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Biblical Reflections on Modern Medicine

Vol. 9, No. 4 (52) 

Contents:


The Tail Is Wagging the Dog

or

The Political Correctness of Modern Medicine

The Medical College of Georgia Hospital and Clinics (MCGHC) just underwent its periodic accreditation review by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). The review became the number-one priority item for administrators and department heads at MCGHC. The opening of a new clinic was delayed more than 3 months so that it could avoid review. A huge inventory of drug samples in the Family Practice Center was ferreted away, unavailable to physicians or patients. 

Yes, the hospital and clinics continued to function during preparation and actual review. But, is not the tail wagging the dog? Has not review and accreditation become ridiculous and petty with its power? Hospitals and departments have received conditional approvals and severe citations for otherwise minor infractions: outdated drugs, faulty medical records, outdated equipment, staff that does not know the code phrase for each security risk, and chemicals in the lab that have expired by only a few days.

The JCAHO is a private organization, but it might as well be directly government controlled. Federal and state funding are dependent upon a hospital's or clinic's being accredited by the JCAHO. Accreditation of residency training programs is also dependent upon JCAHO approval, even though the programs have their own reviews. Federal and state funding of these programs may also be dependent upon JCAHO approval. Then, there is the Food and Drug Administration and Health Care Financing Administration (HCFA), who monitor these reviews, as well. Managed care contracts are dependent upon JCAHO accreditation, but they also operate their own reviews. Answering all the reviewers is now cutting seriously into the provision of patient care, as well as increasing costs.

The American Medical Association is one organization that ought to fight this direction of medicine, but they have only participated in and exacerbated the problem. Just recently they were exposed to have a secret contract with the federal government for the new Evaluation and Management guidelines proposed for all patient-physician encounters in the United States (Medical Sentinel, July/August 1998, pp. 149-150). While pretending to defend physicians, they have made their own power and money grab at the expense of all physicians.

The Emperor Has No Clothes

All this bureaucracy is about "quality of care," something that has never been defined or proven, except possibly in a few narrow instances. (I am doubtful of any.) Treatment of disease and injury is subject to differing approaches and outcomes according to the extent to which individual patients are affected and their own bodies' defenses and the training/experience of the physicians caring for them.) If ever an emperor were naked, Quality of Care is his name

And, yet, this huge bureaucracy has been created to guarantee that quality of care exists. What has happened is the opposite of what was intended. The paperwork of the bureaucracy has become the focus, not patient care. For example, I have worked at a nursing home for 10 years. I have never been criticized or cited for mistreatment of a patient. However, I have been cited numerous times for failing to make an entry in a chart when I was supposed to. Failure in paperwork is a major offense, while my medical care virtually goes unnoticed. 

Estimates of this cost are as high as 70 percent of medical care costs. That means that 70 percent goes to paperwork and bureaucrat salaries and 30 percent to actual patient care. You can work your own math to see the impact of this one contribution to health-care costs.

The priority of modern medicine is no longer the patient but paperwork and bottom lines. On the one hand, to watch physicians and administrators scurry around for a JCAHO review is like a cartoon. On the other hand, this activity portrays the sterility of the political correctness of modern medicine. Medical schools are supposed to be leaders and teachers of modern medicine, but they have become the dog being directed by its tail.

On Moral Medicine (a book review) and Christian Publishing

On Moral Medicine: Theological Perspectives in Medical Ethics edited by Stephen E. Lammers and Allen Verhey and published by Wm. B. Eerdmans, 1998, 1004 pages, $49.00.

This "anthology" is the second edition. Some 67 new selections "respond to new developments in health care," "attend to the care of patients with AIDS," "recognize the importance of nurses to health care," etc.

The only positive comment that I can make about this book is that it might serve as a resource for an eclectic collection of "perspectives" ranging from the liberal fringes of Christianity (Karl Barth) to broadly evangelical (the editors themselves). While they claim "diversity of theological opinion," the Biblically evangelical and Reformed perspective are sorely neglected. The closest that they come are entries by C.S. Lewis (2) and Helmut Thielicke (1). Neither are close enough.

