Biblical Reflections on Modern Medicine
Vol. 10, No. 6 (60)
- Wine, Marijuana, and Intoxication: Asking for Trouble
Treading on Thin Ice in the Wine Press
- Evidence-Based Medicine: A New Fad in Modern Medicine
- The Blind Leading the Blind: CMDS Misses Again!
- Terrell’s Treatises
- Trouble in the Research Base in Medicine:
Where Do These Evidences Leave Us?
- Medical Mistakes Kill 98,000 Each Year:
Physicians’ Handwriting Part of Problem
- Brief Reports with Commentary
Treading on Thin Ice in the Wine Press
I estimate that I have written over 1 million words on medical ethics but have skirted around the edges of the major issue of wine/alcohol. Simply, I have held the position that alcoholic beverages were permissible — since wine is permitted, even encouraged in the Bible — as long as intoxication (drunkenness) was avoided (a sin and destructive to the drinker and others in a variety of ways).
Also, alcoholism, the repeated state of drunkenness which is a life-dominating problem, is a sinful behavior and not a disease. The use of “addiction” to describe alcoholism blurs the distinction. “Addiction” is better understood as a besetting sin, that is, a habituated one. (See my article, “Addiction as Besetting Sin,” Journal of Biblical Ethics in Medicine, Vol. 7, No. 4, pp. 96-99.)
However, recently I was asked to review a paper on marijuana. It seems that some professing Christians were using the principle of “Christian liberty” to defend marijuana use. I initially and cavalierly suggested that marijuana use should be patterned after the use of alcohol, as per my position above. That is, marijuana use was permissible short of the drunken (intoxicated state). But, further thought led to other conclusions and to a review of my position on wine/alcohol drinking.
I foray onto the thin ice of the wine press with trepidation. Many Christians, sometimes along denominational and theological lines, have stated and staked their territory with some vigor. Many theologians have addressed the subject over the centuries. I am not well read on these papers. In some areas, I do not have the thorough research that I would like.
Nevertheless, I foray. This attempt is not to be exhaustive, but to address selective issues. Wine/alcohol and marijuana use are major medical-ethical issues today. Readers may want to send me information, opinions, or papers that could be discussed in a later newsletter.
Unless I receive some thought or evidence that convinces me otherwise, I begin with these assumptions. First, the wine of Scripture is an alcoholic beverage. This description includes “new wine” (e.g., Hosea 4:11 and Acts 2:13). (See Norman Geisler, “A Christian Perspective on Wine-Drinking,” Bibliotheca Sacra, January 1982, 47-55). It is not just grape juice, as David Wilkerson and others have suggested. The wine that Jesus made miraculously at Cana was an alcoholic beverage.
Second, the Bible allows for a minimal effect of alcohol on the brain. “Wine makes merry (glad, cheerful) the heart of man” (Psalm 104:15). “Wine makes merry” (Ecclesiastes 10:19).
Third, the Bible warns against strong drink (except in specific situations, see below). “Wine is a mocker, strong drink a brawler, and whoever is intoxicated by it is not wise” (Proverbs 20:1). “Woe to those who rise early in the morning that they may pursue strong drink” (Isaiah 5:11).
Fourth, drunkenness is a sin. “And do not get drunk with wine, for that is dissipation, but be filled with the Spirit…” (Ephesians 5:18).
Fifth, wine is permissible, and directed, for a variety of uses. a) It is a drink used with meals (commonly portrayed in the Bible). b) There are what appear to be medicinal uses for wine.* Paul directed Timothy to “use a little wine for your stomach and your frequent illnesses” (I Timothy 5:23).
“Give strong drink to him who is perishing, and wine to him whose life is bitter” (Proverbs 31:6). Wine would “refresh those who became exhausted in the desert” (II Samuel 16:2). The Good Samaritan poured oil and wine on the wounds of the beaten man (Luke 10:34).
*(I say “appear to be” because I am not sure of the specific “medicinal” purposes in these passages. They could refer to the alcohol content or to other ingredients in wine. Even if the former is more likely, alcohol has a wide variety of effects on virtually every organ in the body. Comparing modern understanding of the physiologic and pathophysiologic effects of alcohol with the custom, scientific knowledge, and myth of Old and New Testament times is tenuous and unnecessary for our considerations here.)
