The Pharmaceutical Journal
Vol 273 No 7310 p166
31 July 2004

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Misrepresented friend more
Climate change needs more attention more
Swearing by the gods — the value of a professional oath more

Misrepresented friend

The ass, wrote Frederick Zeuner in his ‘History of domesticated animals’ (1963) “is indisputably one of the most useful animals, and yet it is despised nearly everywhere. It is not fully understood why this should be so. In part, its stolid temperament has annoyed its master since time immemorial.” Indeed, we often refer to someone as a “silly donkey’’ or accuse someone of “making an ass of himself” when we intend to convey ridicule.

This attitude is quite unfair to our friend Equus asinus. He is known for his modest food requirements, making do with thistles and straw. Originally he was not despised. The Egyptians boasted of their white asses, and the Romans were happy to pay large sums for the animals. In ancient Greece and Rome the ass became the choice beast of burden for the miller, the gardener and the smallholder. Asses’ milk was highly valued as a medicine for diseases of the lung, liver, gall bladder and kidney, as well as a food and a skin conditioner. Asses’ dung was a valued manure for pomegranates and other fruits.

The domestication of the ass, according to a group of anthropologists writing in Science for 19 June, marked a cultural shift away from agrarian life-styles to more extensive movements and trade. The archaeological evidence from Egypt suggests that donkeys were in fact domesticated some 5,000 years ago, although where this occurred is uncertain.

In an attempt to trace the origins of the domestic donkey the investigators studied mitochondrial DNA from donkeys from 52 Old World countries and found two highly divergent groups. The wild asses were traced to two African sources, Nubia and Somalia, and they diverged 300,000 to 900,000 years ago, long before the earliest known livestock domestication about 10,000 years ago. Assuming this origin, it seems that the wild ass is the only ungulate that was domesticated in Africa and nowhere else. Domestication of the donkey appears to have been prompted by the response of north-eastern African pastoralists to the desertification of the Sahara, which took place some 5,000 to 7,000 years ago.

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Climate change needs more attention

An editorial by Donald Kennedy in the 11 June issue of Science looks at the attitude of public and politicians towards our terrestrial climate. As Kennedy points out, weather is not the same as climate, and the public is unfortunately being persuaded by newspaper comments to link the two without justification. It is regularly suggested that particular weather events are a consequence of global warming, but we do not know.

However, we do know a great deal about our climate and the factors involved in changing it. Human activities are adding to the concentration of carbon dioxide and methane in the earth’s atmosphere. These gases produce a blanketing effect intercepting the radiation of infrared from the earth. The study of global temperatures during the past 10 centuries has shown that they were associated with natural events such as volcanic eruptions and variations in solar flux until the 20th century, when they showed an abrupt rise. This event was associated with an increase in atmospheric carbon dioxide from the preindustrial level of about 280 parts per million to 380ppm at present, and the increase is now accelerating. We do not know whether warming will pursue a slow and steady increase or make an abrupt jump, bringing unknown consequences for natural cycles. The relationship between atmosphere and oceans, clouds and aerosols, affecting earth’s ability to reflect solar energy, might bring vast changes in climate. Unfortunately, scientists who have studied these possibilities cannot agree on their effect in detail, and accordingly politicians can dismiss their warnings as meaningless, so neglecting to take serious measures to protect the future of living creatures.

Nevertheless, scientists generally agree that the increase in atmospheric carbon dioxide to double the preindustrial level by the end of the present century would increase average global temperature by 2–5 per cent, with disastrous results on glaciers, coastlines, plants and all that depends upon them. “Our climate future is important and it needs more attention than it’s getting,” writes Kennedy.

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Swearing by the gods — the value of a professional oath

The Royal Pharmaceutical Society’s branch representatives’ meeting on 13 May considered a proposal that pharmacists should be asked to make a personal professional pledge akin to the celebrated Hippocratic Oath of the medicial profession. In an issue of the New England Journal of Medicine bearing that date, Howard Markel of the University of Michigan reflects upon the ancient and modern aspects of the Hippocratic Oath. He notes that, despite arguments over its exact authorship, the oath is “simultaneously one of the most revered, protean and misunderstood documents in the history of medicine”.

Hippocrates of Cos was a contemporary of Socrates in the fourth century BC. Plato comments that in his home island Hippocrates taught medicine for a fee and promoted the idea that it was not possible to understand the body without also understanding the mind. He was the reputed author of many medical treatises, and many myths have gathered around his name, leading to heated discussions between scholars over the ages.

Markel observes that many doctors practising today are surprised to learn that the famous Hippocratic Oath in a medical school was first administered at the University of Wittenberg in 1508, so far as records go. The oath did not become a standard part of medical school graduation ceremonies until 1804, when it was introduced at Montpellier. During the 19th century the custom spread throughout Europe and America, although relatively few American physicians formally swore the ancient vow. Growing interest in bioethics, and the shocking stories of medical atrocities during the 1939–45 war, prompted more schools of medicine to require taking the oath as part of graduation.

Inevitably, considering the antiquity of the declaration, compromise needed to be made over details of the oath. Modern medical students could hardly make their vows to “Apollo, Asclepius, Hygieia, Panacea and all the gods and goddesses”. Nor could they promise to share financial resources with their instructor and his family. Today they face a quandary over the promises never to perform euthanasia or abortion. Surgeons could not today refuse to use the scalpel, whereas in Hippocrates’s day surgery was relegated to practitioners who were not medically qualified. However, they would still hold to the injunction not to have sexual relations when visiting the sick in their homes, and to the need to observe strict confidence regarding their dealings and conversations with their patients.

As Markel concludes, the Hippocratic Oath “serves as a powerful reminder and declaration that we are all a part of something infinitely larger, older and more important than a particular specialty or institution”.

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