Talk:Iatrogenesis

From Wikipedia, the free encyclopedia

WikiProject Medicine This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
B This page has been rated as B-Class on the quality assessment scale
Mid This article has been rated as Mid-importance on the importance assessment scale
This article is being improved by WikiProject Rational Skepticism. Wikiproject Rational Skepticism seeks to improve the quality of articles dealing with science, pseudosciences, pseudohistory and skepticism. Please feel free to help us improve this page.

See Wikipedia:Contributing FAQ.
B This article has been rated as B-Class on the Project's quality scale.
(If you rated the article please give a short summary at comments to explain the ratings and/or to identify the strengths and weaknesses.)
This article has been marked as needing immediate attention.
Socrates
Philosophy Portal
This article is within the scope of the WikiProject Philosophy, which collaborates on articles related to philosophy. To participate, you can edit this article or visit the project page for more details.
??? This article has not yet received a rating on the quality scale.
??? This article has not yet received an importance rating on the importance scale.

Contents

[edit] Due

Due to the controversy surrounding assisted suicide, I am removing it from the list of iatrogenic circumstances, but leaving the brief mention in the text of that section.Daries 17:26, 30 March 2006 (UTC)

I disagree with this decision. A section on medically assisted suicide should be amplified because of it's cultural relevance and it's pertinence to this topic. It is perhaps the MOST pertinent modern example of iatrogeniesis.
remember, the term means Doctor caused. The term is neutral and can mean good and bad so try to keep your bias out of the decision on whether or not you want euthenasia to be considered doctor caused.

[edit] Many problems here

At the moment the article is purely about clinical iatrogenesis. I removed an article about social iatrogenesis because it was unsourced and vaguely biased against DSM, which is not the subject here.

Where are the really relevant sources? I'd like to see Ivan Illich and his cultural iatrogenesis here. JFW | T@lk 01:46, 3 May 2006 (UTC)

[edit] Inconsistencies

Why are iatrogenic deaths not mentioned in the List of causes of death by rate article? Acetone, 8 November 2006

[edit] Mis-reference to complementary and alternative medicine as being the same

I apologize if I am not doing this correctly but this is my first time to contribute. I am bothered by a reference in this article to Complementary and Alternative medicine as being the same: Further, iatrogenic illness or death is not restricted to Western medicine: alternative medicine (sometimes referred to as complementary medicine) may be considered an equal source of iatrogenesis for the same reasons.

NIH's National Center for Complementary and Alternative Medicine differentiates the two as distinct from each other stating the Complementary medicine is used "together with conventional medicine" and Alternative medicine is used "in place of." Examples cited are aromatherapy for the former and "a special diet to treat cancer instead of undergoing surgery, radtiation...recommended by a conventional doctor" for the latter. Based on this distinction, it appears that complementary medicine should be removed from the citation that coincides with alternative medicine.

It is still possible that complementary therapists may cause iatrogenesis, but I would think it would be as a therapist working with conventional medical practitioner and therefore part of the previous reference in the article as "as a result of actions by others". Thanks for your consideration of this comment. Jgcarney 17:05, 1 March 2007 (UTC)

[edit] Sources of iatrogenesis

In this list, I changed "minimizing the possibility of negative drug effects" to "failure to minimize the possibility of negative drug effects"; I'm guessing at what the original writer meant, but if anybody knows different please say so. —Preceding unsigned comment added by 193.172.19.20 (talk) 13:35, 15 October 2007 (UTC)

You just reversed the meaning. It depends on what minimizing means or intents to mean. Changed to underestimate which is not ambiguous as minimizing is. Jclerman 17:10, 15 October 2007 (UTC)

[edit] fake medicine

Would the deaths caused by fake medicine mentioned in Glycerin#Danger_of_contamination_with_diethylene_glycol be considered a kind of iatrogenesis? --68.0.124.33 (talk) 06:24, 26 January 2008 (UTC)

Agree. I think this deserves a new subsection under 2 Sources of iatrogenesis, perhaps titled "Contamination". Ryanjo (talk) 16:42, 26 January 2008 (UTC)

[edit] Iatrogenic artifact section

I have added refs to the section, deleted OR, made the language more NPOV and fixed a wikilink. ResearchEditor (talk) 21:44, 27 April 2008 (UTC)