(We must maintain the mind/brain distinction. The brain is the physical and biological organ through which the non-physical and spiritual mind operates and projects into this physical world. Alcohol and other substances affect the brain, not the mind. However, the mind is so intimately linked with the brain that its functional expression is limited when the brain is affected. This distinction does not always have to be stated because of this intimacy and unity, but we must maintain in our minds the duality of man as physical and spiritual.)
The problem for me with alcohol arose in consideration of the ethics of marijuana use. If its effects on the brain are allowed, even directed, by the Bible, then the progression to drunkenness is blurred. That is, when one becomes “merry” or “glad” from effects of alcohol, then one’s judgment is already impaired, allowing the progression to drunkenness to occur more easily. If principle allows alcohol to affect the mind, why not allow the same effect by marijuana? Indeed, Christians have used the Biblical use of wine to enjoy beer and even stronger drinks (i.e., higher alcoholic content).
To counter that position, the following landmark article is sometimes cited.
“(Robert) Stein researched wine-drinking in the Ancient World, in Jewish sources, and in the Bible. He pointed out that wine in Homer’s day was twenty parts water and one part wine…. Pliny referred to wine as eight parts water and one part wine…. According to Aristophanes, it was stronger: three parts water and two parts wine. Other classical Greek writers spoke of other mixtures: Euenos — three parts water, one part wine; Hesiod — three to one, water to wine; Alexis — four to one; Diocles and Anacreon — two to one; and Ion — three to one. The average was three or four parts of water to one part of wine.
“Sometimes in the ancient world, one part water would be mixed with one part wine; this was considered strong wine. And, anyone who drank wine unmixed was looked on a Scythian, a barbarian.” (Geisler, “A Christian Perspective…,” p. 50, citing Robert Stein, “Wine-Drinking in New Testament Times,” Christianity Today, June 20, 1975, pp. 9-11.)1
If this report is true, the “wine” of today is not the “wine” of Old and New Testament times. “In New Testament times, one would need to drink twenty-two glasses of wine to consume the large amount of alcohol in two martinis today” (Geisler, “A Christian Perspective, p. 51).
This difference in wines might be argued to fit the Biblical allowances and directives. One could drink wine at meal or in the other means directed by the Bible without worrying about intoxication. One did not need to worry about one’s judgment being blurred and slipping into drunkenness2 (unless a person just intended to get drunk in the first place).
Not so with today’s alcoholic beverages. Ten ounces of beer, one of the weaker forms of modern alcohol, is equivalent in ethanol content to one ounce of whiskey or other strong liquor. (This comparison is rough, as the alcohol content varies between varieties and brands, but is sufficiently accurate to make this case.)
Thus, with almost any modern alcoholic beverage, one does not have the fail safe of large volume that Biblical wine had.
However, a Biblical scholar challenges this historical review of wine.
“Among a considerable number of synonyms used in the Old Testament, the most common are yayin (usually translated ‘wine’) and sekar (usually translated ‘strong drink’). The terms are frequently used together, and they are employed irrespective of whether the writer is commending wine and strong drink as desirable or warning against its dangers. (F.S. Fitzsimmonds [Spurgeon College, London], “Wine and Strong Drink,” New Bible Dictionary [2nd Ed.], p. 1254)
I am inclined to side with this Biblical argument. My observations about the various passages that I referenced about wine seem to make no careful distinction about “strong” wine or “weak” wine.
But, let there be no mistake. The Bible has stern warnings about “strong drink.” Solomon wrote, “Wine is a mocker, strong drink a brawler” (Proverbs 20:1). Priests were to avoid such (Leviticus 10:8-9). Rulers should not take strong drink (Proverbs 31:4-5). “Strong drink is bitter to those who drink it” (Isaiah 24:9).
First, we must be careful in going from specific descriptive acts to a general principle. Wine is a unique and particular substance. Other alcoholic beverages are different, especially in their strong alcoholic content. Marijuana is a different substance altogether.
