IATROGENY:	IATROGENOCIDE?

    Iatrogeny as defined by Mosbys
    Medical Dictionary 5th Ed. 1998
    states: IATROGENIC [Gk., iatros, physician, genein, to produce], caused by treatment or diagnostic procedures. An iatrogenic disorder is a condition caused by medical personnel or procedures or through exposure to the environment of a health care facility, including fears instilled in patients by remarks or questions of examining physicians. See also: 'nosocomial', (iatrogenesis, iatrogeny, n.)

    It is well known that many new drugs, devices, surgeries and treatments are touted as miracles of modern medicine, and albeit this article does not argue this, this writer believes that much of this has two sides, possibly two hundred. This article focuses on a dark side. Caveat Emptor. Buyer Beware.

    I am blessed in that 95% of the people I know is a doctor, scientist or activist in health care, and/or unfortunately, a victim of iatrogeny--including myself. My honour and respect is commanded for the many of these people who are working on one way or another to address iatrogeny.

    A generation ago, people trusted their doctors blindly and implicitly. There seemed to be a personal bond with one's doctor which has eroded with the emphasis on medicine as a business, CPT codes, HMOs and iatrogeny, among other things. The health care market place is not kind and people have lost trust. Iatrogeny plays a large and ugly role in this.

    A recent study published in The Joumal of The American Medical Association 2000:284:94); by Barbara Starfield, MD, MPH showed that in the US, this data was found:
12,000 deaths/year from unnecessary surgery
7,000 deaths/year from medication errors in hospitals
20,000 deaths/year from other errors in hospitals
80,000 deaths/year from nosocomial infections in hospitals
106,000 deaths/year from adverse effects of medications
This totals 225,000 deaths per year from iatrogenic causes, placing iatrogeny as the third leading cause of death in the US, second only to heart disease and cancer. The scary part is that this does not include disabilities and disorders, just deaths in hospitalised patients. In any event, when one ponders that more than four times as many people die in one year from doctors' mistakes than died in the entire Vietnam War, one is aghast at why this information isn't making headllines or why huge think tanks funded by medicopolitical interests haven't forrned. We have the American Heart Association to address heart disease, Richard Nixon's "War on Cancer", and even groups like "Mothers Against Drunk Driving", and organisations to address almost every sort of issue, save iatrogeny. My guess is that medicopolitics have not figured out a way to capitalise off of all these deaths and disorders ... yet. There is, however, a small "experts" consortium that does address iatrogeny in the journals, but such studies are few and far between. Funding such studies doesn't appear to be sound business practice.

    Iatrogeny is not exclusive to the US. The British Medical Journal stated on 18 March 2000 that "In Australia, medical error results is an many as 18,000 unnecessary deaths, and more than 50,000 patients become disabled every year." Studies released in the last ten years show similar trends in the UK, Canada and New Zealand. New Zealand has a larae percentage ratio of adverse drug reactions comparable to the US. It should be noted that the US and New Zealand are the only countries that allow aggressive pharmaceutical drug advertisements.

    One very interesting statistic I came across which deserves mention are deaths attributed to addictive drugs in the UK between 1990 and 1995:
    Benzodiazepines - 1,810
    Methadone - 676
    Heroin - 291
This emphasizes my point that millions of dollars and great concern through organisations and associations are given to the deaths and disablements from myriad causes except iatrogeny. Here we have two legal prescription drugs causing more deaths each, than Heroin.

    Many can pooh-pooh these statistics and claim that to err is human, etc., however there comes a point when one must look deeper when the facts and statistics are too overwhelming to ignore. Those in power have choices to make. They can rationalise, deny or take responsible action. The latter seems to be slow in genesis. There has been much denial and silence from the allopathic medical industrial complex. Since medicine has become an arm of business and since business and politics are such passionate bedfellows, one must look at some other interesting facts.

    Drug companies spend huge fortunes for political influence, in fact lobbying for phamiaceutical interests in the first half of 2000 reached $42.9 million (USD); and it was estimated that $230 million (USD) would be spent during the election. George Bush welcomed $1.7 million (USD) from drug companies just for his inauguration celebrations! (British Medical Journal 27 January 2001). Drug companies are a business and have always been a business. They do not give such an investment without an expected return with profits. Perhaps this is why officials turn a blind eye to the fact that doctors and hospitals are responsible for nearly a quarter-million deaths in the US per year. Or perhaps this is why the pharmocompanies manufacture pesticides and chemicals that cause cancer and disease and then manufacture drugs to treat diseases they cause that can cause even more disorders to create a market for more drugs--and more profit. A very lucrative cvcle. Perhaps this is why funding for disease research successfully diverts attention from the pharmocartels own carcinogenic and deadly products. One need not look too hard for reasons why doctors' and hospitals' mistakes are the third leading cause of death in America, with no end in sight.

    Many believe that Barbara Starfield's study cited earlier is just the tip of the iceberg. After all, the study only looked at hospitalised patients. What of the in home and outpatient errors? There are more people to consider in these groups, and certainly more iatrogeny. Could it be that iatrogeng is the leading cause of death in the US? The World? As startling and unsupported as that sounds, it may very well be true. At any rate, the iatrogenic holocaust makes World War II deaths pale in comparison. Yet only patronising and minimal attempts to recognize and correct iatrogeny have been made.

Murder Or Mistake?

    It would be humanly impossible to eliminate genuine mistakes entirely. The problem is that, "How many times does a mistake happen until it's not just a mistake anymore, but negligence?" This author believes that 225,000 deaths every year may be an example of when mistakes cross over to the darkness of negligence. If so, then we are witnessing the greatest holocaust to befall mankind ever.

    In closing, I leave you with my own definition of a freshly coined word.
Iatrogenocide - [Gk, iatros, physician, genein, to produce, cide, killing] The extermination of a population in a systematic fashion through medical error.

    *For more information on iatrogeny, contact me at freeyurko@bizland.com

Bibliography:

WORLD HEALTH REPORT 2000,
Available at: http://www.who.int/whr/2000/en/report.htm.

Leape, L., Unnecessary Surgery, Annu.Rev. Pub. Health. 1992;l 3:363-383.

Starfield, B., Is U.S. Health Really the Best in the World? Jama 2000:284:(4).

Bagnall, G., Will the Accused Please Rise! Healthy Options, 2001:November:9-11.

Kohn, L., ed., Corrigan,J., ed., Donaldson, M., ed., To Err is Human: Building a Safer Health System. Washington, DC, National Academy Press; 1999.

Weingart, S.N., Wilson, R.M., Gibbard, R.W., Harrison, B., Epidemiology and Medical Error. BMJ 2000;320:774-777.

Evans, R., Roos, N., What is right about the Canadian Health System? Milibank Quarterly 1999; 77:393-399.

Anderson, G., Poullier, J.-P., Health Spending, Access and Outcomes: Trends in Industrialised Countries.

New York, NY: The Commonwealth Fund 1999.