REVIEW FROM THE LANCET:            
            
"Do Less Harm: Ethical Questions for Health Historians Edited by Courtney E Thompson
and Kylie M Smith Johns Hopkins University Press, 2025
pp 384, US$39·95
ISBN 9781421452265"    "Book
Epistemic dignity

“The opposite of love”, as the saying goes, “is not hate, but indifference.” That is, as intense emotions, love and hate are so close they can easily shift one into another—so close they belong together on the same side of a divide, with indifference on the other side. But the subtext of this saying is, really, epistemic. It is about knowledge, about knowing and not knowing. It is about the ethical responsibility to be aware, to pay attention, to not look away, to have respectful regard for the lives of other and othered  people, to  affirm their dignity as knowers, to attend to their knowledge, sensemaking, experiences, and aspirations, on their own terms. It  is  about  how  indifference  breeds epistemic injustice.

Do Less Harm: Ethical Questions for Health Historians, a volume of essays edited by Courtney E Thompson and Kylie M Smith, offers health historians ways  to  think  and  act  against  the still pervasive tendency for epistemic injustice  in  their  field  and  ways  to transcend that tendency altogether. The work of health historians compels them  to  connect  social  injustice in  the  past  to  social  injustice  and health  inequity  in the  present,  and to  bring those  connections to  bear on reparative efforts. Thompson and Smith write that they are “animated by the idea that the history of health and medicine is important today precisely because it is able, in fact it needs, to inform discussions about the greatest problems at present in our health care systems—namely, health disparities, racism, ableism, and discrimination”. But what has often been the case in the field, and for which this book begins to serve as a corrective, is a deliberate looking away, a studied indifference that discredits and sidelines efforts to draw out these connections. Do Less Harm, which is part of Johns Hopkins University  Press’s  series  on  Global Studies in Medicine, Science, Race, and"    "Colonialism,  displays  a  refreshingly studied insistence on the field’s ethical responsibility to itself and to the publics it has hitherto harmed by disregard; people who are, for various reasons, marginalised in the construction of historical records and of contemporary scholarship,   as   producers   or   an audience of knowledge; people whose inherent dignity as knowers has long been violated.

There is a sense in which one might then say that the opposite of epistemic injustice is not epistemic justice, but epistemic dignity. As  love  and  hate are on the same side of a divide, so are epistemic injustice and epistemic justice.  Both  are  about wrongs: the
committing of wrongs and the righting of wrongs. It follows then that just as  indifference  is  a  more  accurate antithesis of love, epistemic dignity— respecting and affirming the inherent dignity  of  marginalised  people  as knowers—is a more accurate antithesis of epistemic injustice. Epistemic dignity goes  beyond  avoiding or  correcting wrongs. The responsibility to affirm marginalised   peoples’   dignity   as knowers exists regardless of and beyond the need to right epistemic injustice. Epistemic  dignity  offers  something higher to live up to.

Written with the “hope to provoke future  conversations”,  Do Less Harm is  divided  into  sections  on  how positionality  shapes  the  focus  and purpose  of  historians’  work,  the ethical entanglements of archives and museums,  and the day-to-day work of research, writing, and teaching. The editors want researchers to consider"    "“questions of violence, power…and our authority to use and tell the stories of patients in the past” and “to ‘decolonize’ their thinking about the methods and approaches we use”. On writing, they want “the reader to confront the choices we make as writers from an ethical standpoint”, as in the choice of audience and citations. The essays about teaching “offer lessons from the classroom on using ethics to shape…pedagogy” as in selecting teaching material, facilitating classroom discussions, and assessing students.  Although   intended   for historians, the book will be of interest to anyone who looks at health as a social phenomenon or pays attention to the health of marginalised people, to health inequity, which can only be fully understood in a historical context. After all, the past lives on in the present. A disciplinary divide can only be arbitrary. Do Less Harm joins  recent  efforts  in related fields—medicine, public health, global   health,   and   international development—reckoning  with  their own  similarly  stubborn  legacies  of racism,  sexism,  ableism,  classism, capitalism, and colonialism—legacies that formed and continue to shape their knowledge practices.

What marks this book apart is the honesty of its contributors. The book reads like an exercise in soul-searching, of souls searching for redemption for themselves and on behalf of their field. The essays span and combine various forms  of  writing:  the  confessional (of past or current harmful practice), the self-defensive (of past or current practice), the illustrative (of carefully considered practice), the argumentative (to support a reparative practice), and the coming-of-age (to show a slow realisation of the harm of a practice). Together, they offer questions more than  prescriptions,  narratives  more than  directives,  and  insights  from practice  more  than  how-to  guides from on high, recognising that what" "constitutes repair, what is just, often
depends on the time and place and purpose of a practice. What is timeless and universal, however, is the ever- present  responsibility  to  recognise and affirm the inherent dignity of the people on the receiving end of these knowledge practices as knowers.

