This aphorism, considered to be part
of the Hippocratic Oath, is attributed to Hippocrates. Wikipedia say, “While there is no
legal obligation for medical students to swear an oath upon graduating, 98% of
American medical students swear some form of oath,” and a modified Hippocratic
Oath was common, according to a 1998 survey of Medical Schools.
“Physician, first do no harm,” is nevertheless, “…one of
the fundamental principles of medicine according to which the physician should
not cause harm to the patient” (Mosby's Medical Dictionary).
Regardless of the oath taken, it is the moral obligation of the physician to do
“the right thing” by his or her patient. Who could disagree with that?
It is therefore all the more interesting that in the
original oath (as translated in the Wiki citation above), Hippocrates pledges,
“With regard to
healing the sick, I will devise and order for them the best diet, according to
my judgment and means; and I will take care that they suffer no hurt or damage.” And it was, after all, Hippocrates,
the father of Western medicine, who said, “Let food be thy medicine and
medicine be thy food,” as I cited in “Retrospective #173.”
In #173 I compared two translations
in Wikipedia for the Hippocratic Oath. The first was, “I will apply dietetic measures for the
benefit of the sick according to my ability and judgment.” The current
translation in the earlier Wiki revised it to, “I will prescribe regimens for the good of my patients
according to my ability and my judgment and never do harm to anyone.” Notice
the difference? “apply dietetic measures” was replaced with “prescribe.”
I understand, of course, that
pharmacotherapy did not exist in ancient Greece, although herbal medicines,
salves, etc. have existed since the beginning of time. But, so has the enduring
and timeless truth: “Let food be thy medicine and medicine be thy food.” And
can any doctor not acknowledge
that the best medicine for treating type 2 diabetes is “the best diet?” Then,
assuming every doctor would agree with that, why would any doctor not
prescribe for every type 2 patient a diet much lower in carbs than the
60%
carbs that is the USDA’s Nutrition Facts Panel standard? (See #288).
If the physician is sincerely acting
in the spirit of the Hippocratic Oath, why would he or she not literally
“…apply dietetic measures for the benefit of the sick according to my ability
and judgment?” The answer to this
question is complicated: There’s are 1) guidelines that a doctor must
comply with to be paid for services by 3rd party payers and 2) low
reimbursement rates by 3rd party payers for patient services, 3) lack
of time with the patient, 4) patient’s “non-compliance” with a restricted calorie,
“balanced,” low-fat diet that the clinician believes
is a “healthy diet” and that is doomed to fail, and 5) probably most
significant of all, education, pressure and monetary incentives from Big
Pharma.
As a consequence, writing a script
and updating the patient’s electronic medical record are all that most
physicians have time to do. As practiced today in many large offices, medicine
is at best just a business; at worst, it’s a sham. I’m lucky. I have a caring sole
practitioner who is glad to see me and gives me the time to answer all the
questions I have.
But if you are overweight, obese,
pre-diabetic or diagnosed with type 2 diabetes, and your
physician is one who actually believes that a restricted calorie, balanced,
low-fat diet is the best way to lose weight and keep it off and see improvement
in these conditions, plus hypertension (high blood pressure) and reduced risk
of coronary heart disease, cardiovascular (CVD) disease, several types of
cancer and even Alzheimer’s disease (AD), but you’re not sure, read on.
The evidence in support of another,
much healthier Way of Eating has been piling up from so many sources, and is
now aggregated in huge meta analyses – a very comprehensive
12-points-of-evidence elucidation by Richard Feinman, el al. in the January
2015 issue of Nutrition. Google this scientific review, and give your doctor a
copy. If this doesn’t work, it can’t be the why your doctor
doesn’t prescribe these “dietetic measures” for you, instead of a cocktail of
pills.
Could it be that it’s very hard to
switch horses in mid-career? Will we have to wait until the current generation
of doctors all die? Will that
be too late for you? The doctor who started me on Very Low Carb was also a sole
practitioner and semi-retired. Maybe he figured he didn’t have much to lose. He
took a chance and put his patient’s health first. But, YOU,
not your doctor, DO have a lot to lose. Maybe you, the
patient, should take a chance, before it’s too late.
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