I will not take up space with further comments here. The review of Genetic Ethics that I wrote for the January-February issue of Reflections can be applied to this volume. Many authors are common to both volumes.

The larger issue here is Christian publishing. Perhaps, the following letter that was sent to me from an editor at one of the largest Christian publishing companies after I protested the eclecticism of his medical ethics book.

"Your objections to some viewpoints expressed raise an issue with which we--an independent, commercial religious publisher--are constantly faced: What single definition, doctrinal or creedal statement authorizes (or which person authorize) the use of the label "evangelical"? As you are probably aware, even scholars of modern evangelicalism disagree (cf., e.g., Dayton and Johnston, The Varieties of American Evangelicalism, IVP). R. K. Harrison, who edited the original edition of the ethics book, thinks himself and the book to be evangelical. At least in Old Testament studies he established himself as quite conservative years ago with his now-famous Introduction to the Old Testament.

"All this to point out that our situation in which we publish for several traditions which claim "evangelical" as theirs: Baptists, Presbyterians, Methodists, etc. As a house, we are bound by the orthodoxy in the Apostles' Creed." (Personal letter to Ed, August 24, 1992)

Methinks of the question that Pilate asked, "What is truth?" Indeed, "evangelical" has become so problematic that it can no longer be used with any accuracy. "Christian" used to suffice. Then came "evangelical." What we are left with is "Biblical."

It seems that "evangelical," as a modifier of "Christian," was an abdication of the "evangelical's" responsibility to rebuke and even excommunicate the "non-evangelical." We have been too loathe to judge both within and without the Church. There are only Christians and pagans.

The answer to Pilate's question is, "(Jesus) is the way, the truth and the life..." The truth about Christ is contained in the Bible. His truth on even the common and esoteric subjects of medical ethics is the Bible.

I am not sure how accurate and limiting is "Biblical." However, I have found that most who are not striving to be Biblical do not like the label. I was once accused of trying to be "too Biblical."

The above editor wanted a "single definition." I would offer him the Bible itself. As a creedal statement, I would offer him the Westminster Confession and the Larger and Shorter Catechisms. I would also offer to him the following text, "Let not many of you be teachers, knowing that we shall receive a stricter judgment" (James 3:1 and verses following), for indeed Christian publishers, if they are anything, are teachers.

What I find most consistent among "conservative" and "evangelical" positions is their almost total omission of the most conservative and evangelical, even Reformed, Christian authors

So, Christian publishers ought to take heed. Their responsibility is to God Himself and to His Word. If they are unable to set a standard that is coherent with that Word, then they ought to get out of the business. They have become part of the "blind leading the blind." There is nothing eclectic about the Lord of Lords and King of Kings. There is nothing eclectic about His God-breathed Word. Let us have none of this "what is evangelical" whining. Let us have solid Biblical scholarship committed to His truth.

Of Prenatal Care and Police States

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

A trend analysis of national birth records over a 14-year period ending in 1995 reported some interesting news.1 The trend found was that the proportion of women who began prenatal care early and received the "recommended number of visits' increased during the period. However, the study is paradoxical with the outcome of previous studies which have shown that premature birth and low birth weight did not improve during the same period. An accompanying editorial discusses the possibility that "The public health and clinical community may have oversold the idea of increasing prenatal care utilization as a way of decreasing low birth weight and preterm delivery."2 The idea that more of what we have been doing will improve outcomes is termed "naive."

Thus, we edge another millimeter toward ditching the vast prenatal care enterprise. It is too little and too late. Expensive, extensive, and invasive practices of no proven value have eaten the substance out of medicine and brought all manner of regulation and economic perversions upon our patients and us. We need to dump them and start again. But we are caught. It is considered unethical to refrain from doing established things. I have never understood what ethical principle requires us to disprove established procedures which have never been proven to begin with. 

