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Biblical Reflections on Modern Medicine

Vol. 9, No. 5 (53) 

Contents:


The Y2K Problem and Medicine

or 

Building Your Medical Bridge to the 21st Century

How will patients and the practice of medicine be affected by the Year 2000 computer problem? Like others in virtually every sector of society, no one really knows. It may be "an annoyance, a crisis, or something in between." Concerning medical technologies, heart defibrillators (both implanted and stand-alone units), x-ray machines that depend upon computer imaging and dating, and infusion pumps that control the delivery of medications and fluids are likely to have problems, if not corrected. In hospitals, climate control, security surveillance equipment, and elevators may have glitches or not even run at all.

The larger problem, however, appears to be the vast computer network of the federal government that governs Medicare and other programs. One computer programmer, Joel Ackerman, who now heads the Rx2000 Solutions Institute, says that "the federal government (is) still using the faulty program that he wrote more than 20 years ago.... We are convinced that the American health-care community is in deeply serious trouble due to anticipated problems in the year 2000 changeover. Patient lives are at stake." (American Medical News, August 10, 1998, pp. 5, 9)

Commentary: As stated above, no one really knows what impact the Y2K problem will have anywhere, including medical care. Among possible catastrophes, however, this problem is precisely predictable as to when it will happen--452 days from the day that I write this line. Forewarned is forearmed! If you or others in your family have medical devices upon which their lives depend (dialysis, pacemakers, implanted defibrillators, etc.), NOW is the time to find out from its manufacturer whether that device will be affected by the year 2000 date.

As to payment for medical services by the government and private third-party payers, perhaps it will continue after 2000, perhaps not. My prediction is that there will be major disruptions of non-payment, payment delays, loss of eligibility records, and other major logjams of the system. The federal government has a computer system that is notoriously old and outdated. If they focused their entire attention to the problem between now and then, most "bugs" might be fixed. However, they have millions of transactions every day which they cannot shut down. So, the time and money that can be spent for correction is limited.

In this regard, the year 2000 may be a blessing in disguise, if people become more directly responsible for the payment of their own family's medical care and develop a better understanding of their own medical problems. Might the health of some suffer? Yes, but far fewer than you might imagine. My prediction is that most people, especially the elderly, are on far too much medication that is more harmful than beneficial.

But, there are some medications that are essential to life and function, e.g., digoxin and digitalis, insulin, some endocrine problems (thyroid, parathyroid, etc.), bronchodilators for asthmatics, etc. Again, forewarned is forearmed. You should buy 2-3 years worth of these medications as soon as possible, preferably from a large mail-order chain or through some discounted program. Like the grocery store, local drug stores are dependent upon frequent refilling of their meager stock. 

And, learn if your medications need special storage (cooling, protection against light, etc.) and their life of potency. Most medications will last years at room temperature, but generally cool and dry is better. Also, most medications are stable and will retain their potency indefinitely. The expiration dates are conservative, so they are usually safe and effective far beyond those limits. 

However, there are a few exceptions. A few medications will lose their potency. A fewer number undergo chemical changes that are actually harmful. Learn the medications for yourself and your family. Know everything that you can know about them. You may want to stop some of them, if your physician and yourself are not convinced that they are helpful, regardless of Y2K.

That problems from the Y2K dating will occur is inevitable and unavoidable. The unknowable is the severity, duration, and correctability of those problems. Forewarned is forearmed.


More on Number Needed to Treat: Breast Cancer

A recent study reported a 45 percent reduction in breast cancer in women who were at increased risk of breast cancer and who took tamoxifen. (Primary Care and Cancer, July/August 1998, p. 21-22)

Commentary: Wow! Breast cancer was reduced by almost one-half. Let's place all women on this wonder drug. Not so fast.

There were "more than 13,000 women randomly assigned to either tamoxifen or a placebo." Let's assume 13,000 for a round number. That makes 6500 in each group. There were 154 cancers in the placebo group and 85 in the tamoxifen group, a reduction of "45 percent." But, note that 6500 hundred women took tamoxifen. That means that 6431 (6500 - 69, the difference in the two groups) did not benefit from tamoxifen: they either had breast cancer in spite of tamoxifen or would not have had breast cancer whether they were treated or not.

