Introduction: medicine’s shadowside: revisiting clinical iatrogenesis

ABSTRACT

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis’ immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.

Keywords:

• Iatrogenesis
• medical anthropology
• ethnography
• medical industrial complex
• medical racism

Acknowledgements

The journey of publishing this special issue has been challenging, for a number of reasons. Our deepest thanks to our contributors for their thought-provoking pieces in this special issue, from which we have both learned immensely. In addition, we are also grateful to the editors of the journal for all their support, particularly Sumeet Jain. Finally, we thank thoughtful and generous readers of this introduction: Lee Cabatingan, Hanna Garth, Susan Greenhalgh, Erin Moore, Lauren Textor and Will Schlesinger, for their insightful comments that made this introduction stronger.

Ethics approval

No ethics approval was required for this Introduction

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Iatrogenic illness is defined as ‘any illness [that] results from a diagnostic procedure or therapeutic intervention that is not a natural consequence of the patient’s disease …[These] are most commonly associated with medications, diagnostic and therapeutic procedures, nosocomial infections, and environmental hazards’ (Suh and Palmer 2007). Injury, meanwhile, refers to ‘tissue or organ damage that is caused by necessary medical treatment, pharmacotherapy, or the application of medical devices and has nothing to do with the primary disease’ (Cheng et al. 2019).

2 Following disability justice organizer Mia Mingus (2015), we understand the medical industrial complex as a system of globalized healthcare forged in the crucible of colonialism and capitalism, yet which presents itself as humanitarian and benevolent. The MIC is deeply implicated with eugenics, neoliberal capital, colonization, slavery, immigration, war, prisons, and reproductive oppression, in different ways around the world. As Mingus puts it, the MIC ‘is not just a major piece of the history of ableism, but all systems of oppression.’

3 Heartfelt thanks to Susan Greenhalgh for this felicitous phrasing.

4 For example, even though medical injury and harm are important themes in both their individual work, Lock and Nguyen’s important volume, An Anthropology of Biomedicine (2010), does not include iatrogenesis as a standalone or significant concept. It is also similarly absent from the global health volume, Metrics: What Counts in Global Health (2016), in which only one essay references ‘injury’ as a key term.

5 Ivan Illich identified four categories of clinical iatrogenesis, the first of which include malpractice, negligence, professional callousness; the second, which describes accidents or ‘systems breaking down’; the third, which focuses on ‘specific risks which are accepted’, such as the uses of certain risky technologies or diagnostic tools; and finally, defensive medicine (Illich 1975a, 78–79). Yet, Illich did not limit his analysis to clinical practices and procedures alone; he also outlined social and symbolic iatrogenesis’, the latter being the hegemony of the medical industrial complex, ‘the most important economic sector after the American war industry’ (Illich 1975a, 80).

6 For example, Nazi Germany’s genocidal use of public health and biomedicine against Jewish populations, as well as the Roma, homosexuals, the disabled, political prisoners, and POWs, during WWII (see Baumslag 2005; Lifton 1986 [2017]), and the American eugenics movement systematic sterilization of persons deemed undesirable, ‘defective’, and unworthy of reproduction (see Cohen 2016, Schoen 2005).

7 See for example the recent JAMA ‘no physician is racist’ controversy (Tanne 2021), the United Kingdom’s 2021 “Commission on Race and Ethnic Disparities”, which, counter to the government’s own data especially during Covid (see Razai, Majeed, and Esmail 2021), rejected ‘the common view that ethnic minorities have universally worse health outcomes compared with White people’ (Gov.UK 2021, 199), and the doctor who was fired for discussing racism in medicine (Lenzer 2021).

8 Covid outbreaks in hospitals and long-term care facilities impact patients and providers alike, with BIPOC frontline personnel suffering the heaviest share of viral exposure, nosocomial infection, and death (Chaudhry et al. 2020; National Nurses United 2020; Rimmer 2020).

9 The medical diagnostics, algorithms, and technologies on which we are so reliant during Covid are themselves shaped by histories of racism, pulse oximeters serving as but one example (Sjoding et al. 2020; Sjoding, Iwashyna, and Valley 2021; Whitehead-Clarke 2021).

10 See Downe (2020), Phillips-Beck et al. (2020), and Stevenson (2014) for more on colonization’s enduring, genocidal presence in contemporary Canadian healthcare.

11 See Susan Greenhalgh’s Afterword, “Ode to Leah” (this issue).

12 Instead, we find some hope in trainings that emphasize provider humility (Metzl, Maybank, and De Maio 2020).