Biblical Reflections on Modern Medicine
Vol. 9, No. 3 (51)
The Road to Hell Is Paved with Good Intentions
The Children's Medical Center at the Medical College of Georgia recently held its opening ceremony. The Governor of Georgia, Zell Miller, praised "CMC as a place for all Georgia's children." There were about 2,000 in attendance. The Children's Medical Center is right across the street from my office.
What was not mentioned was the financial burden of this new hospital wing. In this day of managed care with its severe cost restraints, making ends meet for a hospital is not an easy matter. It is likely that the CMC will make it harder on the hospital budget. Yet, no one seems to care. Why?
Doing something "for the children" today is a primary means for moderns to assuage guilt. With rampant sexual immorality, lies for truth, and a rejection of God from the public square, the guilt is enormous. After all, God writes His laws on the heart of men. With the possible exception of the most callous and hard-hearted, people carry huge loads of guilt.
"There is no condemnation for those who are in Christ Jesus" (Romans
8:1). "As far as the east is from the west, so far has he removed our transgressions from us" (Psalm 103:12). And so on. For the Christian, guilt ought to be laid at the foot of Cross and left there. We are to live lives that are
guiltless, even though they are not sinless.
However, many, if not most Christians, really understand this freedom from guilt. One reason is a lack of Biblical understanding. Another is persistent sin in their lives, causing them to wonder how they can continually be forgiven. Another reason is "Christian psychology," which includes
unbiblical notions such as forgiving oneself, forgiving God, self-image, forgiving others without their asking, etc. And, there are likely myriad other reasons.
For unbelievers, guilt is a huge burden, in spite of reassurances from almost all pagan psychologists and psychiatrists that guilt should not exist. So, they look to charities, social projects, and helping children to assuage their guilt.
Destruction of Families
There is a powerful destructiveness to "helping children." That effect is to destroy parental authority. A children's medical center is a rather benign example, but others are not. The American Academy of Pediatrics wants to ban corporal punishment of children. Social workers interview children apart from their parents and sometimes use deception and coercion to get information against their parents. Courts bounce children from foster home to natural parents to foster home like a merry-go-round.
In a sense, I am preaching to the choir. My readers know much about what I am saying, and pagan society cannot and will not learn. However, we must have a guardedness about any program today that is "for the children," including those that originate with churches and Christian organizations.
Sunday School is an example. Sunday School was started for unchurched
children. Parents found it easier to let their own children sit in these classes than to teach them at home and to have them sit through long sermons. Eventually, the parents themselves had their own Sunday School. For the most part, the same subjects are taught by the same teachers to people who sit there glassy-eyed and passive. Sunday School was "for the children," but it has become an opiate for Sunday Christians. And, it has become an excuse for parents not to teach their children at home and worship in the home.
Not the Best Review
I have skirted complex subjects of guilt and cause and effect, almost simplistically. However, I wanted to address this subject with a little more clarity and length than I have in the past. Perhaps, it will stimulate some discussion and letters.
I am not against a children's medical center. I am not against
legitimate children's programs. However, the best way to help children is to help their parents be better parents. Reduce their taxes from some of these
children's programs so that they can work fewer hours and provide more for their own children. Change the justice system so that parents do not have to fear having their children removed from their home because of corporal punishment or coerced "confessions." Get children off the social merry-go-round and into permanent homes with good parents. And so forth.
No one is "for the children" more than I am. I raised four of my own. I am enjoying my grandchildren. However, like all things, only the Bible has the proper instruction on "good things," including those "for the children." Parents are "to bring children up in the nurture and admonition of the Lord," not social and government programs.
Vindication for Jay Adams
Patients with the diagnosis of chronic fatigue syndrome were divided into two groups. One group performed aerobic exercise at least five days a week. The other group performed flexion and relaxation at the same frequency. Both groups attended a weekly class where these routines were also performed.
After 12 weeks, 16 of 29 patients in the exercise group rated themselves as "much" or "very much" improved, compared with only 8 of 30 patients in the other group. One year after the program, 74 percent of the "exercise"
patients still rated themselves as improved. (Reported in American Family
Physician, November 15, 1997, pp. 2085-2088, from British Medical
Journal, 314:1647-1652, 1997.)