It would rather seem that the established procedures would need to demonstrate their effectiveness before it is fault-worthy not to follow them. Yet, that is not the case in medicine. A complex web of misinformation, liability concerns, economic incentives, and rationale (masquerading as evidence) imprisons medicine in practices of little or no worth. Orthodox medicine is often naive because we are afraid not to be naive and because we are paid to be naive. Information which challenges accepted practices tends not to be produced and to be ignored when it is produced. Once an unproven notion or outright bad idea becomes implanted in our medical culture it becomes very difficult to root out.

Now through the combined genius of the Supreme Courts of the United States and the State of South Carolina we have a magnifying glass on prenatal care. The U.S. Court allowed to stand a South Carolina ruling on a law that makes it a crime to "refuse or neglect to provide the proper care and attention" to a child.3 In this case the law was applied to an unborn child. As many as 40 such cases have been prosecuted in South Carolina under the law. One defendant was sentenced to eight years in prison when cocaine was found in her newborn son's blood.

Even more interesting, the S.C. law makes it a crime for medical professionals to fail to report endangerment of the unborn by their mothers. What constitutes endangerment is not spelled out in the law, so it is open to interpretation.

One can imagine the pro-life camp having difficulties with this one. Some will take a hard line and support such prosecutions as effective for the safety of the unborn. Others will argue pragmatically that women who have mistreated their unborn child by drug use or other behavior can legally cover up their crime by having an abortion, so that the net effect will be to substitute definitely dead babies for possibly damaged ones. It could be argued that the tension in the law is an undesirable but necessary step toward exposing the logical absurdity of abortion for those who will not accept its wrongness. "You can kill your unborn baby with impunity, but you cannot merely injure it." 

Why, indeed, could not a woman just defend herself by saying that her behavior was only a botched abortion that she tried using some drug? When a legal abortionist botches his job and the baby is live-born and damaged, he is liable for civil prosecution, but I recall no criminal prosecutions. It is surely devoid of logic.

One can also imagine the pro-abortion camp secretly delighting in these Supreme Court decisions. With the tide of opinion beginning to set against them, how nice to have the police state image--no--the police state reality, to use against us.

To turn around the familiar saying, bad law (legal abortion) makes hard cases (police state watchers of the womb). Casuistry is inescapable. I think it is not hair-splitting, but if hair-splitting it be, come and let us split hairs together. This S.C. law is a case of bad law begetting bad law. Given the widespread mystique regarding prenatal care mentioned above, the number of maternal behaviors that can be advanced as detrimental to her unborn baby is huge. Reliance upon the common sense and good graces of the police cum prenatal care establishment is leaning on a slender reed. 

I believe that the pragmatic concerns over womb police are realistic though probably not immediate. We are pointed in the direction of Red China with its community watchers on each block who try to track the menstruation or midriff of young women in service to population control. But pragmatism won't do. It is serviceable only when linked to an adequate theology. It cannot stand on its own. What Biblical principles apply?

Abortion is wrong because it is the intentional killing of another human being. It is murder under the Sixth Commandment. Intention is an important element in murder. A tool known to kill, such as a curette or a prostaglandin, is another important element. Neither of these elements is normally present in the case of a newborn with cocaine in his blood. The majority of newborns exposed to illicit drugs are not measurably damaged because of the exposure. 

One of the reasons that physicians do blood tests on newborns is because the infants do not normally come out of the womb seizing or with other gross and evident problems. For most, it takes a urine drug test to tell. Even for those infants who have obvious problems, it is by no means certain that it was the drug use which caused the problem. Drug use and poor prenatal care are markers for infants and children at risk but not necessarily causes of all the problems that are seen. Women who use drugs are also more apt to have venereal infections, and other diseases, less adequate nutrition, greater stress, and more physical trauma. And, when the drug is present and did cause harm, was there intent to harm?

"Well," say some, "She is still at fault because she should have known that marijuana (or alcohol, or cocaine, etc.) was dangerous." So should the pregnant woman have known who drives her car too fast, or who didn't take her folic acid supplement, or who gained far too much weight, or didn't keep her prenatal care appointments thrice in a row. If intent and definite lethality are waived in this matter, there are no significant barriers to Caesar moving in. 

