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Biblical Reflections on Modern Medicine

Vol. 10, No. 1 (55) 


Catching "It" "Early." May I Scream?


Let's All Pretend that Modern Medicine Is Omnipotent and Omniscient


Mother: "Johnny woke up not feeling well. He has the sniffles."

Me: "Has he had any fever?"

Mother: "No, but I wanted to catch 'it' early. He can't afford to miss school."

Me: "Ahhhhhh!" (very loudly)

There are some presentations of patients to physicians that are more trying than others. Headaches, backaches, dizziness, fatigue, etc. are some. But, this one, in a hundred other varieties of "can't afford to miss": work, a ball game, a trip, a date, etc., makes me want to scream.

Nothing comes to mind that I can prevent "early." The earlier, the less likely that I can do anything. Most diseases, including the garden variety of "colds," "flu's," "sore throat," and other "URIs" (upper respiratory infection) define themselves over 1-2 days, rather than hours. But, even then, as the pattern is more clear, most are viruses that I can do little about. 

Asking me to "catch 'it' early," is asking me to be God, omniscient and omnipotent (at least as it concerns this one patient). I would have to be omniscient to know what the illness is and what its course will be. Then, I will have to be omnipotent to prevent "it," because Modern Medicine can neither diagnose "it" in a costly and timely way nor treat "it" effectively. (I have decided to start capitalizing "modern medicine" when it plays a god-like role.)

Shouldn't physicians be allowed to scream? Well, make a fuss? Scold? Uh, uh! Not in today's Modern Medicine.

Where does this notion of "catch it early" come from? I have never talked to a physician who thought that he (or she) could effectively treat "colds" -- or most other diseases for that matter. Yet, their behavior says otherwise. Antibiotics are prescribed by the billions for "colds" and other "URIs." Other drugs are prescribed similarly that are proven ineffective by the best science that Modern Medicine has.

"Catch it early" also comes from attempts to prevent other diseases: breast cancer (see elsewhere in this newsletter), heart disease, colon cancer, strokes, etc.).

"Catch it early" comes from the omnipotent and omniscient role of Modern Medicine. This Role is not explicitly claimed by physicians and medical scientists. And, most of the public would deny such a Role for Modern Medicine. But, our society functions in fact on this god-like status. And, Modern Medicine gladly accepts this role. What other explanation suffices for our spending more than a tithe (14%) for medical care?

I suppose that Modern Medicine is only one illusion of Modern American Society in which pretense triumphs over fact and truth. A great example is the silliness, rather than justice, of the Clinton impeachment. Another example is the myth of education in public schools. Another is the myth that state-sanctioned and open gambling is a "good" source of income for education and other projects. 

I want to scream that I am not God... that Modern Medicine is an emperor with no clothes... that America is increasingly evil... But, who is listening?


...More on Careless Use of Antibiotics

Despite a warning issued by the Centers for Disease Control and Prevention in 1996, physicians continued to use ampicillin in pregnant women who were near delivery. The antibiotic was intended to prevent infection in the newborn ("neonatal sepsis"). A strict indication for ampicillin use would include some problem of pregnancy, such as premature rupture of membranes or prolonged labor. However, it has been estimated that more than 25 percent of women nationally receive antibiotics before delivery. By some protocols, nearly 100 percent of all pregnant women receive prophylactic antibiotics.

Now, some neonatal deaths are associated with this use of ampicillin because of ampicillin-resistant strains of bacteria (E. coli). (Family Practice News, 11/15/98, p. 5)

Commentary (by Dr. Terrell): These physicians were aiming to prevent some of the sepsis deaths among 26,000 deliveries. The number was already small at 1 per 333 deliveries. There was "success" in lowering the deaths from Group B Streptococcus, but what appears to be a corresponding rise in deaths from other bacteria. Also, "We've had several cases of maternal septic shock associated with neonatal sepsis involving ampicillin-resistant E. coli." (So, the mother is harmed as well.)

Pressing for control of our universe has its limits. While it is not intrinsically a wrong thing to do, the more infrequent the event that we are trying to control, the wider our search for other effects should be. These other effects would not have to be very large to nullify any benefits.

