Tag Archives: precautionary

The “do no harm” lie

posted by Carl V Phillips

To complete our series on the amazingly bad anti-THR position statement from the European Respiratory Society (presumably via Christina Gratziou), I will pick up the sentence I skipped in the previous post that pointed out their dishonest and otherwise abysmal use of source citations.

In general, ERS subscribes to the medical principle of primum non nocere and holds that Tobacco users “should not trade one carcinogenic product for another…”[6]

To finish up the theme from the previous post, let’s start with the citation, which is to the 2003 Congressional testimony of US Surgeon General Carmona about smokeless tobacco and THR.  As bad as the other six citations I discussed in the previous post were, this one packs in an unbelievable amount of fail:  They cited what is basically an opinion statement from 2003 — practically the dawn of history in THR terms — in a document about emerging products.  That particular statement is one of the most completely debunked anti-THR polemics in history, and made Carmona look like an idiot to anyone who understood the subject.  It was only about the smokeless tobacco products that existed in 2003, not the majority of the products discussed in the document.  The evidence then, as now, did not support the claim that popular smoke-free products were carcinogenic at a measurable level.

And finally, why would someone cite a source for a normative assertion (i.e., saying what they think should be the case) that is described in terms of “we hold that….”?  Their opinion is still just their asserted opinion (and is just as lies-based and harmful) in spite of someone having used the same phrase once, a long time ago.  Grade: F-minus-minus-minus.

But there is much more to this one horrible sentence (and I am not talking about the odd capital “T”):

That “primum non nocere” for those who do not speak pointless obnoxious pretensiousnessLatin, it means “first, do no harm”, a phrase that is somewhat mis-attributed to the Greek, Hippocrates.  The thing is, there is no such principle.

The words exist, of course, and they are even repeated frequently.  But they do not mean anything very useful, and cannot be the reason for a belief or claim.  The phrase is most often — perhaps even virtually always — used as a rationalization to dress up an existing opinion.  When you see these words used in anti-THR, you know you are dealing with someone with either limited understanding of what they are talking about, or who is a liar.

The simplest interpretation of that phrase is:  never do anything that might cause any harm.  But this effectively precludes all actions in health and medicine, and most any other action of any sort.  Any action stands a chance of doing harm.  Most medical procedures definitely do some harm, and all of them stand a chance of doing more harm than good in a particular case.

The usual response to anti-THR people invoking this non-principle is to point out that even as they oppose THR, they (usually) endorse anti-smoking pharmaceuticals, including those that sometimes cause people to become violent or suicidal — obviously causing harm.  But it is not necessary to get into such details to see that neither they nor anyone else actually believes that “never do anything that might cause harm” is good advice.  Cutting a hole in someone to remove a ruptured appendix does harm to the tissue on the way in, after all.

But, you say, we expect that the surgery will do more good than harm, so it is obviously a good idea.  Of course it is.  But it is doing some harm.  This observation suggests that we need to instead interpret the “principle” as something like: do not do anything that we expect will do more harm than good.  (In economist-speak — and this is really an economic statement — that reads: do not do anything with negative net expected value.)

That seems like good advice.  And it is.  It is such obviously good advice that it is not worth giving.  Of course we should not do things that we expect will do more harm than good.  If that is all the principle means, then the claim that it argues against THR is clearly wrong.  But even apart from that, this is clearly not what they are saying when they cite the “principle”, since making such a claim would require estimating the harm and good of an action and comparing them, and the ERS (and basically all anti-THR statements) fail to do that.

So can we find a definition of that phrase that is not utterly stupid advice (never do anything that might cause any harm) and is also not so obvious as to be unnecessary (do not do things that you predict will do more harm than good)?  It is typically interpreted to mean something like, “if you have no idea what might be helpful for someone, then do not just jump in and go mucking about, doing things that are just as likely to hurt as to help.”  But the key to this is being in a situation where you have no idea whether something will do good.  That contrasts with the situation surrounding THR, where we know that encouraging smokers to switch to low-risk alternative will do good.

In short, the ERS — and anyone making a similar claim — is just throwing out a fancy-sounding phrase that has nothing to do with the situation at hand.  They are lying when they suggest that there is a principle that supports their position. What they are doing is engaging in word games, suggesting that because there might be some harm, maybe, from encouraging THR, that doing so is precluded by the “principle”, whereas all other actions are allowable so long they are expected to do more good than harm.

(Note that when someone refers to the “precautionary principle” in the THR context, they are engaging in basically the same lie, though it is actually a bit worse.  I will come back to that when an example presents itself.  I am tagging with “precautionary” if you come across this post in the future and want to find that.)

I will conclude this series by noting the end of the ERS statement:

ERS…maintains that the best health advice to smokers is to quit smoking.

Oops, maybe I should not have been so hard on them.  Maybe they are pro-THR after all.