Iatrogenesis (from the Greek for "brought forth by the healer") refers
to any effect on a person, resulting from any activity of one or more
persons acting as healthcare professionals or promoting products or
services as beneficial to health, that does not support a goal of the
Some iatrogenic effects are clearly defined and easily recognized,
such as a complication following a surgical procedure (e.g.,
lymphedema as a result of breast cancer surgery). Less obvious ones,
such as complex drug interactions, may require significant
investigation to identify.
While some have advocated using "iatrogenesis" to refer to all
"events caused by the health care delivery team", whether "positive or
negative", consensus limits use of "iatrogenesis" to adverse effects,
possibly including, broadly, all adverse unforeseen outcomes resulting
from medication or other medical treatment or intervention.
Cases of iatrogenesis include:
side effects of possible drug interactions
complications arising from a medical procedure or treatment
use of contaminated instruments
anxiety or annoyance in the physician or treatment provider in
relation to medical procedures or treatments
unnecessary medical treatment resulting from a physician's decision
Unlike an adverse event, an iatrogenic effect is not always
harmful. For example, a scar created by surgery is said to be
iatrogenic even though it does not represent improper care and may not
Professionals who may cause iatrogenic harm to patients include
physicians, pharmacists, nurses, dentists, psychologists,
psychiatrists, medical laboratory scientists and therapists.
Iatrogenesis can also result from complementary and alternative
Globally, as of 2013, an estimated 20 million negative effects
from treatment occurred. It is estimated that 142,000 people died
in 2013 from adverse effects of medical treatment up from 94,000 in
2 Causes and consequences
Medical error and negligence
2.2 Adverse effects
2.4 Iatrogenic poverty
2.5 Social and cultural iatrogenesis
5 See also
7 External links
Risk associated with medical interventions
Adverse effects of prescription drugs
Over-use of drugs, (causing - for example - antibiotic resistance in
Prescription drug interaction
Wrong prescription, perhaps due to illegible handwriting, typos on
Faulty procedures, techniques, information, methods, or equipment.
Causes and consequences
Medical error and negligence
Iatrogenic conditions do not necessarily result from medical errors,
such as mistakes made in surgery, or the prescription or dispensing of
the wrong therapy, such as a drug. In fact, intrinsic and sometimes
adverse effects of a medical treatment are iatrogenic. For example,
radiation therapy and chemotherapy — necessarily aggressive for
therapeutic effect — frequently produce such iatrogenic effects as
hair loss, hemolytic anemia, diabetes insipidus, vomiting, nausea,
brain damage, lymphedema, infertility, etc. The loss of function
resulting from the required removal of a diseased organ is iatrogenic,
as in the case of diabetes consequential to the removal of all or part
of the pancreas.
The incidence of iatrogenesis may be misleading in some cases. For
example, ruptured aortic aneurysm is fatal in most cases; the survival
rate for a ruptured aortic aneurysm is under 25%. Patients who die
during or after an operation will still be considered as iatrogenic
deaths, but the procedure itself remains a better bet than the 100%
probability of death if left untreated.
Other situations may involve actual negligence or faulty procedures,
such as when pharmacotherapists produce handwritten prescriptions for
A very common iatrogenic effect is caused by drug interaction, i.e.,
when pharmacotherapists fail to check for all medications a patient is
taking and prescribe new ones that interact agonistically or
antagonistically (potentiate or attenuate the intended therapeutic
effect). Such situations can cause significant morbidity and
mortality. Adverse reactions, such as allergic reactions to drugs,
even when unexpected by pharmacotherapists, are also classified as
The evolution of antibiotic resistance in bacteria is iatrogenic as
Bacteria strains resistant to antibiotics have evolved in
response to the overprescription of antibiotic drugs.
Certain drugs are toxic in their own right in therapeutic doses
because of their mechanism of action. Alkylating antineoplastic
agents, for example, cause DNA damage, which is more harmful to cancer
cells than regular cells. However, alkylation causes severe
side-effects and is actually carcinogenic in its own right, with
potential to lead to the development of secondary tumors. In similar
manner, arsenic-based medications like melarsoprol for trypanosomiasis
can cause arsenic poisoning.
Adverse effects can appear mechanically. The design of some surgical
instruments may be decades old, hence certain adverse effects (such as
tissue trauma) may have never been properly cauterized[clarification
In psychiatry, iatrogenesis can occur due to misdiagnosis (including
diagnosis with a false condition as was the case of
hystero-epilepsy). An example of a partially iatrogenic condition
due to common misdiagnosis is bipolar disorder, especially in
pediatric patients. Other conditions such as somatoform disorder
and chronic fatigue syndrome are theorized to have significant
sociocultural and iatrogenic components. Posttraumatic stress
disorder is hypothesized to be prone to iatrogenic complications based
on treatment modality. The psychiatric treatment of some
conditions and populations, such as substance abuse and antisocial
youths are regarded as carrying significant risks for
iatrogenesis. At the other end of the spectrum, dissociative identity
disorder is considered by a minority of theorists to be a wholly
iatrogenic disorder with the bulk of diagnoses arising from a tiny
fraction of practitioners.
