On Nonharming: The Debate Continues in Stage I Testicular Cancer

The originally Greek principle of “primum non nocere” (“first, do no harm”) is said to have been translated into Latin by Scribonius Largus, the private physician of the emperor Tiberius Claudius. Scribonius Largus apparently recommended this strategy to his colleagues to improve the image of Roman medics, who at the time had a reputation as poisoners. In the context of the editorial recently published in Journal of Clinical Oncology, “Active Surveillance for Clinical Stage I Testicular Cancer,”1 this statement probably means that you should not harm a patient by giving adjuvant treatment. As a profession, we have made some progress since the time of Scribonius Largus (approximately 50 AD). However, the case vignette presented by Vaughn1 in his editorial illustrates that despite our best intentions, we may expose individual patients to even greater harm by trying to avoid harm. Most physicians would agree in retrospect that despite the attempt to avoid adverse effects of adjuvant treatment, the patient presented was eventually exposed to even greater toxicity with intensive combination chemotherapy.