Cross-check: The Curse of Iatrogenesis: When 'Cures' Make Us Sicker

[Guest guest]

http://www.scientificamerican.com/blog/post.cfm?id=the-curse-of-iatrogenesis-whe\

n-cure-2011-07-18 & WT.mc_id=SA_Twitter_sciammind

The Curse of Iatrogenesis: When 'Cures' Make Us Sicker

By Horgan  |â  Jul 18, 2011 06:15 PMâ 



Share

Email

Print

..

In my previous post, I proposed that much or all of the effectiveness of

antidepressants may stem from the placebo effect. In Anatomy of an Epidemic

(Crown, 2010), the journalist Whitaker raises the even more disturbing

possibility that psychiatric drugs, on balance, may be making many people

sicker. Whitaker notes that over the past two decades, prescriptions for

medications for depression, anxiety and psychosis have soared; meanwhile, the

number of Americans receiving disability payments for mental illness in the U.S.

has tripled. If you are interested in Whitaker's thesis—and you should

be—check out his book and his blog Mad in America.

But my primary topic in this post is not Whitaker's claim per se, but the larger

issue of iatrogenesis, a term—coined from the Greek word for healer,

iatros—that refers to harmful effects of treatment. Iatrogenesis—including

faulty diagnoses, prescriptions and outright malpractice—contributes to the

deaths of 120,000 Americans a year, according to " When Doctors Make Mistakes, " a

1999 article in The New Yorker by the physician Atul Gawande. If Whitaker is

right, drug treatments for mental illness represent a massive case of

iatrogenesis. There are many other such occurrences, especially if the meaning

of treatment is expanded to include realms beyond medicine. Here are a few

examples, small and very big, that come to mind:

Plastic football helmets: In the 1940s professional and amateur football players

began wearing plastic helmets, which were designed to provide more protection

than leather ones. Unfortunately, many players started using their

plastic-encased heads like battering rams, sometimes causing severe injuries not

only to opponents but also to themselves. The plastic helmet is also thought to

contribute to the rising numbers of concussions and even brain damage suffered

by football players, according to the technology historian Tenner, author

of Why Things Bite Back (Vintage, 1997). In the same way, Tenner suggests, the

introduction of boxing gloves in the early 20th century reduced the number of

cuts suffered by bare-knuckled boxers " while increasing less-visible cumulative

brain damage from repeated rotational blows. "

Overprotective parenting: In " How to Land your Kid in Therapy, " a new article in

The Atlantic, the psychotherapist Lori Gottlieb notes that many modern parents

are so obsessed with the happiness of their children that they continually

praise them even for trivial accomplishments and try to spare them any emotional

distress. The paradoxical result, Gottlieb fears, may be that children end up

not knowing how to cope with the setbacks and disappointments that inevitably

befall them. Gottlieb compares this effect with an excessive obsession with

children's hygiene, which can limit their exposure to pathogens and hence

prevent them from developing robust immune systems.

Humanitarian aid: Every year affluent nations as well as nonprofit groups such

as Oxfam give billions in aid to poor nations. Who could possibly criticize

these altruistic programs? Yet in Dead Aid (Farrar, Straus and Giroux, 2009),

Dambisa Moyo, an investment banker born in Zambia and educated at Oxford and

Harvard, argues that aid to Africa has on balance been harmful because it

fosters dependence and corruption. In The Crisis Caravan (Metropolitan Books,

2010), Polman, a Dutch journalist, charges that such aid—especially

funds, food, medical supplies and other items funneled into war-wracked regions

like Darfur—ends up exacerbating rather than relieving violence and suffering.

Militants steal aid or demand a cut from aid workers, Polman asserts; they even

commit atrocities—such as cutting arms and feet off civilians—to attract

more international attention and hence more assistance. For a troubling

discussion of the adverse consequences of humanitarian aid, see this article by

Philip Gourevitch in The New Yorker, " Alms Dealers. "

Religion: Religions can all be viewed as potential cures for the trials and

tribulations of the human condition. Setting aside questions about the validity

of religious propositions, we still must wonder whether religion on balance has

helped or harmed humanity. Believers can point to all the good works done by

people of faith—Gandhi and Luther King come to mind—whereas atheists

can point to all the violence—from the Crusades to the 9/11 attacks—carried

out in the name of religion. Given the enormity of the issue, there is a

surprising paucity of good data on the pros and cons of religion. But according

to this 2005 article in the Journal of Religion and Society by the dinosaur

artist and scholar , " higher rates of belief in and worship of a

creator correlate with higher rates of homicide, juvenile and early adult

mortality, STD infection rates, teen pregnancy, and abortion in the prosperous

democracies. " attributes the higher rates of social problems in the U.S.

compared with other first world democracies—such as Japan, France and

Germany—to its greater religiosity.

Communism: Marx and other theorists proposed socialism as a cure for poverty,

injustice, war and other perennial scourges of human history. In principle,

socialism seems sensible and, in fact, even the U.S., its commitment to

free-market capitalism notwithstanding, helps care for the poor, unemployed and

sick. But the variant of socialism known as communism, which calls for total

state control of the economy, represents the worst case of iatrogenesis of all

time. Counting wars, insurgencies, famines and other forms of state-induced

deprivation, communism has resulted in the deaths of 130,000,000 people,

according to political scientist Rudolph Rummel. Stalin alone was responsible

for 43,000,000 deaths, Rummel asserts, making him the greatest mass murderer of

all time. " Communism [has] been the greatest social engineering experiment we

have ever seen, " Rummel wrote. " It failed utterly. "

Looking at the ubiquity of iatrogenesis through history, perhaps we should be

asking this question: What proclaimed improvements for humanity have been

unalloyed successes?

Image courtesy Wikimedia Commons

Sent via BlackBerry by AT & T