Primum Non Nocere- Time to Revisit a Foundation of Medical Practice

Primum Non Nocere
What it really means

Anyone who knows those of us at Advanced Pediatrics knows that we love what we do — helping families get and stay well.

Over the years we have been in practice, we have come to better appreciate this principle taught to every medical student in the United States: primum non nocere —first, do no harm.

While we spend much of our time helping cure a child's illness, easing someone's discomfort or suffering, preventing a problem from occurring, and offering counsel that helps, many possibilities exist today that could cause a degree of harm — even if slight. Thus we make a real effort to follow the dictum of primum non nocere.

So it came as a real shock to read the report released this week (in mid-July of 2015) by the American Psychological Association (APA) into their own investigation of a pattern of behavior by senior officials of the APA — past presidents, and the head of their ethics division. The report describes that these leading American psychologists gave official APA sanction for the use of “…harsh and abusive techniques…” on prisoners, in an effort to secure and maintain lucrative contracts from the Department of Defense and CIA.

Here is a link to the actual APA report:

The use of harsh and abusive techniques on prisoners of war may be controversial to some, but the notion that some of our country's top mental health professionals would essentially sell out their professional for money is not. The most troubling aspect of this situation is that it is not surprising.

For many years, we have heard of hospitals making decisions that favor profits over good practice; and of doctors taking drug money in exchange for studies with, recommendations of, and prescriptions for profitable medicines. The new motto of the day seems to be primum pecuniam, first money, rather than primum non nocere, first do no harm.

The good news is that this fundamental violation of what it means to be a health care professional was investigated and reported by the same organization whose leadership created the breach, the American Psychological Association (APA). Sadly, I remain skeptical.
While it is unlikely this particular breach will happen again, I doubt that past presidents of the APA and past chairs of their ethics committees will go on record and admit their role in this insult to our healthcare creed.

As a family member of Advanced Pediatrics, you can remain secure in the knowledge that we honor first do no harm. And that we will continue to pursue policies that attempt to keep the marketplace as far from any medical decision making as possible. This is why we when we opened, we created the self-regulating guideline of accepting no items from any pharmaceutical company. And why we try to base all our information on direct readings of the scientific literature, and not through the lens of any particular organization. This is also why we offer direct on-call access to Dr. Hertzer and me, and will not sign up for distant nurse call centers.

We are pleased that the APA has issued this report, but dismayed that leaders of such high stature could have missed so thoroughly the obvious obligation that being a healthcare professional entails. Advanced Pediatrics is an infinitesimal part of the medical professional landscape, but within our small arena, we will continue to make the obvious choices the right ones, namely, that the care of your family comes first.

In these times when trust is questioned so often, we are all the more grateful for the trust you have given to us.

To your health,

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