Commentary: There is considerable controversy about the diagnosis of chronic fatigue syndrome and about the benefits of exercise. However, almost all people who exercise state that they "feel better" more of the time than before they exercised.
Chronic fatigue syndrome is known to have a significant psychological (motivational) component. This study illustrates that that component can be overcome with aerobic exercise. It also shows that muscle fatigue
per se is not a factor in most cases of chronic fatigue syndrome.
Almost 30 years ago, Jay Adams found that "depressed" patients who had ceased to work on their daily responsibilities would rapidly "feel better" if they began tackling their problems
whether they felt like it or not. ("Feeling better" was not the goal, but righteous behavior was.) That teaching went against almost all psychological and psychiatric opinion of that time. "Depressed" patients were often hospitalized, shocked, and held to little, if any responsibilities.
That most patients with chronic fatigue syndrome improve on regular exercise program reinforces the notion in many of us that the syndrome in most people is largely motivational.
A major change in the approach to medicine over the past 50 years, accelerating over the past 20 years, has been to get patients moving. This change has been seen in almost all areas of medicine. In the 1940s, women were counseled to rest in bed for weeks after childbirth. Now, women are pushed to get moving as soon as possible. Serious accident victims with multiple broken bones and even broken ribs are pushed to begin and continue whatever activity they are able. Elderly patients with complete replacements of their hips are gotten out of bed the same day of their surgery. And on and on.
God made man to work. Adam and Eve in their perfect environment had responsibilities. Tasks and movement are vital to health, first in obedience to God, and secondly, in physical and spiritual health.
Purists may argue that I have made a long stretch from a simple study of exercise in chronic fatigue syndrome. And, indeed, I have. But, there is a coherence that is warranted from all the experiences named in the light of Biblical instruction.
Hilton P. Terrell, Ph.D., M.D.
Sex Education: The Empire Strikes Back
The medical mainstream empire has again addressed sex education and again comes up on the wrong side, as usual, on epistemological grounds.
The Journal of the American Medical Association reports on two "interventions" to reduce reported risky sexual behavior among African-American
adolescents.1 One "intervention" was abstinence education, and the other was safer-sex education. There was a control group for whom neither "intervention" was tried. The two approaches were positioned nose-to-nose in a showdown. On narrow technical grounds the study was reasonably well-designed, a "randomized controlled trial." There were problems in that the outcome measure was self-reported sexual intercourse. Self-reports are notoriously unreliable.
On wider grounds, however, the study design is worse than useless. The maximum follow-up interval was 12 months. What is that in a group of youths? What is that compared to eternity? The "teachers" were unrelated to the adolescents. Where were the fathers and mothers? By what authority does Caesar presume to teach children how to have sex, or whether to have sex? The instruction was 8 hours. What is that compared to a whole childhood of
parental influence and instruction? The abstinence instruction was not based on morality or transcendent commands, but only on consideration of consequences. You don't want to spoil your future, you don't want to get pregnant, and you don't want a disease, especially not AIDS. The children were paid to
participate, from $100 - $200. Surely, that cast a pall over any moral grounds that might have strayed into the teaching. Pride and self-interest were the
explicit motivational themes.
The study reported finding in favor of the safer-sex approach at the 12 month maximum follow-up. Neither group, however, had all that impressive a record. Twelve months after the instruction, 20% of the abstinence group reported having sexual intercourse in the past 3 months versus 16% of the "safer sex" group.
The accompanying editorial displayed the epistemological arrogance typical of the mainstream. "To promote the health of adolescents, public health policy should be empirically driven, not ideologically
motivated."2 In this, the editor leaps over all the really relevant difficulties of where ethics originate. Where did the "should" in his statement come from?
There is nothing imperative in mere findings. Empirical findings, even if they are correct and relevant, do not
ever lead to imperatives. Those who have an origin for imperatives - a sovereign God who has spoken in the Bible, for instance - are mere ideologues. The editor of course is not so low a creature.
He has data.
Though I am confident that data could demonstrate the superiority of the Biblical position on sexuality, it is a tactical mistake for Christians to base ourselves on empiricism. When God has spoken on a matter, what is data? We need to be able to nail the opponents of the Biblical position with the fact that they are no less "ideological" than we are.
