> Webby wrote:
> Often we read phrases such as "blame the patient", "blame the victim",
> "blame the doctor", "blame the manufacturer", "blame the homeowner",
> "blame the consumer",  "blame the system".

> Somehow this odd word: iatroepidemic,  easily (seems to) evokes the
> idea that it is about "blame".  This is not true.  It is a word that
> should tell us that we need to go back to the books and study where
> things went wrong in order to get going (again) in a correct direction
> where there is less chance of harming patients because of the
> application of medical ideas to patient care.

> An iatroepidemic results from a process involved with the development
> of medical knowledge.  The phases of transcription, translation, and
> decay are crucial to the development of medical knowledge.  Sometimes
> what is thought to be a good idea is discovered in time not to have
> been such a good idea afterall.  It might have been a terrible idea
> but until it is understood where the ideas went wrong... well, what is
> to say the next ideas are any better?  Research has the potential to
> keep harmful practices away from masses of patients... but if the
> research its flawed... we still risk this problem.  Science is still
> at the hands of mankind.  It is not divine.  Errors can and do happen.

> There is an enormous difference between an iatroepidemic in its pure
> sense and malpractice or worse yet, fraud in healthcare.   Fraud and
> negligence are not the same matters.  And an iatroepidemic and
> malpractice and negligence are not the same matters.  But there is a
> point at which there is or will be overlapping.   For example, if a
> maxillofacial surgeon in the USA implanted Proplast into a patient's
> TMJ in the year 2000, the innocence of that particular tangent of the
> TMJ iatroepidemic no longer applies.  If in 1986, a maxillofacial
> surgeon misrepresented the materials used by Vitek in TMJ implants,
> the misrepresentation of fact would need to be investigated.  Who is
> to say that misrepresentation existed?  If an article had been
> published in the professional journals advising surgeons to advise
> their patients incorrectly,  you can see how complicated the matter
> can become.  Would the surgeon have been to "blame" or was the surgeon
> just following the profession's leaders who were published and
> therefore "authoritative" on their subject matter?

> For those of you who have read the book "The TMJ Iatroepidemic", you
> might realize that the book delivered more than one message.  There is
> ample ambiguity, there is hyperbole, there is metaphor, and there is a
> feeling of human imperfection and struggle.  The content of the
> collective text reveals certain attitudes which are known to foster
> iatroepidemics.   There comes a point at which a particular
> individual's or group's attitude crosses the line between what is
> understandably acceptable to those sincerely wanting to understand and
> what is not.  This "line crossing" can be experienced by reading that
> book.

> Deciding how to weave the story that was needed to be told in order to
> give life to the TMJ iatroepidemic was not a simple decision.   Like
> any good recipe, the "chef" needs to decide how much of any single
> ingredient is just the right amount for the desired flavor... in the
> case of this book, no matter how you cut it, it seems there is too
> much of everything.  But in the real world, this is exactly how it is
> for the patients and many of the doctors who were, are, or continue to
> be caught up in this dilemma.  There is just too much anger, too much
> arrogance, too much bitterness, ... too much lack of trust, ... and
> too much harm to the patients harmed.

> When reading that book, if the reader thinks it is a struggle to
> understand what is what... it is nothing compared to the actual living
> of the patient who struggles to understand what is what... what was
> what... what will be.

> The TMJ iatroepidemic got its start because of what was thought to be
> good medicine but turned out to be not as good as it needed to be. In
> some aspects, it turned into terrible disaster.  This in and of itself
> is a human tragedy but not a crime.  The matter and question of crime
> is not the same as the iatroepidemic.  But without the iatroepidemic,
> the matters thought to be criminal might not have had a breeding
> ground.  Opportunism is a powerful motivator.   The question of
> criminal activity arrives in various tangents of the iatroepidemic.
> This is another reason why thorough understanding of the harm can not
> be underestimated if we are to fully understand this problem
> historically as it relates to treatment (physical and psychological)
> today and tomorrow.

> It is my belief as a "TMJ patient" (I believe the TMJ is central to my
> suffering) that much of what happened, especially to implant
> recipients, will simply never be known and the outcome of what lies
> ahead will come when and if it arrives in the future.  These people,
> the TMJ implant recipients of materials that failed to be safe or
> effective are an orphan population by definition.  Defined, this
> means: approximately less than 250,000 Amercians -- (whatever the
> decided percentage is, I don't know -- so we should remember that the
> number is dynamic) and as a general rule,  orphan diseases are not
> given the attention they deserve mostly because of economics.

> What does all this mean anyway???

>Webby