And added a massive WP:POVFORK about DID and recovered memory therapy. The following section in my mind is far too detailed about a specific single condition which is grossly unnecessary on this page. The section should not discuss the specifics of how this one condition is or is not iatrogenic. That's for either DID itself, or iatrogenesis of dissociative identity disorder. Not here. Or, debatably, it's possible the section could have its own section. I also removed repressed memory - too debatable and it's too easy to get caught into the POV battles. Since it's examples, might as well include examples that are unarguable, or sourced. Also never heard of an iatrogenic artefact, would be nice to see a citation.
Anyway, the page is about iatrogenesis, the section about iatrogenic diseases created by doctors, not about the iatrogenesis of DID. The bottom text looks like the whole section is about only DID and throwing in the RMT, FMSF and FMS is just asking for disputes. Like this one. WLU (talk) 23:15, 27 April 2008 (UTC)

paragraph before ResearchEditor's edits:

An iatrogenic artifact is a disease made up by doctors, often a diagnostic trend or fad that has become or is expected to become obsolete or discredited. Examples of diseases considered or accused of being iatrogenic artifacts include nymphomania, hystero-epilepsy, repressed memory, autogynephilia, and multiple personality disorder. In many cases, it has been shown that "experts" who believe in the disease are able to observe or even induce symptoms matching the disease's description in suggestible patients. Behavioral disorders are particularly susceptible to artifacts. For example, in the false memories syndrome: thousands of psychotherapists have attempted to recover memories of early childhood abuse from their clients. The techniques, practices and exercises used in these attempts are often referred to as Recovered Memory Therapy and sometimes resulted in allegations of abuse being made by individuals against family members. Many of these individuals severed all connection with their parents, hundreds of whom were convicted of these "crimes" and imprisoned.

ResearchEditor (talk) 03:35, 29 April 2008 (UTC)

paragraph after ResearchEditor's original edits:

An iatrogenic artifact is a disease believed to be made up by doctors. It may be a diagnostic trend or fad some believe to be obsolete or discredited. Examples of diseases accused of being iatrogenic artifacts include nymphomania, hystero-epilepsy, repressed memory, autogynephilia, and multiple personality disorder. Some researchers believe that the iatrogenic origins of multiple personality disorder have not been proven.[1][2][3][4] One study found no empirical evidence for the idea that "most patients recover memories of childhood sexual abuse because their therapist had suggested to them that they were abused as children" [5] and studies have consistently demonstrated that amnesia can occur in survivors of trauma.[6][7][8][9][10] It has been suggested that treaters who believe in the disease may be able to observe or even induce symptoms matching the disease's description in suggestible patients. In the false memory syndrome, psychotherapists have been accused of attempting to recover memories of early childhood abuse from their clients. The techniques, practices and exercises used in these attempts have been referred to as Recovered Memory Therapy and sometimes resulted in allegations of abuse being made by individuals against family members. Some of these individuals severed all connection with their parents, some of whom were convicted of crimes and imprisoned. Stephanie Dallam states that "the 'False Memory Syndrome' is a controversial theoretical construct based entirely on the reports of parents who claim to be falsely accused of incestuous abuse...The current empirical evidence suggests that the existence of such a syndrome must be rejected. False memory advocates have failed to adequately define or document the existence of a specific syndrome...This does not imply, however, that memory is infallible or that all people who are accused of sexual abuse are guilty."[11] The term "Recovered memory therapy" (RMT) was coined by affiliates of the False Memory Syndrome Foundation in the early 1990s,[12] It is not listed in DSM-IV or used by any mainstream formal psychotherapy modality.[12] Some believe that there is insufficient evidence that false memories can be created in therapy.[13]

ResearchEditor (talk) 03:35, 29 April 2008 (UTC)

I disagree that a WP:POVFORK was created. "A point of view (POV) fork is a content fork deliberately created to avoid neutral point of view guidelines, often to avoid or highlight negative or positive viewpoints or facts." The paragraph I created contained both sides of the issue. The difference between my paragraph and the one before it was that mine attempted to present both sides of the issue. Since the article is about iatrogenesis, I believe that the arguments about the possible iatrogenesis of MPD and recovered memory should be covered on the page. The section as it stands now has only one side of the issue again, that of the skeptics of MPD/DID. The addition of info. on FMS in my original edit was a reply to the allegation in the original paragraph that FMS is created by RMT. I am open to the idea of a shorter paragraph, but I believe that it should contain both sides of the issue fairly. ResearchEditor (talk) 03:35, 29 April 2008 (UTC)
This isn't a POV fork. This is a coatrack. --FOo (talk) 04:12, 29 April 2008 (UTC)
Since the page is about iatrogenesis, the best choice is to pick examples which aren't controversial as possibly iatrogenic. Leave DID out of this article, put the discussion of iatrogenesis and DID in the DID page. WLU (talk) 13:13, 30 April 2008 (UTC)
I've replaced DID with hystero-epilepsy, which is unequivocally an iatrogenic disorder. If the purpose of the section is to discuss an iatrogenic disorder, then HE is a better choice. At best, the section should contain a sentence saying that DID is considered by some to be iatrogenic, though there is disagreement - two references, one for each side, not the 6 or whatever that was there. WLU (talk) 13:29, 30 April 2008 (UTC)
After some further contemplation, the massive attention paid to the possibly iatrogenic nature of DID suggests it deserves a mention. I don't think that myself or ResearchEditor should make it though. Jack-A-Roe does a good job of pleasing both of us with his neutral representation of sources. I suggest we allow him, or another uninvolved editor, to draft the section/sentences. Agreed? WLU (talk) 13:42, 30 April 2008 (UTC)
I agree with the above. It believe that it is an excellent idea. JAR is an excellent editor, neutral and well-versed in wikipolicy. ResearchEditor (talk) 02:49, 1 May 2008 (UTC)

