Biomedical Model

Biomedical model

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The biomedical model of medicine has been around since the mid-19th century as the predominant model used by physicians in diagnosing diseases. It has four core elements.[clarification needed]

According to the biomedical model, health constitutes the freedom from disease, pain, or defect, making the normal human condition “healthy.” The model’s focus on the physical processes (for example, pathology, biochemistry and physiology of a disease) does not take into account the role of social factors or individual subjectivity. Unlike the biopsychosocial model, the biomedical model does not consider diagnosis, which affects treatment of the patient, to be the result of a negotiation between doctor and patient.[1]

The biomedical model of health focuses on purely biological factors and excludes psychological, environmental, and social influences. It is considered to be the leading modern way for health care professionals to diagnose and treat a condition in most Western countries.[citation needed]

See also[edit]

References[edit]

  1. ^ Annandale, The Sociology of Health and Medicine: A Critical Introduction, Polity Press, 1998

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Holism in science

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Holism in science, or holistic science, is an approach to research that emphasizes the study of complex systems. Systems are approached as coherent wholes whose component parts are best understood in context and in relation to one another and to the whole. This practice is in contrast to a purely analytic tradition (sometimes called reductionism) which aims to gain understanding of systems by dividing them into smaller composing elements and gaining understanding of the system through understanding their elemental properties.[1] The holism-reductionism dichotomy is often evident in conflicting interpretations of experimental findings and in setting priorities for future research.

Contents

1
Overview
2
Examples in various fields of science
2.1
Physical science
2.1.1
Agriculture
2.1.2
In physics
2.1.3
Chaos and complexity
2.1.4
Ecology
2.1.5
Medicine
2.1.6
Neurology
2.2
Social science
2.2.1
Economics
2.2.2
Education reform
2.2.3
Anthropology
2.2.4
Psychology of perception
2.2.5
Teleological psychology
3
Skeptical reception
4
Degree programs
5
See also
6
References
7

Further readingOverview[edit]

David Deutsch calls holism anti-reductionist and refers to the concept as thinking the only legitimate way to think about science is as a series of emergent, or higher level phenomena. He argues that neither approach is purely correct.[2]

Two aspects of Holism are:

  1. The way of doing science, sometimes called “whole to parts”, which focuses on observation of the specimen within its ecosystem first before breaking down to study any part of the specimen.[3]
  2. The idea that the scientist is not a passive observer of an external universe but rather a participant in the system.[4]

Proponents claim that Holistic science is naturally suited to subjects such as ecology, biology, physics and the social sciences, where complex, non-linear interactions are the norm. These are systems where emergent properties arise at the level of the whole that cannot be predicted by focusing on the parts alone, which may make mainstream, reductionist science ill-equipped to provide understanding beyond a certain level. This principle of emergence in complex systems is often captured in the phrase ′the whole is greater than the sum of its parts′. Living organisms are an example: no knowledge of all the chemical and physical properties of matter can explain or predict the functioning of living organisms. The same happens in complex social human systems, where detailed understanding of individual behaviour cannot predict the behaviour of the group, which emerges at the level of the collective. The phenomenon of emergence may impose a theoretical limit on knowledge available through reductionist methodology, arguably making complex systems natural subjects for holistic approaches.[5]

Science journalist John Horgan has expressed this view in the book The End of Science. He wrote that a certain pervasive model within holistic science, self-organized criticality, for example, “is not really a theory at all. Like punctuated equilibrium, self-organized criticality is merely a description, one of many, of the random fluctuations, the noise, permeating nature.” By the theorists’ own admissions, he said, such a model “can generate neither specific predictions about nature nor meaningful insights. What good is it, then?”[6]

One of the reasons that holistic science attracts supporters is that it seems to offer a progressive, ‘socio-ecological’ view of the world, but Alan Marshall‘s book The Unity of Nature offers evidence to the contrary; suggesting holism in science is not ‘ecological’ or ‘socially-responsive’ at all, but regressive and repressive.[1]

Examples in various fields of science[edit]

Physical science[edit]

Agriculture[edit]

Permaculture takes a systems level approach to agriculture and land management by attempting to copy what happens in the natural world.[7] Holistic management integrates ecology and social sciences with food production. It was originally designed as a way to reverse desertification.[8] Organic farming is sometimes considered a holistic approach.[9]

