Why We Need To Replace Hippocrates’ Oath And Apocryphal Trope

The skeptical cardiologist has never liked the Hippocratic Oath and so was quite pleased to read that it is gradually being replaced by more appropriate oaths with many medical graduates taking an excellent pledge created by the World Medical Association.

Here’s the first line of the Hippocratic Oath

Asclepius with his serpent-entwined staff, Archaeological Museum of Epidaurus

I swear by Apollo the Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

Much as I enjoy the ribald hi jinx of the gods and goddesses in Greek mythology and appreciate the back story behind words like panacea and hygiene* I just don’t feel it is appropriate to swear an oath to mythical super beings.

Let Food Be Thy Medicine-The Apocryphal Hippocratic Trope

Hippocrates is often cited these days in alternative medicine circles because he is alleged to have said “let food be thy medicine and medicine thy food.”

I’ve come across two articles that are well worth reading on the food=medicine trope which is often used by snake oil salesmen to justify their useless (presumably food-based) supplements.

The first , entitled “Hey, Hippocrates: Food isn’t medicine. It’s just food” comes from  Dylan Mckay, a nutritional biochemist at the Richardson Centre for Functional Foods and Nutraceuticals, He writes:

Food is so much more than medicine. Food is intrinsically related to human social interactions and community. Food is culture, love, and joy. Turning food into medicine robs it of these positive attributes.

A healthy relationship with food is essential to a person’s well-being, but not because it has medicinal properties. Food is not just fuel and it is more than nutrients — and we don’t consume it just to reduce our disease risk.

Seeing food as a medicine can contribute to obsessing about macronutrientintake, to unfairly canonizing or demonizing certain foods, and to turning eating into a joyless and stressful process.

People tend to overvalue the immediate impact of what they eat, thinking that a “super food” can have instant benefits while undervaluing the long-term effects of what they consume over their lifetime.

The Appeal to Antiquity

The second article is from the always excellent David Gorski at Science-based Medicine entitled let-food-be-thy-medicine-and-medicine-be-thy-food-the-fetishism-of-medicinal-foods.

Gorski notes that just because Hippocrates is considered by some to be the “father of medicine” and his ideas are ancient doesn’t make them correct:

one of the best examples out there of the logical fallacy known as the appeal to antiquity; in other words, the claim that if something is ancient and still around it must be correct (or at least there must be something to it worth considering).

Of course, just because an idea is old doesn’t mean it’s good, any more than just because Hippocrates said it means it must be true. Hippocrates was an important figure in the history of medicine because he was among the earliest to assert that diseases were caused by natural processes rather than the gods and because of his emphasis on the careful observation and documentation of patient history and physical findings, which led to the discovery of physical signs associated with diseases of specific organs. However, let’s not also forget that Hippocrates and his followers also believed in humoral theory, the idea that all disease results from an imbalance of the “four humors.” It’s also amusing to note that this quote by Hippocrates is thought to be a misquote, as it is nowhere to be found in the more than 60 texts known as The Hippocratic Corpus (Corpus Hippocraticum).

Gorski goes on to point out that:

this ancient idea that virtually all disease could be treated with diet, however much or little it was embraced by Hippocrates, has become an idée fixe in alternative medicine, so much so that it leads its proponents twist new science (like epigenetics) to try to fit it into a framework where diet rules all, often coupled with the idea that doctors don’t understand or care about nutrition and it’s big pharma that’s preventing the acceptance of dietary interventions. That thinking also permeates popular culture, fitting in very nicely with an equally ancient phenomenon, the moralization of food choices (discussed ably by Dr. Jones a month ago


We’ve learned a lot about medicine and nutrition in the last 3 thousand years. We can thank Hippocrates, perhaps, for the idea that diseases don’t come from the gods but little else.

It’s time to upgrade the physician pledge  and jettison the antiquated Hippocratic Oath.

We now have real, effective medicines that have nothing to do with food for many diseases. It’s important to eat a healthy diet.

But the food=medicine trope is just too often a  marker for pseudo and anti-science humbuggery and should also be left behind.

