Iatrogenesis

Last updated

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

Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. [1] [2] [3] First used in this sense in 1924, [1] the term was introduced to sociology in 1976 by Ivan Illich, alleging that industrialized societies impair quality of life by overmedicalizing life. [4] Iatrogenesis may thus include mental suffering via medical beliefs or a practitioner's statements. [4] [5] [6] Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions, can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. [7] In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990. [8]

Contents

Iatrogenic avenues

Risk associated with medical interventions

Medical errors

Causes and consequences

Medical error and negligence

Iatrogenic conditions need not 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, a ruptured aortic aneurysm is fatal in most cases; the survival rate for treatment of 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 probability of death if left untreated.

Other situations may involve actual negligence or faulty procedures, such as when pharmacotherapists produce handwritten prescriptions for drugs.

Another situation may involve negligence where patients are brushed off and not given proper care due to providers holding prejudice for reasons such as sexual orientation, ethnicity, religion, immigration status, etc. This can cause mistrust between patients and providers, leading to patients to not go in for treatment, resulting in more deaths.

Adverse effects

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. [9] Bacterial strains resistant to antibiotics have evolved in response to the over prescription of antibiotic drugs. [10]

Certain drugs and vaccines 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.[ medical citation needed ]

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 characterized.[ citation needed ]

Psychiatry

In psychiatry, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition, as was the case of hystero-epilepsy [11] ). An example of a potentially iatrogenic circumstance is misdiagnosis of bipolar disorder for another disorder, especially in pediatric patients considered to have major depressive disorder and prescribed stimulants or antidepressants. [12] Other conditions such as somatoform disorder are theorized to have significant sociocultural and iatrogenic components. [13] Chronic Fatigue Syndrome/Myalgic Encephalomyelitis was historically viewed as a psychiatric/somatoform condition, and the now-outdated treatment of Graded Exercise Therapy is known to have caused iatrogenic harm. [14] [15] [16] [17] Post-traumatic stress disorder is hypothesized to be prone to iatrogenic complications based on treatment modality. [18] Certain antipsychotics have been shown to reduce brain volumes in animals and in humans over long-term use. [19] [20]

Some populations may be at risk of underdiagnosis or misdiagnosis of psychiatric disorders, including those identified as having substance abuse disorders. [21] 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. [11] [22]

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. [23] The assignment of pathological nomenclature is rarely a benign process and can easily rise[ clarification needed ] 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. [24] [25]

Iatrogenic poverty

Meessen et al. used the term "iatrogenic poverty" to describe impoverishment induced by medical care. [26] Impoverishment is described for households exposed to catastrophic health expenditure [27] or to hardship financing. [28] 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. [29] 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

The 20th-century social critic Ivan Illich broadened the concept of medical iatrogenesis in his 1974 book Medical Nemesis: The Expropriation of Health [30] by defining it at three levels.

Epidemiology

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. [8] In the United States, estimated deaths per year include: [33] [34] [35] [36]

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. [33]

History

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. Yearly mortality rates 1784-1849.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 iatros ( ἰατρός , "healer") and genesis ( γένεσις , "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. [37]

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. [38]

With the development of scientific medicine in the 20th century, it could be expected that iatrogenic illness or death might be more easily avoided.[ citation needed ] Antiseptics, anesthesia, antibiotics, better surgical techniques, evidence-based protocols and best practices continue to be developed to decrease iatrogenic side effects and mortality.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.

<span class="mw-page-title-main">Benzodiazepine</span> Class of depressant drugs

Benzodiazepines, colloquially called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, insomnia, and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and was made available in 1960 by Hoffmann–La Roche, which followed with the development of diazepam (Valium) three years later, in 1963. By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide.

<span class="mw-page-title-main">Clozapine</span> Atypical antipsychotic medication

Clozapine is a psychiatric medication and is the first atypical antipsychotic to be discovered. It is primarily used to treat people with schizophrenia and schizoaffective disorder who have had an inadequate response to two other antipsychotics or who have been unable to tolerate other drugs due to extrapyramidal side effects. It is also used for the treatment of psychosis in Parkinson's disease.