In physics[edit]

See also: Physics and Quantum physics

Richard Healey offered a modal interpretation and used it to present a model account of the puzzling correlations which portrays them as resulting from the operation of a process that violates both spatial and spatiotemporal separability. He argued that, on this interpretation, the nonseparability of the process is a consequence of physical property holism; and that the resulting account yields genuine understanding of how the correlations come about without any violation of relativity theory or Local Action.[10] Subsequent work by Clifton, Dickson and Myrvold cast doubt on whether the account can be squared with relativity theory’s requirement of Lorentz invariance but leaves no doubt of an spatially entangled holism in the theory.[11][12] Paul Davies and John Gribbin further observe that Wheeler’s delayed choice experiment shows how the quantum world displays a sort of holism in time as well as space.[13]

In the holistic approach of David Bohm, any collection of quantum objects constitutes an indivisible whole within an implicate and explicate order.[14][15] Bohm said there is no scientific evidence to support the dominant view that the universe consists of a huge, finite number of minute particles, and offered in its stead a view of undivided wholeness: “ultimately, the entire universe (with all its ‘particles’, including those constituting human beings, their laboratories, observing instruments, etc.) has to be understood as a single undivided whole, in which analysis into separately and independently existent parts has no fundamental status”.[16]

Chaos and complexity[edit]

See also: Chaos theory

Scientific holism holds that the behavior of a system cannot be perfectly predicted, no matter how much data is available. Natural systems can produce surprisingly unexpected behavior, and it is suspected that behavior of such systems might be computationally irreducible, which means it would not be possible to even approximate the system state without a full simulation of all the events occurring in the system. Key properties of the higher level behavior of certain classes of systems may be mediated by rare “surprises” in the behavior of their elements due to the principle of interconnectivity, thus evading predictions except by brute force simulation.[17]

Ecology[edit]

See also: Holistic community and Ecology

Holistic thinking can be applied to ecology, combining biological, chemical, physical, economic, ethical, and political insights. The complexity grows with the area, so that it is necessary to reduce the characteristic of the view in other ways, for example to a specific time of duration.[18]

Medicine[edit]

See also: Medicine

In primary care the term “holistic,” has been used to describe approaches that take into account social considerations and other intuitive judgements.[19] The term holism, and so-called approaches, appear in psychosomatic medicine in the 1970s, when they were considered one possible way to conceptualize psychosomatic phenomena. Instead of charting one-way causal links from psyche to soma, or vice versa, it aimed at a systemic model, where multiple biological, psychological and social factors were seen as interlinked.[citation needed]

Other, alternative approaches in the 1970s were psychosomatic and somatopsychic approaches, which concentrated on causal links only from psyche to soma, or from soma to psyche, respectively. At present it is commonplace in psychosomatic medicine to state that psyche and soma cannot really be separated for practical or theoretical purposes.[citation needed]

The term systems medicine first appeared in 1992 and takes an integrative approach to all of the body and environment.[20][21]

Neurology[edit]

See also: Neurology

A lively debate has run since the end of the 19th century regarding the functional organization of the brain. The holistic tradition (e.g., Pierre Marie) maintained that the brain was a homogeneous organ with no specific subparts whereas the localizationists (e.g., Paul Broca) argued that the brain was organized in functionally distinct cortical areas which were each specialized to process a given type of information or implement specific mental operations. The controversy was epitomized with the existence of a language area in the brain, nowadays known as the Broca’s area.[22]

Social science[edit]

Economics[edit]

See also: Economics

Some economists use a causal holism theory in their work. That is they view the discipline in the manner of Ludwig Wittgenstein and claim that it can’t be defined by necessary and sufficient conditions.[23]

Education reform[edit]

See also: Education reform

The Taxonomy of Educational Objectives identifies many levels of cognitive functioning, which it is claimed be used to create a more holistic education. In authentic assessment, rather than using computers to score multiple choice tests, a standards based assessment uses trained scorers to score open-response items using holistic scoring methods.[24] In projects such as the North Carolina Writing Project, scorers are instructed not to count errors, or count numbers of points or supporting statements. The scorer is instead instructed to judge holistically whether “as a whole” is it more a “2” or a “3”. Critics question whether such a process can be as objective as computer scoring, and the degree to which such scoring methods can result in different scores from different scorers.[25]

