Iatrogenesis literally means "brought forth by a healer" (iatros means healer in Greek); as such, it can refer to good or bad effects, but it is almost exclusively used to refer to a state of ill health or adverse effect or complication caused by or resulting from medical treatment. Image File history File links Iatros. ... A healer is someone who intends to aid recovery from ill health, including alleged faith healers. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Complication, in medicine, is a unfavorable evolution of a disease, a health condition or a medical treatment. ... medicines, see medication and pharmacology. ... Look up Therapy in Wiktionary, the free dictionary. ...

From a sociological point of view there are three types of iatrogenesis: clinical iatrogenesis, social iatrogenesis, and cultural iatrogenesis. While iatrogenesis is most often used to refer to the harmful consequences of actions by physicians, it can equally be the result of actions by other medical professionals, such as psychologists, therapists, pharmacists, nurses, dentists, etc. Further, iatrogenic illness or death is not restricted to Western medicine: alternative medicine (sometimes referred to as complementary medicine) may be considered a source of iatrogenesis for the same reasons. A psychologist is a scientist and/or clinician who studies psychology, the systematic investigation of the human mind, including behavior and cognition. ... The mortar and pestle is an international symbol of pharmacists and pharmacies. ... This article focuses on the education and regulation of nurses. ... X-rays can reveal if a person has cavities Dentistry is the practical application of knowledge of dental science (the science of placement, arrangement, function of teeth) to human beings. ... Alternative medicine describes practices used in place of conventional medical treatments. ...

History

Since Hippocrates's time, the potential damaging effect of a healer's actions has been recognized. The old mandate "first do no harm" (primum non nocere) 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. Hippocrates of Cos II or Hippokrates of Kos (ca. ... This article or section does not cite any references or sources. ...

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 antiseptics, anesthesia, antibiotics, and new and better surgical techniques, iatrogenic mortality decreased enormously. (19th century - 20th century - 21st century - more centuries) Decades: 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s As a means of recording the passage of time, the 20th century was that century which lasted from 1901–2000 in the sense of the Gregorian calendar (1900–1999... An antiseptic solution of iodine applied to a cut Antiseptics (Greek αντί, against, and σηπτικός, putrefactive) are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. ... Anesthesia or anaesthesia (see spelling differences) has traditionally meant the condition of having the perception of pain and other sensations blocked. ... Staphylococcus aureus - Antibiotics test plate. ...

Sources of iatrogenesis

There are many sources of iatrogenesis:

• medical error
• negligence or faulty procedures
• Doctor assisted suicide
• poor prescription handwriting
• prescription drug interaction
• adverse effects of prescription drugs
• minimizing the possibility of negative drug effects
• over-use of drugs leading to antibiotic resistance in bacteria
• radical treatments
• misdiagnosis
• nosocomial infection
• mental, nervous, sensorial or muscular disease in physicians (very rare)
• medical torture

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 or chemotherapy, due to the needed aggressiveness of the therapeutic agents, frequent effects are hair loss, anemia, vomiting, nausea, brain damage etc. Excessive or inappropriate dependence on a therapist is a frequent example of iatrogenesis. The loss of functions resulting from the required removal of a diseased organ is also considered iatrogenesis, e.g., iatrogenic diabetes brought on by removal of all or part of the pancreas. See also preventable medical errors In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. ... Negligence is a legal concept usually used to achieve compensation for accidents and injuries. ... Look up prescription in Wiktionary, the free dictionary. ... Penmanship is the art of writing clearly and quickly. ... A drug interaction is a situation in which a substance affects the activity of a drug, i. ... In medicine, an Adverse effect is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as a result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Antibiotic resistance is the ability of a micro-organism to withstand the effects of an antibiotic. ... In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths each year and 1,000,000 excess injuries[1]. It is estimated that in a typical 100 to 300 bed hospital in the United States that excess costs of $1,000,000... // Nosocomial infections are those which are a result of treatment in a hospital or hospital-like setting, but secondary to the patients original condition. ... Medical torture describes the involvement and sometimes active participation of medical professionals in acts of torture, to either to judge what victims can endure, to apply treatments which will enhance torture, or as torturers in their own right. ... See also preventable medical errors In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... It has been suggested that Blockbuster drug be merged into this article or section. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Clinac 2100 C100 accelerator Radiation therapy (or radiotherapy) 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). ... Chemotherapy is the use of chemical substances to treat disease. ... Baldness (formally alopecia) is the state of lacking hair where it usually would grow, especially on the head. ... Anemia (AmE) or anaemia (BrE), from the Greek () meaning without blood, is a deficiency of red blood cells (RBCs) and/or hemoglobin. ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... For the Beck song, see Nausea (song). ... Brain damage or brain injury is the destruction or degeneration of brain cells. ... Dependency has a number of meanings: In project management, a dependency is a link amongst a projects terminal elements. ... This article is about the disease that features high blood sugar. ...

