Biblical Reflections on Modern Medicine
Vol. 11, No. 4, (64)
Contents:
Is Resistance Futile: Another Slippery Slope?
or
Round 2: Medical Economics and Euthanasia. Will Christians Ever Learn?
In 1986 in the Presbyterian Journal (February 12), Dr. Hilton Terrell and
I dared to suggest that limited care in seriously ill and terminal patients might be both an application of limited efficacy, the Golden Rule, and an economic issue. Judging by the opinions expressed in a recent World Magazine article (“Is resistance futile?,” July 8/15, 2000), there has been no progress on Christians’ understanding of these same issues, 14 years later.
The World article begins with a critical review of a survey of AIDS patients with three months to live, 61 percent of whom stated that it would be acceptable for physicians to withhold treatment of pneumonia because of their terminal condition.
The author, Lynn Vincent, then cites Wesley J. Smith of the International Anti-Euthanasia Task Force, that this study “along with myriad journal articles, bioethics debates and academic symposia — was designed to build statistical scaffolding for something called ‘futile-care theory'” (also called “medical futility” or “non-beneficial care).
“Doctors and hospitals practice ‘futile care’ when they set predetermined age limits, medical conditions, or disease states for which medical treatment beyond keeping a patient fed and comfortable is deemed “inappropriate.” Patients who fall into particular categories are refused non-palliative medications, testing, and even life support — whether the patient, or the patient’s family, want the treatments or not.”
Now, neither that article nor my examination here is adequate to address the entire issue of the withholding or withdrawing of medical care. (For a summary and complete review, see our website, bmei.org, soon to be up and running, July 1998, Journal of Biblical Ethics in Medicine, “The Report of the Heroic Measures Committee of the Presbyterian Church in America”). However, there is clear evidence that the article in World had no clue as to the real issues involved.
The Golden Rule and Limited Efficacy
Roman Catholics have long had a principle of Double Effect. That is, whatever decision is made (not just relative to medicine) has both a good and bad effect. It allows a choice for the “bad” when the harm outweighs the “good.” For example, it would allow a patient who is terminally ill with cancer to reject cancer treatments that may add a few days to his life (or even end them prematurely), but also cause him more pain and suffering than the cancer itself.
I do not like the principle itself because it confuses the good and the bad. In the above example, the “good” (or ethically, the “right”) is actually to deny the cancer treatments. I prefer the application of limited efficacy and The Golden Rule, “Do unto others as you would have them do unto you.”
In a survey done about 20 years ago, the family, as well as the patients, were asked whether all means should be used to prolong life. The families mostly chose “everything” (or some semblance thereof). The patients chose limited care.
I find this survey to be consistent. The AIDS patients surveyed above made this application. A letter-to-the-editor (World, August 12, 2000, p. 31) did, also. Lynn Vincent and World did not. There are many situations where medical care is burdensome, painful, and may even cause premature death. The patient has every right to deny its intervention. Such action is the application of limited efficacy and The Golden Rule.
For whatever reasons, Christians have chosen some principles that are inconsistent with the Bible. First, they have elevated the sanctity of life over its Biblical position. Most obviously, they deny self-defense, just wars, and capital punishment. Less obviously and evidenced clearly in the World article, they believe that virtually any denial of medical care is a violation of the sanctity of life principle (absolute?).
At least a component, if not a major or majority influence, is the worship of modern medicine. Now, you will not find many, if any, Christians who state that they worship modern medicine. But, in practice, they give many evidences of it.
They are willing to bankrupt their churches for comprehensive medical insurance. Their are willing to bankrupt themselves and their families for the least chance that medical care will cure their illnesses or prolong their lives. They are willing to use the power of the sword (state taxation and administration) to provide medical care, regardless of the ability of the patients to pay or the morality of their acts that cause their medical problems. (This power of the sword threatens bankruptcy of both states and the federal government.)
I challenge. For what a person is willing to face bankruptcy and disregard other biblical responsibilities to obtain is worship! Of course, beneath this worship of medicine is a worship of earthly life, for that is what modern medicine promises to maximize in health and longevity.
Second, Christians are not willing to face the fact that the provision of medical care is an economics issue, that is, who pays and how much? The government has the power of the sword to reward good and punish evil (Romans 13:1-7), but nowhere does the Bible give the government the responsibility of providing food, clothing, and shelter to its citizens.
