Iatrogenics: Are You Helping or Hurting?

Just hold on loosely

But don’t let go

If you cling too tightly

You’re gonna lose control

Your baby needs someone to believe in

And a whole lot of space to breathe in

-“Hold on Loosely” by 38 Special

Today I drove to school to catch the bus for a track meet. When I pulled into the parking lot a public safety officer was coming down the row of parking spaces that I was driving up. We were positioned so that I had to back up before turning into the one of two available spaces in that row.

Just as I was about to turn in, after backing up, he turned into one of the spaces (the one farther from me). Now I had to back up again before turning to avoid hitting him, partially due to the snow-covered ground with its slippery potential.

When I finally did park there was a substantial amount of space between me and him, but certainly not enough to fit half a car. So I grabbed my things and got out of my car, ready to make a run for the bus which was due to leave any minute. He just sat there and stared at me the whole time. Then he said, “Hey. Can you park a little closer? If everyone parked like you, there would be nowhere to park.” I told him I had to catch my bus and that he had to wait a moment. But I did freeze while talking to him, unsure of what to do as he continued rambling on about something (I think. I wasn’t paying attention).

Of course, just as soon as I resumed movement, the bus left. The officer moved to another part of the lot. I walked back to my car and, being the drama-queen I am, I cried. After a couple minutes I looked up and saw him, in his car, at my left, giving me a disgusted look. I motioned with my hand for him to shoo, stuck the key in the ignition, and left. Now, instead of screaming at people as I record times on a piece of paper, I’m at the library writing this article. You better like it.

So did this idiot have nothing better to do but interrupt me? Because he obviously didn’t have much else going on. Was he totally blind to the fact that he made it harder for me to park properly?!

Or was this a series of roughly-unfortunate events that resulted from a pure incident- us being in the same place at the same time- which forced him to park in that spot, and then so on and so forth.

OR was he just a total douche who became a public safety officer as a way of unleashing his douchiness on college students? He had a foreign accent, so this must be the case. ;)


Our Saviors Fail to Save Us

A tragedy we face in modern society- or perhaps in this life, regardless of where we live- is iatrogenics: harm done with an intention to help. The example above is a bit pretentious, but unless he deliberately bothered me for no good purpose it counts. The guy who’s supposed to help me (specifically, when I need it) screwed me over, albeit in a small way (P.S. I’m aware that I could have left the house earlier. Shut up).

Sadly, there are far more potent examples which we bear witness to everyday- and we don’t always realize it. Police officers and medical doctors kill the people who they are supposed to protect and save. Miracle cures- whether we call them drugs or supplements- turn out to be miraculously murderous. Social workers increase their clients’ frustration and confusion, and perhaps also their debt. The teachers who are supposed to help us be better, more enlightened people instead drive fear into our hearts, making the next red number or letter they write on a piece of paper the biggest deal in the world. Farm practices which are supposed to increase food output actually reduce it and also contaminate the food, and so on.

Of course, for each of these examples, iatrogenics does not occur in every case. Sometimes drugs- at least for a time- do more good than harm. Law enforcement officers catch the bad guy and save the innocent. Genetic modification may provide certain nutrients for people who don’t have access to them otherwise (though as a person who does have such access, I make an effort- which you may call half-assed- to avoid GMOs at this time).

Iatrogenics seems to result, roughly, from a belief in the harmer-turned-helper’s credibility and authority. This is true whether they believe in their own powers or other people agree to those powers (or both). Doctors prescribe us medication because they believe themselves credible enough to do so, and patients share in their belief. The people who produce these drugs may or may not believe in the drug’s efficacy: in fact, they might be well aware that their products are in fact snake oil (read: useless). What counts is that some sucker out there does indeed believe. The consumer’s belief in a product is an extension of the producer’s (or at least, the product’s itself) apparent credibility and awesomeness.


Dangerous but Necessary Product-Testing

This is unless the consumer tests the product himself and finds it to his liking. This isn’t always viable without having to first purchase the product, unless you are a beta-tester, borrow the product from someone, or there is a free trial period offered. Well, or if you steal it. In some cases, this can mean major non-refundable financial costs, perhaps with drugs (I know, that horse will be beaten multiple times).

