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Biblical Reflections on Modern Medicine

Vol. 7, No. 3 (39) 

Contents:


When Is Enough Medical Care Enough?
or
Christians Worship at the Altar of Modern Medicine

"Out of the blue this month came a report that Jane had a mass in her bladder which was removed by a Urologist. We were told that it was a rare and deadly adenocarcinoma which had penetrated the bladder wall musculature and outer bladder wall.

"For the past 8 days, we have made almost daily trips to the physician for some new test or consultation, mostly to try to eliminate all the other possible places this cancer could be: liver, colon, stomach, bone, breast, and lung (Ed's emphasis). As of today, we have not found any indication outside the bladder.

"At the least, we expect the bladder will be taken and some surrounding tissue. We hope to finish diagnostics this week and go to Famous Cancer Research Hospital for a second opinion. Then, we must make decisions about the surgery... where, who, what procedures, what kind of chemo or radiation therapy, etc. We just know that we will have to have surgery as soon as possible....

"Last night she drank a gallon of preparatory fluid (necessary for a colonoscopy) while she watched the academy awards... in her bathroom! She is another "Brave Heart" who also deserves an Oscar... at least in my book!"

This story is real, just sent to me a few days ago. A few readers who are common to their mailing list and to mine will recognize the story. But, no one else will, so no more will know who they are than already do.

The couple is involved in a ministry that addresses critical philosophical issues in the world of ideas, so they are no neophytes to discernment. However, at the risk of seeming mean and cruel, I want to ask, "When is enough (medical care, especially for Christians) enough?" "Are Christians part of the problem (high cost and demand of medical care) rather than a part of the solution?"

Francis Schaeffer had a severe, chronic illness and traveled repeatedly to the Mayo Clinic (Rochester, MN) for treatment. As their methods did not seem to be effective, after a time, he stopped everything and accepted his inevitable death. As I reflect on medical issues, I am continually amazed at the faith that Christians place in modern medicine. Many seemingly ought to know better -- some of whom have been closely involved with our approach to Biblical medical ethics.

In the past, when I was thoroughly familiar with their works, the Christian Medical and Dental Society had no article or tape critical of medicine (or psychiatry) with the exception of high profile ethical issues such as abortion and euthanasia. But, isn't an industry that is sapping more than 13% of the GDP of the United States, but one that has little proven efficacy, an ethical issue? I think so. I think so strongly!

When Is Enough Enough?

What is wrong with Jane and her husband's plans for medical care? Perhaps, nothing. As you might expect, however, I have some concerns.

The most important point is reflected in "all the possible." It is the attitude that all possible avenues of both diagnosis and treatment must be explored. But, the only logical reason for doing everything possible is to affect the outcome of the patient's condition. Overall, modern medicine is not very good at affecting outcomes.

I will not belabor the point that I have made on these pages and elsewhere. For all its claims to modern science, modern medicine has the substance of Swiss cheese. The "war" on cancer (with a few exceptions such as childhood leukemias and lymphomas) has had a resounding defeat. Judging from the last set of studies that really looked, coronary care units do not save lives in the way that they are used. Heart attack victims may do as well at home as in the hospital. And so on.

All knowledge is based on faith principles. Modern medicine is based upon the faith principle that its applied science is better than leeches, snake oil, root remedies, and chiropractic adjustments. The evidence for that science is minimal.

Secondary Issues

This faith in modern medicine has a considerable cost factor. Such a workup and eventual treatment, as described here, is extremely costly. Who pays? Now, they may have a policy that covers "everything." But, I doubt it. There are always gaps in such extensive explorations and treatment. Who pays?

This family cannot. They have barely eked out a living by support from their ministry. Should they go on Medicaid? (I wonder how many Christians are on Medicaid?) Should financial support be directed from their ministry to pay for what may be futile medical pursuits? Should the clinics and hospitals write off (that is pass on to other paying patients and third party payers) unpaid diagnostics and treatment? Should an insurance company be required to accept them as policy holders with this prior medical condition?