On medical care, the Bible is essentially silent except for healing through miraculous intervention. By extension of responsibility for the named basics, however, medical care would fall primarily to the family (I Timothy 5:8) and secondarily to the church (I Timothy 5:4-16). Even in this passage, there are restrictions on who is to receive care and on what basis (for example, old vs. young widows).
The pull-quote on the page of the World article, blazes “If we are refusing to resuscitate patients with severe dementia, how long will it be before we do it to those who are merely mentally ill?” Physicians have been making decisions to withhold treatments in futile situations for the four decades that I have been in medicine, and I suspect since they began taking care of patients. There is nothing new here.
The problem is that Christians, along with everyone else, has welcomed the camels of comprehensive insurance and government provision of welfare and medical care into their tents. (A whole herd of camels is in the tent. We are long past one nose!) To attempt to regulate what is false in the first place is at best naive, and at worst ignorance of God’s Biblical pattern.
Failing to perceive the true issues, great efforts and resources are massed in the wrong places.The battle is, and has always been, government allowance of, and directed, euthanasia. So-called passive euthanasia, is not euthanasia. Certainly, there are concerns about the slippery slope amid the modern disregard of human life.
That battle cannot be properly fought with an incomplete armamentarium. Some potent arms are. 1) Medical care is minimally efficacious and fraught with morbidity and mortality. 2) The government has no role in the provision of medical care (and welfare). 3) Private insurance is a contract between parties which by definition has limitations and restrictions on both parties. 4) There is a time to withhold medical care where severe disease and disabilities will not be affected.
If Christians are to judge angels, and before that, to judge on this earth (I Corinthians 6:1-11), they have made no progress in 14 years. A few of us are crying in the wilderness, for that is the mind of Christ in the mind of the modern Christian on medical issues.
Archiving Trivia: Medical Records, Then and Now
God’s providential supply of time and experience can be very effective in wiping a smirk from one’s face. Years ago, when I opened my medical office, I had a number of patients whose physicians had just died or retired. At first, my partner and I would request that their old medical records be sent to us. We soon ceased, when we learned that these records were often nearly illegible scrawl on 5 by 8 inch index cards: one line to a visit.
A chief complaint, a temperature, maybe one other physical finding, and the name of a drug prescribed was the extent of most notations. It was not uncommon for 15 years to be covered on two cards. We regarded them as useless, even a liability to us, since we might be held accountable for things that we could not take time to read.
We laughed with each other. What dolts were these physicians! These were not medical records. They were a joke. We kept good records. We kept a problem list and an allergy list, and lists of drugs prescribed. Our notes were in the approved, Lawrence Weed-style SOAP format (S-Symptoms/history, O-objective physical exam and laboratory findings, A-assessment of the problem, and P-plan of investigation and treatment of the problem). We listed follow-up and patient education instructions.
It goes around, and it comes around. Cheap dictating machines, word processors, electronic storage systems, FAX machines, and like technology have made it cheaper to store and retrieve information. However, the greed for “documentation” has outstripped the new efficiencies. In a nation which increasingly does not believe in the possibility of truth, the substitute for truth has become the written record.
The federal government does what amounts to a word count to determine whether a Medicare patient’s bill was fraudulent. Insurance companies want inordinate amounts of information. Three calls came this week alone from an alcohol rehabilitation center where one of my patients had checked herself in. The institution’s caller wanted to “document” that the symptomatic medicine that I had prescribed for her for another problem was not essential, since the patient was refusing to take it.
I told the caller that this was just fine for her to omit it. She wanted it in writing, by FAX. The implicit message from her supervisors, which I do not think she caught, was that she was not to be trusted to note down that the doctor has said that is was okay that she missed it. Ditto, the message to the patient.
When I look back at my better-than-average patient records, I wonder who will really care to know there were no surgical-scars on the abdomen of the patient in January of 1986, or that the throat was red in August of 1977. The storage costs are considerable and are charged directly or indirectly to patients. The inane dictum that if is not written down, it did not happen has become accepted through repetition. Lawyers parse every line, looking for chinks in a defense.
Something between the medical records of the 1950s and the 1990s would probably be about right, but, I am forced to admit, closer to the 1950s!
Our sinful lust for detailed control of everything, discounting God’s providence and superintendence, seemingly knows no bounds. The gods of exercise have a huge contemporary following in America today. These gods are reputed to bestow many important benefits upon those who worship in their temples.