Thus, 94 (6500/69) women took tamoxifen for one to benefit. So, 94 is the number needed to treat (NNT). But, this is how will physicians present this study to patients. "If you take this drug, your chances of having breast cancer are cut almost in half." That's a lie! Only those women who are going to have breast cancer will have a chance to benefit, and there is no way to predict who those will be.

Physicians ought to present the information this way. "If you take this drug, you have a 1 in 93 chance of preventing breast cancer." Presented that way, there will not be many takers. And, we have not even reviewed the serious side effects and deaths from this drug.

Such is the nature of medical research and poor thinking on the part of physicians. Medical studies are done on populations of patients. Individuals within these populations benefit, but there is no way to know who these individuals will be. It is not wrong to treat populations in order to treat individuals, but let's tell patients exactly what we are doing and their real chances to benefit or be harmed.


Terrell's Treatises

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

Distortion That Enhances Abortion

Our nation's president is not the only one who can effectively lie by putting a fine edge on a definition. Some years ago the American College of Obstetrics and Gynecology adopted a convenient definition of "conception." 

Previously, the term had meant the fertilization of an egg by a sperm. Now, the term was used to indicate the implantation of the fertilized egg into the wall of the uterus, a process more properly known as "nidation" or "implantation." Human personhood was thus delayed by definition several days. This delay offered the opportunity to experiment with fertilized eggs while pretending they weren't persons. It also offered some kind of killing of the egg while avoiding the term "abortion" or abortifacient."

A "contraceptive" kit is soon to be marketed which acts by making implantation of a fertilized egg unlikely. It is being called a "contraceptive." It is actually being touted as a birth control measure which will not work if a woman is already pregnant. When personhood originates with fertilization, it does no such thing. The trick is done by definition, not by proof.

Abortion clinics will not be put out of business by this approach. Their business may decline, but not likely by the one-half that is suggested by the promoters of this "morning after" pill. By means of these early chemical abortions done in the privacy of one's home the abortion rate may appear to decline, though in fact it may be rising. Those opposed to abortion will have to turn more toward moral and theological persuasion than toward political and legal control of abortion clinics. In the longer term, this is a superior approach anyway.

Since the deed is purified by definition, another effect is to strengthen the hand of those who agree with Peter Singer, medical "ethicist" recently seated in an endowed chair at Dartmouth University. Singer advocates delay in declaring the personhood of newborns until they are a month old. He also favors "active euthanasia" for the dying or chronically and seriously debilitated by illness.

When God is dead, anything is possible. When God is dead, death masquerades as life.

Quality of Care and Medical Licensure

For decades the medical licensing boards of the states served chiefly as a fence to keep "quacks" out of the menagerie of orthodox medical practitioners. Once in awhile, our keepers on the licensing board would turn around and crack a whip in our direction, disciplining some especially egregious case of misconduct but generally leaving the profession alone otherwise. Punished misdeeds were usually drug and alcohol abuse by physicians, sexual conduct with patients, or a felony conviction, often for insurance fraud.

There has been a noticeable change in the behavior of licensing boards in recent years. They are now attempting to actually serve as protector to the public rather than as the profession's protector. Protection of the public was the original selling point for licensure. Protection of the profession from competition was the functioning purpose. After a hundred years of protection, pay-up time has arrived for medical doctors. The public wants what it was led to believe it was getting.

Licensure boards appear to be in actual competition with one another in regard to the percentage of physicians disciplined for traditional misdeeds. Now, the Federation of State Medical Boards has urged the licensing agencies to accelerate discipline because of the delivery of poor quality medical care. While it may sound good, it is actually not a possible task for any central authority. "Quality" is much in the eye of the beholder. For some patients, "quality" means "empathy." For others, prescription of a drug. From the patients' perspective, quality may mean avoiding surgery, having surgery, approval of disability, release from disability, affirmation of self-diagnosis, having an exotic diagnosis, participation in the process, avoidance of participation in the process, etc. "Good quality" is as specific as "good vehicle." Is it four-wheel drive that is wanted, swift acceleration, a certain look, fuel economy, air bags, no air bags, good cornering, trunk space?

Even if quality could be uniformly defined, what central authority can supervise billions of annual contacts? Boards could try to use other markers as a substitute measure for quality, such as completion of educational programs or tests of skills, but these are already known not to adequately substitute.

