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August 15, 1977

Primum Non Nocere

JAMA. 1977;238(7):589-590. doi:10.1001/jama.1977.03280070029018

THE DICTUM primum non nocere—first, do no harm—is a carry-over from the distant past and probably originated with Hippocrates, when therapeutics was not based on sound scientific knowledge and rationale and the medicaments available were more likely to be harmful than helpful. If indeed this phrase originated with Hippocrates, it was undoubtedly taken out of context. In "Epidemics," Hippocrates wrote, "As to diseases, make a habit of two things—to help, or at least to do no harm."

The Benefit-Risk Ratio  This was obviously Hippocrates' attempt to define what we now call the "benefit-risk ratio" in modern therapeutics. The problem is that, strictly interpreted and applied in the modern era of scientific therapeutics, primum non nocere prohibits any risk and therefore effectively prevents any meaningful therapeutic endeavor. It becomes the shield of the therapeutic nihilist, the battle cry of consumer advocates to thwart new drug development, and the justification of