(undent)I've raised this issue on JAR's talk page, he said he'd try to get to it. Can we agree to leave it until he gets to it? If he doesn't manage to within, say a week, (he's really doing us a favour here, since this is pretty far out of his normal interest) then we can discuss possibly including DID and how it should look. The problem is there's a lot of potentially iatrogenic psychological disorders, but this is a page about iatrogenesis in general - it's shouldn't be bloated by a single section that goes in to far too much detail about one area that's equivocal. Let's revisit on the 8th, agreed? WLU (talk) 14:57, 1 May 2008 (UTC)

Agreed. (So far JAR's edits look good.) ResearchEditor (talk) 01:49, 2 May 2008 (UTC)

Thank you both for your kind comments. I'll give this a go and hopefully come up with at least a good starting point for expansion. I've done some reading on the topic and have an idea for an approach, though I'm not sure when I can get to the actual edits on the paragraph. As a result of the reading, I made some adjustments to the definition in the lead of the article. I didn't add references there, but I think I made it more clear; please take a look and see if you approve. --Jack-A-Roe (talk) 23:50, 1 May 2008 (UTC)
PS... by the way, in my reading, I found that the term "iatrogenic artifact" does not appear to be more specifically used to describe psychological conditions; it has several meanings and mostly appears to be an overall synonym for iatrogenic phenomena in general. For example, another use for "iatrogenic artifact" is a tumor caused by x-rays or radiation treatments. The tumor is the artifact; unlike in psychology contexts where the artifact might refer to the collection of symptoms or the name of the syndrome. So I don't think we should separately those terms in this article; I was not able to find any sources that define them separately; if someone finds that we could revisit this question. For the section about psychological effects - I think "psychology" or "psychological applications" would be fine as section heading. ... --Jack-A-Roe (talk) 00:01, 2 May 2008 (UTC)
My brief research on the subject led me to the same conclusion - it's not an exclusively psychological use. Iatrogenic artifact is a vague term, so sticking to iatrogenesis#psychology makes the most sense to me. Draft a section, then RE and I and any other editors can comment. WLU (talk) 01:09, 2 May 2008 (UTC)

[edit] new draft

OK, here's a suggestion for the section. I have references for the list of conditions, but I didn't want to do the work of formatting them if this version is not going to be used. I tried to keep this simple and direct, to avoid getting into the controversies. If there is a controversy about iatrogenisis re a particular condition, it would be better to explore that in the article about that condition. Also, I did not mention FMS at all in the list, because that's not a diagnosed condition, and also - if it's mentioned, then the whole NPOV response is needed and the whole section will go off-topic. So I recommend that FMS be left off the list. I also didn't mention Repressed Memory. That one could be added I suppose, but again, it's not something that's "diagnosed", and also I don't have a reference for that one. But with Repressed Memory, unlike FMS, I don't think it would cause a big controversy to include it.

I have no idea if this is what you're looking for... but here it is:

In psychology, iatrogenisis can occur when behavior symptoms are misdiagnosed or are identified and named as a condition that does not actually exist; or when a diagnosis, medication or other treatment or intervention causes or worsens a condition rather than improving the symptoms. Conditions that have been hypothesized to be associated with iatrogenisis include bipolar disorder, dissociative identity disorder, somatoform disorder, fibromyalgia, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, adolescent antisocial personality disorder, and others. The degree of association of any particular condition with iatrogenisis is unclear and in some cases controversial; research has not yet shown definitive results. A historical example of a condition formerly considered to be a disease that has since been shown to be an iatrogenic artifact is hystero-epilepsy; symptoms disappeared when the treatments were discontinued.[14][15]

--Jack-A-Roe (talk) 08:25, 3 May 2008 (UTC)

Wow, I hope that you've references for those! Fibromyalgia, CFS, PTSD, bipolar as potentially iatrogenic conditions? *whistles*
I think leaving FMS and RM out is a good idea for the exact reasons you suggested. I think the bit about medication can be left out since that's covered in the other sections - the unique aspect about psychological iatrogenesis is that a purely mental treatment can result in a behavioral diagnosis. A suggested revision - it's shorter, and short is beautiful (as someone who is five foot six).