Anthropology[edit]

See also: Anthropology

There is an ongoing dispute as to whether anthropology is intrinsically holistic. Supporters of this concept consider anthropology holistic in two senses. First, it is concerned with all human beings across times and places, and with all dimensions of humanity (evolutionary, biophysical, sociopolitical, economic, cultural, psychological, etc.) Further, many academic programs following this approach take a “four-field” approach to anthropology that encompasses physical anthropology, archeology, linguistics, and cultural anthropology or social anthropology.[26]

Some leading anthropologists disagree, and consider anthropological holism to be an artifact from 19th century social evolutionary thought that inappropriately imposes scientific positivism upon cultural anthropology.[27]

The term “holism” is additionally used within social and cultural anthropology to refer to an analysis of a society as a whole which refuses to break society into component parts. One definition says: “as a methodological ideal, holism implies … that one does not permit oneself to believe that our own established institutional boundaries (e.g. between politics, sexuality, religion, economics) necessarily may be found also in foreign societies.”[28]

Psychology of perception[edit]

See also: Perception

A major holist movement in the early twentieth century was gestalt psychology. The claim was that perception is not an aggregation of atomic sense data but a field, in which there is a figure and a ground. Background has holistic effects on the perceived figure. Gestalt psychologists included Wolfgang Koehler, Max Wertheimer, Kurt Koffka. Koehler claimed the perceptual fields corresponded to electrical fields in the brain. Karl Lashley did experiments with gold foil pieces inserted in monkey brains purporting to show that such fields did not exist. However, many of the perceptual illusions and visual phenomena exhibited by the gestaltists were taken over (often without credit) by later perceptual psychologists. Gestalt psychology had influence on Fritz Perlsgestalt therapy, although some old-line gestaltists opposed the association with counter-cultural and New Age trends later associated with gestalt therapy. Gestalt theory was also influential on phenomenology. Aron Gurwitsch wrote on the role of the field of consciousness in gestalt theory in relation to phenomenology. Maurice Merleau-Ponty made much use of holistic psychologists such as work of Kurt Goldstein in his “Phenomenology of Perception.”

Teleological psychology[edit]

See also: Teleology

Alfred Adler believed that the individual (an integrated whole expressed through a self-consistent unity of thinking, feeling, and action, moving toward an unconscious, fictional final goal), must be understood within the larger wholes of society, from the groups to which he belongs (starting with his face-to-face relationships), to the larger whole of mankind. The recognition of our social embeddedness and the need for developing an interest in the welfare of others, as well as a respect for nature, is at the heart of Adler’s philosophy of living and principles of psychotherapy.

Edgar Morin, the French philosopher and sociologist, can be considered a holist based on the transdisciplinary nature of his work.

Skeptical reception[edit]

According to skeptics, the phrase “holistic science” is often misused by pseudosciences. In the book Science and Pseudoscience in Clinical Psychology it’s noted that “Proponents of pseudoscientific claims, especially in organic medicine, and mental health, often resort to the “mantra of holism” to explain away negative findings. When invoking the mantra, they typically maintain that scientific claims can be evaluated only within the context of broader claims and therefore cannot be evaluated in isolation.”[29] This is an invocation of Karl Popper‘s demarcation problem and in a posting to Ask a Philosopher Massimo Pigliucci clarifies Popper by positing, “Instead of thinking of science as making progress by inductive generalization (which doesn’t work because no matter how many times a given theory may have been confirmed thus far, it is always possible that new, contrary, data will emerge tomorrow), we should say that science makes progress by conclusively disconfirming theories that are, in fact, wrong.”[30]

Victor J. Stenger states that “holistic healing is associated with the rejection of classical, Newtonian physics. Yet, holistic healing retains many ideas from eighteenth and nineteenth century physics. Its proponents are blissfully unaware that these ideas, especially superluminal holism, have been rejected by modern physics as well”.[31]

Some quantum mystics interpret the wave function of quantum mechanics as a vibration in a holistic ether that pervades the universe and wave function collapse as the result of some cosmic consciousness. This is a misinterpretation of the effects of quantum entanglement as a violation of relativistic causality and quantum field theory.[32]