In other situations, actual 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. Negligence is a legal concept usually used to achieve compensation for accidents and injuries. ...

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). 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. A drug interaction is a situation in which a substance affects the activity of a drug, i. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the... This article deals specifically with IgE-mediated hypersensitivity. ...

The evolution of antibiotic resistance in bacteria is iatrogenic as well (Finland, 1979). Bacteria strains resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs. Antibiotic resistance is the ability of a micro-organism to withstand the effects of an antibiotic. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Staphylococcus aureus - Antibiotics test plate. ...

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 (such as lobotomy), some forms of shock therapy, and colostomy for treating recurrent infections. Psychosurgery is a term for surgeries of the brain involving procedures that modulate the performance of the brain, and thus effect changes in cognition, with the intent to treat or alleviate severe mental illness. ... A human brain that has undergone lobotomy. ... Shock therapy is the deliberate and controlled induction of some form of physiological state of shock in an individual for the purpose of psychiatric treatment. ... A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. ...

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 unwitting transmitters of nosocomial infections (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 needles, surgical instruments, and the use of ungloved hands to perform medical or dental procedures. For example, a number of hepatitis B and C infections caused by dentists 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 syringes and needles by nurses spread the Ebola virus, probably causing hundreds of deaths [1]. A nosocomial infection is an infection that is caused by staying in a hospital. ... A physician visiting the sick in a hospital. ... An infection is the detrimental colonization of a host organism by a foreign species. ... // Nosocomial infections are those which are a result of treatment in a hospital or hospital-like setting, but secondary to the patients original condition. ... Different bevels on hypodermic needles. ... Surgeon excising an arrow from a wounded soldier, Stele from Herculaneum, Rome, 1 BC A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access or viewing it. ... Hepatitis (plural hepatitides) implies injury to liver characterised by presence of inflammatory cells in the liver tissue. ... X-rays can reveal if a person has cavities Dentistry is the practical application of knowledge of dental science (the science of placement, arrangement, function of teeth) to human beings. ... A syringe consists of a plunger fitted to a tube, called the barrel, which has a small opening on one end. ... Ebola is both the common term used to describe a group of viruses belonging to genus Ebolavirus, family Filoviridae, and the common name for the disease which they cause, Ebola hemorrhagic fever. ...

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), American physician Richard J. Schmidt (who tried to kill his girlfriend by contaminating her with AIDS-tainted blood), 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 (for an account, see Youngson, 1997). Sleep deprivation is a general lack of the necessary amount of sleep. ... Beverley Allitt (born 4 October 1968), dubbed the Angel of Death [1], was an English paediatric nurse who was convicted of killing four children and injuring nine others, in 1991, on the childrens ward of Grantham and Kesteven Hospital, Lincolnshire where she worked. ... This article or section does not cite any references or sources. ... Harold Frederick Shipman (14 January 1946–13 January 2004) was a British general practitioner who was the most prolific known serial killer in modern history. ... The unusual case of Dr. Richard J. Schmidt marks the first time in forensic history where viral DNA was used prove a link between two people with HIV or AIDS in a criminal trial. ... Ernst Ferdinand Sauerbruch (3rd July 1875– 2nd July 1951) was a German surgeon. ...

Medical torture can be regarded as 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 trials. Horrid perpetrations were recorded even in democratic countries, such as the famous episode of involuntary syphilis inoculation in African-Americans (Tuskegee Syphilis Study), or soldiers and sailors unwillingly subjected to radioactivity (Operation Plumbbob) in the USA. Medical torture describes the involvement and sometimes active participation of medical professionals in acts of torture, to either to judge what victims can endure, to apply treatments which will enhance torture, or as torturers in their own right. ... Torture is defined by the United Nations Convention Against Torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he... National Socialism redirects here. ... Josef Mengele Dr. Josef Mengele (March 16, 1911 – February 7, 1979), was a German SS officer and a physician in the Nazi concentration camp Auschwitz-Birkenau. ... Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is the application of the scientific method to human health. ... This article or section is in need of attention from an expert on the subject. ... // The Pelkola Syphilis Study (1932–1972), also known as the Public Health Service Syphilis Study or the Tuskegee Experiment(s) was a clinical study, conducted around Tuskegee, Alabama, where 399 (plus 200 control group without syphilis) poor -- and mostly illiterate -- African American sharecroppers became part of a study on the... The Smoky shot of Operation Plumbbob. ...

