Readers' Forum

school health programmes at little extra cost. so-called Hippocratic Oath. I think the reason Such investment would reduce the cost of why it is not, as a rule, discussed must be the repeated hospitalization and cardiac surgery. fact that it is in principle taken for granted, Studies are indicated on the prevalence of even when its deficiencies for contemporary rheumatic fever and rheumatic heart disease in medicine are realized. The oath named after rural areas and smaller towns in Malaysia to Hippocrates is generally considered as a identify target groups; if necessary, education universally valid text in medical ethics. Seem­ and control programmes should be started. ingly, it is taken to be "universal" in space and time. In time because it has been a historically Farida Jamal well-known text (in the Western world), Associate Professor, different versions having changes or adapta­ National Streptococcus Reference Laboratory, Department of Medical Microbiology and Immunology, tions in accordance with the dominant secular or religious ideology in a given society. In Hanafiah Mohd Sal/eh space because different versions of the original Lecturer, Department of Community Medicine, text are apparently an indispensable part of the graduation ceremonies of medical schools Tan Sook Pei Medical student, in many parts of the world. Faculty of Medicine, National University of Malaysia, Few people, it seems, ask whether this ancient Jalan Raja Muda, Kuala Lumpur 50300, Malaysia text (which is, by the way, not the oldest one in medical history) could justifiably be valid 1. Taranta A, Markowitz M. Rheumatic fever: a guide to its recognition, prevention and cure. London, MTP in the face of contemporary ethical issues in Press Ltd, 1981. medicine (1) (or in any other health 2. Ekra A, Bertrand E. Rheumatic heart disease in profession). Given the radical scientific, Africa. World health forum, 1992, 13: 311-333. technical, sociopolitical, legal and other 3. Nordet P. Rheumatic heart disease in Africa. World developments in the world which have health forum, 1993, 14: 292-293. evidently affected all human societies, what 4. Jamal F, Abdullah N, Zambahari R. Rheumatic heart disease in referred cases: experience at a cardiology medicoethical relevance could any passage in centre. The family practitioner, 1988, 11(1/2): 46-47. the related texts possibly have: 5. Gururaj AK et al. A clinical, laboratory and echo­ cardiographic profile of children with acute rheumatic in the case of clinical research, where the fever. Singapore medical journal, 1990, 31: 364-367. informed, free, express and specific consent 6. Awang V, Haron AM, Sallehuddin A. Cardiac surgery of the experimental subject is now consid­ in General Hospital Kuala Lumpur: review of all open ered indispensable? heart operations Aprii1982-February 1987. Medical journal of Malaysia, 1987, 42(2): 81-85. when one considers the complex techni­ cality involved in modern surgery? in the increasing role and participation of the individual in social affairs, and of the The hippocratic oath: an anachronism? patient in therapeutic medicine? in the case of compulsory preventive Sir- Having read with great interest the measures such as genetic screening, Round Table entitled "Would Machiavelli vaccination, or the fluoridation of water now be a better guide for doctors than supplies? Hippocrates ?" (World Health Forum, 1993, whenever the rights of the individuals of 14: 105-132), I should like to comment on the other species are taken into account in animal experiments?

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Even in the case of the patient-physician Community epidemiology for students relationship, which is the only aspect of inter­ in Kuwait human relationships in medicine considered in the traditional oath and its derivatives, the Sir- Intensive courses in epidemiology and content and the linguistic formulations of the field research methodology, with active par­ related passages are definitely outmoded and ticipation in data collection and analysis, may even anachronistic -let alone the quite irrel­ be very beneficial, as demonstrated by Pers­ evant passages on one's teacher and his sons, son & Wall (1). The target audience and the on one's own sons, and so on. duration of such courses deserve particular attention. "First protect human beings and society from disease, accidents,. deformity, disability and Our experience has been that epidemiological similar serious unwanted conditions, concepts are more readily mastered by stu­ psychologically, socially, economically, as well dents than by older practitioners. Medical as biologically" should be the principal staff, particularly those engaged in the control maxim in modern medicine. Those of us in of infectious diseases, are sometimes reluctant the profession and in society at large who see to learn simple significance tests or the con­ therapeutic activity as the most important cept of relative risk. Of course, in-service aspect of medicine could make an analogy training for qualified personnel should be between the potential patients and their cars - encouraged, but emphasis should be put on what would they prefer: a well-protected, teaching basic epidemiological skills to under­ well-cared-for vehicle, or one which does not graduates and providing facilities for them to function properly and may break down? carry out field work.

Where the socioeconomic philosophy is As for the course duration, compression of "consume, consume, and consume", as in the broad and different topics such as basic case of the socalled New World Order, and epidemiological principles, community diag­ when health becomes a personal state to be nosis, measures of disease occurrence, study purchased, medical activity will "justifiably" design, potential of microcomputers, etc., as be equated with clinical practice. And in this well as field work, into a single week, unavoid­ respect the Oath would be quite acceptable to ably leads to oversimplification. Possible ad­ those who act as the protectors or stabilizers verse effects may be a false sense of security of the established order. One wonders what on the part of participants and their inability Hippocrates, as one of the greatest revolu­ to implement successfully their insufficient tionaries in medical history, would, and knowledge. could, say about the near-persistence of a moral text in medicine centuries later? Kuwait has a curriculum that emphasizes pro­ viding medical students with skills necessary Yaman Ors to address and meet community needs. The Professor of Medical Ethics and Medical History, six-week course in community medicine Ankara Medical Faculty, comprises epidemiological methods, use of Sihhiye, 06100 Ankara, Turkey computers, organization of health services, 1. Ors V. The physician's oath: a historical and/or ethical and occupational and environmental health. myth? Bulletin of medical ethics, 1992, 76:19-23. However, as the major part of the course is related to project work, it starts with lectures on surveys and the use of library facilities,

58 World Health Forum • Volume 15 • 1994