Government-operated "professional review organizations" (PRO's) have already failed at ensuring quality, as have malpractice lawsuit patterns, and HMO dicta. The "problem" is a problem mainly to those who crave central planning and control. The quality of medical care has always been and will always be determined one by one, between patient and physician. From a centrist's perspective this decentralization of decision-making is threatening. The real threat in this area is the lack of a truly free market for patients. Licensure is a problem; it is not a solution to the problem. How much mayhem will this latest initiative cause? Probably more than did the PRO's and the HMO's together.

Prevention of Breast Cancer and Preservation of Myths

As lava ash falls gently on a town, driving out its inhabitants and burying it, so also to the myriad of well-intended but unproven methods in medicine. Effective medical techniques become encased and inoperative by the sum of the worthless, no single one of which is noticeable. The Journal of the National Cancer Institute (March 5, 1997, pp. 355-365) reported a study of the value of breast self-examination in preventing cancer deaths. Carried out in Shanghai, the study could take advantage of the regimentation of the workforce there to improve instruction and follow-up. The numbers in the study were huge--over a quarter of a million. The instruction provided the women was far better than that usually given in the United States. There was follow-up to demonstrate that the instructed women did indeed acquire the desired skill of lump detection and retained it. There was a control group.

The instructed women did indeed discover lumps, more than twice as many as the control group. However, there was no change in mortality. Given the long lead time of breast cancer, it is possible that there will be a benefit later. The study has been in progress 5 years. However, there was not even a trend for breast cancers to be found at an earlier stage in the instructed group, as would be expected if the rationale for the technique were valid. There were no more cancers discovered in the instructed group than in the control group. Hundreds of women in the instructed group found lumps that turned out to be benign. Thus, their lives were not improved and likely were at least slightly impaired by the fear, expense, and procedures used to ensure that their tumors were benign.

The authors concluded that there was insufficient evidence to recommend the teaching of breast self-examination. Mysteriously, they also concluded that there was insufficient evidence to recommend against teaching breast self-examination. This second conclusion is just weird! The experience of the 800+ women who had a false alarm seems like a good reason to me. A better reason is that it is irrational to require proof that a good idea does not work. Let good ideas prove themselves. By the illogic of the authors, there is insufficient evidence to recommend against the eating of two grams of beach sand daily to prevent breast cancer. In fact, by this weird logic, you could finish the sentence, "There is insufficient evidence against..." almost any action you wanted to insert.

There is a huge number of such procedures, recommendations, or even requirements operating on physicians and others in medicine, each one slowly burying that which is known to be effective. The centralization of control in medicine has regimented physicians and others in ranks behind leaders, some of whom could not find their derriere using both hands.

Of Brains and Souls: Moving Backwards from Descartes*

Neuroscience and psychotherapy have established a dating relationship. Positron emission tomography (PET scanning) shows increased metabolism of glucose in the brain, by which it can be reasoned that the areas of the brain showing up the brightest are the most active. Researchers have noted that there are different patterns of brain activity which correspond to different diagnostic syndromes (Family Practice News, August 1, 1998, p. 14). Among the patterns for which they say they have noticed particular patterns are depression, obsessive-compulsive disorders, eating disorders, and borderline personality disorder. It has been further possible to show changes in the patterns following psychotherapy.

So far, so good. As the organ chiefly identified with our behavior, it would be quite amazing if there were no patterns corresponding to different behaviors. It is, however, not exactly a profound finding. By analogy, imagine a strain gauge implanted in the biceps muscle. It shows increased tension that corresponds to the previously noticed bulge in the upper arm when the muscle is flexed. The measured strain also corresponds to the increased weight that can be lifted. No one would be amazed. If research showed that the level of strain increased with physical training designed to strengthen the muscle, one might even yawn. No one would think that physical training now had significantly improved verification.

The PET scan findings, however, are not so modestly regarded. Rather, we are told, "...functional neuroimaging has put psychiatry on the threshold of grasping the mechanisms of self-consciousness." Psychotherapy is said to be legitimized "as a real form of treatment," by these discoveries.

