restricted access 5. A Naturopathic Perspective on Iatrogenesis
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IATROGENESIS: DEFINITIONS AND INTRODUCTIONS Iatrogenic disease literally means “illness caused by medical exam or treatment” (1). In the United States, iatrogenicity is the third leading cause of death, with preventable harm killing between 210,000 and 440,000 patients each year (2). Some estimates are as high as 700,000 (3,4). This means that harm—up to and including death—­ has occurred, even though the doctor ordered the right prescription or procedure for the right patient with the right directions for use and the patient took the medicine or had the procedure done correctly. Iatrogenicity is ­ doing all the right ­ things, according to conventional medicine, yet having a poor outcome. In other words, mainstream medicine ranks just ­ behind cancer and cardiovascular disease as a top killer in this country. The author of this chapter is not a conventional medical or osteopathic doctor (MD or DO); rather I’m a naturopathic doctor (ND). I chose to pursue my doctorate in naturopathic medicine ­ after working for a de­ cade as a retail pharmacist in central­ Virginia. As a pharmacist, I witnessed firsthand disenfranchised consumers of conventional medicine who, despite being compliant with drug therapy, ­ weren’t getting better. In the short term, with the use of pain medi­ cations for a broken arm or a course of antibiotics for an infection, ­ people did improve. But when symptom control for the acute situation was prescribed for the long term, ­ people too often got worse. For example, Mr. Jones came into the pharmacy with his prescription for a commonly prescribed beta-­ blocker for hypertension. A compliant patient, he faithfully refilled his prescription monthly. His blood pressure readings ­ were better initially. The following year, however, he returned ­ after his annual exam and blood work with two prescriptions: the first for a slightly increased dose of his beta-­ blocker, and the second for a lipid-­ lowering agent. The following year, he brought in four prescriptions : the beta-­ blocker in an even higher dose, the lipid-­ lowering agent, a sleep aid, and an antidiabetic drug. What happened? When prescribers consider only the symptoms—­ which are a consequence of the disease pro­ cess, not the cause—­ and no education is provided to individuals on how they might change their lifestyle to correct the under­ lying imbalance (most often the cause), well-­ chosen phar­ ma­ ceu­ ti­ cal entities often push the patients into a secondary disease pro­ cess. This is called iatrogenic disease. Drugs can cause disease ­ either through nutrient depletions caused by the drug itself or through direct and/or indirect mechanisms of action exerted by the drug on CHAPTER 5 A Naturopathic Perspective on Iatrogenesis Christie Fleetwood Iatrogenesis: Definitions and Introductions / 35 ease, cancer, and osteoporosis. A large­ proportion of the general population is apparently at increased risk for this reason (5). Returning to the subject of cardiovascular-­ specific diseases due to proper administration of conventional medicine, let’s look at direct and indirect effects. An example of a direct effect is a beta-­ blocker disrupting normal blood glucose regulation, causing type 2 diabetes. An example of an indirect effect is when the same beta-­ blocker precipitates anxiety or depression (due to the deviation away from normal blood glucose ). A nutritional depletion that can occur with beta-­ blockers involves the naturally secreted hormone , melatonin. This wasting effect may well explain the sleep disturbances, including nightmares , that some beta-­ blocker users experience. Despite, or perhaps ­ because of, the multitudes of books published on the“best”way to eat, exercise, and sleep for any number of diseases, it is no doubt confusing for healthcare providers with ­ little to no education about nutrition or lifestyle counseling to provide useful information to patients. Rather, it’s easier to prescribe drugs for the current constellation of symptoms. This route takes far less time, which accommodates insurance -­and administrator-­ driven demands for greater productivity in less time. Yet the United States continues to become sicker at a faster rate. For the first time in the country’s history, ­ children are not expected to live as long or as well as their parents (6). The armed forces are turning young ­ people away ­ because of obesity and its associated chronic health complaints , causing a potential security issue for the nation (7). Americans make up 5% of the world’s population but top the chart of obesity, consuming an excess of calories that could feed 80 million starving ­ people elsewhere daily (8). This is a large, multifactorial prob­ lem. Although this book focuses on...