No experiment is truly "controlled." (Shades of Heisenberg! -- Ed) Experimenters control only for issues that they believe will have an influenve. Neither are all the variables examined. As example, rarely are outcomes of any sort that occur a few months or years later checked. Effects on the belief system of the subjects, on the culture, on the economy, etc., are almost never evaluated. The influence of barometric pressure, exact timing of doses, diet, exercise, and myriad other potential measures are assumed to be of no significance.

Given all the uncertainties, it would seem prudent to heed only those medical maneuvers that are really rather powerful, e.g., those with numbers needed to treat or save (NNT) under, say 8, preferably under 4. Also, such treatments should have high NNH's (Number Needed to Harm).

Additional Commentary by Ed. First, my harangue about antibiotics for colds expands further with this report on neonatal deaths.

Second, Dr. Terrell has proposed a level of NNT and NNH to govern what physicians do. That guideline should be pursued. 

Third, the old Primum non nocere, "First of all, do no harm," is perhaps more relevant in our modern age with potent drugs and technologies that have great potential to do harm.

Number Needed to Save: 3,908 Mammograms

"The authors conclude that an 18-month screening interval for mammography in women aged 39 to 49 years has a significant impact on reducing breast cancer mortality. Organizations that develop mammographic screening recommendations should consider these new findings when formulating mammography guidelines for women under 50 years of age." (Abstract in American Family Physician, April 15, 1998, pp. 1954ff, reported from Cancer, December 1997, pp. 2091-2099)

Ah! One of the current rages in Modern Medicine. Screening to "prevent," especially for breast cancer. (I want to "scream," rather than "screen." See elsewhere this newsletter.)

Let's look more closely at this data. There was a "45 percent reduction in mortality from breast cancer." That is, 18 women in the screened group died of breast cancer, while 33 died of breast cancer in the unscreened group (33 is extrapolated from 40 actual deaths because the unscreened group was larger). Thus, 33 minus 18 equals 15 deaths "prevented." Fifteen divided by the 33 is 45 percent. Those are the facts.

But, here are some more facts. There were 11,724 women in the screened group who had mammograms every 18 months for six or seven years. I will assume 6 years for easy calculation. Six years is 5 mammograms each (one at the beginning and one every 1.5 years.) or a total of 58,620 mammograms to "save" 15 deaths. That is 3,908 mammograms for each death prevented.

Now, there are risks from mammograms. There are the possible automobile accidents driving to and from the screening facility, as well as accidents and infectious and radiation exposure within the facility and from the testing procedure. Many of the women will have children who will have to be left with someone else: additional risks of accidents and infectious exposure. There is the money spent for the procedure that is not available for other health care needs of the family (whether paid for out of pocket or paid by a third party). 

Most health-care workers and women who have had a mammogram know that these tests are not straightforward. Radiologists are sometimes called "shadow chasers." Well, shadows are not definitive. Many test have to be repeated. Many have what turn out later to be false positives, the proof of which usually requires surgery. And, the worry: over the test itself while waiting for the results, and more so, should a "shadow" cast a suspicious shadow of cancer for the patient. 

Now, all these risks could be estimated with hours and hours of extensive research. But, is such necessary? Of 3,908 mammograms, is not something associated with the mammogram visit and procedure itself likely to cause or contribute to a death? So many mammograms to prevent one death is not the dramatic statement that a "45 percent reduction" is. And, a conclusion not likely to convince women of the necessity to have the procedure done. 

Thus, I introduce a new term, "Number Needed to Save" (one life--NNS). "Ma'am, as a physician, I can save your life. All you have to do is have 3,908 mammograms! -- Oh, by the way, the (average) time of life that you will save is 11 days." (Calculated from the Years of Productive Life Lost, MMWR, Volume 41, Supplement SS-6, November 20, 1992.)

Addendum: Immediately, after writing the above, I went down to check my mail. In it, I received a letter from an HMO urging me to get mammograms on my patients! OK, but I will add my own explanations to patient's expectations.

2nd Addendum: I am not saying that high-risk women [positive family history, previous breast cancer, etc.] should not have mammograms.

