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The Concept of Iatrogenicity John B. Kostis and Ihor B. Gussak In a narrow sense, iatrogenicity is harm caused by a physician’s diagnosis and treatment , although it does not imply an improper act by the physician. Merriam-­Webster Medical Dictionary defines iatrogenesis, the word from which iatrogenicity is derived, as “inadvertent and preventable induction of disease or complications by the medical treatment or procedures of a physician or surgeon” (1), and The ­ Free Dictionary as “any injury or illness that occurs ­ because of medical care” (2). This book proposes a wider definition of iatrogenicity to encompass intentional or unintended, immediate or delayed, yet preventable or avoidable harm to a person by ­ either an action or inaction on the part of a health care provider or health delivery system. The harm may occur in any interaction of patients with health professionals, ranging from preventive interventions, lifestyle advice, and diagnostic procedures to major surgery. An adverse iatrogenic outcome may occur despite all appropriate interventions. Contrary to commonly held opinion, inaction may result in iatrogenic harm, for example, by not prescribing needed medi­ cation or not performing needed high-­ risk surgery for fear of the practice of publishing physician-­ specific outcome data on the Internet. In some instances, indicated interventions are not administered ­ because higher importance is placed on errors of commission rather than errors of omission. Ethical systems that consider harm from action more impor­ tant than harm from inaction, introduce an asymmetry between ­ these two types of errors. Such systems hold health care providers responsible for (all) harm caused by actions but not for (some) harm that is not prevented. The physician has an obligation to optimize patient care by avoiding both types of errors. For example, statin therapy may prevent many fatal and nonfatal myo­ car­ dial infarctions and strokes at the expense of a handful of serious adverse events among hundreds of patients. ­ Simple utilitarianism implies that moral obligations depend on expected consequences (of action and inaction) without distinction between acts and omissions to produce the greatest happiness for the greatest number .“First, do no harm” may be acceptable when the interventions are not efficacious (placebo-­like). Iatrogenesis has been appreciated since ancient times. The word is rooted in the ancient Greek iatros (physician) and genesis (birth or origin). In Epidemics, Book I, Section XI, Hippocrates acknowledged the possibility of harmful effects of medical interventions by stating that the duty of the physician is to help, or at least to do no harm (ωϕελεειν η μη βλαπτειν) (3). In the first En­ glish translation of Epidemics, Francis Adams wrote that the physician must “have two special objects in view with regard to disease, namely, to do good or to do no harm” (4). Placing primary emphasis on avoidance of harm could have been acceptable at the time of Hippocrates, 2 / The Concept of Iatrogenicity lows, physicians, administrators, and allied health professionals. The intent of the authors is fourfold: • to outline available information in an easy-­to-­use compact volume • to highlight the ­ human and financial cost of iatrogenicity • to explore the reasons and ­ causes of iatrogenicity • to identify potential interventions to ameliorate the current situation. References 1. Merriam-­ Webster Medical Dictionary. https://­www​ .merriam​-­webster​.­com​/­medical​/­iatrogenesis. 2. The ­ Free Dictionary. http://­medical​-­dictionary​.­the​ freedictionary​.­com​/­iatrogenesis. 3. Απαντα τον Ιπποκράτους. Omnia Opera Hippo­ cratis. Venice, Italy: Aldus Manutius; 1526. 4. Francis Adams. The Genuine Works of Hippocrates . London, UK: Sydenham Society; 1849. when most interventions had an efficacy similar to placebo. It is not acceptable in the current era of pharmacological, device, interventional, and surgical interventions that have been proved by a wealth of evidence including randomized clinical­ trials, meta-­ analyses, and high-­ quality observational data. The aim of this book is to generate interest in iatrogenicity as a new clinical discipline and to focus on cardiovascular preventive diagnostic and therapeutic procedures and noncardiovascular interventions that result in adverse consequences on the circulatory system. The book covers the varied aspects of iatrogenicity including adverse effects of medi­ cations, dietary supplements, and herbal products as well as medical errors, unnecessary procedures, negligence, malpractice, financial losses, discomfort, pain, suffering, disability, and loss of privacy. The target audience includes medical students, gradu­ ate students, residents, fel- ...


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