There is the morbidity and mortality (as we call medical harm and death) from medical means. Patients are harmed, and sometimes die, yet there is not a formal or thorough data base for patients who suffer from the effects of evaluation and treatment. A patient dies from accidentally drinking Betadine (a strong antibacterial solution), not understanding that it was intended as preparation for a colon exam. Where is her death reported as a medical consequence? Patients die from chemotherapy. Would they have lived longer without it? People die from ambulance accidents, but their deaths are traffic statistics, not medical morbidity and mortality. And on and on.

It's Easy to Referee from the Sidelines

I have yelled many things to referees at my children's sporting events that I should never have. In all honesty, I could not have refereed better. (Well, maybe there were one or two exceptions!) If faced with cancer or severe heart disease, I would be arrogant to say without hesitation that I would make better medical-moral decisions than anyone else.

But, sometime and somehow, Christians must pop the bubble of pretense of modern medicine. As a nation, we pay 5-6 times as much for medical care as we do to churches and charities (1991 figures). Christians have the security of God's Providence and hope of Heaven as bedrock for medical decisions. Of all people, we ought to be willing to forego that one chance in a hundred. 

And, we ought to forego it not because we are nobly allowing a "needy" person to have our slice of medical care. We ought to forego it as a matter of facing the truth in our lives that medical care is frequently ineffective and that our faith has priority in "the things that are unseen." 

(Too many Christians fall into the equally wrong position that alternative methods are wonderfully efficacious. I have dealt with that worship in a past issue of Reflections.)

Practical Concerns

Should we ever penetrate that fog of medical efficacy, how does one decide what medical diagnostics and treatment to forego? Simply, take responsibility for yourself and your family. Learn to ask the appropriate questions to physicians. What are the actual chances of changing my outcome? What have studies in the past shown about this approach? Would you (the physician himself) have this procedure done to you? What are the nauseating, energy-draining, blood-destroying, immunity-compromising, infectious disease-exposing, and otherwise harmful (and possibly lethal) effects of this procedure? 

Go to a hospital or medical school library and do your own research. There are hundreds of organizations that focus on diseases from Alzheimer's to arthritis to epilepsy to multiple sclerosis to .... (almost certainly) whatever you have. These groups are often quite helpful because they usually have a better grasp of outcomes and unintended effects than physicians. And, they have literature that you can understand. Some, however, have their own adulation of medicine and surgery that must be evaluated.

The bottom line is that you have the responsibility to decide and not simply take the physician's word as fact. You are responsible for adequate knowledge to make a decision. 

Suppose a disease, untreated, kills 495 of 500 in 5 years. Treatment A (cost $10,000) changes those odds to 480 of 500 in 5 years. The research that shows this change would report 4 times as many survivors for treatment A over the untreated (20 survivors vs. 5 survivors). 

However, the risk of death is little changed. A 99% chance of death has been changed to a 96% chance (at a cost of $10,000). Also, the cost for those 15 survivors is $5 million (500 x $10,000) or $250,000 per cure achieved. And--no one knows who those survivors would be. This treatment is one that you should forego. Perhaps you can afford it, but at least realize what you are paying for.

Suppose Treatment B (cost $10,000) changes those odds to 250 deaths for the 500 afflicted over 5 years. The chance of death is 50/50, but the change is risk is substantial in absolute terms. With this treatment, cost per cure is $20,000, and your odds of being the one cured are greatly increased. This treatment is one that you should take and that third parties should contract for. 

Patients need to learn not so much about the treatments in detail, but how to ask questions that penetrate the fog of numbers. Ask, "How many die (or lose a limb or whatever), if NO treatment?" "How many die (or something else) if the treatment recommended is used?" Insist on raw numbers, not proportions or percentages. If the physician doesn't know, make him say so. Then, calculate the cost per 1% change.

Some readers may think that I am hung up on cost. I'm not. If you have the money or have a third party contract with a private company to pay for a treatment and it has a reasonable chance of success, I have no ethical problem with your choice. 

