normal human experience, such as age-related declines. In this way, aspects of medical practice and medical-associated industries can produce social harm in which society members ultimately become less healthy, excessively dependent on institutional care. He argued that medical education of physicians contributes to medicalisation of society because they are trained for diagnosing and treating illness, therefore they focus on disease rather than on health. Iatrogenic poverty can be considered a specific manifestation of social iatrogenesis.

Third, cultural iatrogenesis refers to the destruction of traditional ways of dealing with, and making sense of, death, suffering and sickness. In this way the medicalisation of life leads to cultural harm as society members lose their autonomous coping skills. It is worth noting that in these critiques, “Illich does not reject all benefits of modern society, but rejects those that involve unwarranted dependency and exploitation”.

Unfortunately, even most doctors themselves are completely unaware of this scheme by the big associations. Most of their contact with them comes from medical institutions having them regurgitate and memorise the things that they want them to learn and to apply to earn their degree, along with plush drug reps after they graduate that provide them with free drugs, equipment, lunches, and patient referrals.

Iatrogenesis is a major phenomenon, and a severe risk to patients. In a study carried out in 1981, more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in 10 was considered major, and, in 2 per cent of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications.

Two per cent does not sound like much, however, what if that were you or your child? Is the risk worth the alleged benefit? Some countries consume a Japanese delicacy called puffer fish or blow fish. The toxin in these fish is 100 to 12,000 times more potent than cyanide, depending on species. No one in their right mind would eat this stuff intentionally, right? Wrong. Ten thousand tons of blow fish are consumed every year. This is despite the fact that only licensed cooks are allowed to prepare it. If cooked improperly the dish can cause instantaneous death. At least one serious incident occurs yearly. Now that is very small relative to the number of consumers, but it is still a deadly risk.

Likewise, you better know that the person writing potentially deadly prescriptions for you and your family knows what they are doing, that is it legible and that it is absolutely necessary for life. Pills should be viewed as an absolute necessity, not as a delicacy, and you should always be aware that even though they claim millions of people ingest them without dying, this still does not make it false that they are in fact poisonous and can cause harm and death worldwide. Recall that if it kills you slowly over time, such as through organ failure, that it still kills you.

In the United States alone, conservative figures suggest estimated deaths per year of: 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 nosocomial infections in hospitals; 106,000 due to non-error, negative effects of drugs in general. Based on these figures, iatrogenesis may cause a minimum of 225,000 deaths per year in the United States, excluding recognisable error.

An earlier Institute of Medicine report estimated 230,000 to 284,000 iatrogenic deaths annually. That is approximately 30 deaths every hour. Also, roughly 160,000 people were killed by cancer in the UK in 2011 — only half of this number from iatrogenesis every year in the US alone. Compare that to claims that chiropractic is dangerous because it may or may not lead to two strokes, not deaths, per 10 million adjustments.

This data suggests that iatrogenic illness constitutes the third leading cause of death in the United States, after heart disease and cancer. This trickles down to the rest of the world and chiropractic by any comparison is far safer and much more effective for your overall wellness.

Be sure to look for part four of this topic next week.

Don’t forget to “Ask Your Chiropractor” every week where your questions may be published and answered in subsequent articles. Address questions to: Dr Chris Davis, the Spinal Mechanic and lead doctor, at movethebone@gmail.com; or, Dr Michael Harvey, director, at dr.michael_harvey@yahoo.com