Primum non nocere. 'First, do no harm'

Hippocrates was a Greek physician who lived c. 460 - c. 370 B.C. He is often referred to as the father of modern medicine because he was one of the first to describe his observations in a scientific manner. He wrote more than 70 books.

He might be most well-known for his ancient decree of primum non nocere, or, first, do no harm. This Hippocratic oath is still taken by many medical school graduates. Perhaps politicians should consider taking a similar oath when they take office.

COVID-19 is a dangerous virus to the elderly and the frail (and those who live in New York City). But our reaction to the virus has caused more harm than the virus itself.

As more and more data become available, it is clear that the overall fatality rate of this virus is around 0.2% which is in the ballpark of a bad influenza season. This is twenty times lower than originally assumed by the WHO. The fatality rate is higher for nursing homes and assisted living patients who account for close to 50% of all deaths in the United States, and much lower for younger Americans.

The average age of the deceased in most countries is more than 80 years old. For younger Americans (<25) there is a greater risk of being killed in an automobile accident than from COVID-19 yet we continue to cogitate about opening up our schools. The COVID-19 death toll IS now coming into question as official figures do not differentiate death “from” COVID-19 vs. death “with” COVID-19. In addition, we are learning that many presumed COVID-19 deaths had no laboratory confirmation and may have been coded as such to capture increased reimbursement for COVID-19 deaths from various government agencies.

I believe that when history books are written, we will view our reaction to this virus as the greatest mistake in human history. The continuation of our initial response to the virus is no longer just a mistake it is bordering on malice. With over 30 million Americans now unemployed and estimates that 40% of those will not have jobs to return to, the economic devastation has crippled America and the world. The self inflicted economic shutdown has also caused an almost complete shutdown of our outpatient health care system.

Doctors from all all over our country report devastating consequences to their patients. Recently I co-authored with Simone Gold, M.D., J.D. a letter written to President Trump highlighting this health care crisis.  This is documented at Two days after The White House received this letter Dr. Fauci changed his message: 

Stay-at-home orders intended to curb the spread of the coronavirus could end up causing “irreparable damage.” - Dr. Anthony Fauci

A psychiatrist reported that his office volume is down by 80% and his prescriptions for benzodiazepines (Valium, Xanax, Ativan) are the highest of his career. Patients who require frequent visits to stay functional are not coming into his office due to fear. A cardiologist reports that routine echocardiogram and other non-invasive cardiac testing is not being done due to local decisions making these procedures non-essential. There is also patient fear of coming into a doctor's office. A gastroenterologist reported that his routine cancer screening colonoscopies have stopped altogether and a gynecologist reported that cancer-screening pap smears and mammograms have ceased. I am personally aware of a 61 year-old patient who died of intestinal obstruction because he feared going into his doctor's office. Instead, he suffered at home, ultimately succumbing to sepsis. This is being repeated across our country with devastating consequences. False information about waiting for a vaccination, the need for widespread testing, mask-wearing, and potential asymptomatic spread of COVID-19 fill the airways and stoke unnecessary fear among the American citizenry. Winston Churchill once quipped “Fear is a reaction, courage a decision.”

Primum non nocere. Maybe it is time we remember Dr. Hippocrates' ancient dictum of; first do know harm. It would go a long way not just for our doctors but also for our elected representatives.


Jeffrey I. Barke, M.D. is a board-certified primary care physician.

Image credit: Pixabay public domain

If you experience technical problems, please write to