This important guiding principle was abandoned by
modern medicine, according to which it is the outcome of ignorance, and equals
malpractice. And yet, you examine a woman with a small lump in her breast. She
is, and feels healthy. This small tumor does not cause any pain or other
discomfort. Why not wait?
This is just what Hippocrates in his 38th aphorism, recommends: "It is better not to treat those who have internal cancers since, if treated, they die quickly; but if not treated they last a long time. Was it ignorance, that made him to conclude that, or lack of technological means to remove the tumor? Todays medical establishment would sue him for malpractice, since he knew nothing about cells, tissues, breast cancer genes etc., he obviously was wrong.
On the other hand, Hippocrates was a good patient observer, a gift that modern practitioners generally lack.. Otherwise they would be impressed by the fact that the patient with the lump in her breast is, and feels healthy. "Her feelings deceive her" is the usual answer. "She obviously has a tumor!" And yet, since even today treatment generally fails, Hippocrates recommendation holds.
Since organism is extremely complex, treatment involves uncertainty, that justifies a "Primum non nocere" approach. Medicine, on the other hand, presumes that this complexity may reduced to simple rules, and uncertainty is minimized. It views the organism as a complex machine, that can be reduced to physical and chemical laws. A wait and see attitude, is unnecessary.
Modern technology reveals that the organism cannot
be viewed anymore as a machine. A revolution that sweeps Physics, known as
Chaos theory, reveals that when Physics turns its attention, to phenomena
like climate, or stock market, its simplifying attempts fail. Machine laws fail
to predict weather, since it cannot be reduced to stable components like a machine.
What underlies weather are processes, e.g., wind, temperature gradients, and
water streams. The organism like a hurricane "eye" is made of processes,
and like hurricane defies machine laws.
The basic element of weather and biology is not an atom or molecule, but a dynamic non linear process. Weather is a changing process, and so is disease. In this context "Primum non nocere" acquires a new meaning: "wait until the process ripens for treatment!" The question is not only whether to treat, but when to intervene. Disease has to be watched like a growing fruit until it ripens for treatment.
Despite ever changing processes that operate in the organism, it maintains an unchanging appearance, known as homeostasis, that is controlled by the Wisdom of the Body (WOB). WOB is a metaphor for the capacity of the organism to maintain its processes unchanging. Like gravity in physics, WOB has to be taken by medicine for granted. The significance of gravity is that it exists, and drives most physical phenomena. In the same way WOB also exists, and controls processes in health and disease. Gravity has a direction. It pulls toward earth center. So does WOB. Its drive (pull) is to improve health. Like life, this drive is also taken for granted.
Treatment is justified only if improving health. Unfortunately, medicine lacks a health measure for evaluating treatment. Until such a measure is found, treatment has to be in accord with WOB, since only WOB knows how to improve health. When health is threatened it communicates with our consciousness. Like the message "thirst" which means: "Your water reserves are diminishing. Unless you drink water, I cannot maintain an unchanging water balance." Other messages that inform our consciousness about the state of different processes, are ignored by medicine. Yet they have to be considered during any treatment, otherwise health is threatened.
In this context , "Primum non nocere" means: "Consult the WOB!
Cancer Yogi drives his system (organism) further, along the same path.
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