However, HMOs and other cost-cutting measures are upon us because we have wanted everything (in medicine) for everybody without discernment of the above issues. This approach has become overly burdensome in its cost. Unless we understand the economic issues that have brought us to the brink of administrators, not physicians, choosing who gets what medical care, we are part of the problem rather than the solution. 

As usual, I have rapidly gone over issues that are broad and deep. I may have offended or confused some readers. However, I want Christians to be problem-solvers, not problem-participants. Thus, I place this issue before you.

Christians, let's don't worship modern medicine, but accept its utility where it gives us a reasonable chance of benefit and place it within the care of our First Love. 

Antibiotics for Colds: A Follow-up

The Liberal Philosophy at Work

A friend writes in a personal letter to me:

"I should never read your newsletter while I'm doing my shift in the ER--as I unfortunately did your last issue. You only fan my fire with a gasoline-laden blanket. Your theme of useless medical treatments was right on target. I get so weary of trying to explain to the ignorant public that they don't need antibiotics for colds that I could eject emesis on their shoes. What ridiculous expectations we physicians have engendered in a naive public. We should be placed in the public stocks. And to make it worse, all those physicians who cave in to the instant-cure-craving public cause me to appear an ogre as I try to practice with a modicum of science. I (uncompassionate swine that I am) won't give'm the ole Quick Cure the way Old Doc Birdbrain always does--and usually over the phone!

And, speak of timing. The Journal of Family Practice (April 1996, pp. 357-361) had a research article on the prescribing practices of primary care physicians in the Kentucky Medicaid program. Sixty percent of these patients who presented to their physician for the common cold received a prescription for an antibiotic.

The authors concluded:

"A majority of persons receiving medical care for the common cold are given prescriptions for an unnecessary antibiotic. Unchecked, this practice may lead to greater antibiotic resistance and unnecessary use of health care resources. Future research should focus on the ability to institute behavioral changes for treatment of the common cold in both closed systems (e.g., managed care) and open systems (e.g., general community of physicians."

And, There's More

While I have been vindicated by my friend and by one leading journal of my specialty, I discovered that the issue is also philosophical, as in liberal. In an article entitled, "The Problem with Liberalism" (First Things, March 1996), the author, J. Budziszewski, observed a difference between liberals and conservatives (more specifically, Bible-believing Christians).

The liberal sees a problem and concludes, "Better to harm magnificently in the name of help, than to help but a little." The conservative sees the same problem and concludes, "Do no harm, and help where possible." 

In welfare, the liberal has spent trillions "to end poverty" and, if anything, it is worse. In medicine, generally, the liberal is compelled to give "access" and full medical services to "the indigent" in spite of no single study that shows that medical services alone improve the health of a given population.

But, I had no idea that my diatribe against antibiotics was also a liberal-conservative issue. The liberal wants to "harm magnificently in the name of help" by prescribing antibiotics. He harms immediately with a lie that antibiotics help the common cold. He harms more generally and severely the good that antibiotics could do in proven situations because the bacteria "learn" how to defeat these antibiotics. So far, we are able to treat most bacterial infections, but for how long will we be able to stay ahead?

Woe to him who challenges me on this issue again! The medical literature, as the only medical science available, is overwhelmingly on my side. The physician who prescribes antibiotics for colds has no more standing for that practice than the "quacks" he so vociferously denounces. And, he is also taking a stand with the liberals who care nothing for the long-term and general disasters that they are causing. They had rather "help a little" and "harm magnificently!"

On Pap Smears, Furniture Polish, and Ball Point Pens

Hilton P. Terrell, Ph.D., M.D.

A study recently published in The Journal of the American Medical Association1 reviewed other studies of the effectiveness of screening women for cancer of the vagina after they had their uteruses removed for reasons other than a cancer. Amazingly, physicians continue to do Pap smears on women who have no uterus, having had the organ removed for reasons other than cancer. Maybe as many as 11% of Pap smears are done on women in this category.