3rd Addendum: I came across this additional study which I was not particularly looking for:

The "estimated cumulative risk" for a false positive mammogram or clinical breast examination in 10-years was 49.1 percent. For 2400 women, these false positives resulted in 870 outpatient (additional) appointments, 539 "diagnostic" mammograms, 186 ultrasounds, 188 biopsies (with risks of infection, side effects of anesthesia, etc.), and one hospitalization. (The New England Journal of Medicine, April 16, 1998, pp. 1089-1096)

4th Addendum: The far greater risk to women is heart disease. For most of this century, women over the age of 40 are much more likely to die of heart disease than breast cancer. See Brief Reports for a related report.

Terrell's Treatises

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

Aspirin Stands Trial and Is Acquitted by a Narrow Margin

One of the handiest concepts to come to our attention in recent years has been "number needed to treat" (NNT). Though mentioned in these pages before, it deserves another blow of the hammer. Traditionally, medical research has focused on the concept of statistical significance--how likely it is that a given research finding could have occurred by chance rather than because of some true relationship between the variables.

Normally, a result would not be trusted as statistically significant unless the chance is less than one in twenty. One in a hundred is preferred. The important thing that is omitted in such numbers is the practical significance of a relationship. The presence of clouds in the sky is related to rain with immense statistical significance, but the practical ability to predict rain based upon clouds is quite poor, because most clouds do not produce rain. The concept of NNT helps us to grasp how practically useful a treatment or preventive technique is.

It has long been believed, on reasonable grounds, that regular aspirin in small doses is related to decreases in both stroke and heart attack, with high statistical significance. On this basis, millions of Americans take aspirin daily as a help in preventing these two serious illnesses. Aspirin has advantages of being very cheap, available without a prescription, and a very long history of use so that we have much experience with it.

We were surprised, therefore, to find from a recent "meta-analysis" that the practical significance of using aspirin this way is very modest indeed (The Journal of the American Medical Association, December 9, 1998, pp. 1930-1935). The number of people who would have to take aspirin to prevent one heart attack is about 73. To prevent one fatal heart attack would require that 278 people take aspirin. To prevent one ischemic stroke (one caused by the plugging of an artery in the brain by atherosclerosis) requires that 256 people take aspirin. 

On the other hand, aspirin can slightly increase the chance of hemorrhagic strokes (caused by bleeding from a broken blood vessel), though not as much as it decreases ischemic stroke. To produce one hemorrhagic stroke by taking aspirin requires that 833 people take the drug. In the net, when all causes of death are taken into account, it appeared that about 120 people needed to take the drug to prevent one death. That finding is far less effective than we had supposed, but it still seems a reasonable thing to do, given the cheapness of aspirin, provided that one does not have a known contraindication to its use, such as peptic ulcer or an allergy to it.

Moxibustion Units: A New Standard for Medicine


Chinese Medicine Exposes Bias of Modern Medicine

A recent issue of The Journal of the American Medical Association (November 11, 1998) was devoted almost entirely to alternative medicine. I don't know about moxibustion (pp. 1580-1584), but I can count on this issue to discomfit the medically "orthodox" ("Modern Medicine"--Ed) by demonstrating their fixation with mechanism and their discounting of actual results. The NNTs (see above) are impressive. 

I asked one of our Pharm. D.'s to calculate them. (Helpful people, Pharm. D.'s. They can still think!) The ones that she calculated ranged from a high of 7.6 to a low of 3.6, depending upon which exact outcome was investigated. All these compare very favorably with many sacrosanct standard medical techniques, and beat the stuffings our of vast numbers of other standard methods. (For example, the medical mania about lipid-lowering drugs started with an NNT of 42 to prevent one heart attack in a 5-year period.)

I have even started comparing some locally beloved treatments to this one, using the concept of "Moxibustion Units" of effectiveness. If a beloved treatment has an NNT of, say, 15, then it is about 0.5 Moxibustion Units, or half as effective as the least effective moxibustion treatment (NNT of 7.6). 

Osteoporosis prophylaxis by means of some of the expensive pharmacological agents would have effectiveness levels of about 0.07 Moxibustion Units.

A conversation with a patient might run as follows:

"That treatment is about a 0.07 Moxibustion Unit treatment," says I.

Says the patient (or better yet, subspecialist), "Moxibustion unit? What is that?"