"True believers" in the power of prenatal care, who control that unproven practice today, will push the envelope. The South Carolina law is not limited to drug use. Drug use has merely been used to walk point (to take the lead in an assault) on raids against liberty. Likewise, the welfare of children is used to further erode other governances established by God. The nexus of drugs and children is a handy burglar tool in the hands of the thieves of liberty. Caesar would be father of all, if we let him.

At some point, we have to learn to rely on other spheres of governance to limit evil than just the civil ruler. Conservatives too often act just like political liberals in wanting Caesar to step in and fix everything using central control. Acting in that mode, both liberals and conservatives are centrists in a world sorely in need of more dispersed control. Rather than politicizing everything, we might emphasize the power of family life, a disciplining church community, and even social pressure to operate on the problems of poor pregnancy outcomes. Social condemnation is not always bad. Afraid to imagine a sinner bound up with her sin, Christians are too prone to gush acceptance where there is no repentance. The murdering mother is usually treated only as a victim of the abortionist, not as collaborator. Thus, we are practical antinomians.

Jesus taught an expanded understanding of the commandments. "Thou shalt not murder" has both an outward and an inward dimension, a positive and a negative side (Matthew 5:22). Outward murder legitimately involves the civil ruler. Hatred in the heart is inward murder and is sin (I John 3:1-5). The positive side of the commandment enjoins us to take care with human life, our own, and that of others. The woman who carelessly or recklessly endangers her unborn baby's health is indeed before God guilty of the sin of murder through the failure to exercise this positive aspect. She is not, however, legitimately under the state's authority for these lapses.

In this matter, pro-life Christians need to use a crisis pregnancy center model, not a legal, punitive one. We need to appeal to the heart of the women under temptation to engage in hazardous practices. The conscience is the centurion for sins of the heart. Caesar's centurion has no access there and no legitimate business. As to the positive side of the commandment, he can reward those who do good, but he cannot punish those who fail to do good (Romans 13:3). Does the power of the conscience, the family, the church and the community seem too weak to really save babies from damage by careless mothers? That weakness speaks to our neglect of those governances as we have run to Caesar for things that are not Caesar's. The authority of these spheres of governance is clear. What, by comparison, is so impressive about the performance of the state that encourages us to have such confidence in its abilities in a matter of this sort: the Postal Service, public education, welfare, Medicaid and Medicare, etc.?

The womb may be God's quintessential fleshly example and image of security. It is the secret, hidden place of the body. He condescended to be hidden there Himself. He trusted Himself to His servant, Mary. Mary's preparations included a submissive, servant's heart and the support of Joseph. We have let the womb become a signally insecure place today by legalizing abortion, by neglect of the preaching of the Word to ignite the conscience, and by neglecting family life and church discipline. Let Caesar repent of protecting and paying for deliberate murder, but let us not have pregnancy patrols.

References

1. Kogan, M.D., et al., "The Changing Pattern of Prenatal Care Utilization in the United States, 1981-1995, Using Different Prenatal Indices," The Journal of the American Medical Association, May 27, 1998, pp. 1623-1628.

2. Misra, D.P. and Guyer, B., "Benefits and Limitations of Prenatal Care: From Counting Visits to Measuring Content," The Journal of the American Medical Association, May 27, 1998, pp.1661-1662.

3. Carelli, R., "Pregnant Women Can Be Prosecuted," America Online, [Associated Press], May 27, 1998.

Brief Reports with Commentary

On Automobiles And Horse Manure

A favorite theme of Al Gore is the destructiveness of the pollution produced by automobiles. In his book on environmentalism (the name of which I do not recall), he calls the automobile the greatest threat to life on earth (or something to that effect). Rev. R. J. Rushdoony has a challenge that you might want to use with Mr. Gore and others of his ilk.

"In the horse and buggy era, transportation meant much land was tied up growing hay. Manure was the worst pollutant cities have ever seen, a major health problem. Urban epidemics were then more common. Air quality has improved since the advent of the automobile transportation." ("Random Note" #2, Chalcedon Report, July 1998, p. 28)

Can you imagine New York City, Los Angeles, Chicago, or any other large city with thousands of horses used for commuting each day? Can you imagine the amount of land that would be tied up for hay and other produce to feed them each year? Did you ever see a car breed the flies that carry all kinds of infectious diseases?