The ideology is that data leads to imperatives. That is an absurd, illogical ideology.
This kind of study will now quietly be footnoted to ignorant statements intended to weaken Biblical doctrine. Watch for assertions that "abstinence training doesn't work as well as safer sex training, " to cite this study. But, the Biblical point is unaffected by this study. God has said that
fornication is wrong, and we are not to teach how to do a wrong thing "safely." The study design in no way injures the inculcation of a conscience on the matter of sexual behavior, by parents and the churches, beginning from birth. Parental teaching and supervision is not limited to eight hours. Sexual training is not a matter of facts only or even facts mainly. It is more primarily about responsibility to God and to other people. The study did not speak to that at all. Indeed, abstinence training that begins at age 11 and reasons from motives of pride and self-interest shouldn't be expected to work anyway. Even if it did, it would not accomplish the end of glorifying God.
This kind of study is exemplary of the blind leading the blind.
1. J. B. Jemmott, L.S. Jemmott and G. T. Fong, "Abstinence and Safer Sex HIV Risk-reduction Interventions for African-American Adolescents: A Randomized Controlled Trial,"
The Journal of the American Medical Association, May 20, 1998, pp. 1529-1536.
2. R. J. DiClemente, "Preventing Sexually Transmitted Infections Among
Adolescents: A Clash of Ideology and Science," The Journal of the American Medical
Association, May 20, 1998, pp. 1574-1575.
The Emptiness of the Hippocratic Oath
Criticism of the Hippocratic Oath is beating an old drum in a familiar rhythm, but there is no beating stout enough for that benighted Oath.
Preparing for graduation this year, honor students at the University of South
Carolina School of Medicine practiced a revised version of the Oath. One of the students explained that the revision had omitted the pledges not to give a deadly drug if asked to do so, as well as not to help produce an abortion. "We will be facing those issues, but we want to be individuals and make
decisions for ourselves as to how we will deal with them." Accordingly, this revision substitutes a line as follows: "And [I] will give no drug and perform no operation for a criminal purpose, far less suggest it."
Those who promote what they style "Hippocratic medicine" claim that the appeal to a transcendent set of values is the valuable core of the oath. The details, such as the Oath's original appeal to Apollos, Hygeia, Panacea, and the gods and goddesses, they say, can be set aside while retaining the
valuable idea of transcendence. It is a vain claim. The Oath has been regularly altered according to the whims of those who alter it.
The Oath never did really transcend the pagans or the neo-pagans who recite it. There is no appeal to any authority transcending the one who swears; it is not real transcendence. "Making decisions for ourselves" is not transcendent, it is blatant self-justification and self-deification. Far from acknowledging the God Who is the source of all morality, this modern version substitutes mere legality for morality. They forswear what is criminal, not what is wrong, and evidently they don't even know the difference. Should it become criminal not to "mercifully" put to death "defective" newborns or "hopelessly ill" old people, what moral force has such a lame oath? None. What if it becomes criminal to remove an implanted birth control device from someone Biblically competent to conceive but unfavored by the state. With only man's law as for an ethic, there is nothing to transcend that binding and "obey God rather than men."
One wonders, here in the Bible Belt, how many of the 64 graduates of this school of medicine are Christians? Where is their discernment? Have their churches not inculcated doctrinal and ethical awareness?
Levona Page, "Aspiring Doctors to Take Oath," The State (Columbia, SC), May 8, 1998, p. B-2.
From the "You-Can't-Win" Department
A cancer specialist in Tennessee has been sued by a woman who claims that he gave her husband false hope about recovering from cancer (American Medical News, May 18, 1998, p. 6). Having been told by physicians that he would die, the patient tried an experimental treatment offered by another physician. From this doctor, he received some encouraging news, but died nonetheless. If the patient had committed suicide or some other drastic action after being given the bad news by the first physician who saw him, would there have been a cause of action of inappropriately dashing his hopes?