Degree programs[edit]

Schumacher College in the UK, offers an MSc degree program in Holistic Science

See also[edit]

References[edit]

  1. ^ Jump up to:
    a b Marshall Alan (4 October 2002). Unity Of Nature, The: Wholeness And Disintegration In Ecology And Science. World Scientific. ISBN 978-1-78326-116-1.
  2. ^ David Deutsch (14 April 2011). The Fabric of Reality. Penguin Books Limited. ISBN 978-0-14-196961-9.
  3. ^ Winther, Rasmus Grønfeldt (29 September 2009). “Part-whole science”. Synthese. 178 (3): 397–427. doi:10.1007/s11229-009-9647-0. ISSN 0039-7857.
  4. ^ Andres Moreira-Munoz (19 January 2011). Plant Geography of Chile. Springer Science & Business Media. p. 283. ISBN 978-90-481-8748-5.
  5. ^ Stephan Harding (15 September 2006). Animate Earth: Science, Intuition, and Gaia. Chelsea Green Publishing. ISBN 978-1-60358-149-3.
  6. ^ John Horgan (14 April 2015). The End Of Science: Facing The Limits Of Knowledge In The Twilight Of The Scientific Age. Basic Books. p. 128. ISBN 978-0-465-05085-7.
  7. ^ Paull , John (2011) The making of an agricultural classic: Farmers of Forty Centuries or Permanent Agriculture in China, Korea and Japan, 1911-2011, Agricultural Sciences, 2 (3), pp. 175-180.
  8. ^ Coughlin, Chrissy. “Allan Savory: How livestock can protect the land”. GreenBiz. Retrieved 5 April 2013.
  9. ^ Babita; Ahmed, Naseer; Manish, Thakur (November 2016). “ORGANIC FARMING: A HOLISTIC APPROACH TOWARDS SUSTAINABLE FRUIT PRODUCTION”. European Journal of Pharmaceutical and Medical Research. 2 (2): 108–115. Retrieved 29 June 2018.
  10. ^ Richard Healey (25 January 1991). The Philosophy of Quantum Mechanics: An Interactive Interpretation. Cambridge University Press. ISBN 978-0-521-40874-5.
  11. ^ Dennis Dieks; Pieter E. Vermaas (6 December 2012). The Modal Interpretation of Quantum Mechanics. Springer Science & Business Media. pp. 9–44. ISBN 978-94-011-5084-2.
  12. ^ Myrvold, Wayne C. (2002). “Modal Interpretations and Relativity”. Foundations of Physics. 32 (11): 1773–1784. doi:10.1023/a:1021406924313. ISSN 0015-9018.
  13. ^ Paul Davies; John Gribbin (23 October 2007). The Matter Myth: Dramatic Discoveries that Challenge Our Understanding of Physical Reality. Simon and Schuster. p. 283. ISBN 978-0-7432-9091-3.
  14. ^ Richard Healey: Holism and Nonseparability in Physics (Spring 2009 Edition), Edward N. Zalta (ed.), first published July 22, 1999; substantive revision December 10, 2008, Stanford Encyclopedia of Philosophy. Section: “Ontological Holism in Quantum Mechanics?” (retrieved June 3, 2011)
  15. ^ David Bohm; Basil J. Hiley (16 January 2006). The Undivided Universe: An Ontological Interpretation of Quantum Theory. Routledge. ISBN 978-1-134-80713-0.
  16. ^ David Bohm (12 July 2005). Wholeness and the Implicate Order. Routledge. p. 221. ISBN 978-1-134-43872-3.
  17. ^ Gatherer, Derek (2010). “So what do we really mean when we say that systems biology is holistic?”. BMC Systems Biology. 4 (1): 22. doi:10.1186/1752-0509-4-22. ISSN 1752-0509. PMC 2850881. PMID 20226033.
  18. ^ Rick C. Looijen (6 December 2012). Holism and Reductionism in Biology and Ecology: The Mutual Dependence of Higher and Lower Level Research Programmes. Springer Science & Business Media. ISBN 978-94-015-9560-5.
  19. ^ Julian Tudor Hart (2010) The Political Economy of Health Care pp.106, 258
  20. ^ Federoff, Howard; Gostin, Lawrence O. (2009). “Evolving from Reductionism to Holism: Is There a Future for Systems Medicine?”. Journal of the American Medical Association. 302 (9): 994–996. doi:10.1001/jama.2009.1264. PMID 19724047.
  21. ^ Federoff, Howard J.; Gostin, Lawrence O. (2 September 2009). “Evolving From Reductionism to Holism”. JAMA. 302 (9): 994–6. doi:10.1001/jama.2009.1264. ISSN 0098-7484. PMID 19724047.
  22. ^ ‘Does Broca’s area exist?’: Christofredo Jakob’s 1906 response to Pierre Marie’s holistic stance. Kyrana Tsapkini, Ana B. Vivas, Lazaros C. Triarhou. Brain and Language, Volume 105, Issue 3, June 2008, Pages 211-219 doi:10.1016/j.bandl.2007.07.124
  23. ^ Boylan, Thomas A.; O’Gorman, Pacal F. (2001). “Causal holism and economic methodology : theories, models and explanation”. Revue Internationale de Philosophie: 395–409. Retrieved 29 June 2018.
  24. ^ Rubrics (Authentic Assessment Toolbox).[1]
  25. ^ Charney, Davida (February 1984). “The Validity of Using Holistic Scoring to Evaluate Writing: A Critical Overview” (PDF). Research in the Teaching of English. 18 (1): 65–81. Retrieved 29 June 2018.
  26. ^ SHORE, BRADD (1999). “Strange Fate of Holism”. Anthropology News. 40 (9): 5–6. doi:10.1111/an.1999.40.9.5. ISSN 1541-6151.
  27. ^ Daniel A. Segal; Sylvia J. Yanagisako (14 April 2005). Unwrapping the Sacred Bundle: Reflections on the Disciplining of Anthropology. Duke University Press. ISBN 978-0-8223-8684-1.
  28. ^ “Definition of Anthropological Holism”. anthrobase.com. Retrieved 29 June 2018.
  29. ^ Scott O. Lilienfeld; Steven Jay Lynn; Jeffrey M. Lohr (12 October 2014). Science and Pseudoscience in Clinical Psychology, Second Edition. Guilford Publications. ISBN 978-1-4625-1751-0.
  30. ^ Pigliucci, Massimo. “Demarcating science from pseudoscience”. askaphilosopher.wordpress.com. Retrieved 27 June 2018.
  31. ^ Victor J. Stenger (2003). Has Science Found God?: The Latest Results in the Search for Purpose in the Universe. Prometheus Books, Publishers. p. 274. ISBN 978-1-61592-158-4.
  32. ^ Park, Robert L. (October 1997). “Alternative Medicine and the Laws of Physics”. Skeptical Inquirer. 21 (5). Retrieved 28 June 2018.

