Talk:Iatrogenesis/Archive 1

Archive 1

Due

Due to the controversy surrounding assisted suicide, I am removing it from the list of iatrogenic circumstances, but leaving the brief mention in the text of that section.Daries 17:26, 30 March 2006 (UTC)

I disagree with this decision. A section on medically assisted suicide should be amplified because of it's cultural relevance and it's pertinence to this topic. It is perhaps the MOST pertinent modern example of iatrogeniesis.

remember, the term means Doctor caused. The term is neutral and can mean good and bad so try to keep your bias out of the decision on whether or not you want euthenasia to be considered doctor caused.

Many problems here

At the moment the article is purely about clinical iatrogenesis. I removed an article about social iatrogenesis because it was unsourced and vaguely biased against DSM, which is not the subject here.

Where are the really relevant sources? I'd like to see Ivan Illich and his cultural iatrogenesis here. JFW | T@lk 01:46, 3 May 2006 (UTC)

An important bias was the addition of the word "unintended." That is not part of the original definition "brought forth by the healer." If "unintended" is added there is no need for the word Iatrogenesis. Adding "unintended" reduces it to covering nothing more than errors. All medical errors might be iatrogenic, but all of the things harming patients are not errors. I have removed "unintended" from the definition.

Without the word "unintended" in the definition, it should not be merged with the word "error."Sighalot (talk) 12:40, 25 June 2014 (UTC)

Inconsistencies

Why are iatrogenic deaths not mentioned in the List of causes of death by rate article? Acetone, 8 November 2006

Mis-reference to complementary and alternative medicine as being the same

I apologize if I am not doing this correctly but this is my first time to contribute. I am bothered by a reference in this article to Complementary and Alternative medicine as being the same: Further, iatrogenic illness or death is not restricted to Western medicine: alternative medicine (sometimes referred to as complementary medicine) may be considered an equal source of iatrogenesis for the same reasons.

NIH's National Center for Complementary and Alternative Medicine differentiates the two as distinct from each other stating the Complementary medicine is used "together with conventional medicine" and Alternative medicine is used "in place of." Examples cited are aromatherapy for the former and "a special diet to treat cancer instead of undergoing surgery, radtiation...recommended by a conventional doctor" for the latter. Based on this distinction, it appears that complementary medicine should be removed from the citation that coincides with alternative medicine.

It is still possible that complementary therapists may cause iatrogenesis, but I would think it would be as a therapist working with conventional medical practitioner and therefore part of the previous reference in the article as "as a result of actions by others". Thanks for your consideration of this comment. Jgcarney 17:05, 1 March 2007 (UTC)

Sources of iatrogenesis

In this list, I changed "minimizing the possibility of negative drug effects" to "failure to minimize the possibility of negative drug effects"; I'm guessing at what the original writer meant, but if anybody knows different please say so. —Preceding unsigned comment added by 193.172.19.20 (talk) 13:35, 15 October 2007 (UTC)

You just reversed the meaning. It depends on what minimizing means or intents to mean. Changed to underestimate which is not ambiguous as minimizing is. Jclerman 17:10, 15 October 2007 (UTC)

I added 'anxiety and annoyance' to the initial list of sources, since it is -extremely- common (even normative) for people to have higher blood pressure and heart rate and other stress-related effects in the presence of authority structures, medical personnel, or other context where individuals have others exert control over them. Experienced medical technicians are well aware that people might show hypertensive blood pressure who show no signs of hypertension outside the clinic. —Preceding unsigned comment added by 216.55.170.9 (talk) 07:22, 25 April 2011 (UTC)

fake medicine

Would the deaths caused by fake medicine mentioned in Glycerin#Danger_of_contamination_with_diethylene_glycol be considered a kind of iatrogenesis? --68.0.124.33 (talk) 06:24, 26 January 2008 (UTC)

Agree. I think this deserves a new subsection under 2 Sources of iatrogenesis, perhaps titled "Contamination". Ryanjo (talk) 16:42, 26 January 2008 (UTC)

faddishness in psychotherapies

From decade to decade, the emphasis and frequency of certain mental illness diagnoses varies considerably. For example, obsessive compulsive disorder was a more frequent diagnosis a decade ago, and bi-polar disorder is more popular now. There is no real epidemiological justification for these wide variations and unnecessarily designating a person as mentally ill is clearly an iatrogenic source of emotional stress, identical to a physician telling you that you have cancer, when you do not. Homebuilding 70.130.44.250 (talk) 14:38, 6 September 2008 (UTC)

Iatrogenic artifact section

I have added refs to the section, deleted OR, made the language more NPOV and fixed a wikilink. ResearchEditor (talk) 21:44, 27 April 2008 (UTC)

And added a massive WP:POVFORK about DID and recovered memory therapy. The following section in my mind is far too detailed about a specific single condition which is grossly unnecessary on this page. The section should not discuss the specifics of how this one condition is or is not iatrogenic. That's for either DID itself, or iatrogenesis of dissociative identity disorder. Not here. Or, debatably, it's possible the section could have its own section. I also removed repressed memory - too debatable and it's too easy to get caught into the POV battles. Since it's examples, might as well include examples that are unarguable, or sourced. Also never heard of an iatrogenic artefact, would be nice to see a citation.