The Pap smear has been held up as the model screening test for years. However, it has been a model for detection of cancer of the cervix of the uterus, not of the vagina. The two types of cancer, though in close physical proximity, are vastly different in their frequency and behavior. The Pap smear has never been shown to be an effective screening test for cancer of the vagina. Given the frequency of both hysterectomies and Pap smears in the United States, the matter is not a small one. Perhaps one-third of all women have a hysterectomy by age 60, and there are about 44 million Pap smears done every year in this country. The authors calculate that there are about five and a half million Pap smears done annually on women who have no uterus, at a charge of $43 million.

Physicians provide all sorts of excuses for the bizarre practice of pretending to be able to find the one woman in about 100,000 who has a vaginal cancer. "Women won't come in for other checks if we don't do a Pap smear." "A cancer of the cervix of the uterus might have spread to the vagina and not have been noticed when the uterus was removed." "I don't like any of my patients to die of any malignancy."

None of these excuses hold water. Ovarian cancer deaths are about 19 times more common than vaginal cancer deaths, yet no one has been able to sustain an argument that we can screen and prevent ovarian cancer deaths. The ovaries are usually the other organs indicated when a health maintenance pelvic examination is done by a doctor after a hysterectomy. Using a Pap smear as a come-on to get women in to do another ineffective test is not very impressive. The probability of cancer of the vagina is so low that, even if a Pap smear indicates one may be present, the odds that one really is present are still less than one in 100. This small number results because the inevitable inaccuracy of the test interacts with the very low frequency of the disease. To make the practice even more indefensible, about 80% of all cancers of the vagina are a cancer that has spread from some other organ. Such spread makes the probability of a cure even lower. So, in the rare event that such a cancer is found after sorting through 4000 false positives, it is less likely to be curable. The whole purpose of screening is to find disease in curable stages.

With an understatement typical of professional journals, the authors of the study concluded that "there is insufficient evidence to recommend routine vaginal smear screening in women who have undergone a total hysterectomy for benign disease, i.e., no history of premalignant or malignant genital disease, and no history of maternal [diethylstilbestrol] exposure." The understatement borders on hyper-wimpiness. There is, likewise, insufficient evidence that furniture polish can grow scalp hair, that Cessnas can double as ball point pens, or that Bosnia could be towed to the South Pacific. In a profession which accepts FDA requirement of positive evidence of drug effectiveness before use, why are we so tentative about such worse-than-worthless testing?

One answer can be found by reference back to the $43 million. Another answer has to do with the idolatry of modern medicine. We believe in our own deity if we believe we can reduce such small risks. Even if we could reduce them, the cost would divert resources from far more productive enterprises. Suppose someone proposed a method costing $43 million to prevent pedestrians from being run over by pink and purple polka dot trucks driven by left-handed Lutherans in New Jersey. It would be a joke. Pap smears in women who have had hysterectomies for non-malignant disease are in the same category, but no one laughs. We need some good stewards of Christ's creation to laugh the derisive holy laughter that holds such practices to scorn.

Reference

1. Fetters, Michael, Fischer, Gayle, & Reed, Barbara, "Effectiveness of Vaginal Papanicolaou Smear Screening After Total Hysterectomy for Benign Disease," The Journal of the American Medical Association, March 27, 1996, pp. 940-947.

Ed's Note

See the article herein, "Antibiotics for Colds: A Follow-up." Doing Pap smears is another category of "trying to help a little."

Now to the King eternal, immortal, invisible, 

the only (wise) God, be honor and glory 

forever and ever. Amen. (I Timothy 1:17)

Letters-to-Ed

Saving Faith and Faith to Be Healed

Dear Ed,

In the March 1996 "Reflections" you, by your own admission, came down very hard on a single statement in Christian Medical Foundation's "Progress Notes", regarding whether God wills a person to die of illness or to take leave of a healthy body. I think you have missed the point here, and in all humility may these following statements be offered to point out what is being said.

