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


hammer and sickle of communismIn 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 Robert 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 Edward 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), Linda 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 Martin 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 Gregory Paul, "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." Paul 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

The views expressed are those of the author and are not necessarily those of Scientific American.

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