This soul-searching is long overdue. People on the receiving end of epistemic injustice,  as  the  editors  recognise, “raised questions about ethical practices long before we thought of them, but somehow history as a discipline has largely held itself at a remove from these debates”. Of course, scholars and communities  at  the  periphery  have always wanted and demanded to be regarded as humans in their full dignity, but the centre manages to keep those voices unheard, on the periphery, mildly tolerated when considered a harmless irritation, excluded when considered dangerous.  But  there  is  something wilful about indifference. It is never by chance. It is either willed by the individual or eased by the institutions that structure their practices. The very act of indifference, of looking away, from the  legacies of discrimination, exploitation,  and  violence  in  the knowledge practices of health research is  connected  to  indifference  to  the death and suffering of others wrought by those same forces today in Palestine, Congo, Sudan, Ukraine, Yemen, or of the next person, or a marginalised fellow researcher or researched community who should be the primary audience and beneficiary of research.

So, why now? Why are those hitherto disregarded  voices  starting  to  get heard, or their questions starting to get a non-dismissive, considered response? Evident among the authors of Do Less Harm  is  the  in-your-face  presence in  academia  and  related  knowledge platforms of people so far denied the status of knower—of people intimately connected to past and present injustice. Their  presence  as  producers  and  an audience of knowledge is starting to check  academics’  accounts  of  their reality: its presentation, interpretation,"    "and academics’ rationale for researching
it. They are present in health history and in related fields as community, as  experts  by  experience,  as  fellow scholars, and as students. This sense of rupture was captured in disabled historian  of  disability  Nicole  Lee Schroeder’s essay in the book: “Long have I (and other marginalised scholars) felt absent from academia’s collective pronouns.” The intended audience of an account, whose gaze has shaped it, is apparent in who is assumed to be part of first-person collective pronouns like “we”, “us”, and “our”.

Writing from a powerful pose, it is notable that some contributors had to self-educate themselves out of the indifference into which they had been socialised,  finding  ethics—knowing what it is to be an ethical researcher— late in their career, sometimes after moments of realisation triggered by having caused harm, a result of their often  misleading  and  inadequate ethics training. Perhaps because such training was delivered by status quo- compliant ethicists with a biomedically set tunnel  vision  of  what  is  ethical and little attention to the full range of  scenarios  in  which—and  groups to  whom—a  researcher  might  have ethical   responsibilities.   Perhaps because  the  training  was  designed to  pass  on  entrenched  norms  that disregard  marginalised  people  as credible  producers  and  a  legitimate audience of knowledge; norms codified in law or the formal and informal rules that  govern  knowledge  practices  in research. Perhaps because the training was  optimised  for  the  minimalist, procedural,   institution-protecting ethics of ethics committees or peer review.  It  is  a  system  in  which  the powerful get to decide what is ethical on behalf of and in their relations with people who are marginalised.

The  book’s  title  is  a  play  on  the Hippocratic dictum, primum non nocere (Latin for first, do no harm)—a low bar brought even lower by the title’s defeatist swapping of “no” for “less”. Benefit should be a condition of any"    "intervention,  with  “no  harm”  only
acceptable as a tolerable step below. The Yorùbá say “Òrìsà, bí oò le gbè mí, se mí bí o se bá mi” (“Deity, if you cannot save me, leave me as you met me”), which means “second, do no harm”. Hippocrates  laid out the options  in the same order. As a prelude to stating the  options,  he  described  the  due diligence it would take to meet this expectation: “The physician must be able to tell the antecedents, know the present, and foretell the future—must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.” We should ask no less of health researchers. A precondition of research should be a studied assessment of time and  place,  a  situated  connecting of the past to the present and the future, matched  to  purpose,  and,  at  every stage, a  deep regard for the dignity of the people being researched and related marginalised  others,  as  knowers— people on whose behalf researchers do not have the right to tolerate harm. We all want to be harmed less, and better still, not harmed at all, or not harmed on balance. The “no” in do no harm offers something higher to live up to.
With  this  book,  health  historians have provided a model for other health and  related  fields. That  is,  scholars, marginalised and not, (and none of whom is a trained ethicist), reflecting honestly, openly, on the ethics of their practice, in order to affirm the epistemic dignity of marginalised people. That such academic soul-searching exercises are not already commonplace among health researchers perhaps reflects a tendency in public health and medicine to outsource ethical thinking to ethicists or  bioethicists.  The  collective  soul- searching that this book signifies is long overdue in public health and allied fields. After all, ethics is everyone’s business.

Seye Abimbola

School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia seye.abimbola@sydney.edu.au"
        
            
"2210                                                                                                                                                                                                 www.thelancet.com  Vol 406  November 8, 2025"