You correctly stated that God took Enoch and Elijah alive (as man will sometime later go up). What you failed to acknowledge are the many who have simply vacated their earth-suits to be in His presence without having to be evicted by some malady. This is God's Plan A, and it should never be called mean and cruel simply because most of us for one reason or another select Plan B. Heaven is the result of either plan for the Christian.

Several generalities may help you to soften your harshness toward those who will not accept your doctrine of death by disease being God's "ordinary" plan.

First, Jesus (God with us) never gave someone disease or left in their morbid states those who sought his healing touch.

Secondly, to encourage someone to increase his or her faith is neither cruel nor deceptive. "The just shall live by faith." No mature Christian would suggest that a person's failure to receive his healing is demeaning in any way, but to say that God does not respond to faith would be to wipe out a large portion of His Word.

Certainly many Godly people have "suffered and died from acute and chronic diseases." But the annals of Christianity and the Works of Jesus are also filled with people who have been healed naturally and supernaturally "according to their faith." 

Finally, in regard to the curse, you should read Galatians. My Bible says we believers have been delivered from the curse, Jesus being made a curse for us (in our stead).

Regardless of what we may see in the natural (which is where we must practice to the best of our abilities), I am going to keep my eyes on Jesus, the Giver of better promises, and on His New Covenant, built upon better stuff.

Marion W. Griffin, M.D.
Ashboro, NC

Ed's Response

I am glad that Dr. Griffin wrote this letter because it describes in more detail the approach that I attacked in the March Reflections. My criticisms stand.

How, pray tell, can someone distinguish whether a dead person died from "God's Plan A" or "God's Plan B?" Will someone please send me an autopsy report that concludes, "This body was in complete health. Cause of death unknown."

Simply looking at Biblical context will often solve some problems. In Galatians 3 (to which Dr. Griffin refers), the passage is about the curse of the law, not the curse of death. It does not apply to bodily health. The curse of the law is unforgiven guilt. We are delivered from that curse.

The issue of faith is more complicated. I once wrote a book on faith to clarify such issues, but it remains unpublished. Saving faith and other kinds of faith are confused. The most fundamental (true) Christian belief is belief that the Bible is true. As someone once said, "God is truth" must necessarily precede "God is love." That is, how can I believe the latter without the former?

Saving faith follows from or simultaneous with faith that the Bible is true. God gives a person the ability to believe, "For by grace you have been saved through faith; and that (salvation) not of yourselves, it is the gift of God" (Ephesians 2:8, NASB). 

However, "Faith to move mountains" and "faith to be healed" differ in that they are given for specific situations. For example, a blind man received his sight because of his faith (Luke 18:42). But, if his faith was all that was required for him to be healed, why did he need to ask Jesus in person? He believed that he would be healed because God had given him the assurance (faith) that he would be healed. God chose to give this faith simultaneous with his contact with Jesus.

But, faith was not required for some to be healed by Jesus. Ten lepers were healed, but only one returned to praise Him (Luke 17:11-19). I conclude that the others did not believe that Jesus had healed them or that He was not God or something else. How else could they not return to worship Him or at least to thank him?

Some Conclusions 

The simple solution to these issues of faith is that there is more than one definition or application for the word faith. Does not every dictionary have more than one definition for most words? However, Christians spout forth principles and doctrine as though the Bible had only one definition for each word. This problem has more to do with simple scholarship than differences of interpretation.

There are two components of all these types of faith. First, faith is a gift. As seen above, faith to believe in the Bible and our Savior is a "gift of God." Belief that God will heal in specific situations is also a gift. Whether that belief (in healing) is from God or somehow welled up from within is whether the healing actually takes place or not. It does not matter how much we pray or who prays, if that request is not in God's plan.

Second, the value of faith has everything to do with its content. Many wives have had faith in a husband who eventually betrayed them. The faith that I have in my car has not always gotten me to my destination. The faith of many Christians that God would work in a specific manner never came to fruition. 