One of their latest advertisements is the value of physical activity in preventing strokes among women. In recently reported research, we discover that “… physical activity, including moderate-intensity exercise, such as walking, is associated with a substantial reduction in risk of total and ischemic stroke in a dose-response manner.” (The Journal of the American Medical Association, June 14, 2000, 2961-2967)
Let us examine “substantial.” Approximately 72,000 nurses were assorted into 5 groups according to the vigor and regularity of their exercise and followed for 8 years. This group amassed over a half-million person-years of observation. During these half-million person-years, there were 407 strokes. The strokes were distributed very differently according to the amount of exercise, with those who had the least exercise having the most strokes. Between the lowest level of exercise and the highest, there was a 50 % difference. That is “substantial.” The prosecution rests.
Not so fast! The actual number of excess strokes in the low exercise group was 50, compared to the high group. Remember that there were 72,000 participants. Members of the high exercise group exercised about one million hours more during the 8 years than did members of the low exercise group, per stroke averted.
Further, there was no accounting for illness, injury, and death from other causes than stroke. Therefore, it is not certain that there was any net gain for the vigorous exercise group. Did more of them drown? Suffer a heart attack? Die from a bee sting?
For those who enjoy vigorous activity, there is a direct, one-for-one immediate benefit. No study is required to establish that, since each woman is the world’s expert on what makes her feel good. She may include exercise in her life on those grounds alone and, as a Christian, allot the time and effort expended on exercise according to general principles of good stewardship.
These principles need include next to nothing for stroke prevention, for that is the actual state of affairs. For everyone else who does not enjoy exercise, a million hours at the altar of exercise to prevent one stroke sure looks like an idolatrous search for control.
More and more often, there is a disconnect between reported study results and the conclusions. The authors of the cited study close with “Our findings lend further support to current guidelines from the Centers for Disease Control and Prevention and the National Institutes of Health that promote regular moderate-intensity physical activity for prevention of chronic disease.”
A million hours to avoid one stroke? That is more than one entire life-time! Give a life rowing or running in order to get less than one lifetime back? Then, again, is it not so with idols? In the final analysis, they do not deliver what they promise.
Some may recall the media coverage of a U.S. Department of Health and Human Services press release during the late summer of 1999 about the payoff from the 1971 National Cancer Act. The five-year survival rate for all cancers taken together was noted to have improved, and this improvement was declared to be evidence of progress against cancer. Moreover, the progress was inferred to be evidence for success of the political process in fighting the dread disease.
Not so fast! A careful review of the data that the government relied upon indicates that the effect is not progress against cancer at all (The Journal of the American Medical Association, June 14, 2000, pp. 2975-2978). It is due, instead, to changes in diagnostic patterns and a phenomenon known as lead time bias.
Suppose a cancer takes 4 years to grow from the first aberrant cell to a size large enough to be noticed. Once noticed, treatment usually is begun, and the “survival clock” is started. A certain number of people with the cancer at found at this stage will still be alive 5 years after the clock started.
Suppose that diagnostic methods become available that are able to find the cancer only 2 years after the first aberrant cell goes amok. The “survival clock” is started. If it ticks off 7 years, it appears that the patient has achieved a benefit. Not at all. In fact, the patient may have achieved only an extra two years in which to worry and expend money on physicians. The better way to measure the benefits of changing treatments is on total mortality rates from the target cancers. The government did not select that measure.
Another problem with using 5-year survival in this manner is that diagnostic search patterns are uncovering smaller tumors, the ultimate behavior of which is not known. There is an excellent reason to believe that many of the tumors would never be noticed and would never cause disease or death. “Curing” them cures no disease and skews the data in a favorable direction.
While there has clearly been some progress against some cancers, misuse of measurements by an agency of this power and size is unlikely to be due to ignorance or carelessness. Boldly, the authors of the study correcting the misuse suggest a political motive, “…increasing 5-year survival is often presented to the public as evidence of the value of cancer research and early detection. Arguing against Republican tax cuts, the vice president announced that 5-year survival rates for all cancers improved almost 50 percent in the early 1990s from 51 percent in the early 1980s.”
One wonders what the chances are that these authors could receive federal grants for research now. One also wonders, though not very much, whether the public news media will pick up on this corrective report and give it similar coverage.
Fishing for Medical Research Trophies: The Problem of the Bycatch
Over the last several decades, some fishing buddies and I have hauled nets through the waters of Medical Research Gulf. The most numerous fish that we have caught has been the Nihil facient. Since my Latin teacher has died, I can pretend that this translates into “It makes no difference.” This little fish is neither pretty nor tasty. It is useful largely for fertilizing academic fields, three fish for each hill of corn.