Anyway, the page is about iatrogenesis, the section about iatrogenic diseases created by doctors, not about the iatrogenesis of DID. The bottom text looks like the whole section is about only DID and throwing in the RMT, FMSF and FMS is just asking for disputes. Like this one. WLU (talk) 23:15, 27 April 2008 (UTC)

paragraph before ResearchEditor's edits:

An iatrogenic artifact is a disease made up by doctors, often a diagnostic trend or fad that has become or is expected to become obsolete or discredited. Examples of diseases considered or accused of being iatrogenic artifacts include nymphomania, hystero-epilepsy, repressed memory, autogynephilia, and multiple personality disorder. In many cases, it has been shown that "experts" who believe in the disease are able to observe or even induce symptoms matching the disease's description in suggestible patients. Behavioral disorders are particularly susceptible to artifacts. For example, in the false memories syndrome: thousands of psychotherapists have attempted to recover memories of early childhood abuse from their clients. The techniques, practices and exercises used in these attempts are often referred to as Recovered Memory Therapy and sometimes resulted in allegations of abuse being made by individuals against family members. Many of these individuals severed all connection with their parents, hundreds of whom were convicted of these "crimes" and imprisoned.

ResearchEditor (talk) 03:35, 29 April 2008 (UTC)

paragraph after ResearchEditor's original edits:

An iatrogenic artifact is a disease believed to be made up by doctors. It may be a diagnostic trend or fad some believe to be obsolete or discredited. Examples of diseases accused of being iatrogenic artifacts include nymphomania, hystero-epilepsy, repressed memory, autogynephilia, and multiple personality disorder. Some researchers believe that the iatrogenic origins of multiple personality disorder have not been proven. One study found no empirical evidence for the idea that "most patients recover memories of childhood sexual abuse because their therapist had suggested to them that they were abused as children" and studies have consistently demonstrated that amnesia can occur in survivors of trauma. It has been suggested that treaters who believe in the disease may be able to observe or even induce symptoms matching the disease's description in suggestible patients. In the false memory syndrome, psychotherapists have been accused of attempting to recover memories of early childhood abuse from their clients. The techniques, practices and exercises used in these attempts have been referred to as Recovered Memory Therapy and sometimes resulted in allegations of abuse being made by individuals against family members. Some of these individuals severed all connection with their parents, some of whom were convicted of crimes and imprisoned. Stephanie Dallam states that "the 'False Memory Syndrome' is a controversial theoretical construct based entirely on the reports of parents who claim to be falsely accused of incestuous abuse...The current empirical evidence suggests that the existence of such a syndrome must be rejected. False memory advocates have failed to adequately define or document the existence of a specific syndrome...This does not imply, however, that memory is infallible or that all people who are accused of sexual abuse are guilty." The term "Recovered memory therapy" (RMT) was coined by affiliates of the False Memory Syndrome Foundation in the early 1990s, It is not listed in DSM-IV or used by any mainstream formal psychotherapy modality. Some believe that there is insufficient evidence that false memories can be created in therapy.

ResearchEditor (talk) 03:35, 29 April 2008 (UTC)

I disagree that a WP:POVFORK was created. "A point of view (POV) fork is a content fork deliberately created to avoid neutral point of view guidelines, often to avoid or highlight negative or positive viewpoints or facts." The paragraph I created contained both sides of the issue. The difference between my paragraph and the one before it was that mine attempted to present both sides of the issue. Since the article is about iatrogenesis, I believe that the arguments about the possible iatrogenesis of MPD and recovered memory should be covered on the page. The section as it stands now has only one side of the issue again, that of the skeptics of MPD/DID. The addition of info. on FMS in my original edit was a reply to the allegation in the original paragraph that FMS is created by RMT. I am open to the idea of a shorter paragraph, but I believe that it should contain both sides of the issue fairly. ResearchEditor (talk) 03:35, 29 April 2008 (UTC)

This isn't a POV fork. This is a coatrack. --FOo (talk) 04:12, 29 April 2008 (UTC)

Since the page is about iatrogenesis, the best choice is to pick examples which aren't controversial as possibly iatrogenic. Leave DID out of this article, put the discussion of iatrogenesis and DID in the DID page. WLU (talk) 13:13, 30 April 2008 (UTC)

I've replaced DID with hystero-epilepsy, which is unequivocally an iatrogenic disorder. If the purpose of the section is to discuss an iatrogenic disorder, then HE is a better choice. At best, the section should contain a sentence saying that DID is considered by some to be iatrogenic, though there is disagreement - two references, one for each side, not the 6 or whatever that was there. WLU (talk) 13:29, 30 April 2008 (UTC)

After some further contemplation, the massive attention paid to the possibly iatrogenic nature of DID suggests it deserves a mention. I don't think that myself or ResearchEditor should make it though. Jack-A-Roe does a good job of pleasing both of us with his neutral representation of sources. I suggest we allow him, or another uninvolved editor, to draft the section/sentences. Agreed? WLU (talk) 13:42, 30 April 2008 (UTC)