In general, "the faith" in the Bible concerns knowing God and His plan. We increase our faith with knowledge from the Bible, not from welling up some sort of emotion or "having enough faith." You see, our concern should be His will, not ours. The more that we understand God as Sovereign and Wise God, the less we become concerned about whether we are granted certain things. Great Christians (my personal estimation) whom I have read have been so overwhelmed with wonder and praise of God, that bodily afflictions in themselves or others paled in contrast.

"Increasing our faith" is increasing our knowledge of God. It is not increasing our desire for health or "to take leave of a healthy body." I have observed charismatics and Pentecostals (and other evangelicals in different terms) make convoluted arguments (what I call "mental gymnastics") in an attempt to resolve conflicts between their beliefs about "being healed by His stripes" and the physical maladies that they experience. It is funny in a way because it is so ridiculous. Dr. Griffin's fuzzy concept of "God's Plan A" and "God's Plan B" is an example.

However, in application, it is a vicious and cruel task that is placed on others. Again, I call you to read Joni Eareckson Tada's One Step Further about her experience with "if you have enough faith, you will be healed." Fortunately, she was taught correct beliefs about God's promises. Many have despaired in the attempt.

Many charismatics that I know are wonderful people. I enjoy their enthusiasm about their faith, and many have better understanding of medical ethical issues than evangelicals. However, on this issue, I cannot retreat. Faith is both simple and complex. The simplest person who can understand that Christ died for his sins can be saved. However, the various applications of faith are more complex. Most of the confusion might be overcome with the simple principle that words have more than one meaning and application. 

Two excellent books on the subject are : What Is Saving Faith? by J. Gresham Machen and Faith and Saving Faith by Gordon H. Clark. Yet, these lack some specific applications that are causing problems for Christians today. Perhaps someone will eventually tackle those issues. 

Brief Reports: Focus on HMOs

The HMO Bottom Line

"Don Printz, M.D., President of the Association of American Physicians and Surgeons (AAPS), reports that two Atlanta HMOs (Blue Choice and PruCare) ran out of money at the end of October 1995. They didn't bother to inform the doctors, until the week before Christmas, that they would not be paid for any patients seen during November or December. One dermatologist wrote off $20,000--not for voluntarily providing life-saving care to the needy, but for providing discretionary services to 'insured' patients. He signed up again, saying that the HMOs had promised to do better this year. U.S. HealthCare physician 'providers' in Atlanta also had a bad year--so bad that more than half of them quit. It is not known whether the $9-million-per-year chief executive got his paycheck garnished too.

"Managed care is also increasing physician overhead. Medical Protective Co., one of the largest professional liability insurers in Texas, said that the use of 'gatekeepers' is a major factor behind their 23% rate increase. The company had noted increased losses due to misdiagnosis.

"CAN Insurance Cos. of Chicago is asking state regulators to approve a 45% overall rate increase in liability premiums, and American Physicians Insurance Exchange of Austin is seeking a 32% rise.

"Precise statistics on the impact of managed care don't exist because the rapid spread of managed care has occurred so recently (American Medical News, April 1, 1996)

"Patients are apparently feeling some impact on their care. According to a March, 1996, survey by Aragon Consulting Group, less than 25% of HMO subscribers and 26% of P.O. members are completely satisfied, with their coverage, compared with 42.5% of conventional policyholders. Only 38.8% of those enrolled in an HMO and 44.2% in a P.O. are highly satisfied with the selection of doctors available to them, compared with 76.5% in traditional insurance plans." (AAPS News, May 1996, p. 2)

Commentary: The worship of HMOs (as they are currently designed) as the answer to health care costs in the United States will be the shortest fad of modern medical economics. Neither patients nor physicians will be satisfied and corporations will not make the huge profits that they think that they will (at least after the first few years). 

State Regulations Raising the Bottom Line for HMOs

More than 400 bills to regulate managed care plans have been introduced in about 40 states this year. Changes include mandating certain benefits (e.g., maternity stays) and changing contract regulations (e.g., allow patients to see non-network physicians). These bills have been called a "backlash" against HMOs. (American Medical News, April 22/29, 1996, p. 4)

Commentary: "There is no right answer to wrong situations." Medical care costs have escalated primarily because of government regulation, but everything else is blamed: physician greed, excessive profits by insurance companies, patient demands for care, etc. While these are factors, they are secondary.