But the more major problem with testing is other types of damage, such as those to your body. The only way to know if taking L-tryptophan (an amino acid) in supplement form will benefit you is to take it. And then, of course, you might end up like thousands of other people have and get completely messed up from it. On top of that, the first 30 days of supplement use is probably not free, unlike the latest update of World of Warcraft. Darn it!

This might be extended to say that a city could test certain cops (analogous to the product) for a while, and find that their product ruthlessly harasses, punishes, and perhaps even kills innocent people. Whoopsie. Would you like a refund?

The premise of trying new things can feel so fragilizing. If a person dies from your product, you’re totally f*cked. If you are said person who dies, then you’re a hapless victim, perhaps one who has tried something new in hopes of it being a miracle cure.

Perhaps there is- or we must make- a subtle agreement that if we choose to test a product on ourselves, then we accept all its potential consequences. Being conscious of what all this entails, however, can be overwhelming. This means I have to accept that the next tin of mixed nuts I buy might be contaminated with aflatoxin (or farmer sh*t, that asshole) and kill me and my unlikely-to-ever-exist future-children.

Every time you put something in or, yes, on, your body you take a risk. The more you eat, the more toxins you are exposed to. Of course this varies from food to food, but in essence this is inevitable. Tomorrow’s burger patty might be stewed up with a party of Escericha coli, which sounds quite festive. The next breath you take might be filled with cigarette smoke (and knowing you, dear reader, it probably is). The one after that might be carbon monoxide.

Likewise, today’s best friend might be next week’s murderer (so much carnage in this article! I say!). The past year’s laptop will probably be in tomorrow’s junkpile, presuming the batteries leak their sweet juices through my house first and kill me. Hopefully this juice is at least tasty, like antifreeze. Mmm…

What I wish to convey is that, when I read some report about how a product has gone horribly wrong, I sense a displacement of responsibility somewhere. Perhaps there is too much on the producer, and not enough on the consumers. I realize this defies a tendency to blame the victim.

At the same time as the blame-the-culprit image, though, there’s a sense that these consumers are hapless, unwitting fools, subject to the horrors conjured up by the mad-scientist witch doctor. And you know, this probably is indeed the case.

A few years ago my mom received a letter announcing a recall on the brakes of her car, the Toyota Camry 2007, as numerous other owners of the same car found their brakes suddenly giving out. The letter requested that all Camry owners visit, I presume, Toyota to have their brakes replaced. Do you think my mom did a full examination on the car before buying it, which enabled her to determine that the brakes would completely crap out in several years? Hell no. She just jumped into that thing everyday and drove, and I now follow in her footsteps with it (this better not happen again, you slimy Toyota manufacturers).

It would indeed be ideal if we could all be experts on each of the products we buy. This way we could largely avoid being swindled, and create our own solutions when things go wrong. I recently smashed that very car into a guardrail, and now it must be shipped off to an auto body shop for repair. It would be pretty damn neat if I could fix that thing myself; which, I probably have the potential to, but I’d need some time and patience to figure out what I’m doing. Well, and maybe a prayer or 12, also.


Iatrogenics as a Break in Trust

And there we have the problem of consumerism: we must rely on others to give us credible products, and to treat us and our purchases well. In that case, taking things from other people (usually with money) is an exercise in trust. Of course, I have written about this before: the very act of living is an exercise in trust. To start, you must trust yourself to make sufficiently sound judgments (i.e. choices that won’t kill you). Then, you must trust the world to not kill you.

But, as many an angry boy knows, sometimes you trust the world and it turns on you. I’m sure my parents had decent trust in themselves when they chose to purchase a Camry. I’m sure they trusted Toyota, and I’m sure that Toyota trusted themselves (unless they’re a bunch of dirty f*cks). We get pretty good gas mileage on that mofo, and it has had near-zero problems.

Except, of course, for the one dire problem. But do you think my parents, Toyota, or any other consumers expected the mechanism on that car which keeps it from killing people to die out suddenly? I doubt it. They trusted life, and life ate ‘em. Tough stuff man.