Further reading[edit]

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Iatrogenesis

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pastedGraphic_2.png

Ancient Greek painting in a vase, showing a physician (iatros) bleeding a patient

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 other persons acting as healthcare professionals or promoting products or services as beneficial to health, which does not support a goal of the person affected.[1][2][3][4][5][6]

While some[7] have advocated using the term to refer to all “events caused by the health care delivery team”, whether “positive or negative”, consensus limits use of iatrogenesis to adverse effects, including (in the broadest sense) all adverse unforeseen outcomes resulting from medication or other medical treatment or intervention. 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.

Cases of iatrogenesis may include:

Unlike an adverse event, an iatrogenic effect is not always harmful.[7] For example, a scar created by surgery is said to be iatrogenic even though it does not represent improper care and may not be troublesome.

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 medicine treatments. Globally, as of 2013, an estimated 20 million negative effects from treatment occurred.[8] It is estimated that 142,000 people died in 2013 from adverse effects of medical treatment, up from 94,000 in 1990.[9]

Contents

1
Examples
2
Causes and consequences
2.1
Medical error and negligence
2.2
Adverse effects
2.3
Psychiatry
2.4
Iatrogenic poverty
2.5
Social and cultural iatrogenesis
3
Epidemiology
4
History
5
See also
6
References
7

External linksExamples[edit]

Causes and consequences[edit]

Medical error and negligence[edit]

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 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 drugs.