This is specious reasoning. Could we have even more refined methods of examining the intact, living central nervous system, we would surely find functional and structural changes corresponding to each memory, each emotion, and each skill. These changes would have been produced by experiences, teachers, parents, and the whole variety of our lives. But such discovery would not prove these changes to be the primary causes of thoughts or behavior. Furthermore, dismembering the neural processes avoids the overarching matter of value. It cannot distinguish what is good behavior from what is evil, nor good thoughts from bad ones.

Medicine's fascination with molecular and physiologic reductionism is thus revealed again. The philosophy underneath such investigations is usually a belief in a universe that could be entirely comprehended, if its physical parts were diced finely enough. By definition, not by proof, science admits of nothing that transcends it. Meaning and purpose are inventions, interlopers. Revelation from the Creator is specifically to be forbidden. Full of sonorous sound and fascinating fury, scientific life ultimately signifies nothing. Life is to be managed to give pleasure, not given to God in service. Enthralled with self-consciousness, this ill-conceived science has no room for consciousness of the divine.

That psychotherapy has an effect has never been an issue. Talking to anyone has an effect. Unlike the other organs which are set to maintain homeostasis, the brain is the plastic organ, designed to be altered by what we experience. Discovering some of the alterations through PET scanning is not a decisive step forward. The issues have been whether the effects of psychotherapy have been beneficial. There have, in fact, been powerful effects of psychotherapies, but they have been evil. Psychotherapy has distracted our whole culture from God and treated the Word of God as insufficient, irrelevant, or wrong. Psychotherapy focuses its victims on themselves and sets a hedonistic goal of improved satisfaction with the self. Beautifully colored PET images of the active brain do not establish a benefit for psychotherapy, nor verify what could not be known on other grounds.

* Rene Descartes (1596-1650) believed that the soul resided in the pineal gland, a small, centrally located appendage of the brain. Descartes believed in God and in the soul, as contrasted with the atheism and materialism of modern medical science, as described by Dr. Terrell-- Ed.

Funding Medical Care: Prayer to the Payer

From time to time we read of some American adviser telling the Soviets in the former USSR that they should stay on the path to "a market economy." This is interesting advice coming from a nation in which large segments of the economy are not part of "a market economy." The health-care industry, representing about one-seventh of the U.S. economy, is not a market economy. Indeed, it is moving further in the wrong direction, toward central planning. As example, the "Balanced Budget Act of 1997" (a misnomer) included a drastic change in the federal funding of home health care. 

The effect of the Act was to cap the amount of federal payment for each patient, though, as always, the legislation was not so straightforward as to leave that plain to the casual observer. Within a year, this misbegotten Act has produced chaos in home health care, requiring a bill to be introduced in July of this year to place a moratorium on the new payment system. This is a clear example of central economic planning and the distortions that it produces. It stumbles along trying to rescue itself from its last error by new ones, never able or willing to see that the whole endeavor is doomed.

No central planner, however bright and well-intentioned, can manage medical care. Medical care is a highly subjective enterprise, not accessible to "bean counting." Medicine is intrinsically a very decentralized enterprise because God has distributed the authority and responsibility for the care of illness to individuals, families, and charitable organizations, including the Church. There are thus myriads of loci of control. Central planning is also not conducive to mercy and compassion, without which medical care can become a horror. When the State is the central planner, as in the example given, it is acting outside of its God-ordained role as a servant to Him to establish justice.

Christians sometimes are urged to become part of lobbying campaigns to "correct" certain Acts such as the home health funding Act. When we do that, we become a part of the problem. It is the very idea of such an Act, indeed of any form of government provision of medical care, that needs correction.

Brief Reports with Commentary

Dr. Laura Is Right: One's Live-in Will Not Marry

"Everyone knows that adultery means deception. Less known is that so does premarital sex. In one study, 80 percent of the women but only 12 percent of the men expected to marry their partner." (World, August 22, 1998, p. 29)

"Of 100 couples that live together before marriage, 40 break up before they marry. Sixty will marry, but 45 of these will end in divorce. (Michael McManus, Marriage Savers, Zondervan 1995.)

Commentary: "Dr. Laura" (Schlesinger), "licensed psychologist," on a 3-hour radio call-in show, deals with women daily who are living with male "partners" whom the women often expect to marry. In the situations on her show, the man usually "runs" when confronted with "Marry me or leave." These statistics are consistent with that scenario.