Of course, this phenomenon isn’t new (yes, both crappy brakes and being betrayed by life). You could trust that the forest you hunted in everyday would treat you kindly, just as it always would, and then one day you get eaten by a bear. However, there are two key differences between this more-primitive decision and modern consumer choices.

Number one: the alternative to trusting the forest was probably to go hungry. There are many things we buy which we don’t have to, although in the case of drugs and supplements we may perceive that we do. The likely-incentive of many buying choices- aside from chimp brain mania- is the perceived downside of not buying the product (e.g. continuing to be ill). You gotta make this shit seem necessary, business-bros.

Number two: in the scenario of the forest, we could say that you’re trusting “life” or “the universe,” or at least “nature.” If a bear sneaks up while you’re loading an arrow, well, maybe there’s not much you could do about that. Stuff like that happens, man: it’s the food chain.

But, in the modern economy, the party we must trust is other human beings: specifically, people who we can interrogate and hold accountable and sue and rightfully be angry at forever. It looks like now it is much more easily their fault than it is our conscious responsibility.

You know there might be evil bears lurking around when you walk into the woods. When you go to the store, you expect that what you walk out with will be blessed with the highest known magic, blessed by level 200 druids.

Would it be more constructive of us to generally expect the worst then? Maybe not overtly. The easiest way I can answer that question is to say, have standards. Many standards rise from the aftermath of shit that has happened. That’s why I stare into the abyss of food labels when I go to the grocery (though more often the health food) store: I was beaten up by bad products for a long, long time.

Our economy appears to run mostly on a policy of “innocent until proven guilty.” For people on the fringes, however, who don’t quite have some measure of external validation (e.g. certification for people, presence in a store for products), “guilty until proven innocent” more often applies.

A food might be up to snuff on or even better than the certified-organic standards, but it gets ignored because it lacks the USDA’s label. On the flipside, people attract to pharmacy-approved drugs and even FDA-unregulated supplements like magnets, assured that only the most noble of witchcraft is in store for them.  What a sad but probably-undeliberate paradox we live in.

To reiterate what I stated earlier, I suspect the reason for this state of things is that the certified conveys a better appearance of being necessary. The product or service looks credible, so credible that surely it can do more for us than we can for ourselves; we need it thus.

This dichotomy is not bad, per se. Certainly there are things “out there” which can help us better than we can help ourselves. Typically, you need something out there to help yourself with anyway (e.g. food), though it certainly does matter what exactly you are using.

Additionally, some professionals probably are actually more trustworthy than their uncertified counterparts. However, I suspect this to be more often true of products than people.


Avoiding Iatrogenics: for the Practitioner

If you suspect yourself to be guilty of iatrogenics, I suggest you take a step back and examine what’s happening. Do friends become turned off by your attempts to solve their problems? Are people clearly harmed by your products? Have others died after taking your advice? You aren’t infallible, but you are improvable.

If you are trying to “fix” people to be a certain way- perhaps just like you- you are bound to commit the crime of iatrogenics, soon enough if you haven’t already.

For me this has looked like wanting other people to be enlightened, understanding that what is fear-based is bullshit and that most of their problems are imagined and that they probably aren’t at all who they think they are, and so on and so forth.

Because I tend to keep to myself I haven’t enforced this too much, but unfortunately I did scare away someone special to me. I was well-intentioned but also somewhat deluded: I didn’t really understand what I was doing. I suspect many humans suffer this state of being in some form.

Merely having this mindset of looking for what’s wrong with people and trying to correct them put a damper on my relationships. It was hard to communicate with people without a storm of all these criticisms and things I need to say crashing into my brain. Certainly thinking this way has contributed to my relative solitude.

Of course, the fix-people mindset defies the “enlightenment” I wanted to spread, and it reflects my own lack of being lit up (yes, by every definition of that term). Clearly I haven’t understood and loved myself too well, since I would not have such a dire need to change others if I did.

On top of that, my silliness demonstrates a key crime- or really, the essence- of iatrogenics: enforcing the idea that people can’t heal themselves. This belief is necessary, I presume, to the administration of most surgeries, drugs, dietary supplements (though people may be unaware of it in this case? It’s a tricky one), and perhaps also to formal education (people cannot learn sufficiently and correctly on their own terms).

