Quack Word #20: ‘Iatrogenic’
Iatrogenesis is not a concept that is confined to quackery, but like most of the words in my Quack Words series it tends to show up more often than not on quack web sites and so can be a good quackometer word.
Iatrogenic illness covers the concept of harm having been done by the healer. Harm could come from many quarters including mistakes in diagnosis or treatment, professional negligence, adverse reactions to drugs, infections acquired during surgery or in the ward, and mis-presciption. Undoubtedly, all these things happen and quite regularly too. But, the charge by quacks, when discussing iatrogenic illness on their web sites, is that medical greed and their ‘addictions’ to using toxic drugs kill hundreds of thousands of people unnecessarily. The conspiracy of ‘Big Pharma’ wants to keep us ill and sell us more toxic and harmful drugs.
Often figures are presented that are used to show that iatrogenic death is the third or fourth leading cause of death in the western world. A typical example is given here where figures for adverse drug reactions cause 106,000 deaths per year in the USA.
On this basis, doctors look like mass murderers. Their pursuit of profit and the monopoly of health care is causing genocidal-scale evil. By contrast, alternative medicine is presented as risk-free, gentle, holistic and free from commercial influences.
On the face of it, the charge is very serious. Is it that simple?
In short, the sort of analysis used by quacks to present real medicine as a terrible killer is completely devoid of the medical context of the supposed deaths and concentrate only on negative outcomes and ignore positive outcomes of treatment. These figures are unbalanced and deliberately misleading.
For example, looking at the first reference given in the link above (Lazarou et al), it is worth noting that the authors point out that the major cause of problems was due to known highly toxic treatments, such as warfarin. These sorts of drugs are given to people who are seriously ill and at risk of dying. If a small percentage experience an adverse drug reaction then that has to be balanced against the overall benefits of lives saved by the treatment. In considering seriously ill patients who would inevitably die without intervention one should be able to take risks with known drugs in order to save a high number of them. Deaths in this case are a special sort of failure – not a case of negligence or malpractice – but a part of the risks of doing real grown-up medicine. Hospitals have to deal with seriously ill people and sometimes have to be quite aggressive in their treatments. The alternative is certain death. Most quacks are spared this confrontation with reality as they treat their headaches and skin complaints.
Undoubtedly, the side effects could be reduced by better understanding of the drug and that is exactly why medical research is done, with trails and experiments. For anti-rational alternative medicine quacks to use such data as a way of highlighting the ‘evils’ of real medicine is an act of propaganda and scaremongering. It is shameful denigration of a profession that has to daily make life or death decisions with the most complex system in the known universe – the human body.
If you are not convinced, an analogy: ambulances are responsible for many accidents, injuries and deaths every year. They charge at high speed through populated areas, ignoring road conventions and distracting other drivers. If you were to publish a table of injuries and deaths due to ambulances, they would look quite starting. In fact, one source reports an average of one collision each day involving an ambulance in the UK. Not all result in death of course, but still a big number.
Would you ban ambulances and set up alternative, low pollution, holistic and carbon neutral cart and horse emergency transport? How about bicycle ambulances? Of course not. There is no such thing as alternative and complementary ambulances. Even quacks get in the ambulance after a bad road accident. The reason is that by taking appropriate risks, ambulances save thousands of lives every year. Seconds counts when hearts and lungs are failing or you are bleeding badly. The lives saved vastly outweigh the iatrogenic injuries caused. It is up to society to balance the benefit and risks and choose how ambulances should behave.
The same goes with medicine. The culture of informed consent requires doctors to discuss the risks and benefits of any treatment. Patients, doctors and society all have a role to play in deciding if the risks for a particular treatment outweigh the benefits. This is an open process. Mistakes are reported and outcomes monitored. The fact that quacks can find the statistics show this to be true.
But what about alternative medicine? Do quacks consider that they may too cause iatrogenic illnesses? Homeopathy is a classic example. The mantra is that their pills are completely side effect free and homeopathy is gentle and safe. At one level, I would agree. Sugar pills with no active content ought to be pretty safe for the same reason that they are also completely ineffective against anything. But manufacturing processes can go wrong. Some very nasty substances are used in some preparations including viruses, poisons and mobile phone radiation(!). Getting it wrong could risk the patient. Do homeopaths know that they get it right? What tests have been done?
One Italian study claims to have looked at this. “Harm in homeopathy: Aggravations, adverse drug events or medication errors?” reports that.
Out of 335 homeopathic consecutive follow-up visits between 1 June 2003 and 30 June 2004, nine adverse reactions were reported (2.68%) including one case of allergy to lactose, excipient of the granules.
You have to laugh, don’t you?
Seriously, I would take this report with a pinch of salt, much as I would take any study of homeopathy by homeopaths with deep scepticism. What worries me far more is that homeopathic iatrogenesis is going to come from the skewed and twisted propaganda they dish out about the evils of real medicine and the power of their own ‘gentle art’. Its the thinking that leads homeopaths, like the SHEAF charity, to go out to Kenya to set up homeopathic malaria clinics that scares me to death and undoubtedly ends in iatrogenic deaths of the most negligent and deluded kind.
Related posts:
- Auricular Acupuncture: A Word in Your Foetus Like… Prince Charles’ Foundation for Integrated Health (FIH) is listened to by many in our Government as a sound source of information on complementary medicine. It has been given large sums...
