Vaccine harm and the Hippocratic oath

One thing I have noticed from those critical of modern medicine is their misuse of the Hippocratic oath of premum non nocerce – “first do no harm”. Despite the original oath not stating this at all, it has become one of the foundational myths of the anti vaccination industry.

There was no mention of taking the oath in my medical school, and its uptake is variable. So what does it, or at least, a reasonable translation of the oath actually say?

“I swear by Apollo 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 Healer’s oath, but to nobody else.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. 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hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.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”

The good

So much of the oath is noble enough; respect for ones teachers, care with dietary advice, not poisoning people, referral to specialists when needed, confidentiality, abstention from all intentional wrong doing and harm of course. The notion of “first doing no harm” at all came much later.

The bad

There are a number of problems, mostly relating to its antiquity. Aside from the non existent gods, believed in (as are gods modern upgrades) by intelligent people at that time, the notion of holding ones teachers as highly as kin and to teach other freely has been overtake entirely by modern medical training. The role of pessaries to procure abortion was a different matter in those days and has now become a safe and effective means of women controlling their lives. The original oath is thus outdated.

The Ugly

Anti abortionists, a minority lobby with growing polticial influence, have used the oath to reduce access to abortion, and anti vaccine industry has jumped on the bandwagon to claim that vaccines which do so much more good than harm, but of course, some harm are a dereliction of medical duty.

And what this means for Vaccine harms in the UK

Legal action in the UK is now being taken against AstraZeneca for harm done by their vaccines. This relates to rare but tragic cases of blood clotting which resulted in significant disability.

£120k is available to those who have been seriously affected throughout the Vaccine Damage Payment scheme. To qualify, you have to be 60% disabled, so this clearly lets down those who have lost 50%, or lesser but still hugely significant amounts of ability.

As of June 2023 this year, 1,614 claims were rejected out of the 5,708 received, while 109 did not meet the service’s criteria for medical assessment. So far 148 payments have been made, 144 of those due to side effects from the AZ vaccine. This is helpful, but of course, will hardly compensate for the loss of earnings suffered by many. The other matter, typical of the UK creaking public sector, is the anger at the 18 months it takes to assess cases, and even inexcusable delays of agreed payments which adds further insult to injury.

The next insult down the line is that the payments will affect those in receipt of state benefits due to disability, thus reducing income. It is no wonder that people are taking legal action.

and in the USA….

In the US, even before COVID, their vaccine compensation programme from 2016 to 2021, is summarised in this report:

“According to the CDC, from 2006 to 2021 over 4 billion doses of covered vaccines were distributed in the U.S. For petitions filed in this time period, 11,247 petitions were adjudicated by the Court, and of those 8,044 were compensated. This means for every 1 million doses of vaccine that were distributed, approximately 1 individual was compensated.”

Problems rating to COVID vaccines are compensated through the Countermeasures Injury Compensation Programme, who to date have had 12,223 applications, have decided on 1,267, finding 32 eligible for compensation, compensating 6 and denying 1,235.

Antivaccine harms

Some of these applications will be from people who believe they have been harmed by vaccines, but without sufficient evidence. A proportion of these will have been influenced by the American anti vaccine movement who seem to put any misfortune suffered after the vaccine down to the vaccine, and are thus themselves creating harm and as I have said before, damaging minds.

It cannot be easy for those feeling anger and despair that misfortune has befallen them after the vaccine, and that they have been needlessly damaged by an evil Big Pharma. Depression and anxiety resulting from this belief and the consequent frustration is a distinct and needless harm created intentionally.

Benefits

Of course, this has to rebalanced against the benefits. In the case of AZ, their vaccine is estimated to have saved 6.3 million lives by Airfinity whose job it is to predict all things pandemic and by this study, amongst many others, in the Lancet. Not to speak of protection against admission, suffering and disability.

I had my booster yesterday as for me the risk from infection remains worse that the small risk from vaccination. I am convinced also by the ongoing worries about long term side effects from infection that are emerging, particularly those affecting the heart and brain. I know of two people who did not get vaccinated who have sufferred serious heart problems; one a heart attack requiring a stent, and the other sadly fatal heart problems. Both of them were low risk. Just an anecdote, but it lingers in my mind.

Society

This raises important issues for medical communication and what sort of society we live in.

In consenting to vaccination for my booster yesterday I balanced the ongoing risks of COVID19 infection and the relatively small risk from the vaccine itself. Medical intervention will always involve some harm and this needs to be discussed realistically without scaring people away from effective care. Advice that vaccines are “safe and effective” is correct, but that does not mean when you give millions of doses there will not be any problems.

The wider issue for society is political. Safety nets have bigger and bigger holes and more people are falling through into despair, including health professionals who have lost their career in the service of patients. Those with long term harms from COVID19 have our ailing benefits system to rely on and no recourse to specific compensation of any kind.

Given the profits made from the vaccines, which are frankly outrageous, it might make sense for Government to ask Pfizer and Moderna in particular for the resources to fully fund a more efficent compensation scheme, even though government taking the legal responsibility for vaccine harm is correct as society also benefits.

Hard times

Life can be comfortable for those who are well, working in stable jobs or with enough resources to carry them through. If you cannot work, and are materially poor, life is increasingly difficult, benefits complex and life harsh. For those who really fall on hard times, even living rough in a tent is seen as a lifestyle choice by none other than a British Home Secretary who is sufficiently evil to try to convince that victims of hardship have simple chosen not to be opulent.

This is the sort of society we have become. Government income could be increased, spending priorities can be changed and policies which genuinely redistribute our hideously unequally distributed wealth could be enacted.

Till then struggle will define the daily life for millions, indeed, around the globe billions. This includes those harmed by COVID and the comparatively tiny numbers harmed by vaccines.