I agree with the above. It believe that it is an excellent idea. JAR is an excellent editor, neutral and well-versed in wikipolicy. ResearchEditor (talk) 02:49, 1 May 2008 (UTC)

(undent)I've raised this issue on JAR's talk page, he said he'd try to get to it. Can we agree to leave it until he gets to it? If he doesn't manage to within, say a week, (he's really doing us a favour here, since this is pretty far out of his normal interest) then we can discuss possibly including DID and how it should look. The problem is there's a lot of potentially iatrogenic psychological disorders, but this is a page about iatrogenesis in general - it's shouldn't be bloated by a single section that goes in to far too much detail about one area that's equivocal. Let's revisit on the 8th, agreed? WLU (talk) 14:57, 1 May 2008 (UTC)

Agreed. (So far JAR's edits look good.) ResearchEditor (talk) 01:49, 2 May 2008 (UTC)

Thank you both for your kind comments. I'll give this a go and hopefully come up with at least a good starting point for expansion. I've done some reading on the topic and have an idea for an approach, though I'm not sure when I can get to the actual edits on the paragraph. As a result of the reading, I made some adjustments to the definition in the lead of the article. I didn't add references there, but I think I made it more clear; please take a look and see if you approve. --Jack-A-Roe (talk) 23:50, 1 May 2008 (UTC)

PS... by the way, in my reading, I found that the term "iatrogenic artifact" does not appear to be more specifically used to describe psychological conditions; it has several meanings and mostly appears to be an overall synonym for iatrogenic phenomena in general. For example, another use for "iatrogenic artifact" is a tumor caused by x-rays or radiation treatments. The tumor is the artifact; unlike in psychology contexts where the artifact might refer to the collection of symptoms or the name of the syndrome. So I don't think we should separately those terms in this article; I was not able to find any sources that define them separately; if someone finds that we could revisit this question. For the section about psychological effects - I think "psychology" or "psychological applications" would be fine as section heading. ... --Jack-A-Roe (talk) 00:01, 2 May 2008 (UTC)

My brief research on the subject led me to the same conclusion - it's not an exclusively psychological use. Iatrogenic artifact is a vague term, so sticking to iatrogenesis#psychology makes the most sense to me. Draft a section, then RE and I and any other editors can comment. WLU (talk) 01:09, 2 May 2008 (UTC)

new draft

OK, here's a suggestion for the section. I have references for the list of conditions, but I didn't want to do the work of formatting them if this version is not going to be used. I tried to keep this simple and direct, to avoid getting into the controversies. If there is a controversy about iatrogenisis re a particular condition, it would be better to explore that in the article about that condition. Also, I did not mention FMS at all in the list, because that's not a diagnosed condition, and also - if it's mentioned, then the whole NPOV response is needed and the whole section will go off-topic. So I recommend that FMS be left off the list. I also didn't mention Repressed Memory. That one could be added I suppose, but again, it's not something that's "diagnosed", and also I don't have a reference for that one. But with Repressed Memory, unlike FMS, I don't think it would cause a big controversy to include it.

I have no idea if this is what you're looking for... but here it is:

In psychology, iatrogenisis can occur when behavior symptoms are misdiagnosed or are identified and named as a condition that does not actually exist; or when a diagnosis, medication or other treatment or intervention causes or worsens a condition rather than improving the symptoms. Conditions that have been hypothesized to be associated with iatrogenisis include bipolar disorder, dissociative identity disorder, somatoform disorder, fibromyalgia, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, adolescent antisocial personality disorder, and others. The degree of association of any particular condition with iatrogenisis is unclear and in some cases controversial; research has not yet shown definitive results. A historical example of a condition formerly considered to be a disease that has since been shown to be an iatrogenic artifact is hystero-epilepsy; symptoms disappeared when the treatments were discontinued.

--Jack-A-Roe (talk) 08:25, 3 May 2008 (UTC)

Wow, I hope that you've references for those! Fibromyalgia, CFS, PTSD, bipolar as potentially iatrogenic conditions? *whistles*

I think leaving FMS and RM out is a good idea for the exact reasons you suggested. I think the bit about medication can be left out since that's covered in the other sections - the unique aspect about psychological iatrogenesis is that a purely mental treatment can result in a behavioral diagnosis. A suggested revision - it's shorter, and short is beautiful (as someone who is five foot six).

In psychology, iatrogenisis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy) or when medical or psychotherapeutic treatment causes or worsens symptoms. Conditions hypothesized to be partially or completely iatrogenic include bipolar disorder, dissociative identity disorder, somatoform disorder, fibromyalgia, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse and adolescent antisocial personality disorder, though research is unequivocal for each condition.