In psychology, iatrogenisis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy[14][16]) or when medical or psychotherapeutic treatment causes or worsens symptoms. Conditions hypothesized to be partially or completely iatrogenic include bipolar disorder, dissociative identity disorder, somatoform disorder, fibromyalgia, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse and adolescent antisocial personality disorder, though research is unequivocal for each condition.

The hystero-epilepsy seems a bit awkward but it's the best place I can think of. I removed 'and others' at the end of the list - wikipedia's not done, but that's a pretty good list so I say leave out 'others' pending references. WLU (talk) 11:19, 3 May 2008 (UTC)
That seems OK to me, pending comment from ResearchEditor; though I'm not sure medication should be omitted because there is some overlap with purely psychological treatments as will show up in some of the references. I'm glad you agree about leaving out FMS & RM. Regarding the references, I found that wIth some of them, like Bipolar, it's not that the disease itself is completely iatrogenic, but rather that some of the therapies can make it worse; some treatments include medications (that's why I had included medication in this section), but also surprisingly - there's a reference that states re Bipolar: "Thus, CBT [cognitive behavioral therapy] had significant therapeutic effects on the patients with less highly recurrent illness courses, but it appeared to have had an iatrogenic impact for those with the worse prognoses." I don't have the time right now - later today, I'll post the links to the refs here so you and ResearchEditor can vet them. --Jack-A-Roe (talk) 16:57, 3 May 2008 (UTC)
You both did a lot of good work on this issue. Though I do sometimes appreciate succinctness in writing, sometimes IMO quality and accuracy is served by thoroughness as well.
Here's my version, based on both versions (please note the spelling and grammatical fixes). IMO, this may read a bit better:

In psychology, iatrogenesis can occur due to misdiagnosis. Conditions that have been hypothesized to be associated with iatrogenesis include bipolar disorder, dissociative identity disorder, somatoform disorder, fibromyalgia, chronic fatigue syndrome, posttraumatic stress disorder, substance abuse, adolescent antisocial personality disorder and others. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial. A historical example of a condition formerly considered to be a disease that has since been shown to be an iatrogenic artifact is hystero-epilepsy; symptoms disappeared when the treatments were discontinued.[14][17]

I do have some concerns however that Spanos and McHugh's refs w/o balancing refs could be seen as not being NPOV, based on their stances on DID, though they are not being used for this purpose. ResearchEditor (talk) 22:56, 3 May 2008 (UTC)
Sorry, I've been busy today and haven't had a chance to add the refs; some of those go with DID so that may resolve the issue about those other two refs seeming unbalanced. I'll get back to this as soon as I can to post the refs, but it might be late or tomorrow AM. --Jack-A-Roe (talk) 23:05, 3 May 2008 (UTC)

Here are the references that led me to the list of conditions in the draft paragraph. They are not unilateral, some of these support iatrogenesis for a particular condition and some oppose, but they all mention it as a consideration. Also, in some, medications are involved, but regard other treatment interventions. If you don't think they apply, feel free to modify the conditions list one way or the other.

Some of the articles are long, so it might be a good method to use your browser find-command to search for "iatro" in the text - to cover locate forms of the word. For the ones that are Google Books links, the Google in-book search box on the right hand side of the page works in most browsers though some have trouble with it - also in Google Books it only searches for whole words, so it might be necessary to search for both iatrogenic and iatrogenesis. Here's the list:

[1] [2]

[3] [4] [5] [6](page 369)

[7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]

[18] [19]

[20] [21] [22] [23]

  • other
    • general: [24] [25]
    • autogynephilia: [26] [27]
    • psychoanalysis - unresolved transference: [28]
    • Transvestic Fetishism: [29]
    • chronic pain: [30]

Some of those references could also be useful in the articles about each of the listed conditions.

