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Biblical Reflections on Modern Medicine

Vol. 9, No. 1 (49) 

Contents:


Genetic Ethics: Do the Ends Justify the Genes?: A Book Review
or
The Good, the Bad, and the Ugly

The only notification list of new releases that I am on is that of Wm. B. Eerdmans Publishing Company. Recently, I received Genetic Ethics: Do the Ends Justify the Genes? (1997, 291 pages, $22.00). 

The list of notable Christians and their titles who contributed is impressive. Its editors are John F. Kilner, M.Div., Ph.D., Director of the Center for Bioethics and Human Dignity (CBHD) in Bannockburn, IL, on the campus of Trinity International University; Rebecca D. Pentz, Ph.D., clinical ethicist and Associate Professor of Clinical Ethics at the University of Texas M.D. Anderson Cancer Center; and Frank E. Young, M.D., Ph.D., former commissioner of the U.S. Food and Drug Administration (FDA) and director of Adult Education at the Fourth Presbyterian Church, Washington, DC. Other contributors will be noted later.

The Good

The book is the compilation of presentations given at a conference on genetics held at Trinity University in July 1997, sponsored by CBHD, Christian Legal Society (CLS), Christian Medical and Dental Society (CMDS), Nurses Christian Fellowship (NCF), Trinity Evangelical Divinity School (TEDS), and the Wilberfore Forum (WF). The book has a thorough discussion and presentation to help laymen understand issues and methods in genetics and see an overview of the current science of genetics, including a discussion of the Human Genome Project by its Director, Francis Collins, Ph.D., M.D., (a professing Christian). (The Project is the mapping of the entire human chromosome by an international team of scientists.) There is a helpful "Glossary of Genetic Terms" and an Index (a frequent omission in Christian books).

Charles Colson, J.D., Director of WF and Prison Fellowship, was an insightful keynote speaker. E.g., "Harvard could not possibly teach ethics. Ethics cannot be taught by people who say there is no absolute truth.... They (do) not even know the questions to raise" (p. 221).

He was critical of evangelicals "who do not look much better." Quoting from a 1994 Barna survey, 62 percent of "born-again" Christians agreed with the statement, "There is no such thing as absolute truth" (p. 222). He challenges Christians to "a well-reasoned Christian apologetic on all issues" (p. 226). And much more.

C. Ben Mitchell, M.Div., Ph.D. candidate, serves on the Christian Life Commission of the Southern Baptist Convention. He names abortion as a central pillar in the current focus on genetics. "When social engineers link up with behavioral geneticists, trouble is bound to follow" (p. 235). "Genetic screening advocacy wedded to abortion advocacy yields a breathtaking form of self-loathing" (p. 236). "The church's confession is that the source of all our problems is sin and its effects on the cosmos" (p. 236).

David Biebel, D. Min., editor of the CMDS Journal (Today's Christian Physician), writes a helpful chapter on suffering, as he has lost two young children to a rare genetic disorder. Michael S. Beates, S.T.M., Instructor at Reformed Seminary, Orlando, FL, writes on "God's Sovereignty and Genetic Anomalies." 

The Bad

This book is appalling in its ignorance of basic Biblical truth and fundamental Biblical, ethical issues, especially as it may contain the most prestigious group of evangelical scholars and leaders in any one source on medical ethics. 

First, there is no consistent agreement on abortion. Allen D. Verhey, B.D., Ph.D., Blekkink Professor of Religion, Hope College, and prolific author on medical ethics, writes "Some Christians, it should be noted, give reluctant approval to abortions under highly unusual, tragic conditions (e.g., Trisomy 18 and Tay-Sachs)" (p. 70). His footnote cites himself, several others, and Hessel Bouma, III, Ph.D., another author in this book.

For clarity, let me re-state Verhey's position. If any situation is tragic enough, ethical principles can be violated! Does that ring familiar? How about Joseph Fletcher's Situation Ethics? Is not Verhey's statement contradictory to Beates' chapter on the sovereignty of God in genetics?

The problem about abortion here is more fundamental than this book. The primary sponsoring organization, CBHD, has no stated position on abortion. They have no standard by which to accept or reject authors and presenters by their position on abortion. 

I initially evaluate any book on medical ethics by looking in the Table of Contents, the Index, and scan the book for discussions on abortion. Dear readers, abortion is a fundamental issue in medical ethics. If a person is not against abortion for any reason other than to save the life of the mother (a rare situation today) and does not believe that individual human life begins at fertilization of the egg by a sperm, then his ethical structure already has a foundation of "sinking sand."

