To the Editor,
The argument raised by Drs. Schaffer and Ahn [1] is of course on point, but there are reasons that support my original version.
First, there is the issue of path dependence. We must not only plant a new, superior standard, we must also deracinate the flawed existing one. To uproot a “do no harm” mindset, we may have to overshoot aptly. The motto suggested by Drs. Schaffer and Ahn (primum noce optimum, or “first, do the optimal”) simply does not go far enough.
Second, I don’t think people will conflate appropriate harm with sadism or anything like it. Well known is the saying, “no pain, no gain”—or “nullum dolorum, nullum quaestum,” as Cicero did not put it.
Third, and not insignificantly, this journal is not fond of the word “optimum.” Indeed, according to my Google Scholar search, the few times that this word (or some variant of it) appears in our little exchange here roughly matches its entire incidence in CORR® over the last five years. Thus, even if the word is in all other ways optimal ideal, respecting the house style is just good manners. [Editor’s Note: Dr. Bernstein is correct. The editors at CORR® tend to remove the word “optimal” and its relatives from papers here. It is seldom possible to know when something in medicine or surgery has been “optimized,” the word is an overused bit of jargon, and it’s often employed in strange ways. For example, some authors write about “optimizing” patients before surgery. By this, I think they mean taking generally good care of patients’ modifiable medical conditions, supporting patients who have emotional distress, or buttressing their social supports. The idea that we can “optimize” another human being strikes us as rather dehumanizing, though I know that authors probably don’t intend it in that way. For those reasons, we try to remove and replace the word where we can. Obviously, we left it in place for purposes of this dialogue. Seth Leopold (ED)].
Footnotes
(RE: Schaffer NE, Ahn J. Letter to the Editor: Not the Last Word: Primum Non Nocere Is Harmful. Primum Noce Apte May Help. Clin Orthop Relat Res. 2023. DOI: 10.1097/CORR.0000000000002677.)
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Reference
- 1.Schaffer NE, Ahn J. Letter to the editor: Not the last word: primum non nocere is harmful. Primum noce apte may help. Clin Orthop Relat Res . 2023;481:1444. [DOI] [PMC free article] [PubMed] [Google Scholar]