One comment is that women and men are quite different. Men want sex without commitment. Women want security, even if pretended. Or, more crudely, "Women want everything from one man. Men want one thing from every woman." 

Generalities are not just that--with many exceptions. However, they often paint a picture that might not otherwise be seen so clearly. Biblically, one does not violate the laws of spiritual gravity and not be broken on the rocky roads of life. The Bible says so. Statistics say so. He who has ears let him (and her) hear.

Big Brother Wants to Know Your Warts, Wrinkles... and Much More!

Congressman Ron Paul, M.D., (R-TX), writes of a current bill in Congress:

"The National Provider ID will force physicians who use technologies such as e-mail in their practices to record all health care transactions with the government. This will allow the government to track and monitor the treatment of all patients under that doctor's care. Government agents may pull up the medical records of a patient with no more justification than a suspicion that a provider is involved in fraudulent activity unrelated to that patient's care (his emphasis)!

"The National Standard Employer Identifier will require employers to record employees' private health transactions in a database. This will allow co-workers, hackers, government agents, and other unscrupulous persons to access the health transactions of every employee in a company simply by typing the company's identifier into their PC!" (Bulletin of the Association of American Physicians and Surgeons, October 5, 1998)

Commentary: Here is a $64,000 question: "What is the watershed issue that has led to this invasion of privacy?" Gong! Time's up. The answer is state licensure.

The practice earlier in this country and mostly in recorded history was private transaction between the patient and his physician (one of the tenets of the Hippocratic Oath). Caveat emptor applied. But, then consumer legislators and physicians decided that caveat emptor did not apply. Caveat big brother applied. (I never studied Latin!) That is, the state will protect the patient.

Well, ultimately for the state to protect the patient, it must know everything about physician-patient transactions. These laws referred to by Dr. Paul are only logical from licensure. You cannot oppose these bills without opposing licensure and be logical. You cannot accept government payment of your medical bills without support of licensure. But, then, consistency is sorely lacking in modern society, both within and without the Church. It is no coincidence that Big Brother wants to know everything. If we will not allow the rightful claim by He Who is omniscient, then we have to allow that claim by the state. Logically and consistently there is no other choice.

Should We Always Tell Children the Truth?

"Should We Always Tell Children the Truth" was the title of a lecture in the Department of Pediatrics at the Medical College of Georgia on September 18, 1998, to be given by a "visiting professor," Dr. John Lantos from the University of Chicago. I did not attend, primarily because the lecture should have been quite short, if Biblically based.

The answer to the question is "Yes." Our God is the God of truth. Children are to be raised in the "nurture and admonition of the Lord." End of lecture.

Well, maybe a little more. Children should be told the truth at the level at which they can understand. And, they should be allowed to talk freely about what their understanding is. They often have images that are quite foreign to reality, and those misunderstandings must be handled with tenderness and gentle explanations.

But, the question goes further. Should we tell adult patients the truth? That is a medical ethics question that has been debated for centuries. And, the answer is the same, as for children, except that adults usually have much greater understanding.

I suspect that the thrust of this question for children comes from the same evil notion that has caused the American Academy of Pediatrics to take an official stance against spanking children. And, the notion of the American Medical Association, the American Academy of Family Physicians, and other "official" medical organizations to be "neutral" on the issue of abortion.

That notion began with Satan's lie in the Garden, "Hath God not said..." It is the evil belief that rightness exists anywhere other than within God Himself, primarily within man himself. It is further propagated by the modern worship of psychiatry and psychology and medicine in general. To these entities, God is either dead or never existed. Thus, man in his hubris attempts to make god-like edicts. The result is another crash on the rocky roads of life.

Alternative Medicine Into the Mainstream

The Program on Integrative Medicine at the University of North Carolina at Chapel Hill School of Medicine presents "Herbal and Nutritional Supplements Used by Patients in Health Care: A Review of the Evidence, Biological, and Clinical Effects," October 23-25, 1998. 

Commentary: Progressively, alternative medicine is moving into the mainstream. This conference is a major step forward, sponsored by a medical university. I have two additional thoughts that I have not expressed before.

First, if alternative medicine becomes mainstream ("orthodox"), will it lose its appeal? Much of its allure seems to be truly an alternative, that is, to go outside the system when the system has failed.