Abortion and euthanasia (active, intentional killing of innocents) may be the simplest issues in medical ethics. Some issues, including genetics, are admittedly difficult in their many facets. However, if there is no foundational agreement, what clarion call do Christians have to secular society? -- a stated goal of CBHD, CMDS, and other organizations represented in this book.

CMDS, another sponsoring organization, is a Johnny-come-lately to the abortion debate. They first published a weak statement on abortion in 1981 (8 years after Roe v. Wade). Only with pressure from me and others did they finally re-write the statement in 1985. (The Board of Trustees had to bypass their own Ethics Commission to get this more conservative statement!) Still, they could not affirm that individual human life begins at conception. (They later did in a statement on another issue.) Further, they continued to publish articles and have leaders in CMDS with unbiblical views on abortion.

Second, and relative to my abortion discussion, this book is eclectic. Now, "eclectic" is not often used by Christians today. Webster's Third Collegiate Dictionary defines "eclectic" as 1) "selecting what appears to be best in various doctrines, methods, or styles"; and 2) "composed of elements drawn from various sources." May I coin a synonym? Eclecticism is evangelical multi-culturalism. This book, CBHD, CMDS, and other evangelical groups and products today have their own multi-culturalism. For example, not all Christians are anti-abortion (as I have defined above), but they have much to say that is good, so we can have our names associated with them. After all, we are all brothers and sisters in Christ and ought to embrace one another. Who has a corner on the truth, anyway? 

Perhaps, we should look at some of the labels that Jesus called the religious leaders of His day. Oh, horrors, He called people names! More horrors -- Paul confronted Peter in public (Galatians 2). Calvin had unkind names for the Roman Catholics, and Luther was ruthless in his condemnation of Erasmus.

Since I am making enemies, I will go a little further. Is not evangelical multi-culturalism nothing but fearing man more than fearing God? They say, "I want to belong, so don't let me offend. Or, I will be such a small, insignificant voice (organization) unless I group with others with similar views." 

I find it amazing that the more biblical one is, the less friends and associates he has. The more unbiblical he is, the more of these he has. With Jesus' warning about the "broad and narrow ways," it would seem logical that Christians would steer toward being too narrow, but in general they do not. There are far greater numbers of liberal and moderate "Christians" today than conservatives. I can accept that. However, my difficulty is that among evangelicals the same looseness of standards also exists! This book is representative.

Third, in this eclecticism is a governing level of emotionalism. The last thing many of these authors and speakers want to be seen as harsh and uncaring. They want this opinion so badly that they are willing to compromise the truth! Note the sadness, but acceptance of abortion. Note that Chapters 1-3 have this emotional focus: "The Riddle of Suffering," "The Disease of Isolation," and "The Search for Shalom" (a curious and recently prominent term used by Christians).

Again, may I take the meek and lowly Jesus (also Almighty God!) as our example? He was "full of grace and truth." Did anyone ever "care" more than He did? (Curiously, "care" is not a Biblical word or concept.) Yet, He expressed anger and took a whip to those who desecrated the Temple. He disappeared from crowds who wanted a "piece" of Him and His popularity or His gifts. 

I contend that truth must become before grace. How else can one know where grace ought to be extended, as Jesus did? This book and others, however, place a fuzzy concept of grace before truth. 

The Ugly

Obviously, my standards differ from most of the authors in this book. However, several suffer from a failure to achieve their own intended goals. 

Reductionism. V. Elving Anderson, Ph.D., Professor Emeritus of Genetics, University of Minnesota, wrote the chapter, "Resisting Reductionism by Restoring the Context." His attempt is "to resist ... reducing us to a biochemical entity" (p. 84). First, he discusses such things as "genes never act alone" and "environment is important" (86). Then, he "restores the context" (pp. 87-90) by looking at the broader complex of individuals, families, and populations; multiple disciplines of science (sociology, psychology, biology, chemistry, and physics); and finally "Biblical perspectives" (pp. 90-92). 

Ah, I thought, at last we will have a specifically Christian perspective. Yet, Dr. Anderson spends two pages on a rather stilted and limited analysis of Genesis 1:27-2 and 2:15. 