The degree of association of any particular condition with
iatrogenesis is unclear and in some cases controversial. The
over-diagnosis of psychiatric conditions (with the assignment of
mental illness terminology) may relate primarily to clinician
dependence on subjective criteria. The assignment of pathological
nomenclature is rarely a benign process and can easily rise to the
level of emotional iatrogenesis, especially when no alternatives
outside of the diagnostic naming process have been considered. Many
former patients come to the conclusion that their difficulties are
largely the result of the power relationships inherent in psychiatric
treatment, leading to the rise of the anti-psychiatry movement.
Meessen et al. used the term "iatrogenic poverty" to describe
impoverishment induced by medical care. Impoverishment is
described for households exposed to catastrophic health
expenditure or to hardship financing. Every year, worldwide,
over 100,000 households fall into poverty due to health care expenses.
A study reported that in USA in 2001, illness and medical debt caused
half of the personal bankruptcy. Especially in countries in
economic transition, the willingness to pay for health care is
increasing, and the supply side does not stay behind and develops very
fast. But the regulatory and protective capacity in those countries is
often lagging behind. Patients easily fall in a vicious cycle of
illness, ineffective therapies, consumption of savings, indebtedness,
sale of productive assets, and eventually poverty.
Social and cultural iatrogenesis
The 20th century social critic
Ivan Illich broadened the concept of
medical iatrogenesis in his 1974 book Medical Nemesis: The
Expropriation of Health by defining it at three levels. First,
clinical iatrogenesis is the injury done to patients by ineffective,
unsafe, and erroneous treatments as described above. In this regard,
he described the need for evidence-based medicine 20 years before the
term was coined. Second, at another level social iatrogenesis is
the medicalization of life in which medical professionals,
pharmaceutical companies, and medical device companies have a vested
interest in sponsoring sickness by creating unrealistic health demands
that require more treatments or to treat non-diseases that are part of
the normal human experience, such as age-related declines. In this
way, aspects of medical practice and medical-associated industries can
produce social harm in which society members ultimately become less
healthy, excessively dependent on institutional care. He argued that
medical education of physicians contributes to medicalization of
society because they are trained for diagnosing and treating illness
therefore they focus on disease rather than on health. Iatrogenic
poverty (above) can be considered a specific manifestation of social
iatrogenesis. Third, cultural iatrogenesis refers to the destruction
of traditional ways of dealing with, and making sense of, death,
suffering, and sickness. In this way the medicalization of life leads
to cultural harm as society members lose their autonomous coping
skills. It is worth noting that in these critiques "Illich does not
reject all benefits of modern society but rejects those that involve
unwarranted dependency and exploitation."
Globally it is estimated that 142,000 people died in 2013 from adverse
effects of medical treatment up from 94,000 in 1990.
In the United States estimated deaths per year include: 
12,000 due to unnecessary surgery
7,000 due to medication errors in hospitals
20,000 due to other errors in hospitals
80,000 due to nosocomial infections in hospitals
106,000 due to non-error, negative effects of drugs
Based on these figures, iatrogenesis may cause 225,000 deaths per year
in the United States (excluding recognizable error). An earlier
Institute of Medicine
Institute of Medicine report estimated 230,000 to 284,000 iatrogenic
Evidence demonstrating the advent of pathological anatomy in 1823
Vienna (left vertical line) correlated with incidence of fatal
childbed fever. Onset of chlorine handwash in 1847 is noted (right
vertical line). For comparison, rates for Dublin maternity hospital,
which had no pathological anatomy. (view rates).(Semmelweis 1861).
The term iatrogenesis means brought forth by a healer, from the Greek
ἰατρός (iatros, "healer") and γένεσις (genesis,
"origin"); as such, in its earlier forms, it could refer to good or
Since at least the time of Hippocrates, people have recognized the
potentially damaging effects of medical intervention. "First do no
harm" (primum non nocere) is a primary Hippocratic mandate in modern
medical ethics. Iatrogenic illness or death caused purposefully or by
avoidable error or negligence on the healer's part became a punishable
offense in many civilizations.
The transfer of pathogens from the autopsy room to maternity patients,
leading to shocking historical mortality rates of puerperal fever
(A.K.A "childbed fever") at maternity institutions in the 19th
century, was a major iatrogenic catastrophe of that time. The
infection mechanism was first identified by Ignaz Semmelweis.
With the development of scientific medicine in the 20th century, it
could be expected that iatrogenic illness or death would be more
easily avoided. Antiseptics, anesthesia, antibiotics, better surgical
techniques, evidence-based protocols and best practices continue to be
developed to decrease iatrogenic side effects and mortality.
Adverse drug reaction
Classification of Pharmaco-Therapeutic Referrals
Fatal Care: Survive in the U.S. Health System (book)
Journal of Negative Results in Biomedicine
List of medicine contamination incidents
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