Despite its low value, we note that other fishing boats bring it to shore and mount the embarrassing little things on the wall, as if they were noble marlin. The total weight of N. facientnearly sinks these fishing craft, so that they can barely make it to the dock with the occasional really useful fish that has been caught.
The motivation for such puzzling behavior has been finally traced. There is in all humans a desire to be in control. Of everything! Sovereignly. Illness threatens our sovereign control. Rather than confess that we are not sovereign over our physical and spiritual desires, we fawn over minute effects that we have discovered. As knowledge of, obedience to, and even the memory of the true Sovereign diminish, we have nothing left but our tinker toy structures. On our den floor, we make believe that our structures are great cities, powerful machines.
There are sacred zones in our play areas. There are Zone Exercise and Zone Weight Loss, inter alia. We are soberly informed in the Archives of Internal Medicine (July 10, 2000, pp. 1947-1958) that these two endeavors work to lower blood pressure and work better together. So they do. Overlook the substantial exclusions from the study of other, common diseases, such as, diabetes, heart disease, or simply using antihistamines.
Bypass the fact that the study extended for only 6 months, whereas fat and idleness are inexorable. Ignore the extremely modest absolute reductions of blood pressure. Fixate your attention on the substitute measures of health, such as, insulin levels. Get into the lotus position. Concentrate.
Chant. Om mani padme hum. Om mani padme hum. Om mani padme hum. Empty your mind of logic. Focus. Got it? We are enlightened. We are god. Together we can accomplish anything. We are powerful! You can mount that on the wall.
Amazing Grace — Misplaced and Misunderstood
The erroneous anthropology underlying medicine is cropping up in ever more obvious forms. The World Wildlife Fund has run a series of ads in var-ious publications, including The Journal of the American Medical Association (JAMA), featuring some attractive form of wildlife (do not expect to see a tapeworm!). The caption is the same. “Amazing Grace … Don’t Let It Vanish Without a Trace.” Is just my suspicious nature that sees this as a captive from a hymn to God’s grace towards mankind, as something akin to worship of nature? The grace is nature’s, not God’s. The power to save (nature) is man’s, not God’s power in saving man.
Albert Szent-Gyorgyi was quoted in a recent filler at the end of an article in JAMA as follows, with elisions, as in the quote, “It is sad that man is not intelligent enough to solve problems without killing…. The present world crisis can be solved only by a general human revolution against outdated concepts…. Man is not a blood-thirsty animal, and war is only due to the greed and lust for power of relatively small groups, the conspiracy of the few against the many.”
This Szent-Gyorgyi lived from 1893 to 1986. One wonders how he could have missed all the evidence in that lifespan for the existence of original sin in the heart of every human being. One wonders how he could substitute a concept of “outdated” for the concept of “truth.” He was 21 years old when World War I began. “Not a blood-thirsty animal”? He was nearly 50 when the Japanese tyrannized China, the United States fried many Japanese cities from the air, and the Germans and Russians together killed perhaps 40 million. Surely, he did not think that Lenin, Stalin, Hitler, Tojo, and Roosevelt did these things personally!
He has mistaken the problem for one of conspiracy and lack of wisdom. The problem is sin. The remedy is Christ. Those who hate Christ, love death. There are many such in medicine now who are fundamentally lovers of death, misplaced in a ministry of mercy and life.
Columbine Massacre: Why Be Surprised?
I have never commented on the Columbine massacre. It seemed obvious to me that such evil comes from the depth of man’s being. However, I just read something that is more specific.
“But there is no doubt in my mind that the cause of the murders at Columbine is the Satanic curriculum that still permeates that high school (and all public* high schools – Ed), a curriculum that embraces death education, sex education, multiculturalism, sensitivity training, transcendental meditation, values clarification, drug education , psychotherapy, Eastern religion, suicide education, and most importantly, evolution.” (Samuel L. Blumenfeld, Chalcedon Report, August 2000, pp. 9-10)
More simply, public education in the United States teaches a culture about death. These boys were simply practicing at a graduate level what they had been taught at public schools all their lives.
I remember Francis Schaeffer saying somewhere that the only logical conclusion outside of Biblical Christianity is suicide. Long before that, Moses challenged the Israelites to choose God and life or any other way and death (Deuteronomy 28). If fact, I paraphrased his challenge as the subtitle of my last book, Choosing Life and Health or… Disease and Death.