At least two other authors attempt to avoid "reductionism." Henk Jochemsen, M.Sc., Ph.D., Director, Linddeboom Institute, Ede, The Netherlands, writes the section, "A Critique of Genetic Reductionism" (pp. 77-81). C. Ben Mitchell (above) also writes a section, "Reductionism" (pp. 235-236).

I especially like Dr. Jochemsen's comments. He rejects the "prevailing view" that a direct causal relation exists between the genes and the traits of an organism" (p. 78.). For example, identifying a gene for alcoholism is not necessarily the cause of the behavior. To replace the gene with another sequence will not necessarily solve the problem of alcoholism in an individual.

"Moreover, DNA cannot arguably be the 'cause' or origin of biological life" (p. 79). The DNA cannot even generate its own "message" with the "mechanism" of the organism itself. "God not only created the DNA, he imbued it with meaning." Dr. Mitchell also discusses these limitations of genetics, although not at the depth of Dr. Jochemsen.

That DNA is not the sole determinant of the behavior of cells, organs, and organisms is a major blind spot for geneticists and their supporters. I once asked Dr. Collins what turned the genes on and off. All I received was a blank stare that implied that I was foolish to even ask the question. After all, genes contain all the information about biological systems, and there is no influencing mechanism beyond them. Dr. Jochemsen says that there is... but there is even more beyond what he says.

The Missing Link: The Soul

Man is both body and soul (spirit) (Genesis 2:7 - "a living soul"). Unless the soul is a tabula rasa (blank slate), behavior in humans is certainly influenced by the soul. There is no mention of the influence of the soul in this entire book by any of these distinguished Christian scholars. They fail at their own attempt to avoid reductionism. They never get beyond the material themselves. Sure, God is in there somewhere, but other than the fact that He created genes, He is not relevant to genetic study.

(The soul and the spirit are different words for the same component of man. They represent differences in function and relationship to man's physical side and between the person and God.)

By "coincidence" (an oxymoron for a Calvinist), I was recently transcribing a tape by Dr. Herb Titus on a Biblical view of the right to medical care. He stunned me with the simple statement that the most major defect in any individual is the defect of sin. Any physical or genetic defect pales by comparison. That defect of sin condemns us to a life of misery and destruction and an eternity in Hell without salvation in Jesus Christ.

And to think that some Christians (above) want to abort certain genetic defects! What arrogance and simple-minded reductionism of their own! What bombastic ignorance that souls do not influence behavior and that genes can "cure" alcoholism and other behavioral "diseases."

My belief is that there is some interaction between the soul of man and his physical composition (genes, cells, tissues, etc.). By reductionism, finally, there must be some initiation and maintenance of individual life by the soul. Chemicals alone, even complex biochemicals, are inert. A scientist can mix any variety of chemicals and apply any forms of energy, and he will never have life. Life is more than chemical reactions, even in animals.

Yes, animals have spirits, "the spirit of the beast that goes down to the earth" (Ecclesiastes 3:21). Obviously, their spirits differ from those of humans, but they have a spirit of life as well. They are not just biochemicals either. What plants are is less clear. The Bible never says that plants have spirits. Still, there must be some governing influence that makes them "alive."

In individual humans, there are two traditional views of the origin of the soul. Creationism (not to be confused with the creationism of Genesis 1) contends that God implants souls at the moment of conception. Traducianism contends the soul is transmitted with the sperm and egg of the parents. For many reasons, that I cannot discuss here, traducianism is by far the stronger argument.

Admittedly, this book is on genetics. One could excuse the authors in that their focus is material, not spiritual. Perhaps this focus would excuse their discussion of cystic fibrosis and breast cancer. However, there is considerable discussion about behavioral issues such as alcoholism and other "psychiatric" problems. For a Christian to ignore the influence of salvation and obedience here shows an ignorance and reductionism that is inexcusable.One evidence for their lack of Biblical concern is the absence of a Scripture Index. The Bible is really replete with genetic (both physical and spiritual) descriptions. The "begats" are the union of sperm and egg, as well as the "traduced" soul. Genealogy is crucial to Jesus Christ's humanity and identity. Jacob recognized genetic variations (Genesis 30-31).

In Summary

This book is a great resource for laymen to understand the current state of genetics and genetic issues. It is not particularly a Christian (Biblical) discussion of genetics. Yes, God is the origin of all things, but Biblical specifics are ignored.

