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Biblical Reflections on Modern Medicine

Vol. 11, No. 3 (63)

Contents:

Pain and Suffering According to Compensation

or 

Avoiding the Greenback Poultice

"On January 1, 1995, the tort-compensation system for traffic injuries, which included payments for pain and suffering, in Saskatchewan, Canada, was changed to a no-fault system, which did not include such payments. To determine whether this change was associated with a decrease in claims and improved recovery after whiplash injury, we studied a population-based cohort of persons who filed insurance claims for traffic injuries between July 1, 1994 and December 31, 1995....

"The incidence (of claims) decreased by 43 percent for men and 15 percent for women.... The median time from the date of injury to the closure of a claim decreased from 433 days to 194 days and 203 days, respectively. The intensity of neck pain, the level of physical functioning, and the presence or absence of depressive symptoms were strongly associated with the time to claim closure.

"Conclusions. The elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury." (The New England Journal of Medicine, April 10, 2000, pp. 1179-1186)  

An excellent editorial accompanies this report in the same issue of the Journal (pp. 1211-1213). The editorial reports on other studies. One was done in Australia, where restrictions on who could file claims for whiplash and when they could file reduced the number of claims by 68 percent. In Lithuania, where few drivers have personal-injury insurance, "persons who had been involved in rear-end collisions had no more neck pain or headache one to three years after the collision than a control group of uninjured persons (Ed's emphasis).

Another study found that a 10 percent increase in a compensation benefit was associated with a 1 to 11 percent increase in the frequency and duration of claims. "Among patients with back pain, the level of functioning and severity of symptoms after treatment are worse in those who retain an attorney, initiate litigation, or become involved in workers' compensation proceedings than in those who do not, even after adjustment for clinical findings."

"Soft cervical collars, corticosteroid injections of the facet joints, and pulsed electromagnetic treatments (for whiplash) are ineffective.... use of the soft collar for more than 72 hours, may result in prolonged disability" (Ed's emphasis).

Expanding Our Scope

"So what!" you might say. Such a correlation is to be expected. Well, I would like for us to go beyond the specifics of whiplash to the broader perspective of medical practice: the evaluation and treatment of pain.

As seen in the example of treatments for whiplash (above), treatments often do not work, and sometimes they worsen the outcome. I have been amazed and frustrated at the treatment failures of common prescription medications. In an office practice, one can quickly run through the gamut of NSAIDS (non-steroidal, anti-inflammatory drugs) on patients with chronic pain (headache, backache, "arthritis," etc.). I have previously reported on Dr. John Sarno, who has written two books on his treatment of back pain with only an explanation of the inconsistency of the cause of the pain and his objective findings of injury or disease.

And, we could expand our consideration to other "feelings," such as "depression" and anxiety. Treatment of "feelings" is a huge portion of medical practice today, but over which the physician does not seem to have much control.

I would like to raise the radical question, "Should physicians even be involved in the treatment of subjective or chronic pain?" While one of my own goals of medicine is "to relieve suffering," such relief does not always require an analgesic (pain medication).

In an ideal (Biblically based and practiced) world, most (if not all medications) would be "over-the-counter" (OTC). Perhaps, after an appropriate investigation and no objective basis for pain is found, the physician would leave the patient to his own selection of pain-relievers. I would predict that many patients would either not bother to get anything or would make only a minimal effort.

One anecdotal piece of evidence for this conjecture is that I rarely see a patient who has taken an OTC analgesic to its maximal use. "Oh, I take one or two TylenolTM every now and then for my headache." Of course, there are also those who abuse them, but they are the exception rather than the rule.

"First of all, do no harm" was one of Hippocrates' primary goals for the physician. More accurately stated, "First of all, make every effort to do less harm than the condition itself will do to the patient." 

Considering the cost of medical care involved, the reinforcement of morbidity and disability in the patient's mind, the unintended effects of medications (thousands of deaths each year), and the sheer sham of the process, physicians ought to tread carefully on the thin ice of all subjective symptoms without objective findings.


The State Is No Charitable Institution! 

