Iatrogenic disorders.

The contemporary physician and his patient are riding the crest of the most dramatic expansion of medical capability in history. But the rapid proliferation of medical knowledge has not been entirely benign. Although our reverses have been minor in contrast to our advances, negative effects cannot be ignored. My discussion involves one aspect of this problem-the emergence of what I have called "Diseases of Medical Progress" (Moser, 1964) . Pertinent to the evolution of medical capability has been the improvement in quantity and quality of drugs. In the early days new drugs came in a trickle, and there was time for the physician to become familiar with their virtues and idiosyncrasies. Soon the trickle became a stream, and there was less time for study and reflection. The stream has now become a torrent; it is impossible for the physician to keep pace. His little black bag runneth over. It has been said that druginduced adverse effects are the price we have to pay for more effective medicaments (Zbinden, 1964). There can be no quarrel with this statement; it is the high price we are haggling about. The thalidomide disaster indicated how expensive it can be. The deluge of new drugs has produced widespread discontent with empiricism in therapeutics. The modern practitioner demands drugs with proper credentials. This has precipitated a virtual renaissance in drug investigation, and thus we have come to learn more of the wonders and hazards of contemporary therapeutic agents. The demands of the clinician to know more about drugs are being met by increasing capability in the laboratory. New insight and appreciation of the complexities of drug effects have come from several diverse avenues of investigation. The wedding of percutaneous biopsy and electron microscopy has resulted in dramatic revelations; the mysteries of intracellular morphology and physiology in the living organism have begun to yield. Often, we are able to observe the specific site of drug action within the cell. In other areas techniques continue to be perfected for assay of blood and tissue levels of drugs, intermediate products and enzymes. The problems of adverse drug effects are many. Reduced to simplest elements, when Drug "A" is introduced into the body, ultimately it or its intermediate products will be carried in blood and body fluids to all cells of the organism. The effects of Drug "A" become clinically perceptible only when the function of certain organs is modified, either beneficially or detrimentally, to the point of producing perceptible changes, and it is by these phenomena that we learn to characterize the nature of Drug "A." As we focus attention upon the response of a specific organ (or organs) to th is drug, we are inclined to forget that Drug "A" is also in contact with other tissues of the organism. Effects in