Second, and most importantly, Biblical uses of wine as prototype principles are not needed. “Sober-mindedness,” thinking on right things (Philippians 4:8), and all things in moderation (I Corinthians 9:25) are three applicable principles, among many others about right and clear thinking.In this vein, Christian “liberty” is not applicable. Biblical liberty means
“… freedom from guilt, God’s judgment, and condemnation of the moral law. We are also freed to certain things — we are free to approach God, and free to obey Him from love and willingness, not from fear…. The end of purpose of Christian liberty is holiness. Those who wave the banner of Christian liberty so that they might do whatever they want have not understood the doctrine at all” (Douglas Wilson, paper in progress, his emphases).
There is also the concern of intent. The alcoholic intends to get drunk. The marijuana smokerintends to get high. The social drinker intends to have a better time than he would without alcohol. Weak wine at dinner intends only a small part of a “merry” time of enjoying a meal and fellowship.
We can stretch the argument for Biblical wine too far. The credit given to wine as anti-infective in Biblical times is stretching the truth, if not false (Geisler, “The Christian Perspective…, p. 51). The germ theory of disease was not known until the late 19th century. Wine was just a customary beverage in that day. Its use as an antiseptic is extremely doubtful.3
Further, as stated above, discerning the specific medicinal effects of alcohol in other situations is difficult. However, an attempt would make an interesting paper on the various possibilities. I am not sure that hard conclusions could be drawn.
In both Biblical discussion and modern times, we are overly focused on alcohol as an intoxicant and blind to other causes. Blatantly, is the driver with one martini more or less impaired than the elderly driver whose eyesight, hearing, coordination, and general mental focus are impaired? (Some at young ages are impaired in one or more of these ways, as well). What about all the people on brain and mood altering prescription drugs? Alcohol is indicated in approximately one-half of all fatal crashes, but what is the cause of the others? Mechanical failure is rare, so human error (impairment) in one way or another is responsible. Cell phones have also become an increasing problem of driver distraction.
I am not going to address some bothering questions. Is abstinence from all alcohol the best position in view of the fact that virtually all alcoholic beverages today are “strong drink?” If Christ and the New Testament Christians used wine at Communion, should all Christians today use unfermented grape juice to avoid tempting those struggling with alcoholism? These questions are, at best, tangential to medicine. I leave them to your churches and conscience.
Biblical authors were not careful to distinguish “strong” and “weak” wine. One must follow the Biblical admonitions for “all things in moderation” and knowing one’s own susceptibility towards drunkenness. The use of wine at meals and its limited applications in Scripture are not arguments for the use of other alcoholic beverages. The important principle is honoring God, furthering one’s sanctification, and avoiding the cause of others’ stumbling. John Calvin presents an incisive and balanced overview.
“It is lawful to use wine not only in cases of necessity, but also thereby to make us merry. This mirth must be tempered with sobriety, first, that men may not forget themselves, drown their senses, and destroy their strength, but rejoice before their God, according to the injunction of Moses (Leviticus 23:40), and secondly, that they may exhilarate their minds under a sense of gratitude, so as to be rendered more active in the service of God.” (Calvin’s Commentary on Psalm 104:15).
1. One reviewer writes, “This kind of pretense to detailed knowledge of events centuries ago has to be very tenuous. I am unconvinced. Not able to water down the Hebrew and Greek, like Wilkerson, they have watered down the wine!”
2. The same reviewer continues, “I disagree. I believe that wine and many other substances and practices can have measurable effects on reaction time, sensory acuity, judgment, etc.”
3. He continues. “This is a weak argument. Many “discoveries” are only rediscoveries.”
Within a few days of each other, “expert” speakers from outside the Medical College of Georgia were brought in to speak on “evidence-based medicine” (EBM), a new fad with the veneer of a new era in modern medical care. Now, in its purest form, I am, and have been most of my career, a zealot (if not an extreme one) for EBM except that that approach did not have that name. It has been called the “science of medicine.” It was, and is, simply taking the best research from the medical literature and applying that to the practice of medicine.