Beating a Live Horse.

I received the following which comprised most of a letter.

"I think that it is a mistake to argue against state involvement in charity simply because the family and church are the primary agents for the aged and infirm. That paradigm may have been efficient some years back during an earlier time when the community defined by geographic and intellectual proximity was a fact of life. Moreover, in that earlier time and in most places, the church was a great part of what defined a community. We are, socially speaking, too mobile individually and physically for the family and the local church to function as effectively toward charity as they have in the past.

"While it is true that Scripture nowhere gives the state, as a divinely instituted function in human society in human society, a role in welfare, Scripture does not forbid such involvement. The state is, in a sense, merely a larger form of community. We are presently, I think, working out, in that larger sense of communal existence, how to care for the weak among us.

"The church and the family indeed have a primary responsibility toward the aged and the infirm among us, but we may have to rethink the context in which that responsibility is discharged."

Let's see, "state involvement in charity." Inefficient. Less than 30 percent of dollars actually get to the person being helped. Dangerous and involuntary. No other charity will send a SWAT team to knock down your front door (and worse), if you do not make your "donations" timely and completely. Undirected. The "donor" has no say how his money is spent. 

Impersonal. Someone else provides the actual day-to-day care of individuals. Develops an entitlement attitude. Instead of being grateful, recipients want and demand more and more with outright hostility, if their wishes are not granted. Develops dependency. Personal and family crises can bring out the best in people, developing resources and creativity that they did not have before.

Unbiblical. Scripture does forbid such involvement. The state holds the power of the sword "to reward good and punish evil" (Romans 13:1-7). Good and evil are voluntary actions. With taxation for welfare, the state has inverted its existence, achieving "good" ends with the power of the sword. (See Terrell's Treatises for more on the lack of a role for government in medicine.)

Christians want to defend that system? All I have left to say is, "No wonder modern Christians and their churches are impotent in the face of modern challenges. If we cannot distinguish what clearly is neither practical, definitional, or Biblical, then we have no light for the world. We live under a bushel: warm, cozy, and irrelevant.

Reflections on a Brief Family Medicine Experience (Letter)

Dear Dr. Payne,

I am writing to "pick your brain," so to speak, on a few ethical dilemmas that are regularly confronting me in my practice. I have surveyed other Christian GP's (general practitioners) and am not satisfied with their practices in these areas...

1. I have refused to prescribe the birth control pill to any unmarried woman for the use of birth control. This is by far and wide not practiced by many of my Christian colleagues. My dilemma is what to do with these women who are "common law," and those who are divorced and remarried? Am I overdoing it?

2. So far, I have not made up my mind about prescribing ViagraTM for men with erectile dysfunction who are not married or who are divorced and remarried in "common law" relationships. I must admit that I have used stall tactics for these until I can figure it out. I have been in practice for less than 2 years. They have a medical problem; however, I am indirectly participating in their immoral act. Any advice?

3. I really do not like giving in to patients' wishes and prescribing antidepressant medication. The approach that I take is one of trying to evangelize the non-believer and biblically counsel the believer in times of "depression." However, most of the time the patient rejects this approach and wants the "quick fix" (even the Christian). After telling the patient my firm belief that these medications will not solve their problems, I reluctantly prescribe the medication. Am I a hypocrite? 

4. The other problem is that most pastors will not or cannot counsel their members. These people are left with a theologically unsound Christian counseling center which is really secular in disguise. Because I don't have time to counsel these people fully and cannot recommend this center, I recommend that they change churches to one where the pastor does his job -- too harsh?

5. Another problem is that these patients do not really have any other choice for a GP because here in town, all the GPs have closed practices, leaving me with the occasional frustrated patient. 

6. Parents come in and tell me that their child has ADHD (attention deficit hyperactive disorder). Sometimes, I am able to persuade the parent that this is not the case. However, many insist on a referral to a specialist, who places the child on medication. The problem then becomes mine because here in Canada the primary care physician has to do all the prescription renewals. So I am left refilling these prescriptions for the families, when I don't agree with the way the problems are being treated.

