For healthcare professionals only


Surge in publications on early detection

BMJ 2017; 357 doi: (Published 08 May 2017) Cite this as: BMJ 2017;357:j2102

Primum non nocere

The famous Latin phrase Primum non nocere (first, do no harm) should always be considered. Harms from cancer screening as an example include overdiagnosis and overtreatment, false positive findings, additional invasive procedures, negative psychosocial consequences, and somatic complications [1]. This does not mean that such early detection should be ignored but it means, as this article stresses, that early detection should be balanced. Critical assessment of early detection including early detection technologies and strategies in clinical practice is indispensable to avoid the persisting bias that early detection is only beneficial as the author of this article clarified.

Even with earlier detection of serious infections like acute HIV infection, treatment should generally be started when the patient feels ready to do so [2].

I would like to end my short article with some of Sir Robert Hutchison’s words [3]. Sir Robert was a Scottish physician and a former President of the Royal College of Physicians of London.

“From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art, and cleverness before common sense, from treating patients as cases, and from making the cure of the disease more grievous than the endurance of the same, Almighty God, deliver us.”

Amr Gohar FRCP Glasg UK
Royal College Clinical Educator

1. BMJ 2013;347:f5334.
2. Churchill D, Waters L, Ahmed N, Angus B, et al. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2016; 17: s2–s104. (2016 interim update – BHIVA 2016).
3. BMJ 1953; 1: 671.

Competing interests: No competing interests

14 May 2017
Amr KH Gohar
Consultant in Dermatology and Genitourinary Medicine
Hosary Medical Charity Centre, 2192, 8th Neighbourhood, 2nd District, 6 October City, Giza, Egypt