Friday, February 03, 2012

Primum non nocere

“Primum non nocere”, Latin for ‘first,do no harm’ is one of the fundamental tenets of medicine and is part of the Hippocratic Oath that doctors are expected to abide by. As Wikipedia explains, Nonmaleficence, which derives from the maxim, is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good."

Nassim Nicholas Taleb in an essay writes:

Let's consider Medicine –which only started saving lives less than a century ago (I am generous), and to a lesser extent than initially advertised in the popular literature, as the drops in mortality seem to arise much more from awareness of sanitation and the (random) discovery of antibiotics rather than therapeutic contributions. Doctors, driven by the beastly illusion of control, spent a long time killing patients, not considering that "doing nothing" could be a valid option –and research compiled by my colleague Spyros Makridakis shows that they still do to some extent. Indeed practitioners who were conservative and considered the possibility of letting nature do its job, or stated the limit of our medical understanding were until the 1960s accused of "therapeutic nihilism". It was deemed so "unscientific" to decide on a course of action based on an incomplete understanding to the human body –to say this is the limit of where my body of knowledge stops.

The very term iatrogenic, i.e., harm caused by the healer, is not well spread -- I have never seen it used outside medicine. Sadly, further investigation shows that these iatrogenics were mere rediscoveries after science got too arrogant by the enlightenment. Alas, once again, the elders knew better –Greeks, Romans, Byzantines, and Arabs had a built-in respect for limits of knowledge. There is a treatise by the Medieval Arab philosopher and doctor Al-Ruhawi which betrays the familiarity of these Mediterranean cultures with iatrogenics.

I have also in the past speculated that religion saved lives by taking the patient away from the doctor. You could satisfy your illusion of control by going to the Temple of Apollo rather than seeing the doctor. What is interesting is that the ancient Mediterraneans may have understood the trade-off very well and have accepted religion partly as a tool to tame such illusion of control.
This is an interesting point. Religion by taming the illusion of control that people had and by forcing them to seek divine help may have prevented (and may still be preventing) them from going to a doctor who would prescribe needless medicines that would cause more harm than good.

George Bernard Shaw wrote a short story about the king of a country called Half-Mad. The king took ill and all the doctors of the kingdom attended on him and tried out different remedies to cure him. Nothing worked. Till a wise old man suggested that the king should go to a sea resort, “ Is it because you feel that the salt-laden air of the sea will have a therapeutic effect on him?’ the people ask him. “No”, the wise man replies, “ It will get him away from the doctors and cure him”.

Remember this may not work all the time. So don’t sue me if you decide to go to a temple instead of a doctor when you are ill.


ramesh said...

we had a humourous story in our hindi school prose book .. the fellow there had some stomach ache for which he went to all kinds of people till his wife remarked in the end that all he needed to do was eat less !

Raj said...

Ramesh, sensible wife.