Second, herbs and other "natural" products are not "pharmaceutical." That is, their active ingredients vary in content. When one takes a 5-grain aspirin tablet, he is taking a precise dosage. When one takes ginseng, one does not know the exact dosage at all. This imprecision seems a major limitation (and danger) to many alternative therapies.

Over time, the active ingredients may be discovered, refined, and made precise. Many products have or undergoing this process. In this way, their efficacy (or lack thereof) can be better determined.

The Wonderful World of Abortion

We who are pro-life know that the abortion industry frankly lies and distorts the truth. Here is another picture of the "abortion solution." A former owner, Eric Harrah, of "one of the nation's largest chains of abortion clinics, recently converted to Christianity and walked away from the lucrative business of killing unborn children." He was interviewed by Dr. J. C. Wilke. The lengthy interview filled one recent newsletter. One description particularly caught my attention.

"What I did see was this little game that was played, where the men would come in with these girls and say, 'Oh, honey, right now is not the right time to have the baby, but go ahead and have the abortion and we'll have another baby and get married soon.' Then, as soon as the abortion was over, he'd dump her.... I've seen guys drop girls off at the abortion clinic, pay for the abortion, sit around and wait until they hear the suction machines start--then they know it's over and they're gone. Won't even take her home!" (Life Issues Connector, July 1998, p. 9. The entire issue is available from Life Issues Institute, Inc., 1721 Galbraith Rd., Cincinnati, OH 45239.)

Commentary: Little comment is needed. If one is capable of committing an unborn baby to a horrible death, one is capable of anything. It seems that for many men, sexual intercourse is nothing more than the mindless act of a wild beast. The absurdity of this mistreatment of women is its rabid defense by feminists and liberals. 

Perhaps, it is not so absurd. If God does not exist, man is only a biochemical accident of nature to be valued and discarded no more than chemical waste from high school lab experiments. Such is the achievement of modern feminism and liberalism!

AIDS: Issues and Answers

Vol. 12, No. 5 (78) September 1998

"Heterosexual" Transmission of AIDS: A Reminder

One set of statistics by which HIV/AIDS is tracked by the Centers for Disease Control and Prevention (CDCP) are "Exposure Categories." There are seven of these: men who have sex with men; injecting drug use; men who have sex with men and inject drugs; hemophilia/coagulation disorder; heterosexual contact (5 sub-categories, see below); receipt of blood transfusion, blood components, or tissue, and other/risk not reported or identified.

(Of interest is the contrast of original categories: homosexual/bisexual only, IV-drug abuser, both homosexual/IV-drug abuser, hemophilia/coagulation disorder, other heterosexual [sub-categories of sexual contact and non-U.S. born], transfusion, and undetermined. Note the politically correct changes!)

The sub-categories of "heterosexual contact" are: sex with injecting drug user, sex with bisexual male, sex with person with hemophilia, sex with transfusion recipient with HIV infection, and sex with HIV-infected person, risk not specified.

The point in reviewing these is that the heterosexual category is the fastest increasing category today. Unless one knows what "heterosexual" in this context means, the appearance is that HIV is being spread outside the other "exposure categories." The descriptive titles of the sub-categories belie this conclusion. Heterosexual spread is intimately (pun intended) associated with the other risk categories. It is not primarily the "everyday" promiscuous sex that never intends marriage or occurs before marriage, during marriage, and after divorce. (My definition of promiscuity includes any sexual activity outside of marriage fidelity, including one night stands and so-called "stable" relationships of monogamy, not necessarily different partners on a regular basis.) 

HIV/AIDS has remarkably remained within these "exposure categories" (with few exceptions and very small numbers, e.g., see below.) It is not spreading in the manner once predicted, and often implied, into the sexually active population outside of these categories. If it were, we could be seeing the millions of infections in the United States that some predicted early in this epidemic when numbers were "doubling" every year.

My purpose is not reassurance to fornicators and adulterers, but for readers to understand what this epidemic is about and to be able to interpret news reports. The immoral heterosexual community has plenty to worry about with the plethora and prevalence of other sexually transmitted diseases, but HIV/AIDS is not a primary threat to them.