The basis of iatrogenics is intervention. There would be no need to intervene if that darn pile of squish you call a body could just heal itself.

Maybe our intervention-dilemma is shown in our treatment of the environment. We have created monocultures- some genetically modified, no less- which we tend to harvest before the crop sprouts or gets very large. The monotony, brevity, and crowding don’t allow for the crop to return nutrients to the soil, and the soil thus becomes depleted. The only way it can continue producing as we want it to is by means of fertilizer, which tends to be mostly synthetic (as far as I know) in agro-business.

Of course, we wouldn’t need to add chemicals to the soil if we didn’t treat it so stupidly in the first place, and also if we didn’t continue to pound the heck out of it and expect that it should handle that pounding.

We tend to our bodies with the same actions and the same mindset. Many fewer people would turn to surgery, drugs, and supplements if they did not treat themselves so badly in the first place. Unfortunately, most of us are served up what could be considered the iatrogenics of misinformation (AKA media and formal education), environmental destruction, and parenting misguided by the very same misinformation.

Some people improve from the situation in which they were raised and emerge at some point on the other side, but many more remain stuck in their ways for life. Or, they do improve, but they may still be a long ways away from their highest potential. “A long way” might entail that they take better care of themselves than their parents did, but they are still energy-sapped and sick.

Earlier I stated that iatrogenics requires a practitioner to believe in his own authority. It also tends to entail more talking than listening. Instead of having your consumer explain to you what she needs, you go out of your way to drive across your expertise and make it look like you know what the f*ck you’re doing.

Sometimes they indeed do not know, but this mindset is better taken to business than to a health profession. When you’re trying to help a sick person heal, how can you get by with not listening to him? You can’t even experience his illness, you dummy. Only he can. If your top priority is to squeeze the apparent symptoms into some diagnosis-box as soon as possible so the likely-unsuitable-treatment administration can begin, you just may put yourself on a path to someday killing a human being (or at least doing serious damage to one).

It may not be possible to do zero-harm but you can darn well try. In fact, it is your responsibility to do so. While consumers are responsible for their own wellness, you must take care to not infringe on that wellness. Don’t give your people more than they can bear—that is, unless you’re just trying to make money from them. You’d still probably make more in the long run (especially in this possibly-dying economic system) by treating your customer-base well since you won’t be killing them that way, but, well, I can’t stop you. Unless you show up at my house. Then you’re minced meat (presumably on the shelf next to the 100-cow ground beef).

Remember: when you commit iatrogenics you are like a douchey, annoying, ruthless cop, blinded by his grandeur to the harm of his actions. If you become more aware as to the truth of your intervening you will likely find a way to reduce the harm you do, and you might even decide that quitting your job is the best way. This might seem scary if you’re never truly been guided by consciously-chosen values before, but if they really are consciously chosen odds are they will lead you into actually helping people. The decision is ultimately on you, but it can affect many.


Avoiding Iatrogenics: for the Rest of Us

As for the consumer, we might count damage you do to yourself as iatrogenics, even if your actions are on behalf of another’s intervention (e.g. taking a pill because a doctor told you to).

I’ve had my own minor medical run-in with iatrogenics. I usually tell people that I overcame severe, suicidal, long-term (I probably would have passed for 2.5 years with the condition, though not always that severe) depression almost 2 years ago without any drugs, but that isn’t 100% true.

For about a month I took a supplement called St. John’s Wort, which is supposed to have some mystical depression-healing properties. I didn’t want to take anything but my mom wanted some drug in my body, and this seemed like a far better option than the Prozac I was offered. I had the sense that it gave me a nice boost, but not enough to move me to “not depressed” status (which sounds disgustingly mechanical. Oops).

I also was fairly certain that this supplement was causing some intense GI distress. I could hardly go running without my stomach going wild: I’d have to come home just to hit the toilet. I walked in the door one night, went straight to my room, plopped on the bed, and that was it. I didn’t bother with moving or eating because I was in so much pain. I never even took the recommended dosage of this stuff, but maybe that’s precisely why all this crap (hehe) was happening. You’re supposed to take 3 tablets each day, and I did 1-2. A couple days I just skipped entirely (probably bad).