But, the moniker, “evidence-based medicine,” is new. “EBM is a growing, international movement in health care that aims to bring the best evidence from medical research to the bedside, clinic, and community. EBM is supported by health-care institutions worldwide” (ad brochure for Ovid Technologies). Sounds like EBM is the savior of modern medicine! But, there is only one Savior, and He is truth.
The problem with EBM is the same reason that “scientific” medicine has not worked. There are too many forces at work. Patients want instant cures. “Doc, I never get rid of a cold until I get an antibiotic.” Physicians believe that they know better than the evidence. “Ok, Mr. Jones here is the latest and most broad-spectrum antibiotic.”
Pharmaceutical companies have “evidence” of their own, frequently as misleading advertising. “Biaxin delivers … outstanding clinical success … in adult respiratory trials” (common ad in medical journals). HMOs pay for these antibiotics because physicians do not write down “common cold,” but “acute bronchitis” or “acute sinusitis.”
You see, we have an economic and belief system that is far stronger than the “evidence.” Readers know of my chagrin over antibiotics for common colds. In fact, in my career, I have been transferred out of two clinical situations because I would not prescribe in that way. The evidence against the use of antibiotics has been there since the beginning.
I started the clinical wards in medical school in 1967. This was almost the pre-antibiotic era, as few were available. Even, then, my attendings ridiculed general practitioners who prescribed antibiotics for “colds.” Thirty years later, the world is facing bacteria that are resistant to our latest and most powerful antibiotics because the “evidence” has not been followed over these three decades.
EBM is not going to stop the monolithic, modern system that has too many palms to grease. What, you want “evidence” for my contention? Lipid-lowering drugs or “statins.” I have stated often on these pages that the number needed to treat (NNT) for patients on statins is 1 in 25-50. That is, to prevent some specific endpoint (complication of coronary artery disease [CAD], such as heart attack, saved life, chest pain, etc.), 25-50 people (depending upon the patient population, the specific drugs used, the designated endpoint, etc.) must take the drug for one to benefit.
Virtually, the whole of modern medicine embraces statins! Patients, brainwashed over cholesterol and other “bad” fats (lipids) in their blood demand them. Primary are physicians, backed fully and forcefully by “expert” cardiologists, believe that they have the latest and best weapon against CAD. Drug companies who make them are reaping untold billions in profits. HMOs will likely endorse statins, as well, since they can hardly go against such a tide. However, if statins are used as widely as they are recommended, they will have to increase their premiums to cover these huge additional costs (unless they believe the hype that they will save costs on reduced hospitalizations and expenses associated with CAD.
And, so marches modern medicine. EBM is another fad. Perhaps, a few more physicians will learn and practice by the best “evidence” that is available. But, the system is too huge to be changed by this fad. Now, even academic medical centers where “scientific” medicine ought to be practiced, if anywhere, is under huge pressure to finance their educational mission with their own patient revenues. To compete, they will have to throw EBM out the window (not that they have done that well with EBM, anyway).
There is one good personal note. I can stand up in these EBM meetings and say, “See, I told you so!”
From time to time, the Ethics Commission of the Christian Medical and Dental Society drafts a statement that is presented to the House of Delegates (the voting, governing body of CMDS). At their national meeting in Toronto, the “Allocation of Medical Resources” was passed with 64 delegates in favor, 4 opposed, and 1 abstaining.
The Statement is a Biblical mis-statement. I will not dissect every problem with it, only some egregious examples. “Society must evaluate its total resources and be that adequate dollars are made available for the health care needs of its people.” In several other sentences, “society” is similarly cited for its responsibilities. (Today’s Christian Doctor, Winter 1999, p. 30)
Uh, may I ask, “What is society? And, how does it carry out its responsibility?” Let’s see. Individuals have personal responsibility before a Holy God who has commanded them to act in a certain way. The church has a similar responsibility for its own and those outside. The state (government at all levels) has certain responsibilities. Uh, what obligations has God given “society”?
For that matter, what is society? Society is an aggregate of individuals and myriad groups of varying sizes and inherent connections. It is an amorphous mass. It is a collection of common and competing interests.
