An Overview Based on a Selection of Findings from the
More than 10,000 Articles, Reports, and Scientific Research Studies in the Medical Literature

By Barry M. Charles, MD

Iatrogenic illness — disease produced as a result of medical treatment — is now recognised as a health hazard of global proportions. MEDLINE (the computerised medical research database of the United States National Library of Medicine) includes over 7,000 articles, reports, and scientific research papers since 1966 that show a substantial number of patients suffer treatment-caused disorders and adverse drug reactions. These harmful effects, which can be serious and even lethal, are associated with every facet of modern medicine including drugs, other medical therapies, diagnostic procedures, and surgery.

Massive Detrimental Effects

Detrimental effects have become so extensive as to prompt the use of the term “iatroepidemic.” Reporting in the Journal of the American Medical Association, Dr. Lucien Leape of Harvard School of Public Health calculated that 180,000 people die in the U.S. each year partly as a result of iatrogenic injury — the equivalent of three jumbo-jet crashes every two days.

Another issue of the Journal of the American Medical Association points out that injury from medical treatment in the U.S. dwarfs the annual automobile accident mortality of 45,000 and accounts for more deaths than all other accidents combined.

An Economic Drain

Medication-caused disorders produce a substantial economic drain. For example, the Archives of Internal Medicine reported a cost to the U.S. economy of $76 billion in 1995. This amount is nearly twice that spent on diabetes treatment and near the amount for cardiovascular disease.

Iatrogenic disease can result from many factors including prescribing errors, administration mistakes, accidents, inappropriate diagnostic or therapeutic measures, and the intrinsic potential for harm associated with medications, surgery, and other procedures.

Hazardous Hospital Environment

The hospital environment is especially conducive to medical hazards. Studies, including those conducted at Harvard Medical School, show that as many as 36 per cent of patients admitted to hospitals suffered iatrogenic injury, with up to 25 per cent of those injuries being serious or fatal. Up to half of these injuries were related to medication use.

Analysis of cardiac arrests at a teaching hospital found that 64 per cent were preventable, with inappropriate drug use being the leading cause.

In addition to treatment-caused disorders, hospitals foster life-threatening nosocomial infections involving rare or drug-resistant micro-organisms, which are often difficult to treat.

Fifteen per cent of hospital days are devoted to treatment of drug side effects. Every medication, including over-the-counter drugs, carries side effects. Common reactions include skin rashes, nausea, headaches, dizziness, lethargy, diarrhoea, and gastric bleeding. More severe reactions can include deafness, depression, abnormal heart rhythms, bronchospasm, immune dysfunction, blood disorders, liver or kidney toxicity, Stevens-Johnson syndrome, or anaphylactic shock.

Despite what is known about adverse drug effects, Dr. David Kessler, Chief of the U.S. Food and Drug Administration, stated that only one per cent of all serious drug reactions are reported.

Public Health in Jeopardy

The problem escalates to public health proportions when large populations receive a treatment and experience its side effects. The New England Journal of Medicine noted that even a slight increase in risk from menopausal hormone replacement therapy could yield a substantial increase in breast cancer cases because of the high incidence of the disease.

Similarly, widely used non-steroidal anti-inflammatory drugs (NSAIDs) cause over 3,300 deaths per year and 41,000 hospitalisations.

Poisonous Drugs

Many drugs have side effects serious enough to cause secondary diseases requiring their own intensive treatment. One example is Parkinsonism caused by neurological side effects of anti-depressants or anti-psychotic medication.

A Harvard Medical School study found that drugs were the real cause of original symptoms in 37 per cent of elderly patients treated for Parkinson’s disease. The medication L-dopa, used in treatment, has its own severe side effects that often require additional drugs to control.

Other examples include collagen vascular disease caused by blood pressure medications, Cushing’s syndrome caused by prolonged cortico-steroid use, and new malignancies associated with cancer chemotherapy. Many drugs are teratogenic and can cause birth defects during pregnancy, while others may cause disease later in the life of offspring.

Overuse of antibiotics has also produced resistant strains of formerly susceptible micro-organisms, raising concerns about epidemics that may become difficult to control because of drug resistance.

Unnecessary Surgery Epidemic

Studies also show substantial inappropriate and excessive use of surgery, as well as continued use of outdated operations. A U.S. Congress Subcommittee on Oversight and Investigations into Unnecessary Surgery found that in one year there were approximately two million unnecessary operations, responsible for more than 12,000 deaths and about $10 billion in wasted cost.

Injurious Technologies

Dependence on high technology in diagnosis and treatment has also been shown to be a source of injury through equipment failure or misapplication. For example, 36 per cent of iatrogenic problems in intensive care units were associated with equipment malfunction.

Unreliable Medical Care

Medical care is often based on much less scientific evidence than generally assumed and may undergo radical reversals. The editor of the British Medical Journal revealed that only 15 per cent of all medical therapies have a scientific basis or have been demonstrated to be effective.

An example is the formerly common use of irradiation for enlargement of the thymus in infancy — a condition now recognised to be normal — which was later shown to cause cancer in later life.

Pushing Poisonous Drugs

Pharmaceutical marketing puts strong pressure on physicians to prescribe new products. Hospital Practice pointed out that competition among pharmaceutical companies leads to aggressive promotion and inundation of physicians with data supporting each new drug, often overshadowing opposing scientific information.

Some heavily promoted drugs were later withdrawn only after serious harm had been done. Examples include benoxaprofen, withdrawn after fatal liver toxicity cases, and zomepirac sodium, withdrawn after fatal anaphylaxis. Cardiac drugs such as flecainide and encainide were later shown to cause fatal arrhythmias and increased mortality.

Developing countries have faced special problems from irrational drug marketing by multinational and indigenous pharmaceutical companies. According to several authors in the Journal of Clinical Epidemiology, unjustified claims of efficacy or safety continue to proliferate.

Urgent Need for New Knowledge

Physicians and patients have often come to accept medical hazards as a necessary price for modern diagnosis and therapy, even when those hazards may be seriously debilitating or lethal. The same applies to medical errors, which studies have shown to be so pervasive that mistakes are considered an inevitable part of the medical system, giving rise to the term “necessary fallibility.”

This acceptance reflects a departure from the primary principle of medical ethics — primum non nocere — “Above all, do no harm.” The large body of data documenting the extent and seriousness of hazards associated with modern medicine makes clear that fundamental deficiencies exist in the current medical approach and that new knowledge is urgently needed.

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