<span class="mw-page-title-main">Electroconvulsive therapy</span> Medical procedure in which electrical current is passed through the brain

Electroconvulsive therapy (ECT) or electroshock therapy (EST) is a psychiatric treatment where a generalized seizure is electrically induced to manage refractory mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple or from front to back of one side of the head. However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring with a primary condition. It originates from the Latin term morbus prefixed with co- ("together") and suffixed with -ity. Comorbidity includes all additional ailments a patient may experience alongside their primary diagnosis, which can be either physiological or psychological in nature. In the context of mental health, comorbidity frequently refers to the concurrent existence of mental disorders, for example, the co-occurrence of depressive and anxiety disorders. The concept of multimorbidity is related to comorbidity but is different in its definition and approach, focusing on the presence of multiple diseases or conditions in a patient without the need to specify one as primary.

Orthomolecular medicine is a form of alternative medicine that aims to maintain human health through nutritional supplementation. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as vitamins, minerals, amino acids, trace elements and fatty acids. The notions behind orthomolecular medicine are not supported by sound medical evidence, and the therapy is not effective for chronic disease prevention; even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.

Self-medication, sometime called do-it-yourself (DIY) medicine, is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions, for example headaches or fatigue.

A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.

<span class="mw-page-title-main">Opioid use disorder</span> Medical condition

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects more than 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy.

Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.

An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complication is similar to adverse effect, but the latter is typically used in pharmacological contexts, or when the negative effect is expected or common. If the negative effect results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not an adverse effect. Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects occur only when starting, increasing or discontinuing a treatment. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. Adverse effects may cause complications of a disease or procedure and negatively affect its prognosis. They may also lead to non-compliance with a treatment regimen. Adverse effects of medical treatment resulted in 142,000 deaths in 2013 up from 94,000 deaths in 1990 globally.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

Symptomatic treatment, supportive care, supportive therapy, or palliative treatment is any medical therapy of a disease that only affects its symptoms, not the underlying cause. It is usually aimed at reducing the signs and symptoms for the comfort and well-being of the patient, but it also may be useful in reducing organic consequences and sequelae of these signs and symptoms of the disease. In many diseases, even in those whose etiologies are known, symptomatic treatment is the only treatment available so far.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Overmedication is an overutilization of medication wherein a patient takes voluntarily, or is prescribed, unnecessary or excessive medications. While not strictly a medical condition, common symptoms may include: slurred speech, drowsiness, confusion, and poor motor skills. Hence it is a risk factor for falls, especially among the elderly. Children with behavior problems are also at risk of overmedication, with parents wanting an easy fix, and drug companies and doctors often obliging.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