Consistently, modern medicine has chosen virtually the same death principles. That is why modern medicine currently causes more disease and death than it promotes life and health. But, then, my readers know that from these pages!
* To be more consistent and accurate, one of my editors writes that we should change our terminology from “public” schools to “government” schools. “There is nothing intrinsically wrong with a school that is open to the public.”
Biblical Medical Ethics Website
I am excited to report that a website has been established to provide the library of materials that I and I others have developed over the past 20 years. All issues of the Journal of Biblical Ethics in Medicine have been posted. In progress are all the issues of Reflections. Then, my four books and other publications will be added. See bmei.org.
Getting It Right
A local (Augusta, GA) man, J. Bartlett has Parkinson’s Disease, but opposes fetal stem cell research. In a Letter-to-the-Editor (The Augusta Chronicle, October 13, 2000), he writes:
“I have had Parkinson’s Disease for 14 years, am 48 years old, and have undergone two neuro-surgeries (sic); I feel it would be morally wrong to fund fetal stem cell research. How can I say that my life is more valuable than an unborn baby’s life? After all, I have lived for 48 years already…. Connected to this issue is RU-486. Someone will soon find a way for women to collect their dead babies and sell them to research centers. Abortion is wrong and stem cell research is wrong.
The end does not justify the means.
I do not know Mr. Bartlett. He does not say that he is a Christian, but likely he is. Regardless, he is thinking rightly and not personally. Many conservatives and Christians stand on principle until it requires personal sacrifice. Relative to abortion, I have heard too many first-hand reports or pro-life pastors and other Christian leaders going through with abortions because their daughters became illegitimately pregnant.
Praise the Lord for Mr. Bartlett! May his tribe increase exponentially.
Have You Wondered Where Your Reflections Was?
This year has been one of change for your Ed. I retired from my full-time academic position in Family Medicine at the Medical College of Georgia in March 2000. Since then I have played a lot of golf, applied for various part-time positions, done some medical-legal consulting, played with five grandchildren, and generally reflected on my new situation.
As you will notice from the front page, this issue is four months late. If fact, I have run 1-2 months late for three years, but I have eventually published every issue, six times each year. This issue is my 64th of almost 11 years of publication.
So, do not think that you have missed any issues. When you receive this one, you are as up-to-date as I am. Thank you for your patience.
Brief Reports and Commentary
Anti-mammography and Breast Exams Go Mainstream
I am not a regular reader of USA Today, but when I am traveling, it is everywhere as a freebie. So, I often scan its pages and sometimes read articles of interest.
I was greatly surprised to find in the September 26, 2000, issue, “Questioning mammography: Breast x-rays bring hope, but do they extend lives?”
Now, we have often criticized the hope of mammography on these pages, but to find agreement in one of the most widely read medical publications* in the United States is remarkable. And, the article goes further to add, “Doctors have only indirect evidence that breast exams by doctors can save lives.”
(* As a medical publication, USA Today ranks with Readers Digest, local newspapers, and television.)
One could only hope that the American Cancer Society, the Centers for Disease Control, and most medical-professional organizations would be as accurate with the medical literature. But, then, their livelihoods depend upon portraying such screening measures as life-saving.
For example, my own local paper ran the article, “Doctors urge breast cancer test” (mammography), October 4, 2000. Of course, the “urge” had nothing to do with the largest community hospital in the area opening its Breast Health Center, and its need to pay for that center!
On the Government’s Care of Us (On Airplanes)
Also, I don’t fly on airplanes often, so a recent flight made some impressions to which the “frequent flyer” might have become inured.
First, there is the interview at the ticket counter. The clerk requires a photo ID. Usually offered by the passenger, it is the large, detailed, and accurate picture on his driver’s license. With trained and practiced eye, and with scarcely a glance (if he looks up at all), the clerk knows that you are the person in the photograph.
Next, he asks you whether your bags have been in your possession since you packed them, and whether anyone has asked you to take something on board. Of course, these questions have been carefully researched by the best modern psychologists to ferret out confessions from the most hardened terrorists and determined murderers (and those planning to commit suicide).
Then, there is the x-ray (or whatever “rays” they use) machine. My 1 1/2 inch Swiss Army, drug-rep-freebie knife has made it through dozens of these devices. It is almost razor sharp, but I would never think of holding it to a flight attendant’s throat.