On the one hand, the United States is an enigma. The large majority professes to believe in God and the Bible. A smaller, but significant, population is "evangelical." On the other hand, our nation is out of control with its crime, drug addiction, sexual immorality, alcoholism, and other sins.

Judging by the people of this book, I am not surprised. The authors of this book are not ordinary. They hold prestigious teaching and administrative positions both within Christendom and in the secular world. Where is their influence? I am continually amazed at the numbers of professing Christians in high place of politics, government, and academia. For example, this book was the first that I knew of Frank Young, former head of the FDA. I did know of Francis Collins, head of the Genome Project. I know of many others.

Movements in society, politics, and law are moving Christians and Christianity into a "ghetto," not allowing open participation in schools, social or scientific debate, and politics. Perhaps, we have already "disenfranchised" ourselves by evangelicals' own failure, first, to understand Biblical (theological) basics, and second, to apply them where we have power and influence.

I know that all the foregoing is a searing indictment, but I stand willing to debate in any forum or context. More likely, I will be written off as an irrelevant radical. And, in many ways, I have already been "disenfranchised" by many of them. But, I will continue as one still small voice, hoping that God's truth will yet triumph among His people and then in society.

Note: A glaring omission of this book designed to be a comprehensive treatment of genetic issues is a section/chapter on cloning.

Letter-to-Ed

The Only Certainty in Medical Care 
Is God Himself

I enjoy your newsletter immensely. However, I am in a torn state of mind when I think about many medical issues of our time. In your latest issue, you wrote of the "butter/margarine" article. I liked your advice on taking Paul's advice -- moderation in all things. I read many similar articles in other publications. The sum effect on me has been to make me not have very much confidence in established medical practice. I know you have said many times that medicine takes credit for things that it didn't accomplish. I also know you feel alternative medicine is not (necessarily) the answer either. I agree that if I were having a heart attack, I would want to go to a traditional hospital. In other matters, I'm not sure what I would do.

Are you familiar with Larry Burkett's experience with cancer? Have you heard or read what he chose to do to treat his disease? I contribute to his organization, and he often sends complimentary items. He sent me a tape with his story. He had his cancerous growths removed surgically, but then he did research and went to Europe for what I would call mega-nutrition injections, and no doubt education on what to eat. I believe it's been three years, and he was cancer free at his most recent exam. I often wonder what would have happened had he chosen traditional chemotherapy and radiation. His research showed him that options did not give him much hope.

Are we all so individual that no one treatment will work on everyone? I have thought about several people I know with cancer. One lady was diagnosed with breast cancer eight years ago. At the time, her treatment was fairly new. She had radiation first to shrink the tumor, then surgery, then more radiation. She is still living today. Then I know others who went through conventional therapy and did not survive.

Does this all simply fit into whatever plans God has for us in His wisdom? How does He speak to us when we may face decisions such as these? I liken how I feel to the old story about a kid in a candy shop - when there are too many things to choose from, it's harder to make a decision. When it's a life-and-death decision, it's much more difficult. I am not criticizing you or anyone else in any way, but when I hear and read people I respect, and they don't come to the same conclusions, I feel I have no basis on which to make decisions. I admire you greatly, and I admire Mr. Burkett. If I ever have to make a crucial decision, it would be comforting to know that decision would be made on truth and not error. At this time, I have lost trust in the medical "experts." Yet, when I need to see a doctor, every doctor I know would recommend standard procedure. (I admire any doctor like yourself who would never prescribe a course of action just because the patient demanded it, as in the case of antibiotics for colds. I don't know any doctors in my vicinity who would not "go along" with the crowd.)

One more thing I would like to know is your opinion of mammography. Several of my friends are now at the age where mammography is being recommended. Do any "traditional" doctors feel it is an unsafe procedure? I have read the radiation dosage is low but the compression factor is extremely high. I don't personally know any gynecologists who express any concern or doubt about its efficacy. I haven't gone through all your issues that I've saved to see if you have ever written on the procedure. If time allows, I will try to do that. I have so many issues! And since medical opinion changes, I never know what the current thinking is. That's another bothersome issue to me.

I haven't neglected prayer concerning this whole issue. I know God can speak to us in many ways and give us wisdom. Like Solomon, I greatly desire God's wisdom in my life for the many decisions I may have to make. I pray for discernment. If God uses people through the written word, or through an oral presentation, doesn't He intend for us to hear or read those words? I never feel it's an accident when I hear or read material. God is not a God of confusion, so when I feel confused, I need Him to sort it all out. I will continue to pray for His wisdom.