References

  1. 1 2 "Iatrogenic", Merriam-Webster.com, Merriam-Webster, Inc., accessed 27 Jun 2020.
  2. ↑ "John O. Barr & Timothy L. Kauffman, "Iatrogenesis in older adults", in Timothy L. Kauffman, Ron Scott, John O. Barr & Michael L. Moran, eds., A Comprehensive Guide to Geriatric Rehabilitation, 3rd edn. (Edinburgh: Churchill Livingstone/Elsevier, 2014)". doi:10.1016/B978-0-7020-4588-2.00056-5.{{cite journal}}: Cite journal requires |journal= (help)
  3. ↑ "Intervention Mistakes and How to Avoid Them". Addiction Helper. 11 December 2014. Retrieved 3 February 2021.
  4. 1 2 "iatrogenesis", A Dictionary of Sociology, Encyclopedia.com. updated 31 May 2020.
  5. ↑ David Kuhl, What Dying People Want: Practical Wisdom for the End of Life (New York: PublicAffairs, 2002), p 55.
  6. ↑ Paul F. Lazarsfeld, "Working with Merton", in Lewis A. Cosar, ed., The Idea of Social Structure: Papers in Honor of Robert K. Merton (New Brunswick, NJ: Transaction Publishers, 2012 / New York: Harcourt Brace Jovanovich, 1975), indexing "iatrogenesis", esp. pp. 328–329.
  7. ↑ Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMC   4561509 . PMID   26063472.{{cite journal}}: |first1= has generic name (help)CS1 maint: numeric names: authors list (link)
  8. 1 2 GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC   4340604 . PMID   25530442.{{cite journal}}: |first1= has generic name (help)CS1 maint: numeric names: authors list (link)
  9. ↑ Finland M (1979). "Emergence of antibiotic resistance in hospitals, 1935–1975". Rev. Infect. Dis. 1 (1): 4–22. doi:10.1093/clinids/1.1.4. PMID   45521.
  10. ↑ Llor, Carl; Bjerrum, Lars (16 October 2014). "Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem". Therapeutic Advances in Drug Safety. 5 (6). SAGE Publication: 229–241. doi:10.1177/2042098614554919. ISSN   2042-0986. PMC   4232501 . PMID   25436105.
  11. 1 2 Spanos, Nicholas P. (1996). Multiple Identities & False Memories: A Sociocognitive Perspective. American Psychological Association (APA). ISBN   1-55798-340-2.
  12. ↑ Pruett Jr, John R.; Luby, Joan L. (2004). "Recent Advances in Prepubertal Mood Disorders: Phenomenology and Treatment". Current Opinion in Psychiatry. 17 (1): 31–36. doi:10.1097/00001504-200401000-00006. S2CID   145069868 . Retrieved 4 May 2008.
  13. ↑ Abbey, S.E. (1993). "Somatization, Illness Attribution and the Sociocultural Psychiatry of Chronic Fatigue Syndrome". Ciba Foundation Symposium 173 - Chronic Fatigue Syndrome. Novartis Foundation Symposia. Vol. 173. pp. 238–52. doi:10.1002/9780470514382.ch14. ISBN   9780470514382. PMID   8491101.{{cite book}}: |journal= ignored (help)
  14. ↑ Barry, Peter Walter; Kelley, Kate; Tan, Toni; Finlay, Ilora (28 February 2024). "NICE guideline on ME/CFS: robust advice based on a thorough review of the evidence". Journal of Neurology, Neurosurgery & Psychiatry. doi:10.1136/jnnp-2023-332731. ISSN   0022-3050. PMID   38418217.
  15. ↑ Vink, Mark; Vink-Niese, Alexandra (July 2018). "Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review". Health Psychology Open. 5 (2): 205510291880518. doi:10.1177/2055102918805187. ISSN   2055-1029. PMC   6176540 . PMID   30305916.
  16. ↑ Fleming, Russell (12 November 2020). "BMJ: NICE backtracks on graded exercise therapy and CBT in draft revision to CFS guidance". The ME Association. Retrieved 2 May 2024.
  17. ↑ "Chronic fatigue syndrome advice scraps exercise therapy". BBC News. 28 October 2021. Retrieved 2 May 2024.
  18. ↑ Boscarino, JA (2004). "Evaluation of the Iatrogenic Effects of Studying Persons Recently Exposed to a Mass Urban Disaster" (PDF). Archived from the original (PDF) on 25 June 2008. Retrieved 4 May 2008.{{cite journal}}: Cite journal requires |journal= (help)
  19. ↑ Ho, Beng-Choon; Andreasen, Nancy C.; Ziebell, Steven; Pierson, Ronald; Magnotta, Vincent (February 2011). "Long-term Antipsychotic Treatment and Brain Volumes". Archives of General Psychiatry. 68 (2): 128–137. doi:10.1001/archgenpsychiatry.2010.199. ISSN   0003-990X. PMC   3476840 . PMID   21300943.