HMOs have many strikes against them at the outset. Their primary reason for existence is to lower costs for consumers. If, however, without the freedom to contract without government regulation, their purpose will be thwarted. Will we shortly have the call for nationalized medicine again? That is, will we want to jump from the frying pan into the fire?

Liability Costs Rising in Primary Care

A national trend shows that medical liability costs are rising for primary care physicians. Three factors are responsible: failure to diagnose, misdiagnosis, and delayed diagnosis; medication errors; and the gatekeeper role assigned to primary care physicians by managed care plans. (The MAGnet [newsletter of MAG Mutual Insurance Group], May 1996, p. 1)

Commentary: I want to focus only on the gatekeeper role here. This rise in liability cost counts against HMOs for three reasons. 1) It is an indication that the physician-patient encounter is more hostile than it has been. Many physicians and patients are not happy with the situation. 2) If the liability costs are paid by the HMOs, then their costs will be higher and their profits lower. 3) Limiting services is at least perceived by patients as detrimental to outcome, whether it actually is or not.

The Legal Quagmire of HMOs

In Illinois, a physician violated a 5-year contract with a hospital but had an appeals court rule in his favor under a 1923 Medical Practice Act that prohibits "a corporate entity from practicing medicine by employing licensed physicians." Many states have such legislation on their books. (American Medical News, May 6, 1996, pp. 3, 25-26)

In Louisiana, the Justice Department charged a Baton Rouge hospital with using its physician-hospital organization "to block competition and boost charges" in violation of federal anti-trust law. American Medical News, May 13, 1996, pp. 3, 33)

In Wisconsin, the Marshfield Clinic and its HMO were convicted of anti-trust allegations by a federal appeals court. The U.S. Supreme Court has refused to hear the case. (American Medical News, April 15, 1996, pp. 1, 28)

Commentary: Legal quagmires and roadblocks abound as HMOs, PHOs, and other "alphabet-soups" exist in the medical care arena. American medicine seems to be fast approaching legal and economic gridlock. The days of private contracting between physicians and patients out of frustration and contempt for bureaucratic nightmares may be returning before you know it.

Private schools are a precedent. Many, many families pay double for education. They pay in county, state, and federal taxes for public education, yet forfeit this "free system" to pay further for private schools. Other than some public health measures, no level of government has the moral right to regulate medical practice. Until that issue is resolved, U.S. medical care will continue to be costly and contentious.

AIDS: Issues and Answers

Vol. 10, No. 3 (64) May 1996

Ten Years of Reflecting Back

As noted with some detail in the January 1996 Reflections, I started closely following the HIV/AIDS epidemic in 1987. At that time, there were fewer numbers and a relatively short time frame (6 years) to understand this epidemic. However, 10 years provides for a lengthy period of observation. I have covered all these areas from time to time, but I present them here in summary form.

The Numbers and Distribution

The total number of AIDS cases reported from 1981 to August 14, 1987, was 40,051. Of these, 65% occurred in homosexuals, 16% in IV-drug abusers, 7% homosexual and IV-drug abusers, 4% in "heterosexuals" (sexual partners of individuals at high risk for HIV/AIDS), 3% "undetermined" (i.e., incompletely investigated), 1% in children, and 2% hemophiliacs and transfusion recipients. (Numbers are rounded to whole numbers. Thus, the total is not 100%.)

The total numbers of AIDS cases reported from 1981 to December 31, 1995, was 513,486. Of these, 51% occurred in homosexuals, 25% in IV-drug abusers, 7% homosexual and IV-drug abusers, 8% in heterosexuals, 7% "undetermined, 2% hemophiliacs and transfusion recipients, and 1% in children. (HIV/AIDS Surveillance Report, Vol. 7, No. 2)

Conclusions: HIV/AIDS has remained within high-risk groups almost entirely. That is, one's risk of being infected with HIV outside these high-risk groups is nil. We are not "all at risk" as we have been told. There is no heterosexual spread apart from these high-risk groups. 