Of course, environmentalists would point to public transportation as the answer, rather than individualized transportation. But, that answer does not account for how individuals and families will get from their urban, suburban, and rural homes to their places of work and shopping. Not everyone can ride bicycles!

The debate is more complex than I have presented it here. However, I like the notion that the next time someone criticizes the automobile, you and I can respond that the alternative is horse manure--huge piles of it!

Something New(?) on Alternative Medicine?

Recently, I received a bulk mailing for Alternative Medicine Alert. The Editor, John La Puma, M.D., claims:

"Finally traditional physicians can give their patients real data about alternative medicine. We owe it to our patients to tell them about promising alternative clinical approaches... many of which are in fact proving efficacious. We must also give our patients the unvarnished truth about practices that are frankly useless--and many that may do harm."

I will not comment on the quality and "truth" of this publication, but perhaps some of may readers who are alternative medicine proponents will. (Keep it brief please!). However, there does seem to be a little bias here: all ten of the members of the Editorial Advisory Board are M.D.s. It is also published by American Health Consultants (A Medical Economics Company) for $189 per year. So, there seems to be a profit motive, as well. For those who want a sample copy or to subscribe, write P. O. Box 71266, Chicago, IL 60691-9986 or 1 (800) 688-2421.

The Arrogance and Stupidity of the NEJM

George J. Annas, J.D., M.P.H., wrote "Partial-Birth Abortion, Congress, and the Constitution" under the category, "Legal Issues in Medicine," in The New England Journal of Medicine (July 23, 1998, pp. 279-283). It is a harangue against those who are pro-life and a pretense of discussion of constitutional law.

Dr. Annas writes:

"President Clinton is thus on strong constitutional grounds when he bases his vetoes on the failure of these bills to allow for a physician's action to preserve a pregnant woman's health.... Because abortion foes have never seemed to care whether or not the laws they propose are constitutional...."

Commentary: There is the contrast: President Clinton is constitutional and "abortion foes" are not. Excuse me! I may not have "J.D." after my name, but I can read and understand plain English. The Preamble of the Constitution states that one of its purposes is to "secure the blessings of liberty for ourselves and our posterity." How can that posterity experience liberty if they are denied life before birth?

Now, even beyond the Preamble, the Constitution nowhere elevates the health of women above those of the unborn. What Dr. Annas reveals is his own arrogant bias in favor of abortion and even partial-birth abortion (which is the primary focus of the article). He wrongly confuses "constitutional" with Supreme Court opinion. I defy him or anyone else to find any commentary on the Constitution by the Founding Fathers or their contemporaries that gives the faintest inkling of justifying wholesale murder of the unborn.

I accuse The New England Journal of Medicine and its sponsor, the Massachusetts Medical Society, of gross misinformation and extreme bias that promotes wholesale murder of the unborn. I can accept the article as one side of a modern legitimate debate, but the other side will never see the light of day on its pages except perhaps in the more obscure Correspondence section (letters-to-the-editor).

As might be expected, the article brings in other issues, as well. For example, what is and is not a "medical procedure." Female genital mutilation is not, but dilatation and extraction of an unborn baby is. "Who should have the authority to determine which procedures are legitimate medical procedures?" That is indeed a good question that bears on many issues, but not one that needs more lengthy treatment than I can give it here. Perhaps, I will do so in the next Reflections.

But, sometimes by law the unborn baby is life worthy of protection....

You May Abort Your Baby, But Don't Give Him Drugs!

"In response to the landmark decision of Whitner v. South Carolina, the South Carolina Attorney General's Office developed a comprehensive treatment plan for pregnant women who may be using illegal substances. This plan also include mothers who have neglected their newborn children. The intent of the program is to provide for treatment and counseling as an alternative to criminal proceedings." (Letter to South Carolina physicians from the South Carolina Medical Association, June 12, 1998)

Commentary: On the one hand the laws of our states and nation state that you may murder your unborn child at any time, including when he is half-delivered. On the other hand, you cannot do anything during prenatal development to injure the child or even neglect healthful practices without punishment by criminal conviction. Maybe we should do quickie drug screens on half-delivered babies and just suck out their brains of those who test positive.