Note: All of the statistics compiled by the CDCP are available in the HIV/AIDS Surveillance Report. Individual copies are available "free" from the CDC AIDS Clearinghouse, P. O. Box 6003, Rockville, MD 20849-6003 or 1 (800) 458-5231 or 1 (301) 519-0459. It is also available on the Internet at www.cdc.gov, select "Publications, Software, and Products."

Update on Health Care Workers

The first reported cases of AIDS were reported in 1981. Through December 31, 1997, there had been 54 "documented" and 132 "possible" occupational transmissions of HIV infection or AIDS in health-care workers (HCW). "Healthcare workers are defined as those persons, including students and trainees, who have worked in a health-care, clinical, or HIV laboratory setting any time since 1978." "Documented" cases are:

"Healthcare workers who had documented HIV seroconversion after occupational exposure or had other laboratory evidence of occupational infection; 46 had percutaneous exposure, 5 had mucocutaneous exposure, 2 had both percutaneous and mucocutaneous exposures, and 1 had an unknown route of exposure. Forty-nine exposures were to blood from an infected person, 1 to visibly bloody fluid, 1 to an unspecified fluid, and 3 to concentrated virus in a laboratory. Twenty-five of these healthcare workers developed AIDS.

The "possibles" are: 

"Healthcare workers (who) have been investigated and are without identifiable behavioral or transfusion risks; each reported percutaneous or mucocutaneous exposures to blood or body fluids, or laboratory solutions containing HIV, but HIV seroconversion specifically resulting from an occupational exposure was not documented."

The following are the actual numbers ("possibles" in parenthesis): dental worker, including dentist 0 (7); embalmer/morgue technician 1 (2); emergency medical technician/paramedic 0 (12); health aide/attendant 1 (15); housekeeper/maintenance worker 1 (10); laboratory technician, clinical 16 (18); laboratory technician, nonclinical 3 (0); nurse 22 (32); physician, nonsurgical 6 (11); physician, surgical 0 (6); respiratory therapist 1 (2); technician, dialysis 1 (2); technician, surgical 2 (2); technician/therapist, other than those listed above 0 (9); and other healthcare occupations 0 (3). (HIV/AIDS Surveillance Report, Volume 9, Number 2, Table 16.)

Commentary: More than 700,000 cases of AIDS have been reported to the CDCP. One would expect that each would have had one or more exposures to HCW in these occupations (in the morgue, if no-where else). Daresay that most would have had multiple exposures with office and emergency room visits, hospitalizations, and nursing situations outside the hospital. Thus, HCW have had millions, perhaps billions, of situations of exposure with some of these involving considerable, and sometimes drenching, blood and other body fluids.

HIV is very poorly transmissible outside of "exposure categories" (see article above). Even after percutaneous exposure, there is only a 1 in 250 chance of becoming HIV-infected, with nurses and clinical laboratory technicians being at greatest risk. I suspect that "universal precautions" have had little to do with these limited numbers. Everyone in health care knows how poorly and infrequently these are carried out conscientiously and correctly.

While even one HCW infected by HIV is a tragedy, we can thank God that He has limited HIV/AIDS from spread by casual means and even health care exposure. In that way, it is truly a unique disease.

Music and Medicine

Jefferey A. Becker

Ed's note: The following is not a carefully or thoroughly crafted review of either available research or Biblical theology. However, the subject is sufficiently important to introduce it here with the possibility that someone will develop the treatise that is needed on this subject.

What did David do to "refresh" Saul? Play music (I Samuel 16:23)! What did Martin Luther do to "drive the Devil away"? Sing hymns!

"When sadness comes to you... then say, 'Come, I must play our Lord Christ a song... If the Devil returns... defend yourself and play to my Lord Christ... sing the Devil down until you learn to despise him."1

What do some physicians prescribe to alleviate symptoms of Parkinson's disease? Play music.

"Dr. Oliver Sachs discovered an extraordinarily effective treatment for Parkinson's--MUSIC... Sachs discovered that many Parkinson's patients responded to music."2

There is evidence for the positive benefits of music. Dr. Mary Lockett performed experiments on rats in Australia. When subjected to noise, the rats perished.3 Dr. Adam Knieste notes that "Music... is really a powerful drug... mellow tones can relax you." He was so convinced that he produced a record called "Sound Sleep" to ease sleep and reduce tension.4

While the effects of music are portrayed in both Scripture and research, they find a relatively small place in medical practice and church ministry to individuals. Perhaps this article will contribute to the correction of this omission in both areas of helping people.