Biblically, the closest term to “society” that I can identify is “world.” The world is an enemy of God: always has been and always will be.
The CMDS Statement continues, “The scriptural principle of justice requires us to treat patients without favoritism or discrimination…. The scriptural principles of love and compassion require that we place the interests of our patients and society before our own selfish interests.”
Is my Scriptural commitment to Christian brothers above those of non-Christians and “society” favoritism or discrimination? That is, is my duty to widows of the church less than my duty to patients? Is our Scriptural commitment to our families to provide for them materially and spiritually “our own selfish interests?” That is, when I close my office while there are still patients who could be seen to go home and be with my family, have I pursued my own selfish interests?
Here are some of my issues about the “allocation of medical resources.”
1) State regulation of medicine (including licensure) gives monopolies to physicians, insurance companies, HMOs, and many other individuals and agencies whose “own selfish interests” cause medical costs to skyrocket.
2) Physicians have failed to discern “evidenced-base medicine” and practice accordingly. For example, the tidal wave of lipid-lowering drugs is a huge cost with minimal benefit. There are many, many others.Within this discernment is the probability (certainty in my mind) that total cessation of modern medical care would actually increase the health of the American people.
3) The state provision of medical care, primarily through Medicare and Medicaid is unbiblical and extremely costly. Other than some limited function with public health, the state has no Scriptural mandate for health care. The blindness to this principle has caused many in CMDS to defend the state provision of medical care as charity! However, it is the only charity which will come take your “charitable contribution” by armed force if you do not “donate” it according to their amounts and timetable.
4) There are other issues, but these will suffice here.
CMDS’ Biblical understanding of medical-ethical issues has been woeful since they passed their first statement on abortion. The House of Delegates of the largest group of Christians physicians and dentists in the world passed this Statement overwhelmingly. But, it is typical of CMDS and other Christians to take pious-sounding phrases like “without favoritism and discrimination” and “selfish interests” and mis-apply them.
Are they aware that God discriminates? He chose the nation of Israel and His elect. Are they aware that God is selfish? “I will have no other Gods before me.” The key to correct Biblical principle is correct understanding of God and his specific instructions to believers and unbelievers.
It is no wonder that modern medicine is in such a state of turmoil and competing interests when even God’s children cannot understand His ways and means. Again, CMDS shows that in ethics, the blind are leading the blind.
Hilton P. Terrell, Ph.D., M.D
It is sad to watch animals in a zoo bite and hiss at each other, especially when those animals are human. It is, however, perversely interesting. According to the AMA News (September 20, 1999, p. 6), a patient has won nearly a million dollars in a lawsuit because her psychiatrist implanted false memories of child abuse.
Supposedly a victim of multiple personality disorder with 75 personalities, the patient alleged that what her psychiatrist taught her about herself was both false and led her to crazy behaviors, including the threat of suicide. The plaintiff’s attorney said his client had been falsely taught that her parents belonged to a cult which practiced bestiality and infant cannibalism.
The physician’s attorney defended the suit in part by alleging that good, textbook psychiatry was practiced. Unhappily, bookburning has a needlessly bad reputation. We need the bonfire of the psychiatry texts! (Ed’s emphasis)
The politicos continue to pursue a reduction in the supply of U.S. physicians by several routes. We have seen an increase in “disciplinary” actions by state medical boards, some not well founded. We have seen federal payments to hospitals NOT to train residents. We have seen a plan to reduce the total number of slots for resident physicians in order to reduce the number of foreign medical graduates entering the country. If they do not have a slot, they cannot come. We have seen the literal criminalization of error by classifying simple and minor errors as criminal fraud.
A more recent entry is a move by The Federation of State Medical Boards to end the practice of granting medical licenses after only one year of residency. As is the case in most licensure maneuvers, the plea is to “protect the public” (Family Practice News, September 1, 1999, p. 46). Resident physicians claim that there is “no evidence that setting an arbitrary minimum of three years of training” will ensure quality.