And, as I mentioned above, since it is impossible for these people to get a new family doctor, I can't ask them to do that over such a disagreement. I have been writing the prescriptions and continuing to try to change their minds. What would be your approach in these circumstances?

I went into medicine to solve problems and not cause them. However, I must first remain faithful to the Lord and His written Word. Will you please help me to work toward this end? 

Ed's Answers

That this young physician even asks these questions is unusual, if not rare, even for Christians. Then, if they do ask these questions, they usually stay with the secular answers of the "medical model" (that the practice of medicine, especially "medical science," is the primary source of truth and ethics).

These are recurring questions that we have discussed over the years. However, such a letter prompts a brief review to reiterate and deal with new wrinkles, such as ViagraTM.

1. "Common law" women. "Common law" is still living together outside of marriage, regardless of state statutes that legitimate or give certain rights in this situation. A Christian's witness is to the right (Biblical) principles. There is no difference in the non-prescription of birth control (any kind, not just pills) for single women and those considered "common law."

Divorced and remarried. This situation is more difficult. Divorce can be legitimate for adultery (Matthew 19:9), desertion by an unbeliever (I Corinthians 7:10-11), and possibly for what are clearly life-threatening actions by one spouse towards the other or towards the children in the home (Exodus 20:13).

The question is, then, should physicians inquire as to the legitimacy of the divorce? No. Divorce situations can be quite tricky as to the "guilty" party, or accurately, the "most guilty" party (both are at fault to varying degrees). Such unraveling requires trained elders and pastors. My answer is that the fact of marriage is sufficient for a physician to give (Biblically acceptable) birth control to married women.

2. ViagraTM in unmarried men. This situation is no different than giving birth control to unmarried women. The answer is no. As to "erectile dysfunction" being a medical problem, it is more commonly a problem of the mind than the body and should be approached accordingly.

3. Antidepressants. Antidepressants are prescribed more than 90 percent of the time for temporary periods of "low feelings" and situational problems. However, I am convinced that bodily depression does occasionally occur. I remember one person who came to me for counseling in whom I could not find situational problems. He was helped by an antidepressant.

Even so, there is no proven "biochemical deficit" for which an antidepressant is indicated, despite claims by the vast majority of psychologists, psychiatrists, and physicians. Just because an antidepressant "works" does not mean that a deficit was present. The effect could as easily be additive or synergistic. 

You are right to question patients' use of antidepressants. You are right that even Christians are brainwashed on the use of antidepressants.

There are ways out of the dilemma. Of course, your "pre-evangelism" is primary, but not many patients will be converted in this way. Consider a patient who is not already on antidepressants. a) Follow the textbook approach of the Diagnostic and Statistic Manual - IV. Most situations for which antidepressants are requested (by the patient) or prescribed (by a physician) do not fit these strict criteria. "Depression" is cyclical, and by the time the patient does meet the criteria, he is likely to be feeling better.

Second, briefly explore the patient's life situation. For almost all patients, there is one or more major trials being faced and numerous other minor ones. Pick one or two of these situations in which the patient can improve his own thoughts and actions (regardless of whether they are a Christian or not). Challenge him to change in these ways, and when he does, you will re-evaluate whether he needs antidepressants or not. Rarely will he make the change that you requested, so he has not met his end of the "contract."

What about the patient who is already on antidepressants? Simply ask, "How do you feel or function better because of the medication?" I have been amazed at how many patients actually state that they are aware of little or no benefit from their "psychotropic" medications, including antidepressants. If they are not getting definitive benefit, then say, "I cannot continue on this medication because it has serious side effects, will interact with other drugs, interfere with driving safety, etc." (Develop your own list of precautions from drug information literature appropriate to the medication.) That response, my dear physician, is the truth!

These tactics alone will eliminate about 90 percent of your prescriptions for antidepressants. When they do not work, then you still have the right to deny them to patients in whom they are not indicated, as any other medication (antibiotics for colds, for example). You simply choose whether you decline on a medical or moral basis, according to the battle that you want to face.

