Iatrogenesis | Kaelan

“Iatrogenic” means “caused by the healer” — from the Greek iatros (physician) and genesis (origin). Medical interventions that harm more than they help: unnecessary surgeries, overprescribed antibiotics breeding resistant bacteria, hospital infections acquired while treating something else. The cure becomes the disease.

Ivan Illich expanded the concept in Medical Nemesis. Clinical iatrogenesis is the direct harm from treatment. Social iatrogenesis is the harm from medicalizing normal human experiences — turning aging, sadness, and childbirth into conditions requiring professional management. Cultural iatrogenesis is the deepest: society loses the capacity to cope with pain, sickness, and death without institutional intervention.

The concept generalizes beyond medicine. Every intervention in a complex system risks iatrogenic harm. Economic policy meant to help can backfire: rent control reducing housing supply, minimum wage increases accelerating automation. Educational interventions can harm: testing regimes that destroy love of learning, early tracking that creates self-fulfilling prophecies.

The mechanism is second order effects. Interveners see first-order benefits (the patient feels better, the metric improves) while missing second-order costs (dependency develops, the system adapts perversely). The benefits are visible and attributed; the harms are diffuse and unexplained.

The lesson: respect the system’s existing wisdom before intervening. Bodies often heal themselves given time. Markets often self-correct given space. Communities often solve problems given trust. The question before any intervention: is the cure likely worse than the disease?

Nassim Taleb proposes a simple heuristic: the burden of proof should be on the intervener, especially in complex domains. “First, do no harm” encodes humility about how little we understand the systems we’re trying to fix.