Transfusion Risk

As I reported in the last Reflections (March 1996), the risk of infection from blood transfusion is now even smaller than in 1987. The blood supply is safer than it has ever been. However, caution is still urged, as other infections and unintended side effects of transfusions may occur.

Treatment of HIV/AIDS

Some complications of HIV/AIDS can be treated with some success, e.g., Pneumocystis carinii. For the most part, however, there is no currently available treatment of the virus itself. In spite of priority funding for HIV/AIDS research and treatment, 62% of all reported AIDS patients are dead. This number has never really changed over this 10-year period.

Third World AIDS

Predictions of entire populations being wiped out in Third World countries by HIV/AIDS continue today. The 1:1 ratio of men to women in these areas has been a battle cry by "officials" that everyone is at risk for AIDS. However, we now know a lot more about statistics in these countries. 

First, funding from the World Health Organization and other agencies is dependent upon AIDS statistics. Thus, many non-AIDS/HIV deaths are reported as AIDS, even traffic accidents! (Reflections, July 1995, p. 7) Second, sexual practices of adultery, homosexuality, and other bizarre cultural practices are frequently practiced in Third World countries, providing avenues of transmission not common to the United States and other Western countries.

Conclusion: We really know very little of substance about AIDS in the Third World.

Condoms and Education

For more than 10 years now, condoms and education have been and still are touted as the primary line of defense against the spread of HIV/AIDS. There is virtually no evidence to support this claim. Sexual practices and the use/non-use of condoms is little changed (with minor and insignificant exceptions). 

The Threat of Casual Infection

As noted above, the risk behaviors of HIV infection are clearly documented and defined. If HIV infection occurs outside those avenues, it is rare and unusual. Even with injection of HIV via needles, broken glass, and other medical exposures, only 1 in 250 health-care workers become actively infected with HIV. This virus is amazingly stable, considering the innumerable replications that have occurred in millions of HIV-infected people worldwide without any change in its pattern of infection and its being the most intensely watched epidemic in history. Mosquito-borne and other potential threats have just not materialized.

The Church and AIDS

Theologically, the Church in general is in shambles. As one might expect with a moral/spiritual issue such as HIV/AIDS, it could not be expected to discern the issues. In many quarters, the patient with HIV/AIDS is virtually worshiped as a sort of shrine. Eerdmans just published AIDS and the Sleeping Church, a book written by Patricia Hoffman, a hospital chaplain. In the Foreword, Chris Glaser writes, "Christ has returned in the guise of persons with AIDS." Enough said.

Even in evangelical circles, the person with AIDS is seen as somehow more deserving than the person with cancer, severe heart disease, etc. And, for the most part, with little or no discipline anyway, the issues of homosexuality are either accepted with impunity or they are just ignored.

For example, the current issue of Focus on the Family's Physician carried an article endorsing Americans for a Sound AIDS Policy (ASAP), organized by W. Shepherd Smith, Jr., who has yet to condemn homosexuality and attempted to lay a guilt trip on the Church in his book, Christians in the Age of AIDS.

Summary

In summary, in 10 years of AIDS reflections, virtually nothing has changed except that the same banal, but politically correct, jargon continues by leaders of both Church and state. The tragedy is that hundreds of thousands continue to become infected and die of this disease. The far greater tragedy is that the Church has little or no theological foundation to deal with the primary issues of salvation and forgiveness, much less the moral and social issue of HIV/AIDS.

Unfortunately, what we then suspected with reasonable evidence has only become more certain.

Jonathan Edward Puckett

Died May 8, 1996

Jonathan Edward Puckett was my second grandson. However, in God's Providence, he died before birth at 31 weeks gestation. Our family deeply grieves his loss.

Please pray for my daughter Sherry (his mother) for this time and for her next pregnancy, for health of bodies (mother and child) and peace "that passes understanding." 

"Heaven grows dearer as more and more of our loved ones go there."


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