"Well," say I, "that means that the treatment that you have decided on is only about one-thirteenth as effective as moxibustion."

"What is moxibustion?" says the patient/subspecialist.

"Moxibustion is twisting some Chinese herbs together, sticking them next to the little toenail, and lighting them on fire in order to help a woman not have a breech baby," I reply mildly.

"That sounds weird, but the issue here is not breech babies," says the indignant patient/subspecialist. "It is prevention of bone fractures."

"Yes, I know.," replies Dr. Casper Milquetoast. "But the treatment being recommended is only one-thirteenth as effective for preventing bone fractures as moxibustion is for preventing breech babies. That is to say, it is not very effective at all. I don't think that there is going to be any great rush in America to begin using moxibustion. Why has there been such a rush to use medicines to prevent bone fractures when they don't work a tenth as well?"

Terrell's Treatises end here.

Stem Cell Research: At the Beginning

The use of stem cells is a new direction in the attempt to grow tissues and organs from embryonic cells. Stem cells exist in various tissues in the first twelve weeks after conception (fertilization of the egg by the sperm). In the only such experiment reported to date, Dr. John D. Gerhardt of Johns Hopkins University worked with fetuses that are aborted at 5-10 weeks. Stem cells have not yet differentiated into specific tissues. By manipulation, they could potentially be directed to develop into any tissue desired.

The use of stem cells has the same ethical limitations that use of other embryonic tissue does. Tissue from aborted fetuses should not be used. In a strict application, fetuses that were aborted for other reasons could be used. The abortion is wrong, but the tissue itself is morally neutral. A parallel would be that the organs (except the heart and lungs) of a person who was murdered (e.g., shot) could be transplanted. The act of murder is wrong, the but the tissues themselves are morally neutral.

However, once the use of tissues from abortions are allowed, abortions would be performed for the intent to obtain embryonic tissue. Thus, another reason for abortion would be introduced, and this reason is immoral. Abortion for any reason other than to save the life of the mother in strictly life-saving situations is wrong. Any allowance that actually broadens the reasons for abortion must be condemned. Thus, any tissue used from abortions must be condemned.

However, stem cells could be derived from ectopic pregnancies. (Miscarriages are not likely a source since the tissue would rarely still be viable.) These embryos will die regardless of what is done. Certainly, getting stem cells in this way would be more difficult, but a large number is not necessary. Once successful, these cells could be multiplied indefinitely. There are cancer cells (designated "HeLa") used in research that date back to a patient that died several decades ago!

The potential for this research is enormous. Many are familiar with the potential use of fetal tissue to help people with Parkinsonism. Whole new organs, such as livers, might be grown. Damaged or severed nerve cells might restore feeling or muscle function. And so on.

However, I have more skepticism about such possibilities, as I do about genetic engineering, than most people. My readers know of the shaky, and sometimes false, research that Modern Medicine is based upon. Also, you know of the false hope that has been generated by premature claims. All those limitations have to be applied to stem cell research as well.

I continue to build my perch out on a limb. There are going to be limiting factors with stem cells, genetic engineering, and other such technologies that are based upon the building blocks of human physiology that have not yet been recognized. These will be species- and individual-specific. Every person is unique, and there is a highly complex dependency between the cell nucleus and its cytoplasm. These characteristics will hinder such research. Perhaps, they can also be overcome with technology, perhaps, not.

These technologies are exploring the most basic material components of humans. Humans are not animals. They have souls and are created in the image of God. Somewhere, at some level, there is an interaction and dependency of the physical (material) and the non-physical (non-material or soul/spirit). Somewhere, at some time, man will encounter a limitation in his manipulation of physical matter at these foundational levels.*

I have begun a paper on whether a human being who is cloned in the same way as Dolly, the sheep, would be viable, and if so, would he have a soul. That paper would explore this thinking more thoroughly. Stay tuned.

* Dr. Terrell's review note: I do not agree with the way that you have stated the limitation. We are perpetually up against the limit and will no more come up against a final wall than a WARP 1000 spacecraft could hit the edge of the universe. The limit is experienced in all the unexplained variance in any experiment.

The Uncertain Future of Managed Care


National Health Care Cards, Again?