Physicians, as a group, do tend to be overly optimistic, and there is a theory to support optimism as an effective part of the treatment. Yet,
requiring physicians on pain of monetary penalty to get exactly the right balance is absurd. Whenever I become glum over the sorry state of my profession, I cheer up when I recall that the legal profession will doubtlessly provide an insulation function between us and the hottest
"Those who practice (therapeutic touch) say an energy field emanates from every person and is detectable above the skin through a tingling sensation or a feeling of hot or cold.
"The healer moves his hands over the patient's body to modify the field. Touching the patient is not necessary.
"The technique is practiced in at least 80 North American hospitals and taught in more than 100 colleges and universities in 75 countries..."
(The Augusta Chronicle, April 1, 1998, p. 1A, 12A)
Emily Rosa, nine years old at the time and now eleven, has destroyed this "mainstream practice" in a school science project (helped by her mother, a Registered Nurse and inventor). Emily had 21 "experienced practitioners" put their hands through a piece of cardboard (blocking their sight). Then, she asked them to identify which of their hands was near one of hers. They chose the correct hand only 44 percent of the time -- less than chance alone!
The project was never intended to be published, but a PBS show featured Emily's tests, and Dr. Stephen Barrett of Quackwatch (Allentown, PA),
suggested submitting it to The Journal of the American Medical Association, which published it (April 1, 1998, pp. 1005-1010).
One expert on therapeutic touch called the study, "poor in terms of design and methodology... The validity of therapeutic touch has been
established in numerous doctoral dissertations and 'innumerable' clinical studies."
Commentary: There is much to learn about this child's study. 1) A simple study disproves an "established" and "valid" practice. Some practices can be proved/disproved without elaborate and expensive studies.
2) The prevalence of a practice has no relevance to efficacy. In
nursing, therapeutic touch has become mainstream, but it is bogus. By contrast, it is possible that only one person may practice an effective therapy while everyone else is wrong. That is often how new therapies start.
3) This study should be a warning to alternative medicine advocates. Testimonial (anecdotal) evidence is insufficient to establish advocacy and efficacy. Studies designed to blind outcomes are necessary, and they do not have to be large in size.
Such advocates should also be warned about adopting such ethereal (New and Old Age) practices. For example, is the theory of chiropractic as
therapeutic manipulation of organs and diseases any different from the theory of therapeutic touch? Where is the physiologic connection?
Perhaps, allopathic medicine has missed the boat here. If large and expensive studies are necessary to "prove" efficacy, then such efficacy may not exist or be so minimal that the Number Needed to Treat for one person to benefit is impractical and unethical (if not explained as such).
4) This study should be a warning to allopathic medicine. Because a practice is mainstream (often a criterion even in malpractice cases), it may not be truly therapeutic. Most of psychology and psychiatry has no more basis than therapeutic touch, but they have been become the truth-sayers of modern medicine and society.
In a past issue of Reflections (November 1995), I wrote about
therapeutic touch as bogus. The most severe disharmony of any person is his
unregenerate, fallen spirit. Yet, practitioners of this "touch" never mention this disorder!
The Bible does have many insights into claims of therapeutic
efficacy! And, the Bible does not have to be "proven" in any way. It is either accepted or rejected as truth. Yet, pagans and most Christians blindly wander in the wilderness that is the mix of science produce by secular (pagan) humanism and popular myth. The effect of the Fall on man's reasoning seems almost total.
Hospital Loses 'Wrongful Birth' Suit
"A jury ruled that health care giant Columbia/HCA must pay a couple $42.9 million for refusing their request that their brain-damaged baby not be kept on life support..."Their daughter, born in 1990, after about 22 weeks of pregnancy, weighed 1 1/2 pounds at birth. She is brain-damaged, blind, and almost totally incapacitated... The hospital ignored the (couple's) request not to have doctors use artificial means to revive the newborn.
"Jurors assessed $900,000 in costs for past medical care for the daughter, $28.5 million for future care, $3.5 million in punitive damages against the hospital, and $10 million against the corporation."
(Chicago Tribune, January 18, 1998, Section 1, p. 14)
Commentary: I wonder if zealous pro-life people and organizations will step forward and help pay for this child's care, perhaps, even provide
personal child-care to give the parents some respite. Probably not.