- Quack Word #37: ‘Holistic’ As you know, the quackometer works by counting words, or combinations of words, that strongly suggest the web site is full of quackery. I thought I would write about a...
- Quack Word #3: ‘Doctor’ UPDATE 12/2/07 Congratulations to Ben Goldacre and the crew at Bad Science for getting Dr Gillian McKeith banned from using the title ‘Dr’. In today’s Guardian she is fully exposed...
- Quack Word #40: ‘Energy’ Or ‘How to be debunked by a nine year old schoolgirl’ In the special world of the quack, the crank and the pseudo-scientist the word ‘Energy’ holds the highest place...
- Quack Word #12: ‘Organic’ I believe that organic food is a con, is not necessarily more healthy for you, tastes no different, and is damaging to the environment. There, I have got that off...
More good stuff from the black duck, and the homeopathic malaria connection is indeed alarming. Actually, this highlights the issue of iatrogenic homeopathy; harm done to the patient by mis-diagnosis, and by delaying access to effective medical treatment.
At the same time, and although I agree with your comparative risk assessment of medical iatrogenesis, I would suggest that the use of the pharmaceutical model to treat degenerative disease is intrinsically likely to cause adverse effects, and intrinsically unlikely to offer more than palliation of symptoms. Happy to debate this with you, should you be interested.
Paul Clayton
I’ve just been reading some of the reviews of Wootton’s Bad Medicine: Doctors Doing Harm Since Hippocrates (the more critical ones) so it was interesting to then see this post which is about similar issues, albeit concentrating on the claims of iatrogenic harm.
I posted a detailed critique of one of Sue’s sources which summarised the number of iatrogenic illnesses. Lazrou has been criticised for a flawed mathodology and most of the other papers are even worse. In general very small n samples are extrapolated to the whole population of the USA.
There was only one study that had a large sample size.
Hmmm, I’ve been following Sue’s blog for a while. So many basic biology facts she gets wrong, and is still getting wrong, despite being corrected. She posts irrelevant links, adopts the victim posture when this is pointed out, and then deliberately misrepresents and twists what other people have said (like the critique of her iatrogenic illness sources as mentioned above), sometimes quite snidely. A small minded individual who represents the worst of the CAM community attitudes. Most infuriatingly, she never answers a direct question.[/rant]
(Sorry, I would have posted this on her blog but I’m sure I contravened all of her “POO guidelines”!)
I think her biggest sin is to refuse to acknowledge that her critics are sincere. As such, she feels no compunction to think about any post on her blog or respond in any meaningful way. Her role is just to give herself a platform to trot out her canards.
Sue Young is utterly convinced that her critics:
a) Meet in the pub to conspire against her before posting and
b) Are all in the pay of Big Pharma. Completely ignoring the fact that Big Pharma are heavily involved in the homeopathy industry
YOU LIKE WORDS
Ionizing radiation consists of electromagnetic radiation (photons), including X-rays and gamma rays, and particulate radiation, such as electrons, protons, and neutrons. Clinical radiation oncology uses electromagnetic radiation and particulate radiation, mostly electrons and to a lesser extent neutrons and protons (1).
Radiation damages cells by direct ionization of DNA and other cellular targets and by indirect effect through ROS. Exposure to ionizing radiation produces oxygen-derived free radicals in the tissue environment; these include hydroxyl radicals (the most damaging), superoxide anion radicals and other oxidants such as hydrogen peroxide. Additional destructive radicals are formed through various chemical interactions.
About two-thirds of X-ray and gamma-ray damage is caused by indirect action; heavy particles, such as neutrons, act mostly by direct ionization. Although effective in killing tumor cells, ROS produced in radiotherapy threaten the integrity and survival of surrounding normal cells.
Your point being?
Don’t get me started, quackometer eds!
CAMs use/confuse even more important words…..Diagnosis being one of them….
http://jonathanhearsey.com/?p=35
I’ll change it from within.
JH
How do you account for the fact that the stats for the "quack" reports come from JAMA, CDC and licensed medical doctors etc.? Seems you are ignoring the source of the information as much as the information itself. If the sources of this information was from questionable source then you might have something of importance to say about it. But it seems you don't. Go to the end of the line.
Numbers are one thing. how you interpret them is another. What I present here is how quacks misinterpret – and worse – misrepresent numbers. In short, no discussion of risk is complete without a discussion of benefits – and vice versa.
I think you are a major league liar.
You want a discussion of the benefits of medicine to balance out the arguement? Trends Journal 1998- Physicians cannot effectively treat 80% of disease. Only 10% of disease is effectively treated by doctors and medicine, and another 10% is made worse.’ They are good for emergency situations at saving your life, I’ll give them that, but they are not good at treating disease. The fact of the matter is that regardless of the condition the patient was in when they began treatment, they put their faith in medicine, and they still died! That is because medicine is only effective 10% of the time. Quack?
If you wanted discussion of such a startling figure you would have provided a URL to the paper concerned. I cannot find anything to back up you claim and I would politely suggest you have made it up.
Can you substantiate your claims?
Unfortunately, statistics do not lie. You can spin your opinion any which way, but the facts show that
hospitalization can be dangerous. Take personal responsibility for your health and you may avoid doctors and hospitals altogether!
Is health just a matter of ‘personal responsibility’?