I have predicted for several years that managed care would be short-lived. (See the November 1998 issue of Reflections). The problem is that, like gravity, economics has a bottom line of impact that is unavoidable. Quite simply, HMOs have succumbed to the very forces that created them: patient demands for more care at less cost. For managed care to be successful, the managed care companies must be free to regulate provided care. 

Well, patient demands have caused government legislation to require managed care plans to provide certain benefits, such as more days for newborns and their mothers. These requirements raise costs that HMOs were to keep down.

Thus, The New England Journal of Medicine runs the editorial, "The Uncertain Future of Managed Care" (January 14, 1999, pp. 144-146). It states that managed care plans are not able "to constrain rising health care costs in the face of consumers' demands for more choice and reduced interference in the physician-patient relationship." Their answer, nationalized (federal-state) health care.

One attempt by managed care plans to prolong their existence has been "the departure of dozens of (them) from Medicare.... a similar crisis might be brewing in Medicaid" (American Medical News, December 14, 1998, pp. 5-6).

The mess of American health care has become more messy. The time is ripe for the federal-state program mentioned above. Patients now want it. Employers want relief from provision of health care to their employees. Federal and state governments now recognize that any freedom left in the market prevents the implementation of their schemes. At the Federal level, there is not even the miniscule leadership in Washington that enabled rejection of the Clinton health care plan. Those who tried it the first time, now know better how to make it acceptable next time.

The last gasp and grasp of government regulation of medical care will be nationalized care. It is likely within the next 2-3 years. Unfortunately, that grasp will only be unshackled with the marked loss of federal and state control in all areas, schools, postal service, welfare, etc. That unshackling could take decades, as it did in the former Soviet Union.

Americans, welcome to health care on the postal service plan: long lines, waiting periods, and disgruntled patients and health care workers the likes of which have never seen before. And, "You asked for it!" (Well, not all of you--and neither did I.)

Brief Reports with Commentary

Gulf News Syndrome

To a varying degree, "disease" is as much a creation of news reports as it is derived from medical science. From time to time, I have reported on the so-called "Gulf War Syndrome." It is mostly, if not entirely, a hoax (except for a few specific and known illness directly related to particulars of the Gulf War. An interesting report shows how the news media effects "diseases."

The Gulf War Syndrome has been reported to the public in various ways: a 60 Minutes broadcast, the Duke University Animal (Chicken) Modeling Study news release, a New York Times article on Khamisiyah, and Department of Defense press releases expanding the Khamisiyah review. The weekly referrals for health registry examination to the Department of Defense rose from 2-fold to 5-fold after these reports. (Reported in Vital Stats, December 1998, p. 4 from the American Journal of Epidemiology, August 15, 1998. Statistical Assessment Service, the publisher of Vital Stats is online at www.stats.org.)

Commentary: Let's use our imagination. Pretend that you are a veteran of the Gulf War. You are watching "60 Minutes." You learn that many of your buddies have medical problems from the Gulf War. Well, you have been a little edgy lately and don't have the usual "energy" that you think that you ought to have. Perhaps, your problems are related to your war experience. You can go to the Veterans Administration hospital and receive an elaborate workup for free... and there may be monetary benefits if something is found (or perhaps only suspected). Mmmmm. "I'll go in tomorrow."

Without the report, you would have contributed being "edgy" and fatigued from the rigors of life that cycle in all of us. But, the possibility of blaming your troubles on something else, and receiving money for that blame is too much for (fallen) human nature not to act. How many other "news syndromes" are there? Many.

Spending Too Much for Medical Care: The Other Side

Americans legally wagered $639 billion in 1997. Medical/health care costs were about $1 trillion. (The McAlvany Intelligence Advisor, December 1998, p. 20)

Commentary: I wonder what percentage of medical/health care costs were caused by gambling: money lost; anxiety and depression from losses; associated alcohol, tobacco, and drugs; children left unattended; etc., etc. And legalized is supposed to "help" our children by generating money for education! (Actually, if I remember correctly, no state has increased its funding because of legalized gambling. The states have only increased funding of other government programs with the increase revenue.)

The Truth Is Out There

"A family financial counselor tells me that two parents who both work outside the home are usually kidding themselves, with the help of their bank.

