Iatrogenic illness

Literally meaning "physician-induced," the term iatrogenic describes diseases inadvertently resulting from medical treatments or procedures. With more effective and powerful treatments have come side effects that may be more common and harmful. There are efforts by medical specialists and consumers to quantify and reduce iatrogenic side effects. These efforts are hampered by the natural reluctance of physicians (and other providers) to have their errors publicized and the prospect of malpractice lawsuits. Physicians rarely report iatrogenic events, even though most claim to have witnessed them. Efforts to make reporting mandatory are resisted by the medical profession; therefore, lack of such reporting makes it more difficult to identify and minimize hazards.

Despite these obstacles, the hazards of medicine are emerging in an increasing number of studies and reports. A 2000 presidential report described iatrogenic error and illness as "a national problem of epidemic proportions," causing tens of thousands of annual deaths. The report estimated the cost of lost income, disability, and health care costs to be $29 billion a year. The report concluded that half of adverse medical events were preventable.

The presidential report relied heavily upon another report by the Institute of Medicine, To Err is Human: Building a Safer Health System (2000). Issued by the most respected agency of American medicine, To Err is Human generated considerable attention and surprise by concluding that up to 98,000 Americans are killed annually by medical errors. This number slightly exceeds the combined total of those killed in one year by motor vehicle accidents (43,458), breast cancer (42,297), and AIDS (acquired immunodeficiency syndrome, 16,516).

The Institute of Medicine utilized the findings of two large studies. One found that 2.9 percent of people hospitalized in Colorado and Utah experienced medical errors and 6.6 percent of those people died as a result of the errors. The second study found that 3.7 percent of people hospitalized in New York experienced errors and 13.6 percent of those people died as result. This led the Institute to conclude that a minimum of 44,000 Americans die annually due to error during hospitalization, making it the eighth leading cause of death in the United States. Even so, the report says that these numbers "offer only a very modest estimate of the magnitude of the problem since hospital patients represent only a small proportion of the total population at risk" (Institute of Medicine 2000, p. 2).

While important, these reports fail to address major iatrogenic controversies such as the under-treatment of people with chronic pain and the repetitive misclassification of physical illnesses as psychiatric disorders. (Diseases as wide-ranging as peptic ulcer, epilepsy, asthma, and migraine have been so classified, leading to ineffective treatments, suffering, and death.) However, another important source of iatrogenic illness, the increase of drug-resistant infections due to overuse of antibiotics, is otherwise being acknowledged and addressed.

The Centers for Disease Control and Prevention (CDC) estimate that each year nearly 2 million people acquire infections while hospitalized and about 90,000 die from those infections. More than 70 percent of hospital-acquired bacterial infections have become resistant to at least one of the drugs commonly used to treat them. Staphylococcus aureus (staph), the leading cause of hospital-acquired infections, is resistant to 95 percent of first-choice antibiotics, and about 30 percent of second-choice antibiotics.

In New York City alone, treatment of people with hospital-acquired staph infections exceeds $400 million, according to a study published in 1999. Researchers found that staph infections doubled the length of hospitalization, and more than doubled the patient death rate and per patient costs.

The CDC proposes several methods of reducing hospital-acquired infections. The most important include more discriminating antibiotic use and improved hygiene of hospital staff, the main source of infections.

The modern state is, as Thomas Szasz has described it in Pharmacracy: Medicine and Politics in America (2001), a "therapeutic state" in which medical providers have far more power than consumers. Such an imbalance of power may make consumers increasingly vulnerable to the factors that cause iatrogenic illness to be an important cause of illness and death.

See also: Causes of Death; Technology and Death

Bibliography

Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.

Quality Interagency Coordination Task Force. Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact. Washington, DC: Agency for Healthcare Research and Quality, 2000.

Szasz, Thomas S. Pharmacracy: Medicine and Politics in America. Westport, CT: Praeger Trade, 2001.

Tassano, Fabian. The Power of Life or Death: A Critique of Medical Tyranny. Oxford: Oxford Forum, 1999.

Internet Resources

Rubin, Robert J., Catherine A. Harrington, Anna Poon, Kimberly Dietrich, Jeremy A. Greene, and Adil Moiduddin. "The Economic Impact of Staphylococcus aureus Infection in New York City Hospitals." Emerging Infectious Diseases 5, no. 1 (1999). In the Centers for Disease Control and Prevention [web site]. Available from www.cdc.gov/ncidod/eid/vol5no1/rubin.htm.

Szasz, Thomas S. "The Moral Physician." In the American Iatrogenic Association [web site]. Available from www.iatrogenic.org/library/moralphysician.html.

NICOLAS S. MARTIN