It is doubtful that a board of medical examiners would want to touch that argument, since physicians are not very interested in outcome evidence. If these state boards have their way, there will come a class of medical school graduates who will be left standing when the music stops. Carrying more than $100,000 in debt on the average, medical students are gambling that they will be able to supplement their resident salaries by moonlighting after one year, when loan repayments often have to begin.
If through licensure they are frozen out of the market, many will be faced with default. Look for governments and other “third parties” to exploit their vulnerability with offers to carry the loan in exchange for contracts to do certain things in medicine that none want to do.
Recently, I observed a small room of young physicians reviewing articles from medical journals on the effectiveness of several new drugs. Very ably, they dissected the research on the designs, methods, etc.
It occurred to me that a sounder and more comprehensive understanding of the issues could have been proposed using an economic and marketing model, leaving the medical issues alone. Some drugs are introduced for “secondary prevention” (preventing a second myocardial infarction [heart attack]).
The next marketing step is often a “study” to “prove” some value in primary prevention (that is, a patient at risk but who has never had a myocardial infarction). Primary prevention has a much larger market and this fact alone explains the study. Researchers set it up to achieve a significant “p” value (a statistical value assumed to validate a study), but the actual practical significance is trivial.
They then market the new “indication” to the relevant subspecialists who do not trouble themselves to understand the practical insignificance of the study. These subspecialists do not have the financial incentive to look for things that do not work well.
The specialists are then used by the pharmaceutical marketers to cow or coerce generalists into copying them, using such mystical concepts as “standard of care.” The pharmaceutical marketers are masters in obtaining truthful answers to questions of little relevance.
Where Do These “Evidences” Leave Us?
(Ed’s note. See related articles on evidenced-based medicine, p. 3, and market design for drug studies, immediately above.)
On these pages, I have reported to readers the real problems with both the “scientific” base of medicine (research), as well as its practical application. These include the fact that more than 95 percent of what physicians actually do with patients has no solid scientific base; that physicians do not even practice according to the best science available; that falsification of data in some studies has been proven; that physicians are more influenced by drug salesmen than their own literature; and that “standards of care” are far more often established by a “consensus” panel than scientific evidence. Now, more difficulties with the “scientific” base of medicine has come to light through the process of “meta-analysis” (The Journal of the American Medical Association, November 10, 1999, pp. 1752-1759, 1766-1768).
“Meta-analysis, done properly, is a systematic effort to search for and winnow out all the best evidence and show how well a given intervention (medical treatment or procedure) works. It is crucially important on the identification of all available data from clinical trials” (p. 1766).
First, these analysts found that researchers sometimes publish the same data in more than one medical journal. Occasionally, the same research appears under different authors. Now, it has been known that data from a study is often published in piecemeal form so that the researchers can add additional items to their curriculum vitae. Also, the same data is often published in lesser journals by the same authors.
This piecemeal and duplicate approach has not generally been recognized as a problem. The primary study and its authors are known, so it is still recognizable as one study by one group who are padding their CVs. However, what has been found here is that the same data has been reported to major journals as new data more than once and published under different authors. This deception makes research to be more comprehensive and supportive of a particular treatment than another. In an analysis of the research on ondansetron (a drug to prevent vomiting after surgery), the duplication resulted in a 23 percent overestimation of the drug’s effectiveness.
Second, design methods are structured to effect the outcome. In a study of two anti-fungal drugs, one of them (amphotericin B) was given by mouth, a route that is known for it to be ineffective. It is supposed to be given intravenously. When this distortion was removed from the study, the “better” drug from the study (fluconazole) was found to be “no better” than amphotericin B.
Third, there is an extreme reporting and publishing bias for positive studies. Research that shows “positive results from drugs are reported faster and more often than studies showing neutral or negative results, which may never be published” (Denise Grady, New York Times, November 10, 1999, page unknown). Worse, the problem is not just with journal editors. “The scientists themselves held back the findings” (Ed’s emphasis). When asked why this information was held back, the “major reason they gave is that the results were not interesting.” (Might there also be the knowledge of the editors’ bias?)
Scientific medicine has had its problems. These additional distortions and lies compound its situation. Have we come to the point where modern medicine is no longer valid? That is, should a person place himself under its falsifications? No, he should not without trepidation and a willingness to learn about his own problems and challenge both diagnostic methods and treatments.