"The second income amounts to an illusion. It often pushes the family into a higher tax bracket, thus reducing the primary provider's take-home, makes necessary costly outlays for day care and after-school care, and inevitably results in significantly higher costs in health care, clothing, transportation, and food." (The Augusta Chronicle, December 31, 1998, p. B1)

Commentary: This information and more on the same was written by a syndicated psychologist (John Rosemond) who is no particular friend of Christianity. But, he counters the notion that women have to work to make ends meet and that children are not harmed by mothers working outside the home.

The truth is out there. The zeitgeist of our culture is countered by reality. This "other side" can be readily found in any area: welfare, public schooling, divorce, etc.

Thus, the zeitgeist is not a product of better information or "facts," but bias by the dominant media, educational "leaders," politicians, social workers, and yes, physicians. The zeitgeist is political correctness. It is selective reporting and emphasis. The truth is out there. The problem is that the mind behind the eyes to see, the ears to hear, and the mouth to speak is closed to The Truth.

100,000 Americans Die Each Year from Legal Drugs

I guess that I missed this statistic, or its gravity did not register at the time that I saw/heard it: approximately 100,000 Americans die each year as result of adverse reactions to drugs. (The New England Journal of Medicine, December 17, 1998, pp. 1851-1853, citing The Journal of the American Medical Association, 279: 1200-1205, 1998)

That number is about 3 times as many as die from automobile accidents. It is 0.039 percent of the American population or 1 in 2600 people. It is enough people to populate a large city. It is all the attendees of the Rose Bowl dying each year.

Dear readers, you know that I have criticized modern medicine severely, but this statistic whelms. How many lives would modern medicine actually have to save each year to counter this one statistic? As I have said often, modern medicine does not do very well in actually saving lives. However, it seems that it is actually effective in taking them.

This statistic gives me pause. This 100,000 does not include the non-lethal harm from drugs: rashes, nausea and vomiting, various aches and pains, dizziness, irregular heart beat, etc., etc., etc.

While apples and oranges can be difficult to compare, can all the actual good of modern medicine counter this one deadly statistic? I am not sure that it can. Have we come to the point that it is better to stay home than go to the physician? Except for clearly life-threatening emergencies, perhaps its has!

But, then, perhaps Americans are only getting what they want...

Do You Have Your Eleven Prescriptions for This Year?

Patients had 2.8 billion prescriptions filled in 1998, more than 11 for each man, woman, and child in the United States. Sales increased 15 percent over 1997 to $102.5 billion. (Small Doses, September 8, 1998, published by the South Carolina Pharmacy Association, 1405 Calhoun St., Columbia, SC 29201.)

Reflex Sympathetic Dystrophy: Another Chronic Fatigue Syndrome?

"Many patients with reflex sympathetic dystrophy (RSD), those who neither have organic neurologic damage nor malinger, harbor a primary psychiatric disorder in the realm of what used to be called "psychosomatic disease ..." (American Family Physician, December 1997, pp. 2182-2185)

Commentary: "The term 'reflex sympathetic dystrophy' has been used for most of this century to describe complaints of pain associated with subjective motor or sensory symptoms and erratic objective vascular (blood vessels) changes in color and temperature of the symptomatic body part of the symptomatic body part, often with enigmatic onset and chronic deterioration" (Ibid., p. 2182).

RSD seems about to take the place of chronic fatigue syndrome, Gulf War syndrome, spastic colitis, fibromyalgia, and other such "diseases." By such criticism, no author means to say that there are no true organically caused diseases in these groups of patients. What is being said is that the original concepts, as defined, were far too broad. More importantly, they failed to critically evaluate the body-mind relationship as a causative or complicating presence.

Incidence and Mortality in Breast Cancer

"The commonly reported figure that 1 in 8 women will develop breast cancer only applies to those already in their 80's.... The risk to women under age 25 is 1 in 625, rising to 1 in 56 by age 50, to 1 in 18 by age 65, and to 1 in 13 by age 75.... 

"What of mortality? Before the age of 50, only one woman out of 136 dies of breast cancer. By the age of 60, mortality is one out of 65, by the age of 70, it is one out of 39, and by the age of 80, only one woman out of 26 dies of breast cancer." (Vital Stats, November 1998, p. 4, reporting from information in the British Medical Journal, November 1998.)