The hystero-epilepsy seems a bit awkward but it's the best place I can think of. I removed 'and others' at the end of the list - wikipedia's not done, but that's a pretty good list so I say leave out 'others' pending references. WLU (talk) 11:19, 3 May 2008 (UTC)

That seems OK to me, pending comment from ResearchEditor; though I'm not sure medication should be omitted because there is some overlap with purely psychological treatments as will show up in some of the references. I'm glad you agree about leaving out FMS & RM. Regarding the references, I found that wIth some of them, like Bipolar, it's not that the disease itself is completely iatrogenic, but rather that some of the therapies can make it worse; some treatments include medications (that's why I had included medication in this section), but also surprisingly - there's a reference that states re Bipolar: "Thus, CBT [cognitive behavioral therapy] had significant therapeutic effects on the patients with less highly recurrent illness courses, but it appeared to have had an iatrogenic impact for those with the worse prognoses." I don't have the time right now - later today, I'll post the links to the refs here so you and ResearchEditor can vet them. --Jack-A-Roe (talk) 16:57, 3 May 2008 (UTC)

You both did a lot of good work on this issue. Though I do sometimes appreciate succinctness in writing, sometimes IMO quality and accuracy is served by thoroughness as well.

Here's my version, based on both versions (please note the spelling and grammatical fixes). IMO, this may read a bit better:

In psychology, iatrogenesis can occur due to misdiagnosis. Conditions that have been hypothesized to be associated with iatrogenesis include bipolar disorder, dissociative identity disorder, somatoform disorder, fibromyalgia, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, adolescent antisocial personality disorder and others. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial. A historical example of a condition formerly considered to be a disease that has since been shown to be an iatrogenic artifact is hystero-epilepsy; symptoms disappeared when the treatments were discontinued.

I do have some concerns however that Spanos and McHugh's refs w/o balancing refs could be seen as not being NPOV, based on their stances on DID, though they are not being used for this purpose. ResearchEditor (talk) 22:56, 3 May 2008 (UTC)

Sorry, I've been busy today and haven't had a chance to add the refs; some of those go with DID so that may resolve the issue about those other two refs seeming unbalanced. I'll get back to this as soon as I can to post the refs, but it might be late or tomorrow AM. --Jack-A-Roe (talk) 23:05, 3 May 2008 (UTC)

Here are the references that led me to the list of conditions in the draft paragraph. They are not unilateral, some of these support iatrogenesis for a particular condition and some oppose, but they all mention it as a consideration. Also, in some, medications are involved, but regard other treatment interventions. If you don't think they apply, feel free to modify the conditions list one way or the other.

Some of the articles are long, so it might be a good method to use your browser find-command to search for "iatro" in the text - to cover locate forms of the word. For the ones that are Google Books links, the Google in-book search box on the right hand side of the page works in most browsers though some have trouble with it - also in Google Books it only searches for whole words, so it might be necessary to search for both iatrogenic and iatrogenesis. Here's the list:

• bipolar disorder

[1] [2]

• dissociative identity disorder:

[3] [4] [5] [6](page 369)

• somatoform disorder, fibromyalgia, chronic fatigue syndrome (these appear together in some references)

[7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]

• posttraumatic stress disorder

[18] [19]

• substance abuse, antisocial personality disorder (these appear together in some references)

[20] [21] [22] [23]

• other
  • general: [24] [25]
  • autogynephilia: [26] [27]
  • psychoanalysis - unresolved transference: [28]
  • Transvestic Fetishism: [29]
  • chronic pain: [30]

Some of those references could also be useful in the articles about each of the listed conditions.

As much as I'd like to complete the work on this, I don't have time to choose and format the references so I need to leave that to the two of you. If you end up not using some of these references or omitting some of the conditions, that's fine - use your best judgement, I'm not attached to the results. If you'd like my feedback on the next version of the paragraph, please let me know. --Jack-A-Roe (talk) 19:00, 4 May 2008 (UTC)

JAR, thanks for your excellent work on this. The refs you provided on DID are excellent balancing ones. ResearchEditor (talk) 21:43, 4 May 2008 (UTC)

Misdiagnosis isn't the only way that iatrogenesis can occur in psychology and psychotherapeutic treatment - drugs, improper treatment, these can also cause iatrogenic conditions (witness hystero-epilepsy, or anyone with bipolar disorder treated with antipsychotics). I prefer the middle version for its brevity and comprehensiveness.

I think Spanos alone should be used, as it is the most reliable. Since it's being used to justify hystero-epilepsy, I don't consider it having an NPOV issue. In any case, as long as it is a reliable source, NPOV comes in the portrayal of the source and balancing - this needs no balancing because it's not discussing DID, just hystero-epilepsy.

I'll try to get around to referencing the remaining conditions, I would rather use a single reference because a laundry list with excessive referencing is unbalanced for the article as a whole and replaces the coatracking issue. Iatrogenesis of specific conditions should be discussed at length in the individual pages. WLU (talk) 01:10, 5 May 2008 (UTC)

Maybe I gave the wrong impression - I didn't intend for all those references to be used, I figured just a few would be enough. (by the way, one of the Bipolars was about meds, and the other was about cognitive therapy). Anyway, I think those sources are good for at least some raw material that can be pared down. I certainly agree that detailed discussion should go into the individual articles and that this page just needs an overview.

