I am persistently interested in use of the quotation "first do no harm" that is so often mentioned in medical contexts. There are those who attribute this to the "the ancient Greek Hippocratic oath." However, it turns out that "no translations of the oath contain this language." Scholars note that there are other potential sources of the sentiment or the actual words, perhaps even from other writings of Hippocrates. Some believe, however, that the
"first known published version of 'do no harm' dates to medical texts from the mid-19th century, and is attributed to the 17th century English physician Thomas Sydenham"
The phrase was used more recently in explaining why pediatricians are working to alleviate or eliminate race from medical science. Associated Press. Race-based medicine has been under scrutiny for some time. Recently, in Race Based Medicine (August 2021), the manner of inherent and assumptive racism is discussed as regards the National Football League. That application is largely founded upon historic unscientific conclusions of supposed experts. Before one is too critical of the NFL, it bears considering that the U.S. Government apparently once used the same unscientific methodology in its hiring practices (in its defense, it stopped decades ago).
The Associate Press reports recently that pediatricians are striving to come to grips with racism in medicine. The American Academy of Pediatrics has published a policy and intends to reexamine various guidance (advice) in order to acknowledge and "eliminate 'race-based' medicine and resulting health disparities." It is, after all, 2022. The concern is that such previous guidance has been responsible for "Black youngsters hav(ing) been undertreated and overlooked." Why has this recognition and move toward remediation taken so long?
The article notes that the pediatrician's move is not novel or unprecedented. There is discussion of "similar pledges" by groups such as the American Medical Association. It notes that the reexamination is "spurred in part by civil rights and social justice movements," which is notable. However, there is also recognition that science is an influence particularly as to how "social conditions, genetics and other biological factors play in determining health." It is possible that the foundations and ideas that are now being reexamined and discredited were nonetheless previously viewed at some point as "science" and that those who held the beliefs perhaps back then encouraged others to "follow (that) science. How is it that science has not itself challenged those inappropriate racist foundations previously?
The Associated Press provides specific examples of Pediatric Academy progress, notably as regards issues with urinary infections and newborn jaundice. There are recognitions by some physicians or scientists that new foundations and guidance may include an explanation “of how some of our frequently used clinical aids have come to be — via pseudoscience and racism.” Thus, in a nutshell, those guidances have been longstanding, discriminatory, and not based on science. It is probable, nonetheless, that the groupthink they represent was nonetheless something doctors and society were encouraged to believe or to "follow" (likely blindly).
An interesting side allegation is that at least one expert contends that the racist medicine group think, or pseudoscience, has "harmed patients." That result is noted in the article as regards scientist's "oath as physicians — to do no harm." Which reminds us again of the Hippocratic oath (or other writings, perhaps), or should we say the "Sydenhamic oath?" From whatever source, the concept of avoiding harm is admirable and appropriate in science, medicine, and likely elsewhere. How should that avoidance come, through consensus or science?
The pediatric group is encouraging others to follow its anti-racist lead. It advocates that "other medical institutions and specialty groups" should similarly address their foundations, premises, and guidance to "work() to eliminate racism in medicine." One source was quoted therein characterized medicine as a "a pipe full of holes," and advocated that plugging one hole (pediatrics) will be merely a start that other specialties and groups must emulate in order to address all of the potential faults (leaks). The implication is that there is systemic racism in a variety of specialties and premises.
The broader interest being pursued in this regard has also been newsworthy. An excellent example is a 2021 Nature publication Health Inequities and the Inappropriate use of Race in Nephrology. It concludes
"ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed"
Heterogeneity is "the quality or state of being diverse in character or content." The criticism is of bias, stereotypes, and race-based assumptions. In short, it seems suggestive that the physician should examine the patient, observe the specifics, define a diagnosis, and instigate treatment without reference to biases, prejudice, or racist groupthink. That this may seem a novel approach, is troubling and offensive. Treating the patient based on her/his symptoms, testing, etc. should always have been our course. Learning that care and treatment has been influenced by prejudice and bias is disturbing.
The critical point is that humans are each potentially physically distinct or different based on a variety of causes including personal genetics and biology. Medicine cannot treat each of us identically because we are not identical. Clearly, racism regarding medical diagnosis or treatment is both illogical and inappropriate. One wonders how the scientific community has awaited 2022 to address the false assumptions and foundations that have apparently been heretofore applied.
In a world in which we are all told to "follow the science," there exist such untoward examples of science and scientists not themselves following the science. There are, instead, instances in which consensus and "group think" have prevailed in a scientific community, to the detriment of some, perhaps many, maybe most. Whether we conclude that the pediatric association's current mandate does or does not include "do(ing) no harm," we must remain aware of the potential for consensus thinking masquerading as science.
We must applaud any effort to reexamine theories and postulates which may or may not remain appropriate. That such conclusions previously achieved consensus should not dissuade us from reexamination, critical testing, and new science-based postulates when appropriate. When asked to make assumptions or to reach conclusions based on a person's race, the entire chorus should ask why, challenge and question the science, and decry racism and prejudice. Medicine and science face many challenges, the unknown, the evolving, the pernicious. Racism should not be one of them.