Thank you again for publishing your newsletter. It has been a blessing to me in many ways.

Sincerely,
Name withheld at writer's request 

Ed's Response

I am not familiar with Larry Burkett's experience with cancer. It is interesting that he chose allopathic surgery and an alternative approach. Perhaps, I will some day know the details. However, my question would be, "What confirmation did he have that cancer cells were still growing after the surgical removal?" Possibly, the mega-vitamins had nothing to do with his being cancer-free. The surgery had everything to do with it.

Or, there was evidence that the cancer cells were still there after surgery and the vitamins had everything to do with his being healthy today. And, there are many other questions without knowing details. I am not aware of any alternative method that reports its failures, while allopathic medicine does, even though the numbers may be distorted in the research or the physician presenting choices to patients.

The writer has nailed the difficulty with evaluating treatments. "We are all so individual." While there are similarities among people, enough to group them by certain characteristics, the same medications and treatments have different effects on different people. Then, there is the "placebo effect" in which physical and mental changes occur because something was done, not what was done.

Medical treatment is so variable that, indeed, we finally have to rest in God's sovereignty after we have exercised our best wisdom. No illness and no death is without His intention for the good of the believer. I do not believe that we will always understand the "Why?" of these trials. He does not guarantee understanding, only trust and comfort in the ordeal. 

No, He does not "speak to us" at any time. That communication would be new revelation -- which the Bible strictly forbids. However, He has given us prayer, His Word, and other information by which to make wise decisions, and that He will somehow work within that process (James 1:5-8). Nothing is fortuitous or accidental within God's plan.

I do not recommend mammography as a routine exam for my patients. I have never seen any good evidence that mammography reduces morbidity and mortality from breast cancer. And, there is no research on the morbidity of the extreme emotional turmoil caused by the procedure itself and the often equivocal (scary to the patient) results that are reported. I do recommend mammography for a new lump that the patient or physician has found, in those with close relatives (mother, daughter, sister, grandmother) with a history of breast cancer, or history of breast cancer in the same patient.

There is risk with any procedure, but the current radiation used for mammography is low. There is the chance of bruising or rupture of cysts with too vigorous compression of the breast.

The only certainty in illness, disease, and accidents is that God is Sovereign. If we were more focused on that truth, the facts of medicine and our particular situation would fall into place. Currently, we worship at the altar of modern medicine, spending 14 percent of the Gross Domestic Product (not counting the cost of alternative medicine). Christians pay only 3-4 percent to their churches and Christian organizations. Where our hope is, is obvious.

Number Needed to Treat: 
$254,520 To Avoid a Heart Attack (Maybe)

Number needed to treat (NNT) is a welcome concept to the medical literature. It is a way of expressing efficacy which a patient can understand. For example, consider pravastatin, a cholesterol-lowering drug that is the rage for "preventing heart attacks." A study of pravastatin reported a 30.4 percent reduction in heart attacks over a five-year period (The New England Journal of Medicine, 333:1301-1307, 1995). 

Now, at first glance, what is your reaction? "Wow, almost 1/3 of heart attacks prevented. If I take this medicine, it will lower my chances of a heart attack by one-third." WRONG!

In the group that took pravastatin, 5.5 percent of patients who took the drug had heart attacks. In the placebo group, 7.9 percent had heart attacks. The 2.4 difference, divided by the 7.9 of the placebo group is the 30.4 percent reduction. 

But, note. More than 92 percent of the placebo group were not even at risk of a heart attack. If this treatment group is typical, then 92 percent of patients who take this drug do not need it to prevent the heart attack that they will not have. Only 2.4 patients out of each 100 will benefit from pravastatin.

Thus, the NNT for pravastatin in this study is 100/2.4 or 42 patients. That is, one patient in 42 will benefit from pravastatin by not having a heart attack. The others are taking the medication without this benefit. The cost to prevent one heart attack is $254,520, paid for by the entire group ($6060 each).

How many patients would take this drug, if their chances were explained this way? "You have a 1 in 13 chance of having a heart attack in the next five years. I have this drug that will reduce your chance to 1 in 18. You are a member of a group of 42 patients, but only one of you will have your heart attack prevented. 

