When I read an article in the NY Times last week entitled: “My Transplanted Heart and I will Die Soon” written by Amy Silverstein, author of the book “Sick Girl,” I thought of the word iatrogenic. Iatrogenic is defined as relating to illness caused by medical examination or treatment. In her book and in this article, she writes about the double-edged sword of being saved by two transplant operations she describes as: “not a cure but a treatment.”
“While your adoptive heart goes on beating, every day you must take a toxic triad of immunosuppressive medicines.” These drugs leave a person “reeling from the intractable infections that land us in emergency rooms and hospital beds, the biopsies that pieces of our donor organs leaving us scarred and shaken the skin cancers that blossom rapidly beside an eyelid or ear.”
Now in her last days, she also reveals that it’s considered bad form for a transplant patient to complain about any aspect of transplantation including the required drug regimen. When she did so in her book and online, she got hate mail: “The doctors should have let you die.”
I guess that’s why she never mentions the term iatrogenesis. It’s not a word we often hear, and clearly makes it sound like she’s ungratefully blaming the medical community giving her a life full of challenges. But nowadays iatrogenesis is becoming an all-too common health problem where a disease state is essentially caused by the cure. That online definition I quoted above goes on to say: Drugs may cause side effects which can lead to iatrogenic disease.
In the article, Silverstein painfully delineates the many side effects of her treatment which include: “diabetes, uncontrollable high blood pressure, kidney damage and failure, serious infections, and cancer.” She was diagnosed only recently with terminal metastatic lung cancer, which after spending a lifetime taking very good care of her body, surprised even her cardiologist.
Just last June I was out walking with a friend who told me she’d emerged “so grateful” from a long winter of chemotherapy essentially cancer free. She was a tall, thin woman who, like Silverstein, always took very good care of her health. But to that first grateful observation she added woefully, “now I have diabetes and high-blood pressure which I never had before but were apparently caused by the treatment.” I suspect she had never heard the word iatrogenic, either. Her cancer suddenly returned a month later and she was dead by August.
From my perspective iatrogenesis and stress go hand in hand. Stress, when unrelenting, can have a major impact on the immune system, heart health, chronic pain and possibly even cancer. Since most doctors will readily admit that they receive little or no training in medical school on the origins and treatment of stress-related disease (that’s a mind-body issue and considered to be the domain of psychiatrists) if you ask your doctor if your ulcer or your chronic pain or your high blood pressure or your heart disease is caused by stress the best answer you’re likely to get is maybe.
No doctor – not even psychiatrists – can readily conclude that stress is causing a particular condition - even under the best of circumstances - let alone within the confines of the typical 10-minute check-up. Stress-related health issues are almost always multi-factorial. Still, just about everyone I know at some point in their lives has seen a direct cause-and-effect relationship between catching a cold and going through a period of high stress. Yet, I readily understand, that even this fairly straightforward conclusion is made complicated for a doctor by the fact that stress is different for everyone and even a simple cold requires you to be exposed to a rhino virus, so how can your doctor conclude that stress should be blamed for causing it?
The effects of stress on the body are famously “non-specific.” In other words, there isn’t a specific cause and effect relationship your doctor can point to between your levels of stress and your DIS-EASE! The same level of stress might cause GI tract problems in one person, migraine headaches in another, recurrent colds in a third and absolutely nothing in a fourth!
So, in many cases this cause-and-effect confusion leads to throwing a lot of money and time and medical treatment at the symptoms of stress and not addressing the source of the problem. And it also leads to what in my opinion is a possible epidemic of iatrogenesis. Because when a treatment includes pharmaceuticals as it usually does, for example with insomnia (50% of all insomnia is caused by stress) it also includes side effects, some of which can be disease-causing.
Obviously by the time Amy Silverstein’s adopted heart was transplanted in her chest, she had no choice but to follow the immunosuppressant drug regimen her doctors were recommending. But I certainly think she makes an excellent case for looking at the damage certain so-called curative drugs can bring about as the result of side-effects.
In next week’s installment, we’ll look at how integrative medicine is addressing the problem at its source.