Thankfully, while I was on the supplement I read and thought lots and lots and found the insights I needed to get better, almost too quick. About a month after feeling the worst I ever had, I felt the best I ever had up to that point. I wish you could have been there to see it. I certainly have felt awful plenty of times since then (like the last month), but it has certainly never been quite as hopeless or totally-lost. I might just be a lucky lucky lucky lucky luck boy. I don’t know if such a jump could be replicated, especially by some algorithmic method.

Carrying on from moi, to avoid iatrogenics (particularly in the stricter sense, such as that from medical professionals) it might do to begin by improving on the basics. A healthy human does not need drugs, supplements, and counseling to survive. Unless she’s a magical monk (well, nun), she probably does need food, water, clean air, sleep, and shelter, and would do well with exercise, sunlight, some outdoor exposure, social connection, self-awareness, play, and, yes, sex. It also helps to have a lifestyle and work of some sort that you enjoy, which many people lack.

If by some force you could create each of these things in your life perfectly you would have no need for physical or mental health professionals, except for physical accidents (e.g. your strong, meaty leg gets broken). Man, that sounds like a dream. Imagine if you almost never worried about your health… It’s magic to my ears. And it’s damn near possible, I’m sure. Perfection isn’t needed, but the next best thing? Sounds like a beauty.

If you are hurt by a treatment you ought to let a practitioner know, so as to (hopefully) make them more wary of administering it to someone else. I know we purchase so many products and pay for so many services (like prostitution) these days that the thought of sharing every time something goes wrong may not feel so hot. Plus, you probably won’t go back to your old elementary school and tell all of your teachers about how they screwed up your mind. If nowhere else, start with the doctor. That’s probably the easiest place, and you should do it for your own sake anyway. That man needs to know if the candy you’re shoving down your throat isn’t working.

The second person you can freely report iatrogenics to is me. If I am writing a load of hogwash and you’ve taken advice from me that has made you insane and ruined your life, let me know. I have written some stupid things which could do at least small amounts of harm here and there, and if I destroy another person’s well-being I’d like to be aware of it. If you’re concerned about me demolishing planet Earth, make me aware of it. I command you.

A perhaps-tough thing about iatrogenics is that, especially for physical health, it’s a lot easier to tell people what not to do than what to do. I can rattle off everything you shouldn’t eat in an instant, but give you suggestions on what to eat? Uh, not goin’ there. Sorry buddy. I’ll probably also tell you to avoid drugs if your life doesn’t immediately depend on it, but what drugs to take if you need them? Not a clue. Brain dead. Just like you, at least. :)

Right now I’m in fairly poor physical health. I have the sense I’m way too fragile to be trying any ridiculous powders or pills or injections. I did recently buy a bottle of flax oil and two single packets of Amazing Grass Green Superfood which I trust just enough to try, but I am a tad scared. One of my friends suggested multivitamins and I don’t even want to use those. If any of these things kill me, I’ll let you know.

But I think what might serve me better is another hopefully-not-futile attempt of mine, which is to give up wheat and corn. Every time I sit down for a meal I get this feeling that Something’s not right here, and when these two items aren’t present the feeling isn’t around either. I am a bit worried about calories- particularly when I’m not home. Now it’s even harder to eat at restaurants, but it’s probably better that way. That is, until I get hitched. Which may be never. ;)

Surely knowing what not to do is indeed important to being well. It seems negatively-focused to think about all the things you need to avoid, but it may also be helpful or even crucial. It certainly limits my buying choices, which is nice in ‘Murica, the Land of Choice. If I prioritized simply eating food as opposed to not eating things that will kill me, those things may indeed have killed me by now. I’d probably be sleeping off a painful dinner right now instead of filling your head with bullsh*t.

At this point, I’m trusting Nassim Taleb’s Antifragile (where I learned the term “iatrogenics”): if you reduce your downside, the best will take care of itself. Instead of adding designer-nuttiness to your life, see what messes you could do with cleaning up. Surely you have some unnecessary clutter you ought to get rid of. If you live in America, clutter is a requirement. Haven’t ya heard?

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