"The rest of your group will not have their chances of a heart attack reduced at all, because 38 of your group won't even have a heart attack, even if you don't take this medicine. Three more will have a heart attack even though they are on this medicine. You can participate in this group for only $6060! However, I have no idea who the one beneficiary will be or who the non-heart attack patients will be. You will have to take your chance along with the rest."

All the above concerns non-fatal heart attacks. All patients will survive whether they take pravastatin on not. To prevent one death from heart attack in 5 years, the NNT is 143 (cost $866,580). Since people die of other diseases (heart attacks, strokes, etc.), the NNT to prevent a death from any cause in 5 years is 111 (cost $672,660). Readers can substitute these numbers for my patient encounter above.

I have presented the near ideal situation. The patients for this pravastatin study were carefully selected to fit criteria for which pravastatin is most likely to benefit. In real practice, these criteria are ignored, and less ideal patients are placed on this drug. Thus, improbabilities and costs sky-rocket. Further, most of those who do not benefit from pravastatin will suffer side effects. Thus, they are paying steep costs and suffering side effects for no benefit.

Yet, pravastatin is being pushed by the full weight of the medical community. There was even a full page ad in Parade (November 12, 1997), the nationally syndicated Sunday magazine, by the American Heart Society, advising all men over 50 years of age to be on this medication.

Most physicians are committed to helping patients, but they rarely analyze research in this way. (They receive most of their drug information from drug representatives, i.e., salesmen.) This concept of NNT may help to reverse such blind acceptance. But, all in all, cholesterol-lowering drugs are one of the biggest medical hoaxes perpetrated on the American people. Few will benefit, but many will pay. Unfortunately, that situation exists for many, if not most, medical treatments. Some NNTs are much better, some are much worse. 

Now, I am not against the freedom of physicians to treat and patients to accept almost any kind of treatment that they desire. However, there are better ways to explain statistics to people so that they can make a more informed choice. 

A Reflection and a Comment

Beating Heart Donors: An "Old" Sacrificial System?

Some documentary about the Aztecs recently triggered an association in my mind about modern medicine. The Aztecs cut out beating hearts from their victims. Modern medicine cuts out beating hearts from victims.

Some might be thinking, "Surely, Ed, you have gone off the deep end this time." Perhaps -- but, I am not so sure that the worship of modern medicine to add years to lives is not too dissimilar from what the Aztecs did. God did not intend for these mortal bodies to be worshiped, but to be sacrificed to Him (Romans 12:1-2). At 13.6% of GNP, care and preservation of the body has far exceeded the tithe that God requires. 

AIDS: Issues and Answers

Vol. 12, No. 1 (75) January 1998

The Numbers

AIDS reporting for the United States occurs every six months, coming out about 3 months after the end of the period of reporting. The last figures are through June 30, 1997.

The total number of AIDS cases reported since 1981 are 604,176 adults (13 years old and above) and 7,902 children. Of these, 374,656 adults (62 percent) and 4,602 children (58 percent) have died.

For the 12 months ending this reporting period, there were 64,357 cases in adults: homosexuals -- 38 percent, IV-drug abusers -- 25 percent, homosexuals who inject IV drugs -- 4 percent; hemophilia and other blood coagulation disorders -- 0 percent ( a statistical zero, actual numbers 265), heterosexual -- 14 percent, blood transfusions and other tissue donors -- 1 percent, and "other" (mostly incomplete reporting) 18 percent. For the previous 12 months (July 1995-June 1996), there were 71,376 cases.

Explanatory notes. "Heterosexual" are mostly women (62 percent) and include the categories of "having sex with ... injecting drug user, bisexual male, person with hemophilia, transfusion recipient with HIV infection, and HIV-infected person, risk not specified. Only 10 percent of the "blood transfusions and tissue donors" are infected with blood/tissues that were screened HIV-negative. The others in this category were cases before screening was instituted in the mid-1980s and are just now being reported or have just now developed AIDS.

In children, there were 609 cases, of which 91 percent were children born to HIV-positive or "at risk" mothers. Another 8 percent were "other" (see above).

Commentary: HIV/AIDS has become a reportable disease that has reached a sort of stasis. The numbers are staggering (although falling short of earlier predictions), and in some age categories and sub-populations, HIV/AIDS has become the number one killer, and it ranks in the "top ten" of many of these. The tragedy of this epidemic is that it didn't have to be: hedonism has its price to be paid in "morbidity and mortality."