Commentary: The biggest scare that presents itself to American women is breast cancer, yet their greater risks lie elsewhere, primarily heart disease. I have commented elsewhere in this newsletter that the "benefits" of screening for breast cancer are miniscule. Again, it seems, the medical profession is able to focus on a tree (breast cancer) and ignore the surrounding trees (heart disease and other more common killers of women). Perhaps, modern medicine is, after all, based more upon "news syndromes" than medical science. 

AIDS: Issues and Answers

Vol. 13, No. 1 (80) January 1999

Saving Lives with Less Blood

Blood transfusions1 have been a cornerstone of the care of critically ill patients for decades. The public is familiar with this emergency scene: a patient rolls into the hospital and one of the orders barked is "Type and cross-match x units of blood"! Now, that blood is less likely to get to the patient, as studies continue to direct a more conservative approach to blood transfusions. The early transmission of HIV via blood transfusions (early 1980s) and decreasing donations because of HIV/AIDS fears, is one factor in this more demanding review of the use of blood transfusions.

A recent study divided 838 critically ill patients with hemoglobin levels of less than 9.0 grams (of hemoglobin per deciliter) into two groups.2 The patients in one group were transfused to the orthodox level of 10.0 grams and maintained between 10.0 and 12.0 grams ("liberal" group). The other group was not transfused unless their hemoglobin dropped below 7.0 grams and maintained between 7.0 and 9.0 grams ("restrictive" group).

The 30-day mortality rate in the two groups was similar, but "significantly" lower in the restrictive group among patients who were "less acutely ill" and less than 55 years of age. The one exception in this group were patients with "clinically significant heart disease." The mortality rate for the duration of hospitalization (average of 35 days) was "significantly" lower in the restrictive group.

The authors conclude:

"A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically patients, with the possible exception of patients with acute myocardial infarction ("heart attack") and unstable angina (symptoms of an impending heart attack)."

Commentary: There is a specific and a general lesson from this study. First, the trend of studies about blood transfusions has been to show that less is more (better). Patients saving their own blood for use in elective surgery and the recycling of their own blood from bleeding during surgery is safer than their receiving donated blood. Thus, the attention that HIV/AIDS has focused on blood transfusions will likely help far more patients than were harmed from their infection with HIV from blood transfusions. (Many of those infections could have been prevented except for the delay of any form of testing by blood banks who were protecting their monied interests.)

In general, the practice of medicine is showing that less is more. New and better research is showing that what has been orthodox is not always best, e.g., episiotomies (cutting a larger opening) for delivering babies, treatment of depression, use of antibiotics for "colds" and "flu," etc. There is an old dictum, "The more things change, the more they stay the same." And, the oldest and prime directive of Western medicine is, "First of all, do no harm." Interesting. And, the message of Christianity that modern medicine has rejected is the most healthy dictum of all!

More on Blood Transfusions

Readers should not be left with the wrong impression. Blood transfusions are low risk and often life saving. If all known risks of blood transfusions (hepatitis and other viral infections, bacterial contamination, destruction of red cells [hemolytic reactions], acute lung injury, etc.) are added together, there is a 5.6 in 1000 or 0.056 percent chance of one occurring in a given patient (assuming an average of 4 units transfused in a given patient).3 

Most of these are not life-threatening and patients recover. Although patients do have higher mortality rate than those who are not transfused, they usually die of the disease or injury which caused the need for the transfusion, rather than complications of the transfusion itself.

All this additional information to say, "Be cautious about blood transfusions and have your physicians avoid them when possible, but don't refuse them when they may be life-saving.


1. I am using "blood transfusions" more loosely than my colleagues and technical accuracy would dictate. Today, whole blood is usually broken down into packed red blood cells and other components that have to do with blood clotting. However, in my review here, the focus is on hemoglobin levels, the "red" component of blood, so "blood transfusion" is close enough without going into extra detail about other components.

2. The New England Journal of Medicine, February 11, 1999, pp. 409-417). In addition to this article, there is an editorial and an additional article (below) that discusses these issues further.

