DO No Harm

This is often considered a main component of the Hippocratic Oath, which of course is recited at most medical school graduations.  Well, sort of.  An actual translation of what is written in the Oath would be more like: “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

The words “Do No Harm” are actually a translation of Primum Non Nocere, which is the Latin phrase found in a different work of Hippocrates known as Of The Epidemics.

There is a difference of course.   Avoiding harm is easy to understand but following a system of regimen?  Not sure if I like sticking with a flow chart knowing the incredible complexity and intricacies of human biology.  For the sake of this discussion, let us consider that both are taught to medical students as important principles of patient care.  Can we say that either principle is always followed when we look at all aspects of treatment?

It is hard to say where things may have started to get murky with respect to the no harm component.  Maybe pharmacology and a more allopathic approach overall have resulted in a greater acceptance of collateral damage.  Some might argue that the numerous side effects of medications are acceptable because of a triage-like approach to chronic disease.  I would agree that many surgical procedures are necessary to improve the quality of an individual’s life, despite the potential hazards of specific surgeries.  There are undoubtedly numerous other examples that we can look to which would represent situations where some harm or damage may occur in an otherwise greater effort to improve the state of a patient’s health.  However, when it comes to nutrition and the nutritional support of patients, there are unacceptable levels of patient harm.  The food and enteral formulas that are served to most patients clearly represents deleterious treatment.   Everyday, in hospitals across the US, patients are fed meals and enteral formulas with the same exact characteristics as the diet that may have landed them there in the first place.

How is it that patients are fed heavily sweetened, fried, and processed foods with a high level of pro-inflammatory effects and little nutritional value?  This aspect of medical treatment lies in complete contrast to the point about “abstaining from whatever is deleterious.”  How does the food we serve patients get completely overlooked as an aspect of disease care?  Hippocrates, often considered the father of modern medicine, held nutrition and the healing powers of food as central aspects of treatment.  It was through his and the observations of other early physicians, that a patient could not fully recover or get well without the proper diet.

Apparently there are at least some concerned physicians who are aware of this discord and speak out about it publicly.  As written in the American Medical Association’s Journal of Ethics, some of these physicians see the need to serve foods that support health and to also expose patients to healthy meals that will ultimately teach them how to eat better. http://journalofethics.ama-assn.org/2013/04/ecas3-1304.html

The same should be said for enteral nutrition.  If patients cannot eat food orally, why is it then necessary to provide them with a meal replacement largely made up of sugar?  Wouldn’t this also be considered “deleterious” to health?  In response to that argument we sometimes hear that enteral formulas are: “what is necessary at that point in time.”  There is absolutely no validity to this way of thinking.

Other than cases where there is the necessity of a clear liquid diet or in unique metabolic situations, such as in renal disease, blenderized diets made from whole foods or organic whole food formulas without any significant source of sugar should be the standard of care.  Not fruit juice or fruit juice concentrate sweetened formulas and not fruit puree-based formulas either.

In our opinion, anything other than organic, whole foods, low in sugar, is what we should be feeding everyone possible. Accepting anything less is certainly following “that system of regimen” which is in place, but is doing so without any “ability or judgment”.  It is time that we start getting this right.

 

~ John Bagnulo MPH, PhD.