Do you, reader, know the generic and brand names of your medications (both prescription and over the counter)? Do you know their indications? Do you know their side effects? Do you know their efficacy? Do they help whatever problem you are taking them for?
Not to ask these questions in today’s medical marketplace (for it is more an economic enterprise than a science) is to ask for considerable expense and problems that can be avoided. Patients do not have to become learned physicians, only to learn about their own maladies. With the readily available information on the Internet and in bookstores (for example, Consumer Reports), there is no excuse. Would you drive down the road blindfolded? Driving down the modern medicine superhighway without knowing what is being done to you is almost as dangerous.
Physicians’ Handwriting Part of Problem
A report on November 30, 1999, by the Institute of Medicine of the National Academies stated that 44,000 to 98,000 people die each year in hospitals in the United States due to injuries and medical errors (http://CNN.com/health/).
This number exceeds deaths caused by auto accidents, breast cancer, or AIDS.
“That’s probably an underestimate for two reasons… One is, there are many different kinds of errors we never learn about — even in retrospective studies (reviewing past medical events) — because they are never written down. And second, these studies did not include other areas of care like home care, nursing homes, and ambulatory care centers.”
These errors include improper dilution of full-strength drugs, illegible writing in a patient’s records, and treatment of a patient by several physicians who do not have complete information about the patient’s medications or diagnoses.
The report calls for a 50 percent reduction in such errors over the next 5 years via a four-part plan. 1) A National Center of Patient Safety, created as a part of the U.S. Department of Health and Human Services (HHS), would “set national safety goals, track progress in meeting the goals, and invest in research on preventing medical errors.”
2) A national mandatory system for reporting medical errors would be established.
3) “All stakeholders, including consumers, professionals, and accreditation groups, become involved in the process of improving patient safety.”
4) “The Food and Drug Administration (should) take action to eliminate similar sounding names and confusing labeling and packaging.”
Commentary: These numbers are appalling, not to mention dangerous for Americans. Something must be done! But, looking to national agencies for regulation is just going to cause further problems, creation of monopolies, more paperwork, and greater expense. I am not sure what should be done. Perhaps, it is time that we stopped laughing about physicians’ handwriting. Perhaps, graduation from medical school and specialty training ought to require that physicians write quickly and legibly. Also, reported in the news within the past few weeks is the first damage awards to a patient’s family because the physician wrote a prescription that the pharmacist misinterpreted (AMN News, November 22/29, 1999, pp. 1, 30).
And, there is another problem that is not likely to be addressed in today’s politically correct environment: physicians that speak little English. Patients cannot be sure that they have been understood, and patients are likely to mis-interpret what the physician says.
The target of 50 percent reduction in errors in 5 years, as well as comments in the article, suggests that “to err is human” and cannot be entirely prevented in the dangerous world of deadly medications and procedures. Surely, though, all physicians should be startled sufficiently by this report to take diligence to improve their own practices.
I have reviewed several medical-legal cases recently. Perhaps, all physicians in training should be required to participate in and/or review numerous malpractice cases. There is the difficulty of reading another physician’s handwriting. One case took me two hours to decipher three brief paragraphs, and there were still 4 words that I never recognized. There are also the bad habits that some physicians get into: abbreviated and neglected parts of exams, failure to triage patients, abnormal lab results getting lost, etc.
But, there is also the issue of patient responsibility. My impression from the few cases that I have reviewed is that the legal process assumes that the patient is passive in the whole process. This attitude contrasts with all the talk about “patient autonomy” over the past 30 years. Again, I call for patient involvement in their own care. (The simplest way to decrease the number of fatal or otherwise damaging medical errors is just to decrease the number of contacts with this system. Cutting down all the money earmarked for medical care would do this — editorial reviewer.)
We can all do better. But, “we” includes patients, as well as physicians. And, we will have to accept some errors and deaths or we will have to stop practicing medicine altogether. What we must not do is bring in more levels of bureaucracy. This area is one in which the medical marketplace and legal process must be allowed to function freely.