As much as I'd like to complete the work on this, I don't have time to choose and format the references so I need to leave that to the two of you. If you end up not using some of these references or omitting some of the conditions, that's fine - use your best judgement, I'm not attached to the results. If you'd like my feedback on the next version of the paragraph, please let me know. --Jack-A-Roe (talk) 19:00, 4 May 2008 (UTC)

JAR, thanks for your excellent work on this. The refs you provided on DID are excellent balancing ones. ResearchEditor (talk) 21:43, 4 May 2008 (UTC)
Misdiagnosis isn't the only way that iatrogenesis can occur in psychology and psychotherapeutic treatment - drugs, improper treatment, these can also cause iatrogenic conditions (witness hystero-epilepsy, or anyone with bipolar disorder treated with antipsychotics). I prefer the middle version for its brevity and comprehensiveness.
I think Spanos alone should be used, as it is the most reliable. Since it's being used to justify hystero-epilepsy, I don't consider it having an NPOV issue. In any case, as long as it is a reliable source, NPOV comes in the portrayal of the source and balancing - this needs no balancing because it's not discussing DID, just hystero-epilepsy.
I'll try to get around to referencing the remaining conditions, I would rather use a single reference because a laundry list with excessive referencing is unbalanced for the article as a whole and replaces the coatracking issue. Iatrogenesis of specific conditions should be discussed at length in the individual pages. WLU (talk) 01:10, 5 May 2008 (UTC)
Maybe I gave the wrong impression - I didn't intend for all those references to be used, I figured just a few would be enough. (by the way, one of the Bipolars was about meds, and the other was about cognitive therapy). Anyway, I think those sources are good for at least some raw material that can be pared down. I certainly agree that detailed discussion should go into the individual articles and that this page just needs an overview.
I could go along with the middle version also... though if ResearchEditor prefers to include some note of the controversy on the topic, the last sentence could be modified like this: ", though research is unequivocal for each condition, and has generated some controversy." - or something general like that. --Jack-A-Roe (talk) 01:21, 5 May 2008 (UTC)
I have gone through most of JAR's urls and picked the fewest refs (all peer reviewed, with the exception of Spanos' book, which was pub. by the APA) I could use to support the data in the paragraph. The final version is very close to WLU's suggested paragraph, with the exception of deleting part of one of his sentences and adding one of JAR's to the end, keeping the length almost identical to WLU's version. I made one change to a wikilink. None of the articles mentioned a personality disorder, only antisocial youth. Personality disorders are Axis II diagnoses, usually seen as fixed and unchanging and unless specifically mentioned in the abstract, I believe it would be a misnomer to use the term with an article on antisocial youth. I left out a url on iatrogenesis in peer groups [31] for the sake of brevity. Please feel free to add it if desired. Future work on the paragraph might entail adding balancing reliable sources on all of the listed topics. But, IMO, this may be the best paragraph in the article, due to our combined work. ResearchEditor (talk) 04:04, 5 May 2008 (UTC)

In psychology, iatrogenesis can occur due to misdiagnosis (including diagnosis with a false condition as was the case of hystero-epilepsy[14]) Conditions hypothesized to be partially or completely iatrogenic include bipolar disorder[18], dissociative identity disorder[19][14] , fibromyalgia[20],somatoform disorder[21], chronic fatigue syndrome[21], posttraumatic stress disorder[22], substance abuse[23], antisocial youths [24] and others [25] though research is unequivocal for each condition. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial.

ResearchEditor (talk) 04:04, 5 May 2008 (UTC)

[edit] Homosexuality

I wonder if homosexuality would fit into the page - it was pathologized in the first two (three?) DSMs, if sources turn up it'd be interesting as an addition. WLU (talk) 23:15, 27 April 2008 (UTC)

[edit] Merge

Iatrogenic disorder and iatrogenic artifact both exist, both are stubs, and both duplicate content. Could/should they be merged? I think the page is short enough to handle them, particularly given the duplication of content. WLU (talk) 14:22, 28 April 2008 (UTC)

I am for the merge, provided that several editors are involved in the merge and content transfer, and these issues are discussed first prior to the merge. ResearchEditor (talk) 03:15, 29 April 2008 (UTC)

Good idea. I've done the merges. If anyone notices anything from the other articles I missed that need to be included, please do so. --Jack-A-Roe (talk) 04:04, 29 April 2008 (UTC)

[edit] restoring unproven medical procedures section

I have restored this section, because appears to be sourced and was deleted without sufficient reason. ResearchEditor (talk) 03:10, 28 May 2008 (UTC)

  • Maybe it's me but which source did you see in that section? Second, this reeks as OR. Nomen NescioGnothi seauton 07:29, 28 May 2008 (UTC)
Good points. This is a better reason to remove than your original reason "seems absent from current practice." If the original writer is unable to provide adequate references, then please feel free to delete as OR. ResearchEditor (talk) 02:56, 29 May 2008 (UTC)

[edit] deleting unsourced statement

I have deleted a statement without a source. ResearchEditor (talk) 02:40, 2 June 2008 (UTC)