4. Recommending that patients change churches. Recommending that patients change churches to find one that does Biblical counseling is spiritually correct. However, I have found that such churches are rare. If you have one nearby, then you are blessed indeed and ought to refer everyone there!

5. No other GP. That there is no other physician available is irrelevant to these dilemmas. Every Christian physician's goal is to obey God and provide the best medical care to his patients. There is no conflict in those goals.

6. ADHD. First, try the medical approach. Ask for the records of the diagnosis of ADHD. Likely, the diagnosis was based upon shaky grounds. If so, you can refuse medically to write the prescriptions. 

The "efficacy" test, as with antidepressants, may work, also. Has the child experienced discernible and definitive behavioral or attitudinal changes after being placed on the medications? If not, discontinue them.

Every "expert" that I have ever read or heard has always stated that behavioral changes and counseling must accompany medications; for example, structured times for homework and household chores. However, in actual practice, these changes are rarely implemented. Insist that such changes occur before the medication is given or renewed. 

So, there are non-moral (in the strict medical sense) reasons to get the same end, as moral confrontation. But, again, moral confrontation is rightfully yours, as a Christian. Sometimes, however, we Christians enjoy hitting non-Christians over the head with our "law" to the extent that we are at fault. There is a legitimate means to an end, as well as the end itself.

There is one big and final, BUT! You have to choose your battles. One factor is time. No one physician can fight all the battles of an everyday practice of medicine, as Jesus did not heal every person He encountered.

Another factor is medical review. With increasing government and third party oversight, you could be chastised, fined, and even have your license taken away, even for "scientific" and moral medical care. There is currently an "orthodoxy of medicine" that transcends its own medical science and certainly Biblical morality.

There are battles that you may have to lose to continue to practice medicine. For example, you might compromise on giving antibiotics for colds, or in your situation, giving antidepressants and amphetamines. But, I could not compromise on giving birth control to unmarried women or doing abortions. I would have to surrender my license, my possessions, and possibly my life before I would do those things. But, you must choose your own lines NOT TO CROSS. 


Recommended Reference: Vital Stats

For several years, I have been subscribing to Vital Stats.  However, I am not sure that I have directly recommended it to you. Now, I do so.

Their masthead states "The Statistical Service is a nonpartisan, nonprofit research organization dedicated to improving public understanding of scientific and statistical information."  Their email is vital@stats.org and web address www.stats.org.

I recommend them to you because virtually one-half of their material is medical. They often take medical headlines and discern what is and is not factual, rather than what is headlined. For example, their May 2000 issue discussed the confusing role of fiber in diets. 

They do not know who I am, so I am recommending them strictly out of the spirit of free enterprise and factual information.

Potential Life vs. Actual Life in Contraception

A church Session was queried from a married couple (not members of the same local church) friends about using birth control for a temporary period to prevent life-threatening complications in the mother who has health problems, and, perhaps, also improve their chances of having a healthy baby. The conclusion of the Session was that contraception to prevent life is the same as murder of actual life, e.g., abortion. They reason:

"(Sins) ... all (begin) in the intention of the sinner, and then manifested themselves in the external world. Thus, it is certain that adultery, murder, etc., can be committed in the heart (Matthew 5:27-30), and that mankind is guilty even when such sin only manifests itself in his intentions. In essence, the heart that is angry without a just cause is guilty of murder, even though an actual person was never killed. 

It is enough to intend to kill an actual person to be guilty of the crime before God. Likewise, this applies to intentionally preventing the life of a child. A real life does not have to be taken to incur blame for the sin of murder. Only the intention to destroy life is necessary to make one culpable of murder. It is enough that the intent to destroy life is conceived in the heart."

The Session is to be commended for addressing this issue from Scripture and from church fathers (e.g., John Calvin). Too often, governing church bodies leave their sheep without a shepherd because they are either unwilling to do the hard work of researching and reasoning these issues, they (falsely) believe that such is beyond their ability, or they believe (falsely) that such is not their responsibility, deferring to the "experts."

However, I must disagree with this Session's reasoning and conclusions on this matter, beloved friends that they are.