I have noticed, too, that those people who run those security checkpoints are the most alert guards that I have ever seen. They never miss an alarm bell from the ray machine going off, and thus, would never turn their heads in a split second diversion of a loud noise that would allow the toss of an assault rifle (camouflaged in a package) over or around their checkpoint.
Then, I board the plane. There is the litany of safety measures to which every passenger gives focused attention. I especially like the one about the requirements for the person in the “emergency exit seat.” There are about 20-30 requirements of this person (depending on how they are counted). I have noticed that whoever is in this seat usually uses all the ground time to talk with the flight attendants at length to know and understand all that he or she is to do in case of an emergency. Those that do not, I suppose, are already experienced or have received extensive training in these procedures.
There are many, many other safety measures instituted by our watchful and caring federal government. I feel as a baby in her mother’s arms because these are in place when I fly.
I almost said that I feel as secure as a baby in her mother’s womb. But, today, the same federal government places that baby in considerable peril. Does that contrast say something about the real intent of the federal government with it plethora of regulations and laws?
“So, Ed, what does air safety have to do with medicine?” Only this. Medical care is regulated at least to the extent that air carriers are and every bit as helpful.
DNA Tests: Under-used or Overstated
Are the media in denial over DNA? Since the death penalty re-emerged as a major story this year, much emphasis has been placed on DNA testing as a means of “ensuring” (sic) guilt or innocence. In fact, the San Francisco Chronicle went so far as to claim in an editorial that “DNA tests proved that 13 men on [Illinois’] death row were innocent” (“Avoiding the Death Penalty, July 19, 2000).
In fact, only three of the thirteen … were exonerated as a result of DNA evidence. The remaining ten men had the judgments against them overturned because of insufficient or unreliable evidence.
By its very nature, DNA testing is only applicable in a small minority of cases (mostly where rape is involved), although its use is becoming more widespread as better evidence is collected from crime scenes. Consequently, only eight prisoners nationwide have been exonerated as a result of evidence from DNA tests.
Nevertheless, politicians and the media have latched onto DNA testing as the ultimate scientific answer to the question of guilt (O. J. Simpson excepted – Ed). No matter how good the scientific processes are, however, there will probably always be cases where defendants have to be judged by their peers on the weight of the evidence.
(Quoted from Vital Stats, August 2000, p. 2)
Another Icon of Preventive Medicine Falls: Fiber
“Evidence is mounting that fiber might not prevent colon cancer after all, with a new study suggesting that one type of the supplement might even be bad for the colon…. published this week in Lancet. ‘There is definitely something dietary going on with bowel cancer, but we haven’t really been able to fix on what it is’…. The findings might not be related to the role fiber in general plays in bowel cancer but, considered together with other studies, the plausibility of a protective role looks less likely.” (The Augusta Chronicle, October 13, 2000, p. 12A)
Commentary: “It is appointed unto man once to die…” Folks, we are just not going to live forever in this body in spite of what is the not-so-subtle promise of modern medicine.
Now, if any type of fiber helps regulate your bowel habits, do not stop it because of this article. While prevention is mostly a myth, many such routines, such as exercise and proper nutrition, will make us feel better and make our earthly travails easier. Such is indeed worthwhile!
Avoiding Bed Rest for Your Health!
“From the time of Hippocrates, physicians have recommended bed rest to relieve symptoms and hasten recovery from illness. The association of bed rest with therapy remains deeply ingrained.” (American Family Physicians, February 15, 2000, p. 1164, summarized from Lancet, October 9, 1999, pp. 1229-33)
A review of 39 randomized, controlled trials studied the effect of bed rest on more than 5700 patients being treated for 15 different diseases or conditions. “Bed rest following a medical procedure was studied in 24 trials.”
“For seven outcomes… the results were better with bed rest, but none was statistically significant…. For 26 measured outcomes, the results were worse with bed rest, and nine of these achieved statistical significance…. In 15 trials … bed rest was studied as primary treatment for conditions such as low back pain, spontaneous labor, uncomplicated myocardial infarction, acute hepatitis, and rheumatoid arthritis. Overall, 25 outcomes were worse with bed rest, and nine of these achieved statistical significance….”
“The authors call on physicians to distinguish between inactivity forced by symptoms and recommendations as part of a therapeutic plan. In general, bed rest is not supported by clinical evidence and may be harmful in the few conditions that have been studied.”
