The hubris of the hawks

And the return of the doves

Ideologically doctors can be divided into hawks, who argue for increased intervention in case they might help, and doves, who argue for avoiding intervention in case it causes harm. Earlier in my medical career I was more of a hawk, but like many, time and experience has led to me moving to being a dove. People without medical training tend to be hawks about medicine. Medical hawks play God. Medical doves show deference.

The practice of medicine as a whole sometimes shifts between these extremes too. Surprisingly, Hippocrates was a hawk. (Holding him up as a champion of medical ethics is yet another inversion). The Hippocratic Oath, states, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury or wrongdoing.” This line reveals that Hippocrates saw the physician’s primary duty as taking action to benefit the patient within the bounds of skill and knowledge, with the ethical limitation that harm should never be inflicted deliberately. He cautioned against deliberate injury, not avoiding incidental risks. It was the French physician and translator, François Tolet in the 17th century who added in “primum non nocere” or “first do no harm” a doctrine that prioritizes patient safety above all else, even at the potential cost of inaction. Periods of hawkish hubris are remembered e.g. doctors advertising that their patients should smoke, lobotomies, thalidomide. Periods of dovish deference have less drama to recall them.

Medicine has firmly moved into a hawkish period in the last few years with catastrophic consequences. The hubris has been extreme with the idea we can control an airborne respiratory virus. The interventions that were introduced without apparent thought that they would do more harm than good included:

1. Telling people to “stay home and protect the NHS,” denying them healthcare and even telling the dying to isolate at home because they had a cough or fever

2. Insisting 11% of health and social care staff not attend work because they had a cough or fever

3. Mass testing dialled up to identify only 3-4 virus particles in a single aerosol

4. Overriding civil liberties and stopping people working and travelling

5. Masking

6. Overriding basic medical ethical principles of informed consent, bodily autonomy and adults protecting children not the other way around

7. Injecting everyone possible including those with no possibility of benefiting

This hawkish attitude was summed up by Lady Hallett when she said, “I’m sorry, I’m not following, Sir Peter. If there’s a possible benefit, what’s the downside?”

Those are just the covid related policies. We have also seen removal of body parts and puberty blocking of children and are now headed rapidly towards doctors actively killing their patients. It could not be more extreme than that.

We have a huge vacuum in terms of medical leadership on these issues. The experienced medical doves have been virtually silent (or silenced). Perhaps this is a result of the medical profession allowing unqualified people to lead and strategise throughout the NHS creating a culture where doctors fail to lead. Perhaps it is a consequence of the environment of fear in medicine where those who speak out, even with valid safeguarding concerns can lose their careers. Perhaps it is yet another symptom of the pseudoreligious aspects of medicine where high priests can whip up exaggerated fear of a virus and couple it with vaccine worship such that even dovish doctors are bought into the new belief system.

There has been too much harm. It is high time for the deferent doves to take power back from the hubristic hawks.