I could go along with the middle version also... though if ResearchEditor prefers to include some note of the controversy on the topic, the last sentence could be modified like this: ", though research is unequivocal for each condition, and has generated some controversy." - or something general like that. --Jack-A-Roe (talk) 01:21, 5 May 2008 (UTC)

I have gone through most of JAR's urls and picked the fewest refs (all peer reviewed, with the exception of Spanos' book, which was pub. by the APA) I could use to support the data in the paragraph. The final version is very close to WLU's suggested paragraph, with the exception of deleting part of one of his sentences and adding one of JAR's to the end, keeping the length almost identical to WLU's version. I made one change to a wikilink. None of the articles mentioned a personality disorder, only antisocial youth. Personality disorders are Axis II diagnoses, usually seen as fixed and unchanging and unless specifically mentioned in the abstract, I believe it would be a misnomer to use the term with an article on antisocial youth. I left out a url on iatrogenesis in peer groups [31] for the sake of brevity. Please feel free to add it if desired. Future work on the paragraph might entail adding balancing reliable sources on all of the listed topics. But, IMO, this may be the best paragraph in the article, due to our combined work. ResearchEditor (talk) 04:04, 5 May 2008 (UTC)

In psychology, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy) Conditions hypothesized to be partially or completely iatrogenic include bipolar disorder, dissociative identity disorder , fibromyalgia,somatoform disorder, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, antisocial youths and others though research is unequivocal for each condition. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial.

ResearchEditor (talk) 04:04, 5 May 2008 (UTC)

To be perfectly honest - re the current article it occurs to me (not that my opinion counts) that regarding PTSD. By the way many articles refer to it (including this one) - logically it should have a different 'name' for those 'affected' by incidents termed 'disasters' - eg those situations where people may be affected by a large scale situation (where many people are involved). Post Disaster Trauma (whatever you like) for example - the current reference for Iatrogenesis (PTSD) being based entirely on a telephone survey for 9/11, several years after the event. Worthless! Ergo you have two seperate diagnoses for two completely different (though perhaps on the surface the same). Yet another catch-all 'named' illness (which by all accounts and purposes, personal (traumatic) incidents are completely different from those suffered in group shock. Using PTSD as a catch-all is a bit like suggesting everyone with a runny nose has a 'cold'. The point being it is far more likely that clinicians may be lazy and just group a host of people to have PTSD (if they exhibit any behaviour different from the norm (perhaps not even that)) after hearing the patient was involved in a well known 'disaster' scenario. Therefore PTSD is not iatrogenic, but repeated, high-profile, misdiagnosis may cause it to appear so. Unless more (realistic) research can prove otherwise. Original diagnoses are not the problem, medical mispractice is.MagicalThinking (talk) 12:14, 3 October 2012 (UTC)

Homosexuality

I wonder if homosexuality would fit into the page - it was pathologized in the first two (three?) DSMs, if sources turn up it'd be interesting as an addition. WLU (talk) 23:15, 27 April 2008 (UTC)

Merge

Iatrogenic disorder and iatrogenic artifact both exist, both are stubs, and both duplicate content. Could/should they be merged? I think the page is short enough to handle them, particularly given the duplication of content. WLU (talk) 14:22, 28 April 2008 (UTC)

I am for the merge, provided that several editors are involved in the merge and content transfer, and these issues are discussed first prior to the merge. ResearchEditor (talk) 03:15, 29 April 2008 (UTC)

Good idea. I've done the merges. If anyone notices anything from the other articles I missed that need to be included, please do so. --Jack-A-Roe (talk) 04:04, 29 April 2008 (UTC)

restoring unproven medical procedures section

I have restored this section, because appears to be sourced and was deleted without sufficient reason. ResearchEditor (talk) 03:10, 28 May 2008 (UTC)

• Maybe it's me but which source did you see in that section? Second, this reeks as OR.Nomen Nescio^{Gnothi seauton} 07:29, 28 May 2008 (UTC)

Good points. This is a better reason to remove than your original reason "seems absent from current practice." If the original writer is unable to provide adequate references, then please feel free to delete as OR. ResearchEditor (talk) 02:56, 29 May 2008 (UTC)

deleting unsourced statement

I have deleted a statement without a source. ResearchEditor (talk) 02:40, 2 June 2008 (UTC)

Unnecessary medical procedures

A glaring omission from this article are deaths caused by unnecessary medical procedures, something that the medical literature distinguishes from simple negligence. // Internet Esquire (talk) 06:31, 19 October 2008 (UTC)

This hardly qualifies as a glaring omission, but please give some examples to illustrate more clearly what you mean and then simply add anything to the article under this new heading that you can back up with good sources. thanks Peter morrell 11:41, 19 October 2008 (UTC)

Other terms for "health care badness"

I think it is glaring. And I doubt that it fits under the term iatrogenesis let alone under medical error. For instance, if someone gets roaring drunk, drives 90 mph, crashes into a school bus and kills a dozen children, the intention may not have been to kill a dozen children, but it is difficult to dismiss it as an error or an unintended outcome. The terms iatrogenesis (as currently defined) and medical error do not cover a large swath of what harms patients.

Does Netesq really need sources to back up examples like inebriated surgeons? Incompetent practitioners who are allowed to keep practicing for political reasons? Nurses and doctors who cannot be persuaded to maintain hand hygiene standards? Along with issues like the covering up of problems rather than reporting them resulting in continuing harm that could have been prevented? And selling unnecessary treatments to make money? The intention might not have been to cause financial or physical harm, just like the driver did not get drunk with the intention of killing a dozen children, but such things cannot be dismissed as mere errors or unintended outcomes. If you don't wash your hands and someone dies, you cannot dismiss it with "Whoops." You unnecessarily exposed others to risk just as though driving drunk.

