Ignorantia Peritorum

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First: do no harm

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First: do no harm

... and the need for scientific humility

Ari Trachtenberg
Nov 1, 2022
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Medical students, courtesy of

A great piece on from Sensible Medicine on the need to factor in unknown costs to medications: There is no Such Thing as a Free Med [1]:

Sensible Medicine
There’s No Such Thing as a Free Med
In this guest post from Prof. Fenyves, he discusses the idea of a risk tax. That means there could be downsides to giving a medical product that we only learn of down the road— and we should include this in our decision making today. I think all great physicians think about this, but we don’t discuss it enough. Prof Fenyves puts it into words nicely…
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7 months ago · 31 likes · 2 comments · Paul Fenyves

Some quotes from the article:

  • ‘When suggesting a medical treatment, doctors often proffer the justification “it can’t hurt.” I believe “it can’t hurt” is fundamentally false, and should never be accepted as the sole reason for a medical intervention. A better adage to guide medical decisions is “there’s no such thing as a free lunch.”’

  • ‘To be clear, I say this not as a criticism of the medical community, but as a rationale for medical conservatism. In medicine, we are always playing with fire, wielding potent tools that can bring tremendous benefits, but must be handled with care, lest we get burned.’

  • ‘In the United States, we have recommended bivalent booster vaccines to young healthy people, and have doled out Paxlovid to low-risk vaccinated patients.  Both of these interventions lack evidence of benefit, and the maximum potential benefits are small.  While there might be no benefit, there always might be risk of harm (both known and unimagined), and doctors should scrupulously follow our first dictum to do no harm.’

  • ‘More generally, the history of antibiotics should remind us to exercise medical humility. The human body is complex, our understanding is incomplete, and our interventions can have unexpected consequences that only come to light years later. When the benefits are small and uncertain, we should proceed with caution.’

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[1] P. Fenyves, There’s No Such Thing as a Free Med, Sensible Medicine, 11/1/2022: https://sensiblemed.substack.com/p/theres-no-such-thing-as-a-free-med

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