My journalistic dig comes from unwillingness in some pro-life quarters to pay whatever costs are necessary to prolong the life of seriously ill* patients. Medical costs in the United States are approaching another crisis. While the Clinton Health Care Plan was rejected, the failure of managed care to control costs (not entirely their own fault) will bring another cry that the "government must do something." This time they may.
* Note: I prefer the term "seriously ill" to "terminally ill," because the medical profession is not all that good at predicting the time of a patient's death. Also, there are probably more patients who are severely, chronically ill and for whom a "comfort measures only" approach is ethical. And, there are patients who are temporarily "terminally ill" because of disease or
injury, but who are likely to recover almost completely.
Physicians Seeking Early Retirement
(The following was prompted from an editorial by Charles
Krauthammer, Chicago Tribune, January 12, 1998, Section 1, p. 17. He was speaking from personal observation and not a formal survey or study. I am doing the same and have used some of his examples.)
While politicians and bureaucrats fiddle with Medicare, Medicaid,
managed care, etc., etc., there may by a huge cost not measured in dollars -- the early retirement of physicians. The problems are multiple. A cardiac surgeon spends 60 percent of his overhead on malpractice insurance. Some
obstetricians pay $100,000 a year for it.
A hand and foot specialist performed complex surgery on an injured foot and received a check from the insurance company for $388. High school
graduates answer the phones when physicians call to see whether some tests or hospitalization will be "allowed." The cost of the paper work for many
third-party payments exceeds the reimbursement.
One change that really sticks in my craw is that physicians are now "providers." That word change, as harmless as it may seem, was a major
watershed for the freedom of physicians to treat patients. Perhaps, it was as significant as the licensing of physicians that occurred decades ago.
For many physicians, there is too much cost (in time, energy,
frustration, and money) for them not to seek early retirement or other employment. As the tinkerers go blindly along, those who can actually care for patients are getting out. Let's see how the public likes lines for clinical services!
But then, physicians may then be forced to practice at the threat of extreme penalty, even death. "Not in America," you say? Try telling that to tobacco companies.
Why People Use Alternative Medicine
A number of questions concerning their use of alternative medicine was mailed to "a total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States." Only 4.4 percent of this group relied primarily on alternative medicine.
People who were more likely to use alternative medicine had more
education, poorer health status, a holistic orientation to health, a transformational experience that changed the person's worldview, certain health
conditions (anxiety, back problems, chronic pain, or urinary tract problems), and classification in a cultural group identifiable by their commitment to
environmentalism or feminism and interest in spirituality and personal growth psychology. "Dissatisfaction with conventional medicine did not predict use of alternative medicine."
(The Journal of the American Medical Association, May 20, 1998, pp. 1548-1553)
Commentary: Whew! What an eclectic group! To comment would take more space than I want to give here. But, then, each characteristic is virtually its own explanation. The range is from born-again Christians (the term is not used, but likely) to environmentalists and feminists!
In spite of this diversity, there is real insight here into alternative medicine use. I will let readers make their own conclusions.
Sexually Transmitted Diseases
"One in five Americans under the age of 65 is infected with an incurable viral sexually transmitted disease (STD)."
"Twelve million Americans are newly infected with an STD each year. Three million are teenagers; about seven million are in their twenties."
"Human papilloma virus (HPV) is an STD that causes cervical and other genital cancers (both male and female) as well as
genital warts. Each year, more women died of cervical cancer (nearly 5,000) than die of AIDS-related diseases. Because HPV is
transmitted by direct, intimate (skin-to-skin) contact, condoms provide virtually no protection against HPV." (From the Medical Institute of Sexual Health, June 1997, reported in the May 1998 newsletter of the Augusta Care Pregnancy Center.)
Commentary: The statistics speak for themselves. The thought comes to mind that breaking God's law of chastity before, and fidelity within, marriage is as destructive physically as breaking His natural pull of gravity. The greater the violation, the greater the destruction. However, breaking His moral law has spiritual effects that are far more devastating.
Guilty If You Do, and Guilty If You Don't
In 1997, the Office of the Inspector General "advised" bundling of automated medical tests on patients. Labs all over the country responded to comply with this "advice."