Adverse effects[edit]

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 (thereby potentiating or attenuating 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 iatrogenic.

The evolution of antibiotic resistance in bacteria is iatrogenic as well.[10] Bacterial strains resistant to antibiotics have evolved in response to the overprescription of antibiotic drugs.[11]

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 a similar manner, arsenic-based medications like melarsoprol, used to treat 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 never have been properly cauterized.[clarification needed]

Psychiatry[edit]

In psychiatry, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition, as was the case of hystero-epilepsy[12]). An example of a partially iatrogenic condition due to common misdiagnosis is bipolar disorder, especially in pediatric patients.[13] Other conditions such as somatoform disorder and chronic fatigue syndrome are theorized to have significant sociocultural and iatrogenic components.[14] Posttraumatic stress disorder is hypothesized to be prone to iatrogenic complications based on treatment modality.[15]

The psychiatric treatment of some conditions and populations, such as substance abuse,[16] and antisocial youths[17] 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.[12][18]

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, which has led to the rise of the anti-psychiatry movement.

Iatrogenic poverty[edit]

Meessen et al. used the term “iatrogenic poverty” to describe impoverishment induced by medical care.[19] Impoverishment is described for households exposed to catastrophic health expenditure[20] or to hardship financing.[21] Every year, worldwide, over 100,000 households fall into poverty due to health care expenses. A study reported that in the United States in 2001, illness and medical debt caused half of all personal bankruptcies.[22] 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 into a vicious cycle of illness, ineffective therapies, consumption of savings, indebtedness, sale of productive assets, and eventually poverty.

Social and cultural iatrogenesis[edit]

The 20th-century social critic Ivan Illich broadened the concept of medical iatrogenesis in his 1974 book Medical Nemesis: The Expropriation of Health[23] 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.[24]
  • 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 treating non-diseases that are part of the normal human experience, such as age-related declines. In this way, aspects of medical practice and medical industries can produce social harm in which society members ultimately become less healthy or excessively dependent on institutional care. He argued that medical education of physicians contributes to medicalization of society because they are trained predominantly 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.”[25]

Epidemiology[edit]

Globally it is estimated that 142,000 people died in 2013 from adverse effects of medical treatment, an increase of 51 percent from 94,000 in 1990.[9] In the United States, estimated deaths per year include: [26][27] [28][29]

  • 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 as many as 225,000 deaths per year in the United States (excluding recognizable error). An earlier Institute of Medicine report estimated 230,000 to 284,000 iatrogenic deaths annually.[26]

History[edit]

pastedGraphic_3.png

Evidence demonstrating the advent of pathological anatomy in 1823 Vienna (left vertical line) correlated with incidence of fatal childbed fever. The 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 bad effects.

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.[30]

The transfer of pathogens from the autopsy room to maternity patients, leading to shocking historical mortality rates of puerperal fever (also known as “childbed fever”) at maternity institutions in the 19th century, was a major iatrogenic catastrophe of the era. The infection mechanism was first identified by Ignaz Semmelweis.[31]

With the development of scientific medicine in the 20th century, it could be expected that iatrogenic illness or death might 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.

See also[edit]

References[edit]

  1. ^ “Iatrogenesis | definition of iatrogenesis by Medical dictionary”. medical-dictionary.thefreedictionary.com. Retrieved 2017-02-15.
  2. ^ “Iatrogenesis Medical Definition | Merriam-Webster Medical Dictionary”. merriam-webster.com. Retrieved 2017-02-15.
  3. ^ Illich, I.; Hose, R. Medical Nemesis the expropriation of health. Elkrimbouziane. p. 1967. Retrieved 2017-02-15.
  4. ^ Kuhl, D. (2003). What Dying People Want: Practical Wisdom For The End Of Life. PublicAffairs. p. 55. ISBN 9780786725830. Retrieved 2017-02-15.
  5. ^ Coser, L.A. (1975). Idea of Social Structure, the. Harcourt Brace Jovanovich. p. 336. ISBN 9781412846967. Retrieved 2017-02-15.
  6. ^ “iatrogenesis – Dictionary definition of iatrogenesis | Encyclopedia.com: FREE online dictionary”. encyclopedia.com. Retrieved 2017-02-15.
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