Iatrogenicity
By Annemarie Colbin, Ph.D.

OK, it means: the potential for causation of illness by medical treatment. The word is not in my dictionary, but I think it’s a good word. And it defines what I believe is a major health problem of our times. Let me phrase the problem in the form of a question: How much of the illness and disease running rampant today is caused by medicine? This question came up for me -- once again, I should say -- reading the May 2003 issue of Nutrition Action, the newsletter of the Center for Science in the Public Interest.

In an article on digestion, aptly named "GasBusters", by Bonnie Liebman, there is some commentary on medications such as Pepto-Bismol, which are based on bismuth subsalicylate, a common over-the-counter digestive remedy generally not considered harmful. Ms Liebman goes on to say, "But take Pepto-Bismol every day and you could end up with bismuth toxicity. It causes a dementia that can sometimes masquerade as Alzheimer's disease."

Hello? Alzheimer's can come from digestive aids? Why is this not better known? The comment reminded me of a client I had 20 years ago, who came to take cooking classes and a consultation to see if he could help his ALS, amyotrophic lateral sclerosis, or Lou Gehring's disease. This is a condition in which the muscles just waste away. In the consultation he told me his condition was not improving, but his digestion was 100% better. I asked him how often he used to have indigestion. Every meal, he said. I asked him what did he do about it. Alka Seltzer, he said. Every meal? Yes. Every day? Yes. How long? TEN YEARS. And his muscles were disappearing on him. I knew it in my bones that there was a connection. Shortly afterwards one of my students mentioned that as his grandmother lay dying from Parkinson's disease, he asked her, what did she think caused her condition? She could not speak, but she could write, and she wrote: "antacids," which she had taken daily for more than 20 days. True or not, I don’t know, but possible, yes. Officially, there is no known cause.

Then there is acetaminophen, or paracetamol, sold generally as Tylenol, which has been clearly implicated in the causation of severe liver damage. In fact, there is a condition called "acetaminophen-induced fulminant hepatic failure" -- which means that the drug can cause the liver to fail in a very short time, maybe in hours. Often the only remedy is a liver transplant. Four or five years ago Tylenol was sued in a class-action suit by parents of children who had died because of the adverse effects of this trusted drug. What happened? Nothing much. It’s still being sold. A recent article in Public Citizen's "Health Letter" scolded the FDA for not paying attention to this issue. "Acetaminophen is the leading cause of toxic drug ingestions in the U.S.," having causing an average of 56,680 Emergency Department visits, 26,256 hospitalizations, and 458 deaths per year.

Then there are antibiotics. It has been known for quite some time that antibiotics have many adverse effects. Particularly, they damage the immune system because they:

• Damage the intestinal flora

• Destroy beneficial bacteria as well as harmful ones

• Create resistance in pathogenic bacteria

Antibiotics came into use in the mid-1940's. According to a 1957 study by Leo Schindel, antibiotic use was associated with many illnesses. Among them were Allergic reactions (changes in the skin, contact dermatitis, "hairy" or "black" tongue, fungal infections in the mucous membranes, itching, herpes simplex, rosaceaform dermatitis, purpura; anaphylactic shock, and sudden death.) There were also Specific organ reactions (asthma and hay fever, increased tendency of the blood to clot faster than usual; narrowing of the coronary arteries with subsequent heart damage [my emphasis], damage to the kidneys, toxic reactions in the central nervous system such as convulsions and coma; pneumonia, infections of the genital organs; staphylococcal gastro-enterocolitis [a complication of tetracycline therapy], which manifests as fever, nausea, vomiting, flatulence, diarrhea, and collapse).

I have paid particular attention this study precisely because it is from the '50's, when antibiotics were new enough that scientists could study the difference between those who'd had them and those who hadn't. Nowadays such a study would be almost impossible to do, as pretty much the entire population has been given these drugs one time or another, and the adverse effects of antibiotics have become plain and simple diseases in their own right. And antibiotics are still used, to the tune of $7 billion in drug sales. The American Academy of Pediatrics estimates that half of the 100 million antibiotic prescriptions written yearly are unnecessary.

Compare this to the hysteria over Ephedra, an herbal remedy that has been used safely in Chinese medicine for hundreds of years. Used inappropriately for body building, it has been associated with 123 deaths over the last decade, according to the New York Times. Yet Ephedra is now banned. If mint tea had even a 10th of the problems of acetaminophen, you wouldn't find a leaf in the entire United States. There are all kinds of alarmist articles in the media about the "dangers" of herbs, or of alternative medicine. I was particularly irked by a piece in Parade Magazine. Isadore Rosenfeld, MD, their health columnist, derided the "seductiveness of 'natural,'" and gleefully pointed out that "in 2001 there wee 2471 cases of adverse reactions and 12 deaths related to dietary and herbal supplements," according to Poison Control Centers. Then he goes on to say, "This is not to say that what your doctor prescribes is always safe or can't harm you. Of course it can -- but at least you know the risk if it's taken as prescribed." Considering that according to the Institute of Medicine, close to 100,000 people per year die of properly prescribed and used pharmacological drugs, that may be small consolation. Medical treatment is the fourth leading cause of death in our society. Let's not forget that. It’s time to come up with a safer kind of medicine, and many people are doing that by turning to alternatives.

So what are we to do? Well, I believe several things can be useful.

1. Be slow to believe the positive media hype about any new medical treatments or drugs, especially if it has the word "hope" in it.

2. Wait ten years before you try a new drug or treatment. There is enough already on the market for most serious problems, and almost no new drug is an improvement over what is already available.

3. If you need to use drugs, use only prescription drugs for medically diagnosed conditions.

4. Instead of over-the-counter drugs with their risk of toxicity, use alternative remedies and treatments such as acupuncture, homeopathy, massage, aromatherapy, Bach Flower Remedies, and the like. If you want to use herbs, use the traditional types of dosage such as teas and tinctures, rather than capsules and concentrates which are more "drug-like."

4. Don't believe any of the scaremongering stories about the dangers of herbs and alternative medicine. However, use caution, use your common sense, work with a trusted health professional, and watch out for hype marketing.

The bottom line is still this: Nothing beats healthful eating, clean water, enough rest, stress control, good relationships, work that you like, and plenty of daylight to take help you maintain your health and well-being.