Iatrogenesis or iatrogenic disease is a Greek term, meaning “brought forth by the healer” and basically implies any consequence of medical treatment or advice to a patient. 1 According to Harvard University, the term iatrogenic is defined as “induced in a patient by a physician’s activity, manner, or therapy”. Used especially to pertain to a complication of any medical treatment.” Furthermore, these estimates of death due to error are significantly lower than those in the annual Institutes of Medicine reports.
If you were told that over 100,000 people die and over 2 million people maimed and disabled every year in America from modern medicine, would you believe it? In America every day between 200 to 300 people will die every day from iatrogenic disease, 365 days of the year, year in and year out. If we take a look at the aviation industry for example, this would be the equivalent of one large jet crashing and killing around 300 people each day. If this occurred, nobody would fly and the Federal Aviation Administration would have a lot to answer to.
Drug-induced disease affects our patients on a daily basis, regardless of whether they live in NZ, Australia or USA. The numbers will differ in New Zealand due to our smaller population base, but because NZ is a country with a medical system with strong focus on pharmaceutical prescribing rather than preventative health care (drugs are even advertised on TV), there will still be a considerable amount of iatrogenic disease and drug-related deaths occurring. Sue Kedgley said that in the 2004-05 year, 16,789 patients in New Zealand were discharged with a diagnosis of an “adverse effect from pharmaceutical medicines”. According to Kedgley: “These figures are very high, and we know they are just the tip of the iceberg because reporting of adverse reactions to medicines is voluntary and not mandatory”. In the United States an estimated 225,000 deaths per year have iatrogenic causes, with only heart disease and cancer causing more deaths2.
Ron Law, Executive Director of the NNFA, in New Zealand and member of the New Zealand Ministry of Health Working Group advising on medical error, offered some enlightening information on deaths caused by drugs and medical errors. He notes the prevalence of deaths from medical errors and also from properly researched and prescribed medications in Australia and New Zealand, which serves as a reminder to us that the US is not alone in having this problem.
Official Australian government reports reveal that preventable medical error in hospitals is responsible for 11% of all deaths in Australia (about 1 of every 9 deaths). If deaths from properly researched, properly registered, properly prescribed and properly used drugs were added along with preventable deaths due to private practice it comes to a staggering 19%, which is almost 1 of every 5 deaths.
New Zealand figures are very similar, and according to Mr. Law in the past decade, the equivalent of NZ’s Christchurch and Auckland population has been killed or permanently maimed by preventable medical error and deaths from properly researched, properly registered, properly prescribed and properly used pharmaceutical drugs in AUS/NZ. More than 5 million people have been killed by Western medical practice in the past decade (Europe, USA, Canada, Australia, and NZ) and 20 million killed or permanently maimed. This staggering figure has resulted in over 1 trillion dollars loss of productivity and associated costs.
Some of the more typical and common causes of iatrogenesis include:
- Drug side effects
- Drug interactions
- Medical error
- Incorrect procedure
- Unnecessary treatment for profit
Health care professionals who may cause harm to patients include medical practitioners, surgeons, pharmacists, nurses, dentists, psychologists, and natural therapists such as naturopaths, herbalists, etc.
How Can We Help Our Patients With Iatrogenic Disease?
When it comes to pharmaceutical drugs, some of the most important considerations we can have as natural health-care professionals is to:
- Make a careful assessment what medications our patients are taking.
- Become more familiar with their side-effects (use a drug guide like MIMS).
- Understand likely interactions with drugs themselves as well as supplements and herbs.
- Promptly bring any obvious iatrogenic disease to the doctor’s attention.
- Not scaremonger our patients about drugs, their interactions and side effects.
A serious but hidden problem exists because both a considerable amount of doctors and many of their patients do not realise that practically any symptom (especially in older adults on multiple pharmaceutical drugs) can be caused or worsened by different kinds of drugs. I have noticed in clinical practice that doctors (and even their patients) may falsely assume that what are actually adverse drug reactions may be misconstrued as a sign of “getting older”, such as fatigue, memory loss, aches, pains and inflammation, skin rashes, etc. As an unfortunate consequence many serious adverse drug reactions are in fact entirely overlooked, ignored or in many cases not even recognized as being iatrogenic in origin – until they have caused significant and in some cases irreversible harm.
With the development of scientific medicine in the 20th century, it would be expected that iatrogenic illness or death would be more easily avoided. Antiseptics, anesthesia, antibiotics, and more advanced surgical techniques have been developed to decrease iatrogenic mortality. Drug-induced iatrogenic disease can occur for many reasons
In my experience, most properly prescribed drugs when taken long-term are responsible to some degree for adverse reactions. An important point to mention is that many patients may also be taken (at the same time as their prescribed drugs, and without telling their doctor) various OTC drugs regularly such as aspirin (Cartia), paracetamol (Panadol), diclofenac (Voltaren), omeprazole (Losec) and many other similar drugs. It is the combination of many and varied drugs (poly pharmacy) that can create liver and kidney toxicity in particular, especially if the patient is regularly drinking alcohol and caffeinated beverages.
Some of the more common prescribed medicines that cause problems are synthetic retinoids (acne – isotretinoin), CNS drugs (antidepressants, sleeping, anxiety, etc.), anticholinergic drugs (asthma – ipatroprium), , NSAIDS (ibuprofen), and CV drugs such as blood pressure drugs (ACE inhibitors), and drugs for abnormal heart rhythms; anticoagulants (warfarin) and other drugs such as antibiotics (penicillins, tetracylines, etc.), statin drugs (simvastatin, atorvastatin), etc.
