History and definition of Iatrogenic Disease
The Hippocratic Oath, the promise which is made by every physician contains a prominent phrase, “Primum non nocere”, which in simple English tells us of the primary duty of an attending doctor: “First do no harm.” The illness or effects caused by a doctor, during the process of treatment or medical examination is called Iatrogenesis, coined from Greek word for healers and doctors. Even during those days of the Greek, Iatrogenesis was one major factor that everyone was aware of, and hence the clause became part of the Hippocratic Oath.
Most of the world’s civil and criminal procedural codes of Law, consider it a punishable offense, if there are any iatrogenic illnesses, caused either due to negligence, or error on the attending physicians’ part. In these modern times, medicine has become big business. Many patients complain that the doctor gets all the benefits and the patients assume all the risk. Most pharmacies and doctors cross reference medications so there won’t be a bad interaction between medicines.
Symptoms of Iatrogenic Diseases
If there are undesired effects resulting from administration of any medicine, either orally or through blood-stream (injections to the muscle or into the veins), or resulting because of surgical procedures, these conditions are termed as adverse side effects. Some of these iatrogenic effects could be reversible, may occur for shorter periods, and disappear when the drug is discontinued. However, there are certain medicines that are being used as continual therapies to reduce blood pressure, chronic pains and sleep inducers that result in severe impairments of certain internal organs. These medicines might cause complications often requiring more treatment, more medicine or possible surgery.
Medically, the effects of iatrogenic diseases are measured by considering altered body weight, rate of metabolism, levels of certain hormones, enzymes of the body, loss of function or complication in the functioning of one or more organs.
Reports and websites
Most developed countries of the world have laws in force that make it compulsory for the pharmaceutical companies and doctors to report the different effects that drugs induce in patients. In the United States of America, there are several databases that keep the consumer informed about the adverse effects induced due to administering the medicines. Med Watch is one of its pioneering ventures, which keeps a record of all reports, controlled by the Food and Drug Administration department of the United States federal government. The website of Med watch is: http://www.fda.gov/Safety/MedWatch/default.htm
In the United Kingdom the Yellow Card Scheme helped to compile information of all licensed medicines being prescribed. The organization compiles information on all over-the-counter medicines and herbal food supplements and unlicensed drugs used for skin care are also covered in the Yellow Card Scheme. More information is available at the website:
http://yellowcard.mhra.gov.uk
Some of the common iatrogenic effects associated with famous medications are:
Fever associated with vaccinations
Diazepam and other sedatives and analgesics which may cause drug dependency and addiction
Thalidomide is now banned because it causes deformities and birth defects
Aspirin can cause intestinal bleeding
Acetaminiophen can cause liver damage
Celebrex can cause kidney damage
Gentamycin (antibiotic) can cause kidney failure and deafness
Common antibiotics can cause dry mouth, gastric upset, bone weakening and diarrhea
Cardiovascular bypass surgery can result in dementia
Gastric bypass surgery can result in osteoporosis
Interferon treatments can cause depression and liver damage
Some psychotropic drugs can cause diabetes and weight gain
Antidepressants can cause erectile dysfunction and loss of libido
Misoprostol (labor inducing drug) can cause uterine hemorrhage and could cause death
Anesthesia can cause headaches, nausea and vomiting
Chemotherapy can cause hair loss and anemia
Viagra can cause a heart attack if used with nitroglycerine
Surgery can cause loss of function, hemorrhage, inflammation, scarring and infection
An amputation could cause tissue death and gangrene
A colonoscopy could cause perforation of the intestine
Prevent iatrogenesis
You should always inform the physician about all the medicines, including herbal preparations and dietary supplements that you are using or have used in the past, before your doctor writes you a new prescription. Most doctors ask you to bring your medications with you to each doctor visit; this is done to prevent adverse effects within your body.
If you are taking nitroglycerine, be sure to tell your doctor before asking for a drug like Viagra. The combination of these medications can cause you to have a stroke or heart failure. You must be proactive to remind your doctor of the medicines you are taking because some drug to drug interactions could cause death. You should also be aware of food to drug interactions. For instance, you may be warned not to eat grapefruit or drin the juice of a grapefruit while on blood pressure medications and other meds.
Conclusion
Statistics collected from various hospitals and medical records from insurance companies indicate very alarming incidents of Iatrogenesis. Over a period of one year in the United States, nearly a quarter million deaths were reported due to conditions arising out of iatrogenic diseases.
The main factors leading to iatrogenesis are:
Not evaluating the patient properly
Not performing the appropriate diagnostic tests
Failure to set up follow-up visits
Not cross referencing medications for possible interactions
Not asking the patient about herbal preparations being taken
Not asking about all allergies
Over all, it is the doctor’s responsibility to alert and protect the patient from physician induced illnesses or injury. It is also the patient’s responsibility to research the drugs you may be taking. It is our responsibility to educate ourselves of any possible untoward effect of medicines and treatments to prevent iatrogenesis.
Author’s note: I decided to write this article because my former doctor ordered Celebrex for me in 2000. I’ve been on this medication all this time. I changed doctors about 5 years ago and she also thought Celebrex was the best medication for me. Now after many years of taking this medication I have impaired kidney function. I don’t blame my doctor, because as a nurse, I know that side effects can occur. I didn’t know I was having side effects, but should have had a clue when my kidney function test was abnormal last year. The doctor thought it might have been that it was due to me being dehydrated. I was asked to return in a month for another test and I failed to do it. Now, a year later the test is significantly worse than last year.
Sources:
http://www.cmo-usa.com/iatro.html
http://www.healingtherapies.info/Iatrogenesis.htm
http://www.syracusechargers.org/therapy/chapt54.htm
