Iatrogenesis: A Response From Dr. Phillip Alexander
In the January 27th post entitled, “Small Health Habits Make a Big Difference,” I laid out the 10 leading causes of death in the United States according to the CDC. I recently received a response from Dr. Philip Alexander on this very topic:
Skyler…on the CDC’s own website, they freely admit that the list of the Top 10 Leading Causes of Death always leave out the real #3 cause. I’ve added it below. Sometimes hospitals can be very dangerous places!
- Heart disease: 597,689
- Cancer: 574,743
The medical profession: 225,000
Non-error drug adverse events 106,000
Medication errors in hospitals 7,000
Other errors in hospitals 20,000
Unnecessary surgery 12,000
Hospital-acquired infections 80,000
- Chronic lower respiratory diseases: 138,080
- Stroke (cerebrovascular diseases): 129,476
- Accidents (unintentional injuries): 120,859
- Alzheimer’s disease: 83,494
- Diabetes: 69,071
- Nephritis, nephrotic syndrome, and nephrosis: 50,476
- Influenza and Pneumonia: 50,097
- Intentional self-harm (suicide): 38,364
Incidentally, in 1990 Alzheimer’s Disease wasn’t even in the top 20. In 1999 it was #7, in 2004 it was #6, and is now #5. Medicare says that by 2020 50% of the long-term facility beds in the US will be Alzheimer’s Disease. It’s 50% now. All the others are stable or slightly improving (as in the graph below), but with a frightening increase in Alzheimer’s.
It’s all lifestyle, and we know how it happens and how to prevent it.
So we’ve learned two things: 1) Dr. Alexander never does anything halfway and, 2) treatment is a serious killer. What Dr. Alexander is talking about is called Iatrogenesis, which is where harm comes from the healer. The human body is incredibly complex, as discussions with my physician clients always elucidates. Historically we’ve take a statistical approach to treatment and treatment methods, that is a clinical trial shows that X percent of patients respond to Y treatment, and side effects were less than the benefit, so the treatment is viable. No clinical trial, no matter how huge, can account for the ever growing number of patients physicians are seeing, especially as boomers age into Medicare. There will be somebody who, because of their unique makeup, responds exceedingly poorly to a treatment and becomes part of the statistic above.
However, there is also the patient side of the equation, expecting the physician to “Do Something” when they see them. This is made worse by social ranking systems like Yelp where a patient can boil a physician’s ability down to a 5 star rating system based on one visit. If you’re in a position where you’re effectively arguing with a patient who expects to be prescribed something, you may very well just write the most benign script available and move onto the next patient in your overcrowded day. That’s “Murica for you: give me drugs or I’ll have your head on Yelp.
The human body is not beholden to our temporal expectations as much as we’d like it to be. What may take weeks we want in days, and this leads to some of the ill-advised treatment that results in harm above. To quote my friend Doug McGuff:
My favorite mantra is….”Don’t just do something, stand there!”. We must always be cautious about intervening when mother nature is not taking her course as fast as we would like it. The greater your sense of urgency to act, the more you should wait.
This is not to say that you should do nothing, but that you should understand that not everything has a clean, linear treatment or recovery process and sometimes waiting is the most prudent course of action. That’s why they call it the “art and science of medicine,” folks.
Skyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science. He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.