I did not come up with the term medical harm, and did not especially like it, but I suspect that it was an attempt to fill an omission that is glaring - harm caused to patients that cannot be dismissed as unintended or as mere errors. The omission that Netesq calls glaring might be that there is no word to cover these problems in medicine, unless someone can point us to something else in Wikipedia that does.--Sighalot (talk) 19:23, 17 June 2014 (UTC)

SighalotI do not think anyone here is saying that these topics should not be covered. I want them covered, and I want them findable. The problem is that we have not found an authoritative set of definitions for all the types of bad outcomes that exist, and there is no generally accepted term which includes all bad outcomes. I and others are still thinking about this and doing research to find the right terms for the articles that should contain this sort of information. Blue Rasberry (talk) 12:03, 18 June 2014 (UTC)

What I believe is needed first is not a set of definitions specifying each type of bad outcome, but a single term for all of it, so that the field is not referred to merely as Errors. I have searched for such a term for over ten years. It has been a continual topic of discussion during that time with others also in need of such a term. Various combinations of other words have stood in for such a word. If there were support for "patient harm" as the label, then we would embrace that. But there does not appear to be an appropriate term in existence.

Do you think that it might be time that we act like Virchow and produce an appropriate word ourselves? He first named Lukemia "White Blood" for that problem, not unlike using the words "Medical Harm" for this problem. White Blood didn't work out well either so he made it more academic sounding by using the Greek word for "white," leukos, and called it leukemia. That had a profound impact on the future of understanding the disease.

Isn't it time we do the same thing for this problem? I have proposed using the word Nequamitis (neck' wahm itis). Nequam is Latin for worthless, good for nothing, or bad. "Itis" is, of course, a suffix derived from Greek meaning inflammation. When care injures patients at the least it is worthless. With the amount of injury the field of medicine dispenses, I believe it is not inappropriate to regard the body of medicine as having an affliction that could be called Nequamitis, or some similar word. This kind of language may be conducive to productive thought in a field that has diagnosing and curing afflictions as part of its job description. Reducing errors that are thought to be systems problems isn't what caregivers are trained for. But diagnosing and curing is.

The word Nequamitis cannot be cited anywhere other than one website as far as I know. And it could be that in our lifetimes it would get no traction, but perhaps eventually one or two people would mention it in papers and then, finally, there would be the references the profession seems to need before it will allow a term to be used. Without such a term we will be forced to continue to watch the issue discussed as though the only problem is a small number of errors that probably are unavoidable and certainly are not anyone's fault - not a recipe for finding problems and solving them.

Any thoughts?Sighalot (talk) 03:50, 19 June 2014 (UTC)

Sighalot You raise two issues. One is about coining a word, and the other is about making an article for the concept. About coining the word - Wikimedia community precedent is to say no to that. See Wikipedia:Neologism and on Wikitionary, our own term of art for this sort of thing wikt:protologism. I could say more, but in short, Wikipedia is supposed to summarize what is already said and not say new things.

What has already been discussed and what does appear in citable sources is the nameless concept of "all bad health care outcomes". I have been looking for a term for this concept for about two weeks, and I feel fairly well connected in asking others if such a term exists since I work at an advocacy organization which wants to reduce "all bad health care outcomes", and I just realized recently that none of us have a term for what it is we want to diminish. I started an article at User:Bluerasberry/Undesirable health care outcomes in which I listed all of the things which I felt were bad outcomes of health care. What I would like now is to identify a source which says that all of these things are bad, which I think must exist, but which I have been unable to find. Something that all of these things have in common is that I feel they reduce User:Bluerasberry/Patient satisfaction, which is an established metric for health care quality. I am looking at quality evaluation strategies to see if anyone else has ever listed all of the things which, if lessened, will result in better outcomes for the patient. One of the reasons why I want this is so that I can categorize all of the things that patients should consider when they seek health care, and I want to group those things in Template:Medical harm and in some category. In addition to not having a term for harms, there also is not a term for the good things or opposite of harms. If there were, then people could read that and know what they should desire as an outcome for their health care.

If you have been thinking about this for years, then you might have suggestions for a source on the concept. Even if we do not have a term right now, we can still make an article if only we have sources which discuss the concept of a thing, and even if there is no coined term for it. If we made such an article, it would keep an awkward name like "Undesirable health care outcomes" until such time as someone in another publication made a name for the concept.

I am still not even convinced that this should have an article because I have no good sources, but if this concept is really discussed, then it would be useful to me to have an article on the subject. Blue Rasberry (talk) 15:32, 19 June 2014 (UTC)

The following reference has been cited in facebook discussions from time to time during the last year. Would it be of any use to this end? http://patient-safety.com/errors-medical.htmlSighalot (talk) 17:35, 19 June 2014 (UTC)

Sighalot I read the essay and yes, this is the concept I am trying to articulate. The essay there gives insight into the issue but it is not a reliable source by Wikipedia standards because the author is pseudonymous, there is no editorial process for the website, and the website itself makes no assertion of reliability. For that reason, the content there could never be used to back content creation on Wikipedia.