Such a society is morally insane! The open presence and support of homosexuality pales in the light of the killing fields that are abortion clinics. The weakest and most vulnerable are slaughtered by the millions. 

You say, "So what. You say this in almost every issue of Reflections." Well, yes I do. But, here I want to underscore to you and to me the deep, deep depravity of our society and how far it has strayed from any moral moorings. We are not about to have a "quick fix." Even with consistent change in a positive (Biblical) direction, it would likely take decades to change the culture and laws that it has generated.

We are in a black hole without a moral compass. Unless God chooses to shine His light of truth on legions of hearts, we are doomed to degenerate further into a society that worships death and hates life.

Breast Implants: Science vs. Hype

"Most studies to date have failed to find an excess risk of connective tissue disease (CTD) in women with breast implants, but they were conducted predominantly in North America, where publicity related to litigation may have interfered with objectivity. Investigators in Sweden, where there has been much less publicity, retrospectively reviewed national registry data on women who underwent breast augmentation or breast reduction surgery between 1964 and 1993...."

"After a mean followup of eight years, the implant group did not have a significantly increased risk for CTD (29 cases vs. 25.5 expected). In the breast reduction group, 14 women had CTD vs. 10.5 expected." (Women's Health, March 1998, p. 3, reported from the original, British Medical Journal, February 7, 1998, pp. 417-422)

Commentary: Perhaps nothing in medicine qualifies as "truth," as the Bible is truth. What is best known about medicine comes from "good" studies in which even the "best" always have some flaws. Nevertheless, to practice medicine and law against the best science available is really to depart from any notion of a justified course of action.

The hype over breast implants is just such a departure. There is no scientific basis for the furor over awards for women with diseases caused by breast implants. There is no such basis for the shutting down of all valuable medical products made from silicone. This study only confirms what is already known with reasonable certainty.

The medical profession and our culture claims science as its basis for truth. That claim itself is a lie. Science is easily overruled by greed, political advancement, or news hype. I have previously reported on the Gulf War Syndrome, another example. Some aspects of the management of the AIDS epidemic is yet another example.

The issue of truth is ultimate. While medical science is not truth, nevertheless it is the best understanding of medical practice. We ignore that understanding to the detriment of our health and the degradation of our society.

AIDS: Issues and Answers

Vol. 12, No. 4 (77) July 1998

Too Much of A Good Thing?

There is consensus among clinicians who are actively involved in the research and treatment of HIV/AIDS that a 3-drug regimen (including one protease inhibitor) is effective to decrease complications from AIDS and to prolong the life of AIDS patients. There is no consensus that this regimen ought to be administered in everyone with HIV/AIDS. (The Journal of the American Medical Association, July 1, 1998, pp. 91-95)

"Over 20 years ago, clinical trials showed that multidrug tuberculosis treatment regimens could cure more than 95% of patients and virtually eliminate acquired drug resistance. One might expect then, that the rates of drug-resistant tuberculosis would have decreased in subsequent years as these regimens were adopted in clinical practice. Quite the opposite occurred; around the world, rates of drug resistance increased."

A primary reason for this increasing drug resistance was poor adherence (failure to take all pills at the prescribed time). This failure allows organisms periods of respite to develop enzymes to defeat the drugs that are supposed to defeat the organisms.

This resistance is already occurring with HIV. First, there is evidence of adherence as low as 37% to 39% and 22% to 56% in published studies. And, there is "growing evidence" of resistance to drugs for HIV of the same class. 

Commentary: Whether to treat all HIV/AIDS patients with triple therapy was presented as "pro" and "con." For several years now, clinicians have been pleased to have effective antiretroviral agents that were more effective than AZT. However, good early news is not always good long term news, as with the history of tuberculosis above. 