There is a huge shift in comparison in the paragraph quoted above: from "to kill an actual person" to "intentionally preventing the life of a child." The former deals with an actual person. The second a potential person. The Session cannot make this connection using the same Scripture because "actual" and "potential" are entirely different entities. 

Every intentional act of omission (that is righteous) prevents some "potential" good. I see pictures of starving children in Third World countries in various advertisements by responsible charities. My contributions to them would save and enhance the lives of these children, yet I have rarely ever contributed to them. Am I guilty of starving, and even killing, those children that my dollars could have helped?

(Many legitimate areas of life involve life and death decisions. I do not intend the death of others when I drive my car, but the "potential" is there. Food producers do not intend deaths by their products, but their very business has that potential -- unless one wants to grant that they should be infallible in their work. Deaths in the training of our military are not intended, but occur occasionally.)

Perhaps, perhaps not. God requires the tithe and offerings from His people for His work. But, I cannot give to all the organizations that are doing His work. What He requires of me are obedience to His principles and responsibility to choose.

One principle of giving is that of tithes and offerings. Another is that the primary (some might argue exclusive) recipient of this money should be His Church. Beyond that, I have both the freedom and responsibility to direct the remaining funds. If I do that responsibly (weighing merits of ministries), then I am not guilty for neglecting the others. I am not guilty of the deaths of those starving children to which I choose not to give. However, I might be guilty if I believed that God was requiring me to give and I failed to do so.

Thus, by an example that indirectly causes the deaths of children, I am arguing back to contraception. First, deaths of others may occur because of our actions, but they do not involve our guilt.

Then, as in our example, what are the other principles relative to contraception? Foundational is the Creation Mandate "to be fruitful and multiply" (Genesis 1:22). A married couple is obligated before God to have children unless there are extremely extenuating circumstances. (The issue of how many children is too complex to review here.) 

But, does it necessarily follow that they are to have a child at every opportunity, just as I weighed whether I was to give to every charity? Is the family of very limited means that finds, prior to children, that they are carrying a very crippling genetic condition obligated to have children? I think not. Also, where the mother's life is clearly threatened by the first or subsequent pregnancy, the family cannot be condemned for not having children.

The Session itself allowed for exceptions, by mutual agreement for fasting and prayer (I Corinthians 7:5). (They also included "modesty," but I am not sure that they are correct and cannot address it here.) So, the question then becomes, are these the only exceptions? 

Expanding my example of the tithe and offerings, there are many other righteous obligations under God: church attendance, teaching of children, exercising spiritual gifts, job and/or vocation, and honoring the Sabbath (to name only a few). Further, there are the mundane necessities: getting sufficient rest and sleep, eating properly, personal toilet, preparing meals, and cutting the grass (to name only a few). I call these mundane because at first glance, they are not so "spiritual." However, many, perhaps, most Christian's lives go astray on these, rather than the "spiritual" areas.

My point is that, in general, Christians are stewards of time and resources. Many of Christ's own words are specific here. That is, the general thrust of the Christian life is making decisions that both expand and limit all the areas of life to which we are called. The question for our discussion then, "Is the Creation mandate to have children an exception to stewardship of resources?"

The onus is on those who would contend that it is an exception. 1) Exceptions are already noted and agreed upon, so it is no absolute. 2) There is no specific Scripture for this exception. 3) There is also no specific Scripture that couples are to have as many children as possible. 

Those who would contend that children are special blessings cannot argue that they are the only items of special blessing of God. Any further exceptions would be set over against the freedom (Galatians 5:1), responsibility (John 14:15), and rest in Christ (Matthew 11:28-30).

Those who would contend that "multiplying" and "filling" the earth require having as many children as possible would also have to contend that "subduing the earth" requires 100 percent devotion, something not possible with all the other duties that God requires of us. Subduing the earth is a corporate responsibility. So also filling. Not every individual or family bears the same sub-role in the greater scheme.

