PRIMUN NON NOCERE: First Do No Harm.

c.2009, Judith Acosta(This appeared in edited version on Opednews.com and on www.wordsaremedicine.com)

Primun non nocere. This is still the promise of every medical school graduate across the country as he or she accepts the diploma, the title and the rank of healer in our culture. It is the core of the Hippocratic Oath. In a world of unreasonable speed, in which new discoveries and new pharmaceuticals are being produced in measures of seconds, not years, it may be more than doctors can promise us anymore.

What Does Do No Harm Require?

One, beyond the obvious (deliberate or malicious negligence) being called to “do no harm” requires at the very least a reasonable skepticism. This means that a physician—or any professional providing a treatment, including a pharmaceutical one—should at the very least question whether it has the right stuff to do what it’s touted to do. Does it cure what it says it’s going to cure? Or do people have one symptom go away only to have another (often more dangerous) one appear? Is there an actual need for the pharmaceutical or is it a drug being sold because of a massive fear campaign?

Two, the physician ought to be capable of weighing the risks and balancing the promised benefits against the delivered dangers. Does it reduce the pain of rheumatoid arthritis but give you a statistically significant chance to get cancer? Does it give you a longer-lasting erection but negatively impact your cardiovascular system?

And finally, the physician MUST ask: Is this safe? Will this product or procedure harm my patient?

The Current State of Harm

On July 13th of this year, the WHO presented the global media with their recommendations on the H1N1 vaccines. A small part of their “guidance” as George A. Ure called it in his piece, Calm Before the (Cytokine) Storm. were two points that are pertinent to this article:

1. All countries are being called upon to forcibly immunize health care workers as a tier-one strategy to guard the infrastructure should a pandemic materialize.

2. Since current production is insufficient, they are recommending a laddered approach to “immunization” starting with pregnant women, children of 6 months old with one of a few specific medical conditions, healthy young adults 15 – 49 years of age, then healthy children, then healthy adults 50 – 64 years of age and finally the elderly.

3. Because some of the pandemic vaccines have been created with new technologies which have not yet been properly studied for their safety in certain population groups, the WHO is strongly urging post-marketing surveillance.

What do these recommendations mean? How does a physician who has promised to do no harm interpret then act on this information?

Definitions and Recommendations

Let’s take the first recommendation: “…should a pandemic materialize.” That is a fair statement on the surface, but our track record on these things is not very good. We are usually afraid of far more than we should be and do far less about the things we should be afraid of. People are afraid of household germs as if a serial killer were hiding in their basement, but they (as we saw recently) stand on rocky shorelines as hurricane-force waves batter the boulders they’re standing on.

For instance, in 1976, the US government vaccinated 45 million people for a swine flu outbreak that never materialized. In its wake 500 people developed a rare neurological condition called Guillain-Barre syndrome while left many people in comas and 25 dead.

Recommendations numbers two and three are important to read together because in effect it says: we are targeting specific populations, but we don’t know what it’s going to do to specific populations because the vaccines produced with new technologies have not been properly tested.

If I had taken an oath to do no harm, I would be properly worried at this point.