Multimorbidity, Polyiatrogenesis, and COVID‐19

Abstract

To date, the strongest predictor for dying with COVID‐19 is suffering from several chronic disorders prior to the viral infection. Pre‐existing multimorbidity is highly correlated with socioeconomic inequality. In turn, having several chronic conditions is closely linked to multiple medication intake, especially in richer countries with good access to biomedical care. Owing to its vertical structure, biomedicine often risks giving multiple treatments in an uncoordinated way. Such lack of integrated care can create complex forms of iatrogenic harm. Multimorbidity is often exacerbated by a pharmaceuticalization of social deprivation in place of integrated care. In this article, I explore the possibility that clusters of over‐medication are a contributing factor to higher death rates from COVID‐19, especially in poorer areas within richer countries. Anthropological perspectives on the social embeddedness of multimorbidity and multiple medication use can expand our understanding of who is most vulnerable to SARS‐CoV‐2.

Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective

“…In addition to access to primary care, the differential quality, continuity, and integration of primary care across the socioeconomic ladder [18,19] could have also contributed to the observed socioeconomic difference in the risk of multimorbidity on COVID-19 severity. The lack of integrated care, commonly experienced by the socioeconomically disadvantaged with pre-existing multimorbidity, is likely to harm the disease prognosis of COVID-19 because of uncoordinated multiple treatments and over-medication [44][45][46]. In summary, the better access to integrated primary care among patients of higher socioeconomic position even during the COVID-19 period, coupled with their generally better health literacy, health information-seeking behaviors, and treatment compliance [47], may have enabled them to achieve more effective chronic disease management and therefore be better protected from the excess risk of severe COVID-19 due to multimorbidity if becoming infected.…”

Survival of COVID-19 with Multimorbidity Patients

“…However, in current societies, we have disregarded that multimorbidity is the new normal, as Eck quotes [30]. It accompanies the intake of polypharmacy in the elderly and those not so elderly, with all their untoward consequences.…”

“…Multimorbidity strongly correlates with prolonged medication use. About half of older adults in richer countries are taking five or more medications [30].…”

“…According to Ecks [30], the pharmaceutical industry promotes the regular consumption of five or more medications as necessary for maintaining health. For the industry, chronic polypharmacy is recommended as the new normal because multimorbidity is now normal.…”

Introduction: medicine’s shadowside: revisiting clinical iatrogenesis

“…Shadowside helps us articulate the harms that occur in overreaching, overly-technical, and capitalistic medical industrial complexes (Illich's primary concerns; see also Ecks 2020) to what occurs in low-resourced or 'unstable' health settings (Hamdy 2008;Jaffré 2012;Street 2014;Towghi 2018;Varley andVarma 2018, 2019;Varley 2019). The concept helps us find continuities between the wounding caused by the 'too much' medicine and 'too little' care that happens in neoliberal healthcare regimes.…”