Thursday, May 21, 2009

Are You a “Why not?” Person or a “Do no Harm” Person?

Hippocrates (460-370 BC)

Image via Wikipedia

Michael Pollan pointed out to this distinction when he was describing the mentality that lead to the erroneous low fat diet recommendation. Michael Pollan point to this  in his must read book ‘In Defense of Food: An Eater's Manifesto’ . In the absence of good evidence to recommend a low fat diet, the advice to eat a low fat diet was popularized. Many of us who followed this advice ended up with larger waistlines and worse health. If you don’t agree with this conclusion, read the book or listen to one of Michael Pollan’s podcasts. A Google search will allow you to find one of these.

There are two practices that come to mind that uses the ‘Why not?’ philosophy instead of the ‘Do no harm’ philosophy: aspirin for healthy individuals and tight control for type II diabetics. Discussing the evidence for the fruitlessness of these two approaches is beyond this post. The discussion I would like to raise here is the need to avoid the ‘Why not?’ mentality.

Physicians in primary care deal with two different types of problems when dealing with patients. The first is treating illnesses and the second is preventing illnesses or their complications.

When trying to alleviate human suffering, that is when treating patients’ ‘illnesses', the line between ‘Why not?’ and ‘Do no harm’ can be hazy. But, drawing the same line when trying to prevent illnesses or their complications should be clear. I believe we should not weaken ourselves or to our patients’ desire for an easy and comforting measure by taking a pill to prevent an illness when the evidence is too weak to support it. We should first and foremost do no harm.

Reblog this post [with Zemanta]

No comments:

Post a Comment