The enthusiasm of physician leaders and "officials" to promote homosexuality had a two-fold effect. First, they would not attack homosexuality as the initial primary cause and spread of HIV/AIDS. Second, unprecedented money and effort was targeted at those infected with the hope to allow them their "freedom" and "right" to their lifestyle. In effect, they were saying, "Don't change. We will find the vaccines and medications to help you."

As indicated above, there has been some success. The triple-drug approach has indeed been effective. However, "there are already disturbing signs that availability of potent antiretroviral therapy may decrease perceived risk associated with becoming HIV infected and, thereby, increase unsafe behavior" (Ibid, p. 94).

The medical profession has already attempted to gloss (literally, glossy full-page ads) over the terrible effects of sexually transmitted herpes. Antiviral drugs can lessen the effects of herpes, but these drugs are not a cure. The infection will recur for the remainder of the lives of those infected. Yet, these full-page ads state that women do not have to fear herpes in their promiscuity because of these drugs. That is more than glossing, it is a bald-faced lie!

There is no right solution to a wrong situation, morally or medically. Accepting the immorality of homosexuality (an abomination to God), the medical profession has virtually condemned itself to repeated failure in the treatment of HIV/AIDS. In addition to this acceptance, there have been lies and distortions about the extent of the epidemic and treatments over the years.

The resistance of HIV to this three-drug regimen may not come to pass. Only time will tell. I do know that you cannot shake a fist in God's face and expect to maximize your ability to "help" others.

AIDS Vaccine Moves Into Phase 3 Trials

"The world's first wide-scale efficacy testing of a vaccine to prevent AIDS received the go-ahead from the Food and Drug Administration last month, although some scientists remain skeptical about prospects for success.

"(The trial will be) a 3-year, placebo controlled phase 3 efficacy trial involving 5000 volunteers at high risk for HIV infection (such as homosexual men and women who have HIV-infected partners) in as many as 40 clinics in the U.S. and Canada.

"Because the vaccine cannot be presumed to be completely effective and because some participants will receive a placebo, all participants will receive extensive counseling on how to reduce potential exposure to HIV. While such counseling is necessary for ethical reasons, if study volunteers practice the recommended risk-reduction measures, the likelihood that investigators will be able to determine the vaccine's effectiveness is sharply reduced." (The Journal of the American Medical Association, July 1, 1998, pp. 7-8)

Commentary: The technical aspects of the vaccine and its effects on humans is more complex than I can describe here. I present this information to keep readers updated in this area. The attempt is still an effort to allow those engaged in illegal and immoral activities to avoid the consequences of their sins. 

First, even the suggestion that the bad effects of a behavior can be ameliorated increases the behavior, making any positive effect virtually nil or possibly even causing a negative effect. Second, any positive effects of an HIV vaccine is limited simply because it goes against nature and against nature's God. 

Third, researchers are counting on the failure of their recommended risk-reduction advice. If the advice worked, then no one would contract AIDS for that reason and the vaccine would remain unproven. It is an implicit acknowledgement of the inefficacy of risk reduction.

Poetry and Medicine

An Afterlife in Reno

Floyd Sklook

I try to see my brother walking now
but he remains festooned with tubes, tilted
back as far as the barred bed will allow.
He sleeps, face rippling with tics, the quilted
blanket pulled against his chin, and I know
prayer must travel where my dreams cannot go.

So I try wings, tufted carpet of cloud,
a halo to help with lift, shouldered harp.
Reno would bring his beatific smile. 
Keep the lights bright and samba music loud. 
Let there be dice, chips stacked head high, the sharp
snap of cards turned by a buxom Gentile
dealer who grants him one long run of luck
before dawn. Allow him to be moonstruck.

(The Journal of the American Medical Association, July 1, 1998, p. 88c)

Commentary: This poem reflects the sad state of modern medicine. It starkly contrasts with the true hope of a bygone era in which God and heaven was, if not at the center of American medicine, at least the bedrock of hope when medicine failed. 

The poem is a flashing neon sign on an empty hospital corridor. When God is banished, only the worst despair and banal hope of "one long run of luck before dawn" remain.