By April 1, 1998, however, the Health Care Financing Administration
(HCFA) had mandated the unbundling of such tests to the extent that
non-payment for services, sanctions against laboratories and hospitals, and even civil prosecution are possible for violations.
(Postgraduate Medicine, May 1998, pp. 13-16)
Commentary: Sound familiar? Air bags or no air bags? The government, particularly the federal government, does not always know best. If fact, they rarely do.
There is the old parable about not allowing the nose of the camel in the tent because he will not stop there, but get all the way into the tent or even tear it down in the process.
Physicians are finally waking up to the federal "camel," but it is too late. The camel is already in their offices, examining rooms, surgical suites, and hospitals -- and he is no small camel!
Intrusions and spur-of-the-moment mandates and changes will continue until socialized medicine is complete or the computers break because of the Year 2000 problem. The desire for physical health and immortality is the god of American society with payment of more than a tithe (14 percent) to it. But, the costs to our freedom and economic prosperity are far greater than the actual costs.
The Marketing of Lipid-Lowering Drugs Increases
"Lovastatin reduces the risk for the first acute major coronary event in men and women with average total cholesterol
(TC) and low-density lipoprotein cholesterol (LDL-C) and below average high-density lipoprotein cholesterol (HDL-C) levels. These findings support the inclusion of HDL-C in risk factor assessment, confirm the benefit of LDL-C reduction to a target goal, and suggest the need for reassessment of the National
Cholesterol Education Program guidelines regarding pharmacological intervention."
(The Journal of the American Medical Association, May 27, 1998, pp. 1615-1622)
Commentary: I have commented several times on these pages about the hype over
statins, cholesterol-lowering drugs, to prevent coronary artery disease (CAD). Previous studies were done on people with risk factors for CAD. This new study was performed on "normal" people, more specifically, on people with normal levels of three measurements of lipids in the blood (named above). (Note:
HDL-C is the "good" cholesterol. The higher the value, the better for the patient.)
Previously, I looked at Numbers Needed to Treat (NNT). That is, how many patients have to be treated to receive benefit. In this study, by their own numbers, 83 people have to be treated to prevent one heart attack in 5 years, 143 people to prevent "unstable angina" (precarious oxygen deprivation to the heart usually associated with chest pain), and 59 people to prevent revascularization procedures (to remove, reduce, or bypass narrowing in
arteries of the heart). Or, lumped together, 28 people to prevent one of these events.
I still have difficulty with asking 28 people to spend $1075-$1766 a year for only one to benefit, especially when they are given only the hype and not the reality for them as a single patient.
Let me put this situation another way. The same medical community that supports and performs abortions, embraces homosexuality, and distorts the reasons for the spread of HIV/AIDS is behind this hype over statins. Modern medicine is an ethically rudderless ship. Be careful of practices and
opinions from those on board.
Fact vs. Hype: Early Discharge of Newborns
In a university hospital setting, 3,258 infants born between January 1992 and June 1993 had a mean discharge time of 49 hours ("conventional
discharge" group). They were compared to 2,739 infants born between July 1993 and March 1995, when the hospital had an early discharge policy (mean length of stay of 30 hours). There was no "statistical difference" between the readmission rate for either group. "Early discharge following normal,
uncomplicated vaginal birth is not associated with an increased rate of neonatal readmission when a structured support program exists." (Reported in
American Family Physician, November 15, 1997, pp. 2095-2096, from Obstetrics and
Gynecology, 89:930-933, 1997.)
Commentary: This study is an excellent example of one of the myriad forces governing modern medicine that has nothing to do with the best
available science. Readers have no doubt heard of the weeping and wailing that has gone on over "early discharge" of newborns and their mothers. Virtually all physicians knew that this hue and cry was falsely based. This study proves it.
From this public outcry, costs of third-party plans have increased, and state and federal governments have further entangled their tentacles into the practice of medicine.
From the science of medicine alone that is currently available in the medical literature, medicine can be practiced at less cost and more effectively than it currently
is. The state and the public are not only to blame, as physicians often practice according to their "experience," to curry favor with patients, or other non-scientific reasons.
There is a science of medicine but it is usually overturned with other interests of patients, physicians, and
government. A practicing consistency with that science and a removal of government involvement would make medical care much more affordable
with better care of patients!