Even if the site were a reliable source it only coins the term, which still does not justify making an article on the concept. The sourcing that I want is evidence of use of the concept. I want an academic paper which discusses "Nequamitis" even without naming it, especially one that lists all the concepts which can be included in a category of "Nequamitis". If the umbrella category has been used, then identifying its use in a reliable source is more important than finding a source like this which names the concept without actually using it in a practical way. The practical way I am imagining is finding a paper which says, "These things are all (Nequamitis), and they are bad. Health care should seek to reduce these things, and seek to promote (opposite of nequamitis), which would be good." Have you seen any such paper or book? Blue Rasberry (talk) 18:46, 20 June 2014 (UTC)

I am very glad you are asking this question. I have been thinking about it. I cannot recall having seen such an article. I will ask around. Let me make sure I am asking the question correctly when I do. Is this it: "Looking for an academic paper that lists all the things in health care that are bad and that says that it would be good if health care would seek to promote the opposite of them."Sighalot (talk) 11:13, 23 June 2014 (UTC)

Sighalot Yes, that is exactly what I am doing. As a start, I am looking at articles related to health care quality, because I feel that the field of health care evaluation must be listing all the good and bad things when any evaluation is made. There are multiple perspectives to health care evaluation, as what consumers, physicians, hospitals, government, and insurance evaluate as good and bad often conflict with each other. I hate to jump into this mix and research all these perspectives when I would have expected that someone else already articulated this, at least from each of those perspectives individually but perhaps for all of them collectively and comparatively. See if you have any easy leads, and if not, then perhaps we could talk by voice or video to plan a more complicated way to address this. Blue Rasberry (talk) 13:46, 23 June 2014 (UTC)

Source Number 1

I wonder if any noticed source 1 links to a nutritionist health web site, and not, say, a medical paper that actually states the 250,000 deaths a year number. —Preceding unsigned comment added by 71.240.240.118 (talk) 13:08, 9 December 2008 (UTC)

And you really believe that such so-called medical websites would openly admit such data? The websites [32], [33] and [34] put the figure much higher than 250,000. It is obviously hard to quantify but the message is still clear. Peter morrell 13:57, 9 December 2008 (UTC)

Intentional Iatrogenesis

The means by which a medical personage derives a continued income by intentionally inflicting repeated and constant illness upon an unwilling individual, and then treats the illness and any possible derivative illnesses, such that the treatment may prolong the originally inflicted illness, to then be treated for further profit. See also: carrion feeder, Physician, American. 98.16.0.188 (talk) 12:31, 13 September 2009 (UTC)

Yes, paying out for the tort of battery is extremely profitable. You've cracked the code. 174.60.55.71 (talk) 16:08, 8 August 2014 (UTC)

Health care poverty

The section dealing with this subject talks solely about 'transitional' economies and not about the debate regarding for example developed world health care systems despite the fact that the cost of medicine in the developed world is often multiple orders of magnitude higher then in the developing world.--Senor Freebie (talk) 15:09, 19 October 2009 (UTC)

Corrected Figure

I changed the line "In the United States, from 120,000 to 225,000 deaths per year may be attributed in some part to iatrogenesis." to "In the United States, an estimated 44,000 to 98,000 deaths per year may be attributed in some part to iatrogenesis." after reading the source for the statement. I.E. "Information concerning the deficiencies of US medical care has been accumulating. The fact that more than 40 million people have no health insurance is well known. The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as many as 20% to 30% of patients receive contraindicated care.1 In addition, with the release of the Institute of Medicine (IOM) report "To Err Is Human,"2 millions of Americans learned, for the first time, that an estimated 44,000 to 98,000 among them die each year as a result of medical errors." As we can see the source doesn't give any indication of the 120,000 to 225,000 deaths claimed. Further sorry didn't realize wikipedia logged me out.Donhoraldo (talk) 16:15, 16 September 2010 (UTC)

e-Iatrogenesis

e-Iatrogenesis (or technological iatrogenesis) emerged as a growing theme at last weeks Medinfo conference. Roughly defined as "patient harm caused at least in part by the application of health information technology" according to Weiner et al (2007). Suspected to be a factor in approximately 25 percent of medication errors. bibliography. Should this be included?— Rod ^talk 08:07, 22 September 2010 (UTC)

How is it defined? If that number includes having the patients chart on computer and a nurse or doctor not reading it properly then I'd say it's not really note worthy as it's the same old problem in a new form.Donhoraldo (talk) 14:11, 23 September 2010 (UTC)

It could be that but more specifically I think it relates to errors in coding software which is used to create or transfer electronic records or decision support tools used in eprescribing. An example in the UK was patients receiving excessive doses of radiation because the algorithm used to calculate the dose and length of radiotherapy.— Rod ^talk 14:28, 23 September 2010 (UTC)

Do you have a citation for that? I'd like to read the article before making a statement on it.Donhoraldo (talk) 18:26, 24 September 2010 (UTC)

