By Marika Sboros
“First do no harm” is the golden rule of the Hippocratic oath. Medical doctors around the world have to swear it before their universities let them loose on trusting and unsuspecting patients.
That oath lies at the heart of an innovative online ethics course that launches today.
It is the latest in the menu of online courses that the Nutrition Network (NN) offers. The NN is powered by the Cape Town-based Noakes Foundation. Content is aimed primarily at doctors but has relevance for dietitians, nutritionists, nurses and health coaches, say organisers.
It is a series of online, self-study lectures for participants in their own time. The course carries seven ethics CPD (Continuing Professional Development) points from the South African Medical Association.
Ethics in a digital world
Worldwide, there are codes of conduct governing ethical and moral behaviour and practice for medical doctors. However, experts say that medical and social ethics are not static. These have advanced to the extent that doctors regularly face controversial issues.
The online, digital world and social media also present their own, daunting challenges for doctors on an ongoing basis.
The NN course looks at these grey areas and evolving concepts that many health professionals don’t accept as they don’t see these as “conventional”, say organisers.
Among questions the course covers are:
- What does it mean in today’s changing world for doctors to practise medicine ethically and swear an oath to “first do no harm”?
- What are the ethical obligations of doctors, nurses, dietitians, nutritionists and health coaches? How can they best honour these obligations to patients, the public and other health professionals? and
- In what contexts should ethical obligations change in medicine today?
Ethics and omertàs
“Medicine has become unethical to some extent”, says NN MD Jayne Bullen. An aggravating factor is corporations, drug makers and inadequate public health policies. These have taken over medicine, Bullen says. They are driving an agenda previously held within “the omertà” of modern medicine.
Those are harsh words and omertà certainly is a loaded term. It’s the Italian Sicilian word for the code of silence and secrecy that members of organised crime syndicates swear. It forbids them from betraying their “brothers” to authorities or rival gangs.
Bullen uses the word advisedly. Legal and medical experts say that it is appropriate in the medical profession under certain circumstances.
Changing treatment approaches
“The omertà makes it difficult if not impossible at times for the modern doctor to practice ethical medicine”, Bullen says.
The ethics course looks at the power of the omertà in a changing, digital world. It also investigates “the reason that the many good doctors we know went into medicine in the first place”, she says.
A focus is on how to return medical practice to the principle of “first do no harm”. Lectures cover questions around the “cholesterol myth” and optimum treatment for cardiovascular disease (heart attack and stroke). Another focus is on changing approaches to best treatment protocols for diabetes based on the latest evidence.
A major issue, says Bullen, is the ethics of putting newly diagnosed type-2 diabetic patients onto medication before allowing them to try lifestyle changes first.
“This is a growing, topical and fascinating area of medicine,” she says. “And if you are in medicine and not grappling with ethics regularly, you should be.”
Course lecturers include Czech medical lawyer Jan Vyjidak. He looks at ethical and legal challenges facing doctors using new treatments that are not yet endorsed by clinical guidelines.
Pretoria Advocate Joan Adams (SC) covers modern aspects of practice in the digital age. These include the safe and ethical use of social media in medical practice and information around a virtual practice.
Cape Town GP Dr Neville Wellington, an NN co-founder, covers the changing needs in healthcare landscapes affected by digital technology and social media.
“We as doctors and other health practitioners are inundated with emails, WhatsApp messages and via other social media daily,” Wellington says. “This is in addition to our day-to-day business of actually seeing patients.
“How we doctors respond to these new situations can have huge consequences on our professional and private lives. We, therefore, need to update ourselves in these areas.”
Wellington and GP Dr Hassina Kajee, another NN co-founder, give personal perspectives in their lectures on what it means to practice ethical medicine today. They offer advice for doctors on how to navigate the inclusion of nutritional and lifestyle medicine in sound, ethical ways.
Ethics and tweets
University of Cape Town emeritus professor Tim Noakes covers lessons for doctors in the digital age from his unique experience.
The Health Professions Council of South Africa (HPCSA) put Noakes on trial for more than four years on a charge of unprofessional conduct. The charge arose after a Johannesburg dietitian in private practice reported him for a single tweet in February 2014. Noakes tweeted that good first foods for infants are “LCHF” (low in carbohydrate, high in healthy fats).
Two of the HPCSA’s own committees found Noakes innocent and exonerated him completely on all 10 aspects of the charge against him. His legal team described the case as “an unprecedented prosecution and persecution of a famous scientist simply for his views on nutrition”.
Noakes covers similar cases around the world, including that of Australian orthopaedic surgeon Gary Fettke. As with Noakes, Fettke’s regulatory body, the Australian Health Practitioner Regulation Agency (AHPRA) exonerated him completely. However, unlike Noakes’s case, AHPRA also apologised to Fettke.
Bullen says that these cases have left health professionals in fear of worse consequences when telling clients or patients what to eat. “That’s especially if this advice deviates from conventional dietary guidelines,” she says.
The NN ethics module aims to provide clarity on all of these topics. It also aims to give practitioners “peace of mind that they will be safe in the actions they take”.
The ethics course also covers the global scourge of academic bullying or academic “mobbing” of medical doctors who don’t toe conventional, orthodox medical lines. The lecturer is Dr Travis Noakes, a media studies specialist. He explores online harassment of scholars and health professionals and explains how best to respond.
Kajee has the last word: “As the NN, we want to do our part to help practitioners navigate the pitfalls that may arise.
“In creating the ethics module, we hope to keep interactions between practitioner and patient positive. Doctors should also not be part of escalating issues, especially around nutrition. Rather, we want to be able to deal kindly and factually in this area.”