The Backlash Is Beginning
"At least a dozen prominent Cincinnati obstetrician-gynecologists are rejecting (Aetna US Healthcare's) latest contract terms and leaving the plan.... The physicians object to what they
consider excessive documentation demands and pre-certification requirements, as well as a unique coding system that conflicts with their existing software and office forms."
(American Medical News, May 4, 1998, pp. 1, 27)
Commentary: More and more physicians are being told how to practice by both private and government agencies. And, the paperwork nightmare is getting worse. Well, this group of physicians "is not going to take it any more." Unfortunately, not many others will take such a bold stand. As I said above, the camel is in the tent, and he is huge!
Something other than physician's rebellion will have to bring the tent down or start another one. Too many physicians want that third-party gravy train. While I and others have railed at the American Medical Association, the only organization that has made any inroads is the Association of American Physicians and Surgeons. While medical universities pride themselves on medical progress and leadership, they have not led the fight against the third-party invasion. In fact, they have been only too accepting, as they have had to depend more and more on clinical income in the face of static or dwindling government and private support.
Kudos to this group. May their tribe increase!
Problem of Non-compliance: Transplant Patients
"A recent survey (of Transplant Recipients International Organization) reported that as many as 25 percent of transplant patients regularly missed doses of prescribed medications, putting them at risk of organ rejection and serious complications,
including bone disease, infections, and high blood pressure.... 'These were motivated recipients, people who were willing to join the organization plus volunteer for the survey. If we're seeing this [noncompliance rate] in this group, I can only think that it's a lot higher among transplant recipients in general.'"
(American Medical News, May 4, 1998, pp. 1, 23)
Commentary: Non-compliance is a "compounding variable" that almost destroys what science there is concerning the practice of medicine. If
non-compliance is 25 percent in a "motivated" group, what is it among everyday medical patients, much less "transplant recipients in general?" I recall a study that found up to 50 percent of physicians' prescriptions in the trash can outside their office.
Researchers have come to realize that their results are almost
meaningless without strict protocols to determine compliance. In general, compliant patients are more healthy. Almost any method or medication will show
beneficial results in this group, just because of their being motivated!
Many of us seek the best and truest evidence that medical science can produce. However, that pursuit is difficult and tenuous at best. (See "Fact vs. Hype..." above.) Poor compliance and non-compliance makes our task even more difficult.
The FDA Is Coming After Your Herbs
"The Food and Drug Administration (FDA), in breaking with its traditional practice of working with medical centers
nation-wide to evaluate the safety of a product, has actively sought to build a database of more than 900 'adverse event reports'
(negative reactions) to Ma Huang (a Chinese herbal medicine). These reports are based on anecdotal, incomplete, and/or incorrect evidence gathered via a toll-free hotline set up for consumers by the agency."
(Augusta Chronicle, May 7, 1998, p. 5A)
Commentary: Alternative medicine advocates have long blasted the FDA for neglecting the wonderful benefits of their favorite cures. They are finally getting the attention that they wanted, but the results will not be what they expected. There is an inherent bias among allopathic physicians and
researchers against alternative methods. This editorial is one example of that bias.
Alternative medicine advocates must realize that allopathic medicine is not their enemy.
Their enemy is government regulation, the very attention that they have sought. Allopathic physicians can only talk and plot against alternative medicine, but government regulation can make any method illegal and a crime to promote it.
The United States is not far away from total cookbook medicine. Signs and symptoms will determine what tests are ordered, what diagnosis is made, and what treatment is appropriate. Any departure from this standard will be a criminal offense. The future of American medicine for both patients and physicians is not very exciting, unless this regimentation accelerates the eventual breakdown of the entire system.
Vol. 12, No. 3 (76) May 1998
Whither Needle Exchange Programs?
Advocates of needle exchange programs (NEP) have tried for almost ten years to prove that NEP prevent the spread of HIV, the virus that causes AIDS. The theory is that access to clean needles will prevent intravenous drug abusers
(IVDA) from sharing needles with each other and thereby not spread HIV by this means. However, in spite of several NEPs, no study unequivocally supports this view.