3. The New England Journal of Medicine, February 11, 1999, pp. 438-447. First of a two-part series. Part two appears in the February 18, 1999, pp. 525-533.

Some Covert Causes of Disease and Death

The New Testament pictures the life of a Christian as one that is disciplined and dynamic, yet orderly, and with a sense of peace. 

"Discipline yourself for the purpose of godliness" (I Timothy 4:7, NASB) denotes this type of life, as Paul uses the Greek word gumnazo, the same word from which we get our word gymnasium. The implication of rigorous training and discipline is clear. 

The "power" of the Holy Spirit is another common description of the Christian's life in the New Testament (Romans 15:13, II Corinthians 12:9, II Timothy 1:7). (The Greek word for "power" is commonly translated as "strength," also.) 

"Self-control" (Galatians 5:23) and "sound mind" (II Timothy 1:7) are other words that imply orderliness of life and clarity of mind. 

The "peace" of the Christian was clearly stated by Jesus Himself: "Peace I leave with you, My peace I give to you; not as the world gives do I give to you. Let not your heart be troubled, neither let it be afraid" (John 14:27). 

Of course, these are not the only characteristics of the Christian and his or her life. They are, however, representative of a distinct lifestyle. It is this lifestyle that promotes health. 

Irregular or overloaded schedules are stressful. Irregular sleep patterns prevent the full benefit of sleep. Unresolved conflicts in personal relationships cause tension and other physiological changes. Worry and anxiety trigger hormonal responses that may be harmful. 

These changes weaken the body's defenses against infection and disease. In the presence of these stresses, a person often contracts a disease that he would not have otherwise contracted. 

Furthermore, these stresses may cause bodily symptoms of disease when none is present. They may cause carelessness, leading to accidents that would not otherwise occur. Then, the focus and attention is given to the injury, and the cause is virtually ignored. 

You may have gone to your physician when he ordered a number of "tests," only to have him report to you later that they were all "normal"! Those symptoms for which you went to see him were likely due to stresses of this sort. 

When King David sinned, he experienced severe physical symptoms (Psalm 38:3-5).

The Proverbs have many verses that clearly link righteousness with health, and sinfulness with illness. For example, consider these (13:12, 14:30, 15:13, and 15:30).

Elsewhere, the Bible often connects the health of the spirit with the health of the body. In some cases, symptoms are present without disease. In other cases, the stress causes a real disease in the body. 

I fear that the most prevalent physical symptoms among Christians have to do with these subtle causes with or without disease. True believers are not often involved in gross immorality, but they do have disorderly and stressful lives. The actions most conducive to health are not necessarily nutrition and exercise, but establishing a greater degree of harmony and order in our homes and daily lives. 

Let's take one example -- the Sabbath (i.e., Sunday). From the beginning, God intended one day a week to be one of rest (see Genesis 2:1-3). He considered this day so important that He made the observance of it one of the Ten Commandments (see Exodus 20:8-10). The violation of the Sabbath was one of the most common sins that God pointed out to the Israelites (see Numbers 15:32-36; Nehemiah 13:15-22; Jeremiah 17:19-27; Ezekiel 20:12-24). An entire chapter of the New Testament also speaks about the Sabbath (Hebrews 4). 

Almost all of Christendom recognizes Sunday as the Sabbath under the New Covenant. Is it a day of rest for you? Or, is it a day of activity as frenzied as any other day of the week? Is the entire day one of rest and worship, including reading, reflecting and meditating on God's Word, except for engaging in acts of mercy (Matthew 12:9-14)? To honor God and the Sabbath has the secondary effect of your own spiritual and physical health. To "work" on Sunday is to cause the opposite. 

All the ways in which Christians should change their thinking and behavior into Biblical patterns is too broad a subject to cover here. Jay Adams has written the most practical descriptions of these practices. 

These are detailed in The Christian Counselor's Manual, written by Jay Adams (Timeless Texts, 1-800-800-8141). A more appropriate title for this book might be, "The Practical Guide to the Christian Life." This book was written for pastors and counselors but that should not preclude your study of the Biblical principles and their application to your own life. Few other pursuits will promote your general health to a greater extent. (This article was excerpted from Ed's book, Biblical Healing for Modern Medicine, pp. 27-29.)

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