Medical action, such as assisted suicide (by physicians such as Dr. Jack Kevorkian) and medical euthanasia are also forms of doctor originated (iatrogenic) death. Euthanasia (Greek, good death) is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. ... Dr. Jack Kevorkian Jack Kevorkian, M.D. (born Pontiac, Michigan, May 20, 1928) is a controversial American pathologist. ... Euthanasia (from Greek: ευθανασία -ευ, eu, good, θάνατος, thanatos, death) is the practice of terminating the life of a person or animal in a presumably painless or minimally painful way, usually by lethal injection. ...

A related concept is Institutional Damage but it can occur separately from the medical acts, even in a hospital. The text below is generated by a template, which has been proposed for deletion. ...

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^{[citation needed]} of a patient who had severe arthritis. Cortisone therapy at a high dose was instituted and was effective for a while, but prolonged use caused the first iatrogenic effect in the cascade: diabetes. 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 fractures (including fracture of ribs caused by an external cardiopulmonary resuscitation attempt. Generalized organ failure and infection followed, with death. Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... Cortisone (IPA:ˈkôrtəˌsōn) is a steroid hormone. ... This article is about the disease that features high blood sugar. ... Tuberculosis (abbreviated as TB for Tubercle Bacillus) is a common and deadly infectious disease that is caused by mycobacteria, primarily Mycobacterium tuberculosis. ... Hemoptysis (US English) or haemoptysis (International English) is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... It has been suggested that this article or section be merged with Bone healing. ... The human rib cage. ... Wikibooks has more about this subject: First Aid/CPR Cardiopulmonary resuscitation (CPR) is an emergency first aid procedure for a victim of cardiac arrest. ...

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).

In the United State alone, recorded deaths per year (2000):

• 12,000 -- unnecessary surgery
• 7,000 -- medication errors in hospitals
• 20,000 -- other errors in hospitals
• 80,000 -- infections in hospitals
• 106,000 -- non-error, negative effects of drugs

Based on these figures, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Also, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).

This totals 225,000 deaths per year from iatrogenic causes. In interpreting these numbers, note the following:

• most data were derived from studies in hospitalized patients.
• the estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.
• the estimates of death due to error are lower than those in the IOM report. If higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

(Dr. Barbara Starfield of Johns Hopkins School of Hygiene and Public Health, Journal of the American Medical Association, July 2000)

See also

• Adverse drug reaction
• Adverse effect (medicine)
• Bioethics
• Complication (medicine)
• Dr. Death
• Iatrogenic disorder
• Medical error
• Nocebo response
• Patient safety
• Placebo (origins of technical term)
• Polypharmacy

An adverse drug reaction (abbreviated ADR) is a term to describe the unwanted, negative consequences sometimes associated with the use of medications. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... This article or section does not cite any references or sources. ... Complication, in medicine, is a unfavorable evolution of a disease, a health condition or a medical treatment. ... Dr. Death is a moniker that has been adopted by, or an epithet that has been applied to, multiple people: Aribert Heim, an Austrian doctor and one of the worlds most wanted Nazi war criminals. ... Generically, an iatrogenic disorder is any pathological anomaly in which the dysfunctional symptoms in the patient owe their cause (iatrogenesis) to the actions of the practitioner. ... See also preventable medical errors In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. ... In its original application, nocebo had a very specific meaning in the domains of nosology and aetiology. ... Patient safety is a relatively recent initiative in medicine, emphasizing the reporting, analysis and prevention of medical error and adverse health care events. ... The technical term placebo is precisely applied in the specialized medical domains of pharmacology, nosology, and aetiology to denote the pharmacologically inert, dummy simulator of an active drug that serves as a scientific control in clinical trials designed to determine the clinical efficacy of that particular drug. ... The term polypharmacy generally refers to the use of multiple-medications by a patient. ...

Bibliography

• Finland M. Emergence of antibiotic resistance in hospitals. Rev Infect Dis 1979; 1:4-21. PMID 45521
• Fisher-Hoch SP. Lessons from nosocomial viral haemorrhagic fever outbreaks. Br Med Bull. 2005 Dec 22;73-74:123-37. PMID 16373655
• Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med. 1981;304:638-642. PMID 7453741
• Valenstein, Eliott: Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness.
• Vance MA, Millington, WR. Principles of Irrational Drug Therapy. British Naturopathic Journal 1990; 13(3). Full paper
• Weingart SN, Ship AN, Aronson MD. Confidential clinician-reported surveillance of adverse events among medical inpatients. J Gen Intern Med. 2000;15:470-477. PMID 10940133
• Youngson, R.M.. The demented surgeon is operating. In: Medical Curiosities. Carroll & Graf, New York, 1997.

This article may require cleanup to meet Wikipedia's quality standards. Please discuss this issue on the talk page or replace this tag with a more specific message. This article has been tagged since January 2007.

Michael A Vance and William R Millington Image File history File links Broom_icon. ...

External links

• Yahoo Group: Iatrogenic
• Patient Safety Network