Hygienically Yours,

-ACP

*From Wikipedia, an explanation of the Gods and Goddesses mentioned in the Hippocratic oath

Asclepius represents the healing aspect of the medical arts; his daughters are Hygieia(“Hygiene”, the goddess/personification of health, cleanliness, and sanitation), Iaso (the goddess of recuperation from illness), Aceso(the goddess of the healing process), Aglæa/Ægle (the goddess of the glow of good health), and Panacea (the goddess of universal remedy).


The Physician’s Pledge

  • Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948
    and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968
    and the 35th World Medical Assembly, Venice, Italy, October 1983
    and the 46th WMA General Assembly, Stockholm, Sweden, September 1994
    and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
    and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006
    and the WMA General Assembly, Chicago, United States, October 2017

  • AS A MEMBER OF THE MEDICAL PROFESSION:

  • I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

  • THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

  • I WILL RESPECT the autonomy and dignity of my patient;

  • I WILL MAINTAIN the utmost respect for human life;

  • I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;

  • I WILL RESPECT the secrets that are confided in me, even after the patient has died;

  • I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

  • I WILL FOSTER the honour and noble traditions of the medical profession;

  • I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

  • I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

  • I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

  • I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

  • I MAKE THESE PROMISES solemnly, freely, and upon my honour.

 

 

7 thoughts on “Why We Need To Replace Hippocrates’ Oath And Apocryphal Trope”

  1. This strikes me as a bit like “the tempest in a teapot.” It is much like a prayer that we have an historical connection with, It is about service. .NO ONE thinks about it after it is finished. At graduation, physicians know their responsibilities (whether they live up to them or not). The oath needs no updating, it is formality & nothing more. HRS, MD, FACC

  2. An oath is a one-sided promise’ it is a contract to all intelligent ;life, that says, in effect, that the oath-taker says that he/she will act or not acrt as said, or that if not, his future words should be regarded as worthless and untrustworthy; and that therefore his oath should be published for all to see.
    Now, reflect on oaths taken by public servants and politicians, or anyone who speaks (i.e. or tweets) to the public. Are you a fool to support him/them?

  3. The new pledge thoughtfully expresses what every patient wants/needs from a doctor. It also addresses the key difficulties it seems each generation of medicine must wrestle with.

    I am curious–you mention the oath, but most of your examples come from a saying attributed to Hippocrates, dealing with the trope, so there’s not much from the oath itself. There are many things from antiquities that are timeless and do translate into our modern cultural needs beyond starry-eyed nostalgia–for example, the Biblical list 10 Commandments and similar lists of basic rules found in other ancient texts from Hammurabi to Confucius still match up with basic codes of conduct today, and some groups still claim the creeds of those who have gone before them and to good effect. What is it about the Oath that makes it particularly unsuitable to the medical profession of today? I realize all doctors are familiar with the rest of the oath (and probably mentally filling in all the blanks), but are there particular examples you find outdated besides his swearing by pagan gods no one believes in anymore?

    One more thought, to expand on Dr. Silverstein’s comment–sometimes such formalities & rituals serve to tie us to those in whose steps we follow–even while we recognize their faults and foibles. Isn’t there at least a measure of value in this? Particularly as you have pointed out that the spirit of Hippocrates’ medicine was observation and making connections between patient history and disease (as opposed to the magical thinking of his day that the linked articles point out). It’s the medical struggle we all (doctor & patient) face–objectivity, willingness to question, and limitations both in what we know and in our ability to be as completely objective as we wish to be. Not to mention the limitations we share of living in a world where sickness, disease, and death haunt us all–no matter how good our diet, or dialectic, may be!

    (These thoughts and questions in no way detract from the excellence of the new physicians oath, though! Or the value of putting into our own words even the values we share with our predecessors.)

    1. Heres the full Hippocratic oath which contains quite a bit which I think either irrelevant, weird, outdated or plain wrong. I felt like I would be beating a dead horse to go into more detail.
      I swear by Apollo the Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
      To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.
      I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
      Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
      Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.[4] –

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