NY Times article & ieeee follow up, BBC story on errors in Scotland, Medical physics web reviews, WHO review unfortunately I could go on.— Rod ^talk 18:36, 24 September 2010 (UTC)

Found this article, http://sites.google.com/site/hcinfosys/literature/eiatrogenesis it gives as examples

"# Illegible handwriting on a paper prescription replaced by a mistyped e-script

1. Choosing wrong drug/dose/delivery from a lengthy drop-down list
2. Filling in prescription on wrong patient (when multiple patient windows can be displayed on a screen)
3. Wrong patient information based on breakdown of patient identifier system
4. Formulary used by prescriber allows substitution (at point of prescribing) when pharmacist may not agree (15% of time) if they saw the original brand name drug prescribed as they do in manual prescribing
5. Outdated medications on medication history"

None of thees are unique to e-Iatrogenesis in nature but it dose show some trend.Donhoraldo (talk) 18:43, 24 September 2010 (UTC)

OK after reading that there is some notable information but I'm not convinced of it's uniqueness. Instead I'll just add some references in the Sources of iatrogenesis section.Donhoraldo (talk) 18:53, 24 September 2010 (UTC)

/* Incidence and importance */ section has issues with uncited figures.

This section has a fairly major problem, it makes extensive factual claims involving "studies" that aren't cited, and proceeds to list fairly controversial and debatable conclusions regarding iatrogenics as a leading cause of death in the USA. This all needs sourcing, or it will end up being redacted, I believe. --Pstanton (talk) 08:31, 19 October 2010 (UTC)

Including Citations from Gary Null, of all people?

Why are there citations about statements by Gary Null. Does this really count as a reliable and legitimate source of information?--75.64.73.238 (talk) 06:13, 15 May 2011 (UTC)

I was unable to track down any actual reference to Gary Null in the article aside a small blurb that had been on the bottom line of the lead. Since I couldn't find a reference that should have been paired with the data I removed it and leave it here in the event a reference was in fact there or a reference can be found.

"Other figures put the toll in 581.926 deaths annually. (See: G. Null, M.Feldman,D.Rasio and D. Smith)"

Travza (talk) 06:22, 15 May 2011 (UTC)

Well, it's probably a reference to this self-published online 2-part item Death By Medicine by those same authors, the factual veracity of which is probably open to question as it is not published in a regular peer-reviewed medical journal. FWIW. Peter morrell 13:45, 15 May 2011 (UTC)

This meta-study was published by the Nutrition Institute of America, a nonprofit organization that has sponsored independent research for 30 years, and requires that all data be validated by published, peer-reviewed scientific studies. It's authors are Gary Null PhD, Carolyn Dean MD ND, Martin Feldman MD, Debora Rasio MD, Dorothy Smith PhD. It is the only such meta-study, corroborates the well-documented work of Ivan Illich in his 1974 book Medical Nemesis, and should be included here. --Riversong (talk) 18:17, 6 October 2012 (UTC)

Gary Null is a patently unreliable source for medical claims. Please review WP:MEDRS. Just because a paper cites peer-reviewed sources does not mean that it is peer-reviewed source itself. Skinwalker (talk) 20:44, 6 October 2012 (UTC)

Unreliable authors [35], self-published from a questionable organization [36], Falls afoul of WP:REDFLAG. IRWolfie- (talk) 21:06, 6 October 2012 (UTC)

Yup, wouldn't remotely be considered WP:MEDRS - and add to that the fact that the pdf file could come from anywhere. No way to even ascertain that it is the original.. AndyTheGrump (talk) 22:05, 6 October 2012 (UTC)

Leaving aside for a moment the fact that not even all published, peer-reviewed studies meet Wikipedia's standards for reliable sources on medical topics, merely collecting and citing such studies does not guarantee that the resulting work will (or should) be considered a reliable source itself. As for the Nutrition Institute of America, I'm somewhat at a loss to find information about them; they do not appear to have a significant web presence, nor do they appear to be a publisher of respected scientific journals. (Compare, for example, with the American Society for Nutrition, which publishes the solidly-credible American Journal of Clinical Nutrition.) Seriously, I can't find an official website for the NIA on this first couple of pages of Google hits. TenOfAllTrades(talk) 02:57, 7 October 2012 (UTC)

Psychology

"Conditions hypothesized as partially or completely iatrogenic include bipolar disorder,[5] dissociative identity disorder,[4][6] | issue = 6 | page = 43 |pmid=9270707 | pages = 161–2, 165–6, 171–2 passim }} </ref> somatoform disorder,[7] chronic fatigue syndrome,[7] posttraumatic stress disorder,[8] substance abuse,[9] antisocial youths[10] and others,[11] though research is equivocal for each condition."

In regards to the final sentence. I'm not exactly sure if research on any psychological condition is unequivocal. Perhaps they are highly researched but I think unequivocal should be removed. 24.115.19.178 (talk) 19:27, 7 January 2012 (UTC)

Introversion

Susan Cain mentions anecdotally, that introversion in children might be treated (wrongly) with drugs due to concern by misguided, extroverted parents. I would like to see this added to the psych section if there are additional sources. Viriditas (talk) 03:22, 28 November 2012 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Archive 1