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ia were both quickly cured by chemotherapy. On the other hand, in the United States is estimated at US$3 billion yearly, and malaria has reappeared despite the continued use of antimalarial _ reflects the fact that 1/7th of all hospital days are required to attend drugs, largely because the use of pesticides was eventually super- to patients suffering drug reactions.’ Despite the growing use of seded by the evolution of pesticide-resistant mosquitoes. Syphilis street drugs, deaths attributable to medically prescribed drugs still strains resistant to penicillin have also returned to remind medical exceed the number of deaths caused by the use of illegal drugs. It science that the interlink between mores and medicine are of fun- has been estimated that approximately 30,000 deaths per year are damental importance in understanding disease patterns. the consequence of adverse reactions to drugs prescribed by doc- tors. Serious reactions to drugs as common as penicillin, for exam- ple, occur in 5% of those individuals who are administered the MEDICAL INTERVENTION , in 5% of those individual “ministered th AND IATROGENESIS drug. The anaphylactic shock which results from severe penicillin allergy is often more debilitating than the medical condition that Iatrogenic illness refers to those illnesses which result from pro- the penicillin was used to treat. Clammy skin, profuse sweating, fessional medical treatment, and which could presumably have fallen blood pressure, cardiovascular collapse, and even uncon- been avoided had such treatment not been administered. Ivan Illich sciousness are just a few of the side-effects of acute reaction to has done much to consolidate and bring into bold relief studies penicillin. During the 1960's the drug tetracycline was adminis- concerning this category of tered so frequently that it came to physician or hospital-caused be called the "housecall" antibi- injuries. He writes that "the pain, otic, and a generation of dysfunction, disability, and ...and make the impact of children in America and anguish resulting from technical elsewhere has suffered its medial intervention now rival the di 1 f h adverse effects. In 1970 the morbidity due to traffic and me ICI ne one 0 t e most U.S. Food and Drug industrial accidents and even war-related activities, and make the impact of medicine one of the most rapidly spreading epi- f H drug, admonishing of the demics of our time.* Illich 0 our time. tendency of tetracycline to claims that one out of every five accumulate in bones and persons entering a_ typical teeth.’ One of the more visi- Administration finally rapidly spreading epidemics required that a warning be affixed to all packages of the research hospital will acquire an ble side effects of this chem- iatrogenic disease. Given that every twenty-four to thirty six hours, ical deposition has been to cause the permanent discoloration of from 50 to 80% of all Americans will swallow a medically pre- developing teeth (ie stages of tooth development ranging from the scribed drug, it is perhaps unsurprising to find that one half of _ last half of pregnancy to approximately 8 years of age). Countless iatrogenic episodes arise from complications of drug therapy.6 adults now bear their "tetracycline scars" on their teeth in shades Some patients are given the wrong drugs, others are given drugs of discolored enamel ranging from yellow to yellow-green to gray which are contaminated. Some patients receive injections with brown. improperly sterilised syringes, while others are given combina- Illich's study showed that one in every thirty cases of iatrogenic tions of drugs which in their chemical reactions to each other __ illness leads to death, and that the frequency of reported acci- prove to be harmful. The main problem here, however, is not sim- — dents in hospitals exceeds the accident rates in all industries ply one of negligence. Although the well considered and circum- _ with the exceptions of mining and high-rise construction." Of spect use of drugs may have a role to play in health care, all children admitted to hospitals, one in fifty will suffer an acci- chemotherapy is an interventionist technique whose importance dent for which specific treatment will be required." In a study of and use has been greatly exaggerated. As Mendelsohn has put it: medical malpractice conduced by the United States Department of Health, Education, and Welfare, it is reported that 7% of all "Unfortunately, doctors have seeded the entire population patients suffer compensable injuries while hospitalised, though with these powerful drugs. Every year, from 8 to 10 million few of them take legal action. Nonetheless, it is estimated that in Americans go to the doctor when they have a cold. About 95% 1971 from 12,000 to 15,000 medical malpractice suits were lodged of them come away with a prescription - half of which are for in courts throughout the United States. In as study by berman and antibiotics ... The doctor, once the agent of cure, has become Stamm on misdiagnosis, it was calculated that the number of chil- the agent of disease. By going too far and diffusing the power dren who suffer disability as a consequence of medical treatment of the extreme on the mean, Modern Medicine has weakened for what turned out to be cardiac nondisease exceeds the number and corrupted even the management of extreme cases. The of children under effective treatment for genuine cardiac disease." miracle I and other doctors were once proud to take part in In other cases it has been shown that specific forms of treatment has become a miracle of mayhem.’" actually exacerbate the specific condition they are intended to alle- viate. The epidemic of asthma deaths in the mid-1960s provides a While there has during the past decade been a growing aware- useful illustration. In England and Wales between 1959 and 1966 ness of the limitations of drug therapy, the extent of the use and mortality due to asthma trebled in the age group 5-24 and abuse of drugs in conventional medicine is still staggering. As a _ increased seven-fold in the 10-14 age group." Up to this time mor- consequence of negative reactions to drugs, more than a million tality rates from this cause had remained relatively constant for people every year, or 3 - 5% of hospital admissions, are treated for more than half a century. Although the epidemic was shared by drug complications. It is also reported that 30% of these patients Scotland, Ireland, Australia, and New Zealand, asthma mortality will experience a second drug reaction during the course of their in Europe, Japan and North America remained virtually stable. hospital stay. The cost of health care associated with drug toxicity Once it was ascertained that the prevalence of asthma was not on ia were both quickly cured by chemotherapy. On the other hand, malaria has reappeared despite the continued use of antimalarial drugs, largely because the use of pesticides was eventually super- seded by the evolution of pesticide-resistant mosquitoes. Syphilis strains resistant to penicillin have also returned to remind medical science that the interlink between mores and medicine are of fun- damental importance in understanding disease patterns. ...and make the impact of medicine one of the most rapidly spreading epidemics of our time. "Unfortunately, doctors have seeded the entire population with these powerful drugs. Every year, from 8 to 10 million Americans go to the doctor when they have a cold. About 95% of them come away with a prescription - half of which are for antibiotics ... The doctor, once the agent of cure, has become the agent of disease. By going too far and diffusing the power of the extreme on the mean, Modern Medicine has weakened and corrupted even the management of extreme cases. The miracle I and other doctors were once proud to take part in has become a miracle of mayhem.’" While there has during the past decade been a growing aware- ness of the limitations of drug therapy, the extent of the use and abuse of drugs in conventional medicine is still staggering. As a consequence of negative reactions to drugs, more than a million people every year, or 3 - 5% of hospital admissions, are treated for drug complications. It is also reported that 30% of these patients will experience a second drug reaction during the course of their hospital stay. The cost of health care associated with drug toxicity NEXUS - 18 MEDICAL INTERVENTION AND IATROGENESIS YEAR BOOK - JULY/AUGUST 1991