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@COREIMpodcast Interesting thread, though some very common misconceptions about "primum non nocere" are present here. First do no harm is not in the Hippocratic Oath at all, and the "non-malfeasance" present in oath would likely make most modern doctors squeamish.
@COREIMpodcast It has diktats against performing abortion, and against physician-assisted suicide. Even the commonly cited "do not cut for stone" isn't because of preventing harm, but suggesting that a lithotomist do it.

(good translation here: nlm.nih.gov/hmd/greek/gree…)
@COREIMpodcast The closest quote comes from Epidemics I:

"The physician must ... have two special objects in view with regard to disease, namely, to do good or to do no harm"

(source: perseus.uchicago.edu/perseus-cgi/ci…)
@COREIMpodcast Even in antiquity, physicians took umbrage at this line. Galen pointed out that many interventions that might be helpful can also cause harm in the process.
@COREIMpodcast The context of the quote also points to Hippocrates' point -- the physicians "art" is to help nature (the next line is "the physician is the servant of the art, and the patient must combat the disease along with the physician").
@COREIMpodcast And this is where Primum non nocere became very popular -- in the middle of the 19th century, when the "therapeutic nihilists" started to promote the healing power of nature, primum non nocere was used to attack traditional therapeutics (eg, Oliver Wendell Holmes' famous quote)
@COREIMpodcast Galen's anxieties about "primum non nocere" have been proven even more valid in the era of scientific medicine, as many of the (admittedly effective) treatments that we use cause harm as well -- sometimes grievous harm (for example, ICU care).
@COREIMpodcast The pithiness of primum non nocere disguises the many difficult trade offs we have to make between immediate and delayed harm, efficacy, patient preferences, &c.
@COREIMpodcast I much prefer my eponymous Rodman's law:

"When there is no reason to believe that one treatment works any better than the other, choose the one that sucks less for the patient."

And yes, I'm trying to make this a thing. If only I had written it in 500 BCE 😀
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