Augustine believed men heard not individual notes, but rather whole lines.5 Clearly, reflection on the nature of man from the Scripture, enabled Augustine to suggest what experimentation would not discover for centuries.

Robert Jourdain likens music to pleasure and pain.

"If (Dr. Knieste's) theories ever become popular... the drug industry will suffer tremendously, since the need for narcotics, sedatives, (and) tranquilizers will substantially diminish... As a consequence, many famous research centers... refuse to test his theories."6

As Christians, our final authority is always the Word of God. Certainly, if the Lord indicates that music plays a medical role, we should not shrink from it. While research is not required to confirm Scripture, its consistency does add to the positive impetus for its directives.

The Old Testament presents several examples of connections between music and moods producing medicinal benefits. Cited above, I Samuel 16:23 indicates that Saul was refreshed (Hebrew: breathe freely or revive) and well (Hebrew: good a wide sense) because of David's music.

II Chronicles 20:19ff narrates how Jehoshaphat and Judah were stimulated to heroic deeds by singing and praising. What would be the results if surgeons played music to enhance the strength and courage of patients in the operating room and after surgery?

Proverbs 15:13 teaches that a merry (Hebrew: blithe, gleeful) heart makes a cheerful countenance. Proverbs 17:22 says that a merry heart (same word) does good like medicine (Hebrew: remove a bandage from a wound; heal; or cure). Christians might pioneer here. If there are televisions in every hospital room, why not good music?

Proverbs 25:20 at first glance, appears contradictory, by disallowing singing songs to those who are depressed. Yet, perhaps, God is commending caution. Music is not a panacea: prescribe cautiously and appropriately!

The New Testament has its own prescriptions of music. It is probable that Jesus sang before Gethsemane (Mark 14:26), not only because it was part of the Passover, but also to boost His spirits in contemplating Calvary. When Paul and Silas were imprisoned (Acts 16:25), they sang praises to God. Since their stripes were not treated until later (Acts 16:33), perhaps the melody functioned not just as adoration, but anesthetically?

Then, there is the pivotal passage of James 5:13-16. Most Christians, when afflicted and hospitalized, summon their pastor to come to their bedside and pray, as this text clearly commends. But, how many sing psalms or hymns which is mentioned here. Are we not being selective by picking and choosing from the instructions of this passage?

The book of Revelation is full of music. Chapters 4 and 5 show that the redeemed and the angels join in adoring God in song eternally. If music is perceived as part of a perfected environment (cf. Isaiah 12:2,5 where songs about the LORD echo throughout the earth), shouldn't music reverberate in the corridors of our corrupted world now?

I confess my own sins of omission. Our mid-wife encouraged my wife to play music during labor. I had never thought of it! We also forgot to take music with us for our second son's birth. Later, music enabled my wife to undergo several hours of heavy labor--without any medication--in the birth of our daughter.

I recently spoke to one of my mentors about the role of music in this birth. He told me of a church member who had come to him with lingering bad moods and depression. As a pastor, he recommended a portable cassette player and some quality Christian music and to play it when he was distressed. Within a month, the sufferer reported that his spirits had revived--and without medication! The question is compelling, "What role can music play medically and spiritually in the ministries of both physicians and pastors?" I am convinced that a potent influence directly and indirectly has been neglected for too long. 

References

1. Edwin Plass, What Luther Says, (St. Louis, Missouri: Concordia Publishing House, 1959), pp. 98-103.

2. Robert Jourdain, Music, The Brain, and Ecstasy, (New York: Avon Books, 1998), p. 301.

3. Basil Cole, "Pastoral Reflections on Rock Music," The Wanderer, July 12, 1979. Taken from Christian News Encyclopedia, Volume II, pp. 1386-1387.

4. Family Weekly, January 30, 1983.

5. Gordon Clark, The Incarnation, (Jefferson, Maryland: Trinity Foundation, 1988), pp. 39-40.

6. The Wanderer.

Mr. Becker pastors Calvary Baptist Church, Corning, NY.


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