By contrast:

"Let not your heart be troubled; you believe in God, believe also in me. In my Father's house are many mansions; if it were no so, I would have told you. And if I go to prepare a place for you, I will come again and receive you to Myself; that where I am, there you may be also. And where I go you know, and the way you know." (John 14:1-4)

Bonehead of the Month Award

It has been several years since I gave a Bonehead of the Month Award for a stupid statement made with all seriousness.

Susan R. Johnson, M.D., Associate Dean of Faculty Affairs at the University of Iowa College of Medicine is the esteemed recipient of the July 1998 award. In response to a state law that bans "partial-birth" abortions, "she said that the state ban threatens the school's mission to 'teach and train future physicians, while providing the best, most appropriate care needed by the individual patient'" (Academic Physician and Scientist, July-August 1998, p. 6).

When I was in medical school on Obstetrics, we were taught that we cared for two "individual" patients: the mother, and the child in her womb. I suppose that Dr. Johnson (and a host of her ilk) pretend that a patient does not exist until he has been delivered completely from the womb. It is that last little toe that makes you fully human, you see!

A Letter: On New Christians, Behavior, and Psychological Labels

The following letter came by e-mail. It is quite revealing of the weakness of modern Christianity because of poor Biblical teaching mixed with pagan psychology when Christians try to help themselves and help others. My response to them follows.


Dear Dr. Payne:

Recently a cousin of mine whom I have not seen for 26 years (he is 40 years old) came to live with us. He was homeless, but has recently become a born-again Christian. In the past he was diagnosed with paranoid schizophrenia and panic attack disorder. After being with him for nearly a month, it appears to me that a lot of his "illness" comes from within himself, the way that he has learned to think. 

I am having difficulty relating to him and understanding his erratic moods. He tends to keep talking and thinking about things that have happened when he was a young boy up to the present day. We try to encourage him to forgive others for these things and move on, but he is stuck in a time warp and we are becoming frustrated. 

We want to help him because we feel the Lord wants us to, but we are beginning to think that we cannot help him with more than a home, food, and clothing. He needs professional Biblical counsel, not secular, as he has been that route with no success. Our pastor has met with him once and has encouraged him to go to prayer meeting. He has, but it does not seem enough. At home, we encourage him to read the Bible and memorize verses. Some days he tries and other days he does not. He is a baby Christian. 

I am sharing these thoughts with you because I am hoping that you can point me in the right direction to help him. Any suggestions--Bible studies, books, etc.

Name withheld by Ed

Ed's Response

Dear __________,

First, your observations are likely 100 percent correct. In past counseling, I found that diagnoses were treated as though they were beyond the person's control. What he needs is confrontation that being "paranoid schizophrenic" or having "panic attacks" is not an excuse for sinful behavior, especially when these problems are not manifesting themselves. 

There is no better approach to any person's problems than the chapter on abituation and dehabituation and life-dominating problems in Jay Adams' Christian Counselor's Manual. As a new Christian, he has much to "put on" and much to "put off." He should fill each day with this process. He must have a disciplined daily schedule with productive activity. Does he have a job? What does he do all day? What does he do for someone besides himself?

If he is unwilling to follow this discipline, I would question his being born-again and/or commitment to change and would not continue to try to help him. People must want and work towards change, not just say that they do.

You have made two errors yourselves. First, a person cannot forgive others unless they have asked. This error is a common among Christians today. Forgiveness is two-sided: the offender asks and the offended grants or denies. See Theology of Counseling by Jay Adams. There is a large section on forgiveness in that book.

Second, you said, "We feel that the Lord wants us to." You should not go on feelings but thinking. Too many Christians worry along with someone who is minimally committed, hoping that he will change. It rarely happens. You should help someone because he is committed to change and shows evidence of working at it. For example, your cousin ought to be heavily involved in reading and Bible study. His "diagnoses" don't prevent that.

The same God Who forgives us, also said, "If anyone does not work, neither shall he eat." Motivation (the will) comes from within. Those who are born-again and are committed have the will.

I have answered you rather hastily and placed a lot on you, but you asked. There are Biblical answers for you and your cousin. A Biblical counseling center that I recommend is located only about one hour from you.


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