Friday, April 27, 2007

IATROGENIC ILLNESS

I suffer from a chronic iatrogenic illness. As would be clear to everyone who knows his Greek, iatrogenic illness is illness caused by what doctors do. Usually it is illness caused as a side-effect of medication. As far as we know, iatrogenic illness is universal. All medications have side-effects. The iron law of medication is: "No side effects = No main effects". If we banned all medications that had side effects we would have no medications.

But the hysteria over side-effects never lets up for all that. Aspirin was once thought to be very safe but it does appear to cause some bleeding in the stomach EVERY time is it used. So despite aspirin's very great benefits and the long recognized great safety of it, doctors everywhere for a long time would recommend it only with the greatest hesitation. For routine pain relef they would generally recommend paracetamol instead. We now find, however that paracetamol causes liver damage. The neurosis about small but generally harmless side effects in aspirin has, in other words, exposed people to SERIOUS side effects in paracetamol.

So, as blind Freddy should be able to see, it is the tradeoff that is important. Side-effects that are very rare or side effects that cause little harm should be disregarded if the medication provides significant benefit.

You would think that doctors, of all people, would recognize that and maybe many family doctors do, but many medical researchers certainly do not. If they see a side effect that is found in only one in a thousand people, they will rush to press with warnings not to use that medication. And that is doubly absurd when we realize that very rare effects may be random events anyway. A rare side-effect may not be a side effect at all. If one woman in a thousand is said to get cancer out of taking HRT, what are we to make out of the 999 women who did NOT get cancer from it? Surely they prove that HRT does NOT cause cancer!

And most of the unending stream of scare stories rely on an assumption that is KNOWN to be false. They conclude from a correlation between two things that the correlation indicates causation. Because some studies have found a very slight correlation between taking HRT and getting cancer, for instance, the hysterics claim that HRT causes cancer. Yet "Correlation is not causation" is just about the first thing anyone learns in a course on statistics. For instance, recent history indicates that people have both been living longer and getting fatter. Getting fatter and living longer are correlated. So does getting fatter prolong life? To be consistent the hysterics would have to claim that! That women who take HRT might tend to have more health anxieties to start with and that those anxieties (whether justified or not) might be the problem (if there is a problem) is just not considered.

There is no such ambiguity in the case of real iatrogenic disasters of course. How many women who took thalidomide during the critical periods of gestation delivered normal babies? Not many. How many people who in their youth were frequently given old-fashioned medications containing arsenic (as I was) are now free of skin cancer? Not many.

So we should ignore the attention seekers who are constantly pretending that tiny fluctuations in their statistics reveal iatrogenic disasters going on. There will of course be real iatrogenic disasters in the future (Thalidomide was approved by many national health authorities) but listening to the attention-seekers will just deflect us from gaining the real benefits that medication can also deliver.

(For more postings from me, see TONGUE-TIED, EDUCATION WATCH, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, SOCIALIZED MEDICINE, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here.)

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