Commentary: This review article summarizes a trend that has existed for decades. What is most significant about this summary is that nothing in these studies was helped by bed rest (at least that was “statistically significant”).
We should not conclude from this review that no conditions are improved by bed rest. Neither should we conclude that slowing down is not helpful in many conditions. Continuing one’s life full tilt in face of a serious illness or injury is likely deleterious (although I do not know if that has been studied).
This summary corresponds to studies of depression in which higher levels of activity often improve symptoms. Thus, the most healthy advice in almost all situations where one is tempted to lie down until things get better is to avoid complete bed rest and to continue one’s activities at perhaps a slightly higher level than is comfortable.
I recommend reading the original article in Lancet for the specific conditions studied.
Christians Advancing Other Religions
The front-page article of this Reflections demonstrates that too many Christians worship modern medicine. One element of that worship is a worship of “spirituality in medicine.”
This week (2nd in October 2000), I received a brochure entitled “Spirituality and Healing in Medicine: An Updated Course. Mainstreaming Spirituality: The Next Step.” It might well have been entitled “Mainstreaming the Gospel.”
“The course is supported in part by an educational grant from the John Templeton Foundation.” John Templeton is a professing Christian. Also, professing Christians with central roles in this conference are: Course Director, Herbert Benson, M.D., President Mind/Body Medical Institute, Associate Professor of Medicine, Harvard Medical School, Chief – Division of Behavioral Medicine, Beth Israel Deaconness Medical Center; David B. Larson, M.D., M.S.P.H., F.A.P.A., President of the National Institute for Healthcare Research, and Adjunct Professor of Psychiatry and Behavioral Science at Duke University Medical Center and Northwestern University Medical School; and Robert D. Orr, M.D., Director of Clinical Ethics and Professor of Family Medicine, Loma Linda University School of Medicine, Clinical Co-Director, Center for Christian Bioethics (Loma Linda). There are likely others whom I cannot identify as professing Christians. These who are identified have close associations with the Christian Medical and Dental Society and other prominent Christian groups and institutions.
Some of the titles of the conference give the ecumenical flavor of the conference: “Buddhist Spiritual Healing Practices,” “Islamic Spiritual Healing Practices,” “Jewish Spiritual Healing Practices,” “Catholic Spiritual Healing Practices,” “Protestantism and the Resurgence of Spiritual Life,” and “Christian Science Spiritual Healing Practices.”
Somehow I cannot see the Apostle Paul “blending in” at this conference. At the Aeropagus, which seemed to be a gathering similar to this conference, Paul declared:
“Men of Athens, I perceive that in all things you are very religious; for as I was passing through and considering the objects of your worship, I even found an altar with this inscription: TO THE UNKNOWN GOD. Therefore, the One whom you worship without knowing, Him I proclaim to you…. Truly, these times of ignorance God overlooked, but now commands all men everywhere to repent, because He has appointed a day on which He will judge the world in righteousness by the Man whom He has ordained. He has given assurance of this to all by raising Him from the dead.”
(Acts 17:22-23, 30-31, also read verses in the remainder of the passage)
Such compromise can only be worship of physical health, since Jesus Christ is “the way, the truth, and the life.” Spiritual health can only be in Him.
I suppose that a conference speaker whose central message was “no man comes to the Father but by Me” or “There is no other name under heaven given among men by which we must be saved,” would be asked to leave or not invited in the first place. A failure to state clearly and unequivocally that there is spiritual health in no other is a denial of Christ. And, “Whoever denies me before men, him I will also deny before my Father who is in heaven” (Matthew 10:33).
A More Subtle Application
I continue to be amazed that no national publication of which I am aware has, as one of its regular or major focuses, has reporting and op-ed pieces of ongoing medical news and ethics when more than 14 % of our GDP is spent on medical care. Also, the regulation of medicine at both the national and state levels is a major avenue by which American freedoms are being eroded.
The only medical ethical issue that Christians have generally gotten right is abortion. They have flunked on euthanasia and end-of-life issues (see front page article). On the remainder of the issues, there has been a willy nilly, hit or miss, occasional, and incomplete reporting/analyzing. Medical care and its ethics are one of the “broad ways leading to destruction,” while promising long and healthy life. Like all other “broad ways,” it leads to “destruction” (Matthew 7:13-14). It is fun and exciting to fly down the Interstate — until you come to the washed-out bridge over the bottomless chasm!