The principles are these. 1) Married couples are to have children, "filling their quivers," as "special blessings," and "being fruitful." However, as in every other area of life, 2) they are to be responsible stewards, weighing risks and rewards. This couple intended to have children, but were wisely planning for a time that was more healthy for the mother to-be and child to-be, as a farmer does not plant in winter, but awaits optimal conditions in the spring.

In this vein, there is a harshness that is present in the pro-life community toward legitimate couples having children. While I cannot be sure, I would attribute this harshness to making the "sanctity of life" a virtual absolute (which has also caused wrong Biblical positions on killing for self-defense, war, and capital punishment by the state). This harshness is an onus to have as many children as possible, as quickly as possible.

The Scripture has marvelous analogies about marriage. The husband is head of his wife, as Christ is head of the Church. But, this is a tender, caring, concerned headship, as a man "cherishes" his own body (e.g., burly men often become helpless babies when they are sick and injured). Having child after child in a rapid fashion can easily become a burden for a woman. Not only does she have the burden of pregnancy, but caring for the already-born children.

The Reformed and other strongly conservative (i.e., Biblically based) camps sometimes forget that God's people are "to glorify God and enjoy Him forever." God's laws are to be obeyed, but they are to be obeyed under the grace and forgiveness that He gives us (labor and heavy laden). Can any one of us ever have a pure thought, intent, or act? Not at all! 

Few have argued as strongly as I have for Biblical medical ethics. But, I also recognize that we must be careful going beyond Scripture or even applying Scripture that is overbearing and unforgiving, as the Pharisees did (Matthew 23:1-36).

I have not refuted the Session with specific Scripture, but neither did they have a specific Scripture, rather a reasoning from actual life to potential life. And, they have argued for 100 percent commitment and stewardship only to one feature of obedience where nothing else in Scripture does. Therein, they erred, ignoring other Scripture and taking a position that surely does not warrant breaking of fellowship (I Corinthians 5:1-13).


Terrell's Treatises

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

Your Government's Health Plans for You, You Sheep

Unfortunately, I remember reading about Stalin's Five Year Plans, usually some ambitious centrally-planned set of goals to increase steel, hydroelectric power, or agricultural production. Seeds of those plans were evidently blown across the North Pole and have sprouted in Washington. Through Surgeon General David Satcher, our government has announced its "Healthy People 2010" campaign (Family Practice News, March 1, 2000, p. 9).

The government wants to increase the proportion of people who engage in vigorous physical activity, to decrease the number who are overweight, who smoke, and who use illicit drugs, and who increase those who use condoms, "if sexually active." (Hear that, you faithful married couples! Your government DOES want to enter your bedroom. You just cannot make noise about it unless you are homosexual.)

Also, on the federal level hit list is the number of uninsured people, in blithe disregard of the fact that insurance is a large part of the problem of access to health care, not its solution. Immunizations, unrecognized depression, injury and violence, and air pollution round out its list of interests.

The Constitution's limitation on the scope of the federal government is long forgotten. The health value of liberty is ignored. The population is a herd to the feds, as Russians were to Stalin. Not knowing or heeding the Good Shepherd, we are treated like a herd by other keepers who are interested in obtaining the most wool and meat at the least cost.

Breast Screening Not Justified

Despite general acceptance, the benefit of screening for breast cancer with mammography, 14 years of experience with the method in Sweden failed to decrease mortality from the disease. Why would a method that seems as though it should work, not work? A careful review of the methods of studies supporting mammography suggests significant irregularities in them. The reviewers concluded that "screening for breast cancer is unjustified." 

If the methodologies are not guilty of error as charged, there is the remaining problem that the same data indicate that screening for breast cancer causes more death than it saves. "For every 1000 women screened throughout 12 years, one breast-cancer death is avoided but the total number of deaths is increased by six." (Don't think of direct danger from mammogram radiation. Think rather of very rare bad effects from interventions spawned by false positive results.)

