When medical treatment brings on disease: iatrogenic disorders

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Those who have lasting dysfunctions after taking finasteride or dutasteride are not the only ones whose lives have been altered for the worse because of a medical treatment. This post summarizes diseases and conditions that may arise from medical treatments in dermatology, psychiatry, surgery, radiology and general medicine.

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Every treatment has been approved by FDA—although some have had warnings and restrictions added after initial approval (e.g., isotretinoin and fluoroquinolones). Many doctors believe they are safe and effective, and some patients have found them effective and tolerable. The safety of some treatments remains a subject of debate among doctors and researchers.

This website does not take an absolutist position against these treatments; rather, it advocates for:

  • informed consent of the patient;
  • medical advice in the best interest of the patient and free of industry influence;
  • respect for the dignity of the patient; and
  • research free of industry influence.

Common threads

Although these treatments have different mechanisms and treat different conditions, there are many commonalities in the experience of those harmed by them, including:

Prior to treatment:

  • Lack of informed consent: patients were not fully informed of the risks of treatment before it was offered;
  • Inflated expectations due to physician advice and marketing;
  • Incomplete or unavailable information about harms.

During and after treatment:

  • Denial, discounting or deflection of adverse effects when reported. Contributing factors include preference for official medical knowledge over individual experience; physician distaste for uncertainty; and fear of liability. Some physicians will readily toss unwelcome complaints into the wastebasket of “psychological problems.”
  • Lack of awareness of new regulatory warnings or product recalls;
  • Loss of trust in medicine; demoralization; isolation.

Systemic problems:

  • Biases in clinical trials and medical literature, including publication bias and investigator bias in detection and characterization of adverse effects;
  • Lack of funding for research on treatment-emergent diseases and conditions;
  • Gaps in regulation of medical devices (see 2011 IOM report).

Treatment-emergent (iatrogenic) diseases & conditions

CONDITIONS BY SPECIALTY & TREATMENT

  • Dermatology & cosmetic surgery
    • Finasteride or dutasteride
    • Liposuction
    • Cryolipolysis (CoolSculpting)
    • Breast implants
    • Isotretinoin (Accutane or Roaccutane)
    • Topical steroids
  • Psychiatry
    • SSRI/SNRI antidepressants
    • Benzodiazepines
    • Antipsychotics
    • Transcranial magnetic stimulation (TMS)
    • Electroconvulsive therapy (ECT)
  • General medicine
    • Fluoroquinolones
  • Surgery
    • Nasal surgery
    • LASIK eye surgery
    • Mesh implant
  • Radiology
    • Contrast-enhanced MRI or MRA scans

Dermatology & cosmetic surgery

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Finasteride or dutasteride for hair loss

May result in: Lasting dysfunctions in sexual, neuropsychiatric, cognitive and other domains

Resources:

Liposuction

May result in: Visceral fat deposits; embolism; infection; loss of body contours; death

Resources:

Cryolipolysis; branded CoolSculpting with Zeltiq device

May result in: Paradoxical adipose hyperplasia (PAH)

Resources:

Breast implants

May result in:

  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
  • Systemic symptoms including joint pain, muscle aches, confusion, chronic fatigue & autoimmune diseases

Resources:

Isotretinoin for acne

May result in: Lasting sexual dysfunction

Resources

Topical steroids

May result in: Topical steroid withdrawal, a “debilitating skin condition which can occur after the termination of topical steroid use, after a period of frequent and/or prolonged use.” –Scratch That

Resources

Psychiatry

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SSRI/SNRI antidepressants

May result in: Antidepressant withdrawal syndrome or post-SSRI sexual dysfunction (PSSD)

Resources

Benzodiazepines for anxiety, insomnia, seizures & other conditions

May result in: benzodiazepine withdrawal and benzodiazepine-induced neurological dysfunction (BIND)

Resources

Antipsychotics for schizophrenia

May result in: Akathisia

Resources

Transcranial magnetic stimulation (TMS) for depression

May result in: Significantly worsening depression and anxiety; cognitive impairment; irritability; fatigue

Resources

Electroconvulsive therapy (ECT) for major depression

May result in: Permanent memory loss and cognitive impairment

Resources

General medicine

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Fluoroquinolones for infections

May result in: Fluoroquinolone toxicity which may include:

  • Disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium
  • Hypoglycemic coma
  • Disabling and potentially permanent side effects involving tendons, muscles, joints, nerves and the central nervous system

Resources

Surgery

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Nasal surgery

May result in: Empty Nose Syndrome, “an iatrogenic, post-operative illness resulting from surgical insult to the nasal turbinates.” –@ENS_Awareness

“The most common complaint…is the sensation of decreased nasal airflow… [A] lack of nasal resistance, makes the nose feel too open. Other symptoms include nasal and throat dryness, nasal burning and crusting. Patients may experience a sense of suffocation. Most ENS patients experience anxiety, depression, and poor sleep quality. The psychological impacts reduce effectiveness, both at work and in daily life.” –American Rhinological Society

Resources

LASIK eye surgery

Complications may include: Night vision problems, dry eyes, depression and suicide, eye pain, corneal neuropathy, ectasia (“keratoconus”), late flap dislocation, flap complications, floaters and vitreoretinal damage, infection and other symptoms (Source: LASIK Complications website)

Resources

Mesh implant for stress urinary incontinence, pelvic organ prolapse and hernia

Complications of mesh implants may include: pain, erosion, voiding dysfunction, infection, recurrent urinary tract infections, fistulae, organ perforation, bleeding, vaginal scarring, neuromuscular alterations, lower urinary tract symptoms, bowel complications and immune disorders. (Adapted from Reyes & Hashim, 2020)

Resources

Radiology

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Contrast-enhanced MRI or MRA scans

May result in: Gadolinium toxicity, inducing nephrogenic systemic fibrosis (NSF), a “potentially disabling and lethal disease” (Blomqvist et al, 2022)

Symptoms:

  • Itchy, red bumps on arms and legs, as well as the torso
  • Joint pain that can become disabling
  • Hardening and thickening of the skin especially over the arms, legs and trunk
  • Progression of fibrosis with deposits in the muscles, lungs, esophagus and heart that damage these organs
  • This condition can be fatal.

(Symptoms adapted from Cleveland Clinic page on NSF)

Resources

Further reading

Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med. 1981. doi:10.1056/NEJM198103123041104 • PubMed