There are many different types of aggravations people experience who come to seek the help of a health care professional. Some people come in with one or several pharmaceutical drug induced side effects, such as after an antibiotic, others experience a reaction when they stop taking a drug or change brands of drugs, etc.
Many people can potentially develop an aggravation at the beginning of natural therapy treatment, and this can be quite discouraging for some. Those who are used to conventional Western medicine find the concept of “feeling worse before you feel better” a bit disturbing and some find it even downright crazy, particularly those who strongly adhere to tenets of modern medicine. Modern medicine believes that a diagnosis must first be made before treatment usually in the form of a drug that supposedly cures the complaint by way of eradicating the symptom.
Aggravations can come about for many different reasons and here are six examples of common reactions that I see occurring regularly with patients:
- Drug side effects (iatrogenic disease).
- Coming off any medications or detoxing from pharmaceutical drugs.
- Any change in diet after commencing treatment.
- Combining several different treatments, drugs and dietary supplements, all at the same time.
- Improperly combining drugs and natural medicines at the same time.
Cleansing reactions of the body after commencing natural medicine treatment, often times this will be drug residues clearing from the body.
I have found that these aggravations are often due to a combination of several factors and cannot be blamed solely on drug side effects. Many diseases often get somewhat worse with effective treatment for a multitude of different reasons.
Unfortunately, we live in an age that seems to be obsessed with speed, everything has to happen now. It seems as if we can’t seem to wait until tomorrow for anything anymore. As technology increases and everything speeds up, so do our expectations of healing our bodies. As a result, our patients expect a quick fix, and conventional medicine certainly comes up trumps here, they gets rid of symptoms (suppresses them) so the disease goes somewhere else and gets buried deeper inside the body.
Is it any wonder our patients get aggravations once they actually stop these kinds of suppressive treatments and all these hidden and buried symptoms rise to the surface of their bodies? Drugs taken even many years ago have residues which can remain deeply buried inside the body, and these toxins can and will resurface at the most inconvenient times, often when a person attempts to improve your health by natural means. Reactions are likely to be a thorough house cleansing, especially if your patient has been on a drug cocktail in the past.
Drug-Induced Sickness – Real Life Case Study
If there is one drug I have a strong dislike for, it’s accutane (isotretinoin). This is a synthetic vitamin A, why would anybody want to take a synthetic form of a vitamin, when then can take the natural, real thing? It’s just plain crazy! This case is about a 27 year old female who had been taking accutane for 8 months to help with acne. It certainly worked for acne, of that there is no doubt. The only problem is that it also caused inflammation in her digestive system, and her presenting complaint in my clinic was passing blood with each bowel motion, something her doctor and specialist had “no idea” of the origin. The bleeding began about 8 weeks after starting on accutane, and no link was established by her doctor, something I find astonishing.I’ve written a post on this website about isotretinoin already, and caution anybody to think twice about taking this synthetic vitamin A on a regular basis. We are still waiting for the colonoscopy report from this patient and I can tell you that since she has thrown this drug in the trash can, her bowel problems seem to have magically cleared up. Thank goodness she had only been taking it for 8 months.
In a court case in New Jersey USA, a jury awarded $12.9 million to three patients who were diagnosed with inflammatory bowel disease after being treated with the acne medication Accutane (isotretinoin). A number of similar multimillion dollar lawsuits preceded this one. Accutane was FDA-approved for the treatment of severe recalcitrant nodular acne in 1982 by Roche, but is very commonly prescribed by doctors here in New Zealand for acne in general, and certainly not “severe recalcitrant nodular acne” as it was originally intended for. In New Zealand a patient is unable to sue a drug company, but in USA it is more likely that compensation is possible.New Zealand in addition is possibly the only country in which a GP (regular medical doctor) can prescribe this drug, in most all other countries only a registered Dermatologist is able to do this. There are many websites in America that can even help a patient receive the compensation they are looking for after becoming maimed from a drug. Roche were found liable in 400 suits of Accutane.
The U.S. Food and Drug Administration recommends that:
“All patients treated with isotretinoin should be observed closely for symptoms of depression or suicidal thoughts, such as sad mood, irritability, acting on dangerous impulses, anger, loss of pleasure or interest in social or sports activities, sleeping too much or too little, changes in weight or appetite, school or work performance going down, or trouble concentrating, or for mood disturbance, psychosis, or aggression. Patients should stop isotretinoin and they or their caregiver should contact their healthcare professional right away if the patient has any of the previously mentioned symptoms. Discontinuation of treatment may be insufficient and further evaluation may be necessary.”—U.S. Food and Drug Administration, “Isotretinoin (marketed as Accutane) capsule information”. Postmarket Drug Safety Information for Patients and Providers. Retrieved 28 February 2014.
The U.K. National Health Service, in its guidance on side effects of 20 mg isotretinoin tablets, includes the following as “rare” side effect (more than 1 in 10,000 users):
Thoughts of committing suicide, behavioural problems or worsening of behavioural problems including: aggression, feeling anxious, mood changes, depression or psychosis or psychotic-like behaviour – you or your carer must seek medical advice if you become depressed or if your depression worsens.—National Health Service, “Side effects of isotretinoin”. NHS Choices. Retrieved 28 February 2014.
- Jacobs JP, Benavidez OJ, Bacha EA, Walters HL, Jacobs ML (December 2008). Cardiol Young. 18 Suppl 2: 81–91.
- Starfield B (July 2000). “Is US health really the best in the world?” (PDF). JAMA 284 (4): 483–5. doi:1001/jama.284.4.483. PMID10904513.
- severe recalcitrant nodular acne