Either way, "the effect of screening programmes, if any, is small, and the balance between beneficial and harmful effects is very delicate." Is this matter, except for its immense cost and diversion of resources, a tempest in a teapot? (Lancet, January 8, 2000, pp. 129-133)

No Effect of Aspirin on Prevention of Stroke

Eight million elderly Americans who do not have evident vascular disease consume aspirin regularly in the hope of averting a stroke. A review of randomized trials of primary prevention for this purpose indicates that it has no effect. (Archives of Neurology, Volume 57, pp. 326-332)

Screening by Risk Factors

Contrary to common practice, using risk factors to decide whom to screen for a disorder is not normally very useful. (British Medical Journal, Volume 319, pp. 1562-1565)

Price Controls -- Among the Last Resorts of Tyrants

Those who seize illegitimate power by creating and declaring crises are at it again, this time in the states of Maine and Vermont (Managed Care, May 2000, pp. 12-13). Legislators there have passed bills which are attempting to cap the prices of pharmaceuticals. The maneuver of choice this time is to use Canadian prices as the guide. Wide gaps are noted between Canadian and U. S. drug prices. No one seems to notice the ailing state of the Canadian economy and to think that there might be a connection between that nation's socialist ways and its economy.

No one seems to notice that one of the reasons for high pharmaceutical prices is the high entry fee required of the pharmaceutical industry by the U.S. government in the form of extremely expensive testing and licensure procedures. These costs establish an oligarchy of wealthy players, keeping those annoying little entrepreneurs out of the market. Little guys might bring prices down, if they were allowed in the game. 

A really free market would produce the lowest overall price for value relationship that could be had. Early automobiles were very expensive, but mass production and expiration of patents soon allowed people of more ordinary means to afford good quality cars. Price controls on limited-edition, hand-built automobiles would have squelched innovation. It will be so with pharmaceuticals.

When a civil government sets prices for your products, it means that you do not own them. That is socialism. Socialism morally is a form of theft. Those who support it are abetting thievery, in violation of the commandment against stealing. God's commandments are not set in opposition to each other, such that in order to obey one you have to disobey another, seeking some imaginary balance (Ed's emphasis). There is no moral refuge from the charge of stealing to point out that some people acquire six doses of ZithromaxTM for $19 more cheaply because of your action.

The existing pharmaceutical industry may not be the victim of theft, but rather of a business gone bad. Their demands for government protection against small, numerous competitors has issued forth now into compression of their profits by that same government. The victims are all those who have tried or would try to offer pharmaceutical manufacturing services but who cannot use their talents because of the monopolistic nature of the industry. Add as victims all those patients who in the future will not benefit from the innovations of would-be manufacturers frozen out of the competition.


Ed Payne Made a Faux Pas! 

Round Three on Feeding Tubes. 

God Is Above It All.

In the March-April 2000 Reflections, I made a faux pas. In writing about feeding tube issues, I wrote:

"A recurring theme on these pages is that 'There are no right answers for wrong situations.' Were it not for the state sponsorship of medical care, most feeding tube issues would be resolved on an economic basis alone -- few could afford them. 'Ah!' I hear the cry. 'What a heartless person you are to let people die simply because they cannot afford it.'

"Well, I suppose that I will just have to stand with the Apostle Paul and His God. 'If anyone will not work, neither will he eat' (II Thessalonians 3:10).  Food is a far more basic need of life than medical care!"

One astute reader made the connection between "anyone who will not work" and those on feeding tubes. From the context, I can see that connection, but it was one that I did not intend. Of course, those on feeding tubes cannot work because of their condition that requires the feeding tube.

What I intended was that those who require feeding tubes are the responsibility of their families. If those families are unwilling or unable to provide feeding tubes, then those persons should be fed by mouth or allowed to die.

Feeding tubes are largely a creation of the medical welfare state and well-intended, but erroneous "medical indications." They would be rare were it not for state-paid support because of the tremendous cost (both the feedings and that nursing homes are required to manage and maintain the feeding tubes). The number of feeding tube candidates who could swallow on their own might be surprising. (The study cited in the January 2000 Reflections refutes placement of feeding tubes for aspiration problems). At the risk of seeming even more heartless than requiring those on feeding tubes to eke out their own feedings, I throw out a concept that I am not sure that I have introduced before. God is above human life and death!