"Officials" Reverse Stand On HIV-Reporting

"We are at a defining moment in the epidemic of HIV infection and AIDS. With therapy that delays the progression to AIDS-related illnesses and death, HIV infection or AIDS is becoming a complex clinical disease that does not lend itself to monitoring based only on end-stage illness. Unless we revise our surveillance system, health authorities will not have reliable information about the prevalence, incidence, and future directions of HIV infection, the kinds of behavior that currently increase the risk of HIV transmission, or the heightened impact on specific subpopulations.... To correct these deficits, we propose that all states require HIV case reporting." (Reported in HIV/AIDS Prevention, December 1997, p.11, from The New England Journal of Medicine, October 16, 1997.)

The co-authors included a representative of the Centers for Disease Control and Prevention, a law professor of the Georgetown University-Johns Hopkins University Program on Law and Public Health, and the Executive Director of the National Association of People with AIDS.

Commentary: Readers will recall that AIDS (acquired immunodeficiency syndrome) is caused by HIV (human immunodeficiency virus). The initial infection may cause a flu-like illness, or its effects may be so mild as to go unnoticed. Over time, which may be a few months, or more typically, several years, HIV suppresses the host's immune system, allowing infections and cancerous growths that would not otherwise occur. AIDS is HIV-infection plus one of these other diseases. HIV infection alone, after the initial effect, has little or no discernible physical effect.

The reporting of HIV-infection in this pre-AIDS stage has been required by 26 states and accounts for only 24 percent of the AIDS cases reported to CDCP. Until now, reporting in other states has been vigorously fought by homosexual lobbyists and AIDS activists to protect those infected from discrimination and other mistreatment. Clearly, this failure of HIV-reporting was a violation of standard epidemiologic protocol learned over decades. The only possible conclusion for this omission was that HIV/AIDS was a politically protected disease.

Now, with the number of AIDS cases declining, information on those infected with HIV is seen to be more important, as noted above. So, the current situation "scientifically" calls for universal HIV reporting.

Nothing has significantly changed about this need for HIV reporting except a softening of the attitude of those who opposed it. The study of a disease only in its later stages is a half-study at best -- hardly scientific. Now, much time has been lost. It will take several years to crank up the system for this reporting. More time will be lost.

See, I told you so! Many years ago, I predicted that HIV/AIDS would eventually be tracked as any other infectious disease. The force of what ought to be done because it is the best approach that we know could not be squelched indefinitely.

Are You Willing to Bet Your Life... ?

For over a year now, I have been pondering the Y2K -- year 2000 computer problem. It has major relevance to medical care for physicians and patients.

The Y2K problem exists because in the early days of computers, memory was a premium. So, memory required for the two digits "19" of any year were left out of computer programs -- the year 1975 became 75. With today's computers measured in megabytes, instead of bytes (a one million-fold difference), that omission seems inconsequential. But, it has huge consequences for the year 2000, because that year is read as 00.

To these computers, however, this 00 is not 2000, but 1900. Around the world, in government and business the majority of records and transactions take place either within or interacting with these 19-omitted systems. If you were born in 1963, your age will be read as 63 years, not 37 years. But, that is not the worse part.

The worse part is that many systems will not recognize 00 as a year, making all information derived from a computation invalid. Or even worse, the system will lock down. Suppose bank A cannot get $10 million owed it from bank B. That puts bank B in debit to bank C and all other banks with which it does business. Suppose that happens in 100 banks. Suppose it is an international bank transferring $100 billion!

Use your imagination. You cannot receive your salary because your employer's bank's computer is "down." Worse, policemen cannot receive their salaries because all the banks' systems are either locked down or on hold for money from those that are. This lockdown goes on for weeks and months. No salaries and no income for anyone. Our commerce takes place with 8 percent cash and 92 percent credit (electronic records), so there is not enough cash to pay for salaries and debits among people, companies, and banks. You have no electricity because of bank failures or failure of the electrical companies own computers. You have no running water, heat, or air conditioning.

Use your imagination. Your grocery stores are now stocked 24 hours a day. You have experienced or seen in the news how quickly supplies are depleted in natural disasters. What if prolonged for weeks? What if the police and firemen are not available because they are not receiving salaries either. Mobs are forming for "someone to do something." Worse, individuals and groups begin looting and burning for food and other supplies. 