  20. ↑ Donald C. Goff, M. D. (4 May 2011). "Antipsychotics and the Shrinking Brain". Psychiatric Times. Psychiatric Times Vol 28 No 4. 28 (4). Retrieved 5 June 2020.
  21. ↑ Moos, R.H. (2005). "Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention". Addiction. 100 (5): 595–604. doi:10.1111/j.1360-0443.2005.01073.x. PMID   15847616.
  22. ↑ Braun, B.G. (1989). "Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD". Dissociation. 2 (2): 43, 161–2, 165–6, 171–2 passim. hdl:1794/1425.
  23. ↑ Aboraya, Ahmed; Rankin, Eric; France, Cheryl; El-Missiry, Ahmed; John, Collin (2006). "The Reliability of Psychiatric Diagnosis Revisited". Psychiatry (Edgmont). 3 (1): 41–50. ISSN   1550-5952. PMC   2990547 . PMID   21103149.
  24. ↑ Basaglia, Franco (1987). Psychiatry inside out: selected writings of Franco Basaglia. Nancy Scheper-Hughes, Anne Lovell. New York: Columbia University Press. p. 11. ISBN   0-231-05718-0. OCLC   14212238.
  25. ↑ Richards, Sue; Aziz, Nazneen; Bale, Sherri; Bick, David; Das, Soma; Gastier-Foster, Julie; Grody, Wayne W.; Hegde, Madhuri; Lyon, Elaine; Spector, Elaine; Voelkerding, Karl; Rehm, Heidi L. (May 2015). "Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology". Genetics in Medicine. 17 (5): 405–424. doi:10.1038/gim.2015.30. ISSN   1098-3600. PMC   4544753 . PMID   25741868.
  26. ↑ Meessen, B.; Zhenzhong, Z.; Van Damme, W.; Devadasan, N.; Criel, B.; Bloom, G. (2003). "Iatrogenic poverty". Tropical Medicine & International Health. 8 (7): 581–4. doi: 10.1046/j.1365-3156.2003.01081.x . PMID   12828538.
  27. ↑ Xu; Evans, DB; Carrin, G; Aguilar-Rivera, AM; Musgrove, P; Evans, T; et al. (2007). "Protecting Households from Catastrophic Health Spending". Health Affairs. 26 (4): 972–83. doi: 10.1377/hlthaff.26.4.972 . PMID   17630440.
  28. ↑ Kruk; Goldmann, E.; Galea, S.; et al. (2009). "Borrowing And Selling To Pay For Health Care in Low- And Middle-Income Countries" (PDF). Health Affairs. 28 (4): 10056–66. doi:10.1377/hlthaff.28.4.1056. hdl: 2027.42/63445 . PMID   19597204.
  29. ↑ "Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds". Consumeraffairs. 3 February 2005.
  30. ↑ Illich, Ivan (1974). Medical Nemesis: The Expropriation of Health . London: Calder & Boyars. ISBN   0-7145-1096-3.
  31. ↑ Pearce, Wright (2003). "Obituary: Ivan Illich". The Lancet. 361 (9352): 185. doi: 10.1016/S0140-6736(03)12233-7 . S2CID   6678368.
  32. ↑ Barnet, Robert (2003). "Ivan Illich and the Nemesis of Medicine". Medicine, Health Care and Philosophy. 6 (3): 273–286. doi:10.1023/a:1025991708888. PMID   14620464. S2CID   151359050.
  33. 1 2 Starfield B (July 2000). "Is US health really the best in the world?" (PDF). JAMA. 284 (4): 483–5. doi:10.1001/jama.284.4.483. PMID   10904513. Archived from the original (PDF) on 24 December 2010. Retrieved 20 January 2020.
  34. ↑ Leape L (May 1992). "Unnecessary Surgery". Annual Review of Public Health. 13: 363–383. doi: 10.1146/annurev.pu.13.050192.002051 . PMID   1599594.
  35. ↑ Phillips DP, Christenfeld N, Glynn LM (February 1998). "Increase in US medication-error deaths between 1983 and 1993". Lancet. 351 (9103): 643–4. doi:10.1016/S0140-6736(98)24009-8. PMID   9500322. S2CID   10122133.
  36. ↑ Lazarou J, Pomeranz BH, Corey PN (April 1998). "Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies". JAMA. 279 (15): 1200–5. doi:10.1001/jama.279.15.1200. PMID   9555760.
  37. ↑ Jason A Wolf; Heather Hanson; Mark J Moir; Len Friedman; Grant T Savage, eds. (12 July 2011). Organization Development in Healthcare: Conversations on Research and Strategies. Advances in Health Care Management Series #10. Emerald Group Pub. p. 292. ISBN   978-0-85724-709-4.
  38. ↑ Hanninen, O; Farago, M.; Monos, E. (1983). "Ignaz Philipp Semmelweis, the prophet of bacteriology". Infection Control and Hospital Epidemiology. 4 (5): 367–370. doi:10.1017/S0195941700059762. JSTOR   30142576. PMID   6354955. S2CID   25830725.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.