Let me explain. Modern medicine goes far beyond what it should to keep people alive with respirators, feeding tubes, excessive attempts at resuscitation (in the elderly, crushed accident victims, very premature babies, etc.) and hyperalimentation. Preservation of life has become the focus, and we have swallowed it, hook, line, and sinker.

God is not so much concerned with the preservation of life as He is salvation and obedience. He had his Son killed to provide life. His prophets (Biblical and missionary) have been killed by the hundreds for their messages. The lives of highly gifted and promising Christians are killed in accidents and gunfire. There are many accounts of one or more people being killed by the good intentions of others.

Finally, God caused death. It is His curse that causes us all to experience death. 

Does anyone die apart from the Providence of God? Never!  Does anyone ever die accidentally from His perspective? Never!  So, what is our concern? To share the Gospel and be obedient in all the opportunities and responsibilities that God has given us. Even in these endeavors, we perform them poorly and with considerable taints of sin. There is none righteous. No, not one.

Perhaps, this statement is not the best here, but in a real sense, death is a part of life. Not in the Kubler-Ross sense that we must "accept" it for our own growth, but in the Biblical sense that it is inevitable and that God is in control. 

Perhaps, I have gone beyond many Christians' perception of God here, but in a real sense our failure really to understand who God is and what He does is at the root of all modern problems. Life at all costs is not to be worshiped -- God is.

Do you want some evidence that even Christians worship life more than God? What proportion of our money do we give to God vs. what we give to medical insurance and other means to preserve our health and lives? As a portion of the Gross Domestic Product, "health" (medical) care now exceeds 14 percent. Do you think that Christians' spending is any less? God only requires the tithe (and offerings), but "life" now requires considerably more.

Worship God and obey Him. As we increase in those endeavors, simple preservation of life becomes less important. Christians, we are guilty, as well. Let us repent.


Brief Reports with Commentary

Post Abortion Syndrome: The Right and the Wrong

The January 2000 issue of the Life Issues Connector advertises a new pamphlet, "Women Hurt." The "answer" to Post-Abortion Syndrome is found in this brochure. It has a five-part process.

  1. Stop the denial process and admit to being a part of killing your own offspring.
  2. Grieve.
  3. Ask for Divine forgiveness.
  4. Forgive others.
  5. Forgive yourself.

I could spend several pages dissecting this outline point by point. I am not going to spend that effort now. I have already done so on the same issues on these pages. 

Here, I just want to point out that the just (righteous) cause of anti-abortion has chosen unjust (unrighteous) psychology as an answer for women who have had abortions. Instead of the Rock, sinking sand. Instead of the true Birthright, a bowl of porridge. Instead of truth, a lie. Instead of Jesus Christ, forgiveness from an ethereal "Divine."

Chronic Depression: No One Knows What to Do

In an editorial entitled, "Treatment of Chronic Depression,"  Jan Scott, M.D., writes in The New England Journal of Medicine (May 18, 2000, p. 1518).

"The treatment of chronic depression (compared to acute depression) is more problematic... The poor response of patients with chronic depression to treatment with antidepressant drugs alone is not fully understood, but it cannot be explained solely on the basis of inadequate dosing or the failure of patients to take their medication. Psychotherapy has been advocated as an alternative. 

"Unfortunately, a review of nine studies of psycho-therapy for chronic depression that were published before 1998 revealed that in only two trials were patients appropriately randomized, and the combined sample size was only 126 patients (far too few to make any conclusions)."

"Given the lack of empirical data, establishing the relative efficacy of pharmacotherapy and psychotherapy for this disorder has been difficult."

Removing equivocal jargon, the last sentence should read, "The efficacy of any treatment for chronic depression is virtually unknown." Ah! It is so refreshing when honesty appears in "major" medical journals. If only it translated into actual medical instruction and practice. 

Like the equivocal language of Dr. Scott, teachers and practitioners are not willing to admit that do not have a clue what they are doing.

At the risk of being overly repetitive, there is reality in the medical literature, if one only has the presuppositions and skill to recognize it. Unfortunately, medical practice is mostly based on something other than its own science.


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