Why don't they simply fix the simple problem of two digits? The problem is simple, but it is huge. Experts have projected that if every person capable of correcting these computer codes were to work 24 hours a day between now and the year 2000, the task could not be completed. And many private and government agencies have not even addressed the problem yet.

Relevance for Medicine

If you have not read in detail the possibilities of the Y2K problem, I have listed two sources (below) that you can write for more information. Fore-warned is fore-armed! You have only 23 months left. Actually, much less, because many information systems are currently working with statistics well into and beyond the year 2000. Some credit cards have already failed because of the Y2K problem.

The major impact for physicians and patients is a supply of medicines. Your pharmacy re-stocks often. In a matter of days, it could be depleted of your life-dependent medication. Now, you know from me and others that more than 90 percent of medication is not life-prolonging, but either unnecessary or for comfort of some ailment. However, some diseases depend upon truly life-saving medications: heart failure, angina, insulin-dependent diabetes, severe hypertensives, asthma, etc. How often do we physicians see patients whose visit is also the day that they ran out of their medication. "I took my last pill this morning." 

Patients must learn whether their medications are truly life-sustaining. Some medications for comfort seem life-saving, such as those for migraine headaches. Patients must learn and decide what medications they cannot physically live without. They ought to think in terms of a two- or three-year supply. I know the objection: expense. I laugh! 

Almost all Americans spend the large majority of their money on non-life sustaining things. Only food, shelter, and clothing are truly essential. And, we overindulge in most of those. Everything else is want, comfort, enjoyment, and labor-saving. Think about it. For those on severely limited incomes, do you have family? A church? A helping agency? Yes, a few cannot afford it, but almost all can in one way or another.

Physicians need to stockpile medications for such times. Even apart from the possibility of dire events, the exercise to decide what is and is not a life-essential medication is worthwhile. Like personal expenditures, most medications are non-life-essential. But, some are. Which? Consider this recommendation:

"Many medicines last quite well under moderate conditions -- temperatures about 54o F. to 78o F., low humidity and darkness. A styrofoam cooler with a silica gel pack in it, taped at the lid joint, containing the medicine(s) would work well. Excess space in the cooler may be filled with tightly capped water containers as a heat sink to moderate temperature fluctuations. In general, solid form medications last longer than liquid. I have a strong suspicion that printed expiration dates are unduly conservative... A few drugs become positively harmful, such as tetracycline, when they age. Most just lose some of their potency." (Personal communication from Hilton Terrell, M.D.)

Most life-essential medications are dirt cheap from mail order places in large quantities. Patients can stock up. Physicians can stock up. Both could evaluate what is truly essential and perhaps shifting to an older, cheaper, but equally effective medication.

The cost need not be lost. From time to time, use the stored medicine and substitute fresher supplies. Actually, money will be saved buying in bulk.

Modern Americans are spoiled. I love creature comforts as much as anyone and despise the thought of truly hard times. We have had glimpses of possible scenarios: the gas shortage (contrived) of the early 70s, South Central Los Angeles and Watts, Augusta (my own town, 1969), current road rage, etc. Someone has said, "Civilization is only a thin veneer over barbarianism." Well, our civilization is only as good as its technology to transfer electrons, a first in human history.

I hope the Y2K problem does not happen. At best, it will be temporary, short failures here and there. At worse, there will be mob violence and a return to the culture of the computer problem itself: 1900. The larger the city, the worse the problem.

Food storage used to be a way of life. God recommends it (Proverbs 6:6-11). Wise thinking recommends it. A local or larger scale disaster is inevitable. It may be Y2K, a war, an international currency crisis, a natural disaster that disrupts the link in world-wide banking, etc. As a wise steward, "Be prepared."

Note: I have not thought through nor prepared fully for such a crisis either. However, this Y2K problem ought to motivate us to consider it and other events. What I have presented here is far from comprehensive or substantive, but a warning with some practical direction. I have done my job to warn you of a possible disaster; any action is up to you, your family, and your church.

For more information on the Y2K problem:

MoneyChanger
P. O. Box 341753
Memphis, TN 38184-1753
e-mail: moneychanger@compuserve.com
(901) 853-6136

Remnant Review
1217 St. Paul Street
Baltimore, MD 21202
web site: http://www.garynorth.com

For food supplies, contact:

Walton Feed
P. O. Box 307
Montpelier, ID 83254
website: http://waltonfeed.com/


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