If fact, some studies suggest that NEP can increase the spread of HIV. The explanation is that NEP become gathering places, "attracting not only scattered users but opportunistic dealers" and "new sharing networks."
A "confounding variable" that might be used to support NEP is that HIV incidence (rate of new infections) dropped in an outreach/education program in Chicago
without NEP. So, if NEP and education, are used in a locale, then the NEP might falsely get the credit.
Commentary: This whole debate is really an attempt to determine ethics by scientific or statistical means. (See Terrell's Treatise for more on this subject, p. 3.) There is a huge bias that preventing HIV infection is more important than any associated issues. However, my readers should
understanding that science can never determine ethics. Science is a means to theorize and investigate the physical world.
Ethics is transcendent, religiously derived.
NEP aid and abet IVDA in their sin. There is no historical precedent nor principle in Scripture by which we are to assist people in their sin or prevent the consequences of their sin. The same applies to birth control methods for unmarried men and women. The practice is unethical and
unbiblical, in spite of a pretense to prevent unwanted pregnancy and subsequent abortion.
Even so, making science a pawn for one's own ethics is usually
difficult, because even poor science has a way of reflecting God's reality. In this case, the reality is that IV-drug abuse is sin and has serious
consequences, only one of which is AIDS. Even modern medicine finds it difficult, if not impossible, to modify significantly the consequences of such profound sin. And, that is the difficulty of "proving" the benefits of
Through December 1997, 641,086 cases of AIDS had been reported to the Centers for Disease Control and Prevention (CDCP, formerly CDC). Of these, 629,870 were in adults, 3,130 in adolescents (13-19 years old), and 8,086 in children. Of these, 385,968 adults/adolescents (61.0 percent -- adolescent numbers are not separated here) and 4,724 (58.4 percent) have died.
For the 12 months ending with December 1997, there were a total of 59,782 cases of AIDS in adults, 379 cases in adolescents, and 473 cases in children. The numbers for the year ending December 1996 were 67,736 adults, 401 adolescents, and 671 children.
Also, for the 12 months ending with December 1997, 35 percent of AIDS cases occurred in "men who have sex with men" (MSM), 24 percent in "injecting drug use" (IDU), 4 percent in MSM and IDU, 0.33 percent in hemophiliacs, 13 percent by "heterosexual contact," 0.68 by blood products or tissue, and 22 percent with "other/risk not reported or identified." (Except for MSM and
MSM/IDU, these percentages include women. These numbers also include adolescents who comprise a small portion of these numbers, as listed above.)
Commentary: These numbers are taken from the "Year-end Edition" of the
HIV/AIDS Surveillance Report for 1997.* It is a 44-page booklet with 33 Tables, 7 Figures, and pages of footnotes and explanations of presented data. So, I have presented a miniscule of the data therein.
Mostly, the current data are only confirmation of previous information that I have presented. The total numbers continue to decline. Homosexuals
("MSM") still account for the largest number of cases. (Remember that
"heterosexual" comprises high risk exposure to HIV/AIDS: "sex with injecting drug user," "... bisexual male," "... person with hemophilia," "... transfusion recipient with HIV infection," and "... HIV-infected person, risk not
specified." These are not your everyday fornications and adulteries! They have their own risks of sexually transmitted diseases, but rarely HIV/AIDS.)
"'Other/risk not reported or identified' cases include persons who are currently under investigation by local health department officials; persons whose exposure history is incomplete because they died, declined to be
interviewed, or were lost to follow-up; and persons who were interviewed or for whom other follow-up information was available and no exposure mode was
identified. Persons who have an exposure mode identified at the time of follow-up are re-classified into the appropriate exposure category."
HIV/AIDS continues to be a huge tragedy of the "sexual revolution" that began in the 1960s. That culture has "reaped the whirlwind." HIV/AIDS will continue to be one dimension of that debauchery. The larger, but less fatal, epidemic of sexually transmitted diseases is another dimension. (See
"Sexually Transmitted Diseases" in Brief Reports with Commentary.)
* A single copy may be obtained by writing the CDC National Clearing House, P. O. Box 6003, Rockville, MD 20849-6003 or viewed/downloaded from the "net" at
www.cdc.gov, selecting "Publications, Software, and Products."