“Schizophrenia is the most serious common brain disorder of young adults, affecting 1% of the world’s population, but we know much less about it than about most other widespread diseases. There is no reliable biological test or animal model, no objective clue like the plaques and tangles in the brains of people with Alzheimer’s disease or the focus of an epileptic seizure. The disorder takes different forms in different persons and at different times….
“It is not easy to identify what all people diagnosed with schizophrenia have in common and how it differs from other brain disorders. Even the boundary between normal and schizophrenic is vague.” (Harvard Mental Health Letter, Vol. 15, No. 11, p. 1, reprinted in PsychoHeresy Awareness Letter, July-August, 1999, p. 4)
Commentary: Honesty is so refreshing! Rarely is such ignorance of “mental illness” admitted. Nevertheless, the worldview that is materialism can allow no other etiology than that which is biochemical. As I have said often, the medical literature has abundant evidence of the flaws in theories of “mental illness.” However, those flaws rarely make their way into actual practice. This failure only demonstrates that such practice is based far more upon belief (premises and assumptions) than science.
I have commented on the problems with “research” that attempts to prove that prayer is efficacious. Another such report appeared in the Archives of Internal Medicine (October 25, 1999, pp. 2273-2278). In a note that I received, one doctor summarized such attempts with these comments.
“More New Age trash! It does not matter who is being prayed to. It does not matter if the one prayed for is saved. The intercessor does not have to be Christian.
“It does not matter if the intercessors are “brothers” of the one being prayed for.
“This is trash — they are trying to reduce my Savior to a mere scientific experiment and His miracles to data points.
“Prayer is a treatment like antibiotics — interesting.”
Sometimes, matters are best put in perspective when spontaneous and straight from the heart!
A physician writes more reflectively.
“One way of comprehending our age is that it has very little concern for right means. We (they) are concerned with ends and tip our (their) hat to motive. The means of knowing — epistemology — is a dark continent to our post-moderns. That supernatural interventions of God is by definition out-of-bounds for natural science (the way it is defined) is lost on us (them).
“For the first time, scientists have mapped virtually an entire human chromosome, one of the chains of molecules that bear the genetic recipe for human life.” (The Augusta Chronicle, December 2, 1999, p. 3A. The details of the study appear in the journal Science.)
Francis Collins, chair of the international project from the National Institutes of Health, is a professing Christian and member of a Southern Baptist Church. He comments, “I think that this is probably the most important scientific effort that mankind has ever mounted. That includes splitting the atom and going to the moon.”
Commentary: I am more skeptical than Dr. Collins. Modern medicine is not the great savior that most everyone believes it to be. Correction of chromosomal abnormalities will be problematic, even apart from ethical considerations. Further, I continue as a voice crying in the wilderness that there is a great deal more in a cell than its DNA: mitochondria, RNA, ribosomes, and hundreds of identifiable and active parts.
And, most importantly, at some level in animals and humans, life is spirit. A human is not the summation of his cellular content, but a unity of physical and non-physical substances. Dr. Collins and others ignore the other parts of the cell and this non-physical dimension of life. However, they will find out the reality of these other parts as they encounter unexpected problems with experiments that are narrowly focused on DNA.
With the somach-upsetting qualities of aspirin, perhaps we ought to change the traditional put-off by physicians. A Swedish study in The New England Journal of Medicine found that placebos work as well as the drug cimetidine (a blocker of acid production) in patients who have “chronic indigestion” but no ulcers (Science Digest, June 1986,* p. 15).
Physicians prescribe antacids and blockers because they assume that acid plays a role in non-ulcer acid pain. However, “stomach disorders are poorly defined. We don’t know what nonulcer indigestion is.”
Commentary: Dare I say it? If the placebo effect were removed, physicians and all other practitioners (including those in alternative medicine) would be out of business. Our real help (uncommon) and cures (rare) would be insufficient to build a patient base. Our prestige and income is dependent upon the placebo effect! So, take a placebo (or anything else that is not harmful) and call me in the morning — so I can see you and give you